Vancomycin-Resistant Enterococci (VRE) in Nigeria: The First Systematic Review and Meta-Analysis

Abstract

Vancomycin-Resistant Enterococci (VRE) are on the rise worldwide. Here, we report the first prevalence of VRE in Nigeria using systematic review and meta-analysis. International databases MedLib, PubMed, International Scientific Indexing (ISI), Web of Science, Scopus, Google Scholar, and African journals online (AJOL) were searched. Information was extracted by two independent reviewers, and results were reviewed by the third. Two reviewers independently assessed the study quality using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. OpenMeta analyst was used. The random effect was used, and publication bias was assessed using a funnel plot. Between-study heterogeneity was assessed, and the sources were analysed using the leave-one-out meta-analysis, subgroup analysis, and meta-regression. Nineteen studies met the eligibility criteria and were added to the final meta-analysis, and the study period was from 2009–2018. Of the 2552 isolates tested, 349 were VRE, and E. faecalis was reported the most. The pooled prevalence of VRE in Nigeria was estimated at 25.3% (95% CI; 19.8–30.8%; I2 = 96.26%; p < 0.001). Between-study variability was high (t2 = 0.011; heterogeneity I2 = 96.26% with heterogeneity chi-square (Q) = 480.667, degrees of freedom (df) = 18, and p = 0.001). The funnel plot showed no publication bias, and the leave-one-out forest plot did not affect the pooled prevalence. The South-East region had a moderate heterogeneity though not significant (I2 = 51.15%, p = 0.129). Meta-regression showed that all the variables listed contributed to the heterogeneity except for the animal isolate source (p = 0.188) and studies that were done in 2013 (p = 0.219). Adherence to proper and accurate antimicrobial usage, comprehensive testing, and continuous surveillance of VRE are required.

Prevalence of Vancomycin-Resistant Enterococcus (VRE) in Companion Animals: The First Meta-Analysis and Systematic Review

“…Nigeria is the only nation in Africa where a single survey detected VRE in horses [ 35 ]. In a systematic review and meta-analysis, Wada et al [ 40 ] reported 25.3% VRE prevalence in Nigeria. Europe has been the hot spot for VRE since it was first reported in humans in the 1980s [ 7 , 40 , 41 ] and was also the first continent to collectively move for the ban of avoparcin as a growth promoter [ 42 ].…”

Pharmacodynamics of Linezolid Plus Fosfomycin Against Vancomycin–Resistant Enterococcus faecium in a Hollow Fiber Infection Model

“…We speculated that this compensatory cost may be similar to that previously reported in terms of the possible transfer of virulence-traits and antimicrobial resistance ( Lata et al, 2016 ). However, VREfm is organism of low virulence and low pathogenicity ( Puchter et al, 2018 ; Wada et al, 2020 ), and the beneficial effect on the clinical efficacy of fosfomycin brought about by the attenuated virulence of their strains is much less than the adverse effect on the clinical efficacy of fosfomycin brought about by the high expression of fosfomycin resistance. Therefore, in the face of severe infections where fosfomycin monotherapy may cause a high degree of resistance, the combination of fosfomycin is recommended.…”

Chances and prevention of antibiotic resistance in primary health care: literature review

“…In Ethiopia, Melese et al estimated the prevalence rate to be 14.8% (95% CI: 8.7-24.3) while in Nigeria, Wada et al estimated the prevalence of VRE from 19 original investigations to be 25.3% (95% CI: 19.8-30.8%) Acinetobacter baumannii resistance to antibiotics was also reported by many previous investigations which showed that the prevalence rate of this resistance was hugely variable according to the applied antibiotic per country. 19,20 Pormohammad et al analyzed the results of 150 original investigations in a single meta-analysis to estimate the prevalence rate of cefotaxime and colistin by country. 21 Africa had a 99% prevalence resistance rate to cefotaxime which was the highest while countries in the Western Pacific had the lowest prevalence rate of 1.1%.…”