Department of Medical Laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
BMC Infect Dis. 2020 Feb 11;20(1):124. doi: 10.1186/s12879-020-4833-2.
BACKGROUND: The emergence of Vancomycin resistant enterococci (VRE) poses a major public health problem since it was first reported. Although the rising rates of VRE infections are being reported elsewhere in the worldwide; there is limited national pooled data in Ethiopia. Therefore, this study was aimed to estimate the pooled prevalence of VRE and antimicrobial resistance profiles of enterococci in Ethiopia. METHODS: Literature search was done at PubMed, EMBASE, Google scholar, African Journals online (AJOL) and Addis Ababa University repository following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Both published and unpublished studies reporting the prevalence of VRE until June 30, 2019 were included. Data were extracted using Microsoft Excel and copied to Comprehensive Meta-analysis (CMA 2.0) for analysis. Pooled estimate of VRE was computed using the random effects model and the 95% CIs. The level of heterogeneity was assessed using Cochran's Q and I tests. Publication bias was checked by visual inspection of funnel plots and Begg's and/or Egger's test. RESULTS: Twenty studies fulfilled the eligibility criteria and found with relevant data. A total of 831 enterococci and 71 VRE isolates were included in the analysis. The pooled prevalence of VRE was 14.8% (95% CI; 8.7-24.3; I = 74.05%; P < 0.001). Compared to vancomycin resistance, enterococci had higher rate of resistance to Penicillin (60.7%), Amoxicillin (56.5%), Doxycycline (55.1%) and Tetracycline (53.7%). Relatively low rate of resistance was found for Daptomycin and Linezolid with a pooled estimate of 3.2% (95% CI, 0.5-19.7%) and 9.9% (95% CI, 2.8-29.0%); respectively. The overall pooled multidrug resistance (MDR) rate of enterococci was 60.0% (95% CI, 42.9-75.0%). CONCLUSION: The prevalence of VRE and drug resistant enterococci are on the rise in Ethiopia. Enterococcal isolates showed resistance to one or more of the commonly prescribed drugs in different or the same drug lines. Multidrug resistant (MDR) enterococci were also found. Although the rates were low, the emergence of resistance to Daptomycin and Linezolid is an alarm for searching new ways for the treatment and control of VRE infections. Adherence to antimicrobial stewardship, comprehensive testing and ongoing monitoring of VRE infections in the health care settings are required.
背景:万古霉素耐药肠球菌(VRE)的出现是一个重大的公共卫生问题,因为它是首次报道的。尽管世界各地都有报告 VRE 感染率上升的情况;但在埃塞俄比亚,全国范围内的数据有限。因此,本研究旨在评估埃塞俄比亚 VRE 的总体流行率和肠球菌的抗菌药物耐药谱。
方法:按照系统评价和荟萃分析的首选报告项目(PRISMA)指南,在 PubMed、EMBASE、Google Scholar、非洲期刊在线(AJOL)和亚的斯亚贝巴大学数据库中进行文献检索。纳入截至 2019 年 6 月 30 日发表和未发表的报告 VRE 流行率的研究。使用 Microsoft Excel 提取数据,并复制到综合荟萃分析(CMA 2.0)中进行分析。使用随机效应模型和 95%置信区间(CI)计算 VRE 的汇总估计值。使用 Cochran's Q 和 I 检验评估异质性水平。通过视觉检查漏斗图和 Begg's 或 Egger's 检验检查发表偏倚。
结果:有 20 项研究符合纳入标准并找到了相关数据。共纳入 831 株肠球菌和 71 株 VRE 分离株进行分析。VRE 的总体流行率为 14.8%(95%CI;8.7-24.3;I=74.05%;P<0.001)。与万古霉素耐药性相比,肠球菌对青霉素(60.7%)、氨苄西林(56.5%)、强力霉素(55.1%)和四环素(53.7%)的耐药率更高。达托霉素和利奈唑胺的耐药率相对较低,汇总估计值分别为 3.2%(95%CI,0.5-19.7%)和 9.9%(95%CI,2.8-29.0%)。肠球菌的总体多药耐药(MDR)率为 60.0%(95%CI,42.9-75.0%)。
结论:VRE 和耐药肠球菌在埃塞俄比亚呈上升趋势。肠球菌分离株对不同或同一药物线的一种或多种常用药物表现出耐药性。还发现了多药耐药(MDR)肠球菌。尽管这些比率较低,但达托霉素和利奈唑胺的耐药性出现是寻找治疗和控制 VRE 感染新方法的警钟。需要在医疗保健环境中遵守抗菌药物管理、全面检测和持续监测 VRE 感染。
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