Tesfa Tewodros, Mitiku Habtamu, Sisay Mekonnen, Weldegebreal Fitsum, Ataro Zerihun, Motbaynor Birhanu, Marami Dadi, Teklemariam Zelalem
Department of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, P.O.Box, 235, Harar, Ethiopia.
Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, P.O.Box, 235, Harar, Ethiopia.
BMC Infect Dis. 2020 Mar 17;20(1):225. doi: 10.1186/s12879-020-4950-y.
Otitis media is inflammation of the middle ear, comprising a spectrum of diseases. It is the commonest episode of infection in children, which often occurs after an acute upper respiratory tract infection. Otitis media is ranked as the second most important cause of hearing loss and the fifth global burden of disease with a higher incidence in developing worlds like Sub-Saharan Africa and South Asia. Therefore, this systematic review is aimed to quantitatively estimate the current status of bacterial otitis media, bacterial etiology and their susceptibility profile in sub-Saharan Africa.
A literature search was conducted from major databases and indexing services including EMBASE (Ovid interface), PubMed/MEDLINE, Google Scholar, ScienceDirect, Cochrane Library, WHO African Index-Medicus and others. All studies (published and unpublished) addressing the prevalence of otitis media and clinical isolates conducted in sub-Saharan Africa were included. Format prepared in Microsoft Excel was used to extract the data and data was exported to Stata version 15 software for the analyses. Der-Simonian-Laird random-effects model at a 95% confidence level was used for pooled estimation of outcomes. The degree of heterogeneity was presented with I statistics. Publication bias was presented with funnel plots of standard error supplemented by Begg's and Egger's tests. The study protocol is registered on PROSPERO with reference number ID: CRD42018102485 and the published methodology is available from http://www.crd.york.ac.uk/CRD42018102485.
A total of 33 studies with 6034 patients were included in this study. All studies have collected ear swab/discharge samples for bacterial isolation. The pooled isolation rate of bacterial agents from the CSOM subgroup was 98%, patients with otitis media subgroup 87% and pediatric otitis media 86%. A univariate meta-regression analysis indicated the type of otitis media was a possible source of heterogeneity (p-value = 0.001). The commonest isolates were P. aeruginosa (23-25%), S. aureus (18-27%), Proteus species (11-19%) and Klebsiella species. High level of resistance was observed against Ampicillin, Amoxicillin-clavulanate, Cotrimoxazole, Amoxicillin, and Cefuroxime.
The analysis revealed that bacterial pathogens like P. aeruginosa and S. aureus are majorly responsible for otitis media in sub-Saharan Africa. The isolates have a high level of resistance to commonly used drugs for the management of otitis media.
中耳炎是中耳的炎症，包含一系列疾病。它是儿童最常见的感染性疾病，常发生于急性上呼吸道感染之后。中耳炎是导致听力损失的第二大重要原因，也是全球第五大疾病负担，在撒哈拉以南非洲和南亚等发展中地区发病率更高。因此，本系统评价旨在定量评估撒哈拉以南非洲细菌性中耳炎的现状、细菌病因及其药敏情况。
从主要数据库和索引服务中进行文献检索，包括EMBASE（Ovid界面）、PubMed/MEDLINE、谷歌学术、ScienceDirect、Cochrane图书馆、世界卫生组织非洲医学索引等。纳入所有在撒哈拉以南非洲进行的关于中耳炎患病率和临床分离株的研究（已发表和未发表）。使用Microsoft Excel编制的格式提取数据，并将数据导出到Stata 15软件进行分析。采用95%置信水平的Der-Simonian-Laird随机效应模型对结果进行合并估计。异质性程度用I统计量表示。用标准误差漏斗图并辅以Begg检验和Egger检验来呈现发表偏倚。该研究方案已在PROSPERO注册，注册号为ID：CRD42018102485，已发表的方法可从http://www.crd.york.ac.uk/CRD42018102485获取。
本研究共纳入33项研究，涉及6034名患者。所有研究均采集了耳拭子/分泌物样本进行细菌分离。慢性化脓性中耳炎亚组细菌病原体的合并分离率为98%，中耳炎亚组患者为87%，小儿中耳炎为86%。单因素meta回归分析表明中耳炎类型可能是异质性的一个来源（p值 = 0.001）。最常见的分离株是铜绿假单胞菌（23 - 25%）、金黄色葡萄球菌（18 - 27%）、变形杆菌属（11 - 19%）和克雷伯菌属。观察到对氨苄西林、阿莫西林 - 克拉维酸、复方新诺明、阿莫西林和头孢呋辛的耐药水平较高。
分析表明，在撒哈拉以南非洲，铜绿假单胞菌和金黄色葡萄球菌等细菌病原体是中耳炎的主要病因。分离株对常用的中耳炎治疗药物耐药水平较高。
