Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Antimicrob Resist Infect Control. 2023 Aug 30;12(1):86. doi: 10.1186/s13756-023-01291-3.
Vancomycin-resistant Staphylococcus aureus, identified as a "high priority antibiotic-resistant pathogen" by the World Health Organization, poses a significant threat to human health. This systematic review and meta-analysis aimed to estimate the pooled prevalence of vancomycin-resistant Staphylococcus aureus in Ethiopia.
This systematic review and meta-analysis was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that reported VRSA prevalence due to infection or carriage from human clinical specimens were extensively searched in bibliographic databases and grey literatures using entry terms and combination key words. Electronic databases like PubMed, Google Scholar, Wiley Online Library, African Journal Online, Scopus, Science Direct, Embase, and ResearchGate were used to find relevant articles. In addition, the Joanna Briggs Institute quality appraisal tool was used to assess the quality of the included studies. Stata version 14 software was used for statistical analysis. Forest plots using the random-effect model were used to compute the overall pooled prevalence of VRSA and for the subgroup analysis. Heterogeneity was assessed using Cochrane chi-square (I) statistics. After publication bias was assessed using a funnel plot and Egger's test, trim & fill analysis was carried out. Furthermore, sensitivity analysis was done to assess the impact of a single study on pooled effect size.
Of the 735 studies identified, 31 studies that fulfilled the eligibility criteria were included for meta-analysis consisted of 14,966 study participants and 2,348 S. aureus isolates. The overall pooled prevalence of VRSA was 14.52% (95% CI: 11.59, 17.44). Significantly high level of heterogeneity was observed among studies (I = 93.0%, p < 0.001). The region-based subgroup analysis depicted highest pooled prevalence of 47.74% (95% CI: 17.79, 77.69) in Sidama region, followed by 14.82% (95% CI: 8.68, 19.88) in Amhara region, while Oromia region had the least pooled prevalence 8.07% (95% CI: 4.09, 12.06). The subgroup analysis based on AST methods depicted a significant variation in pooled prevalence of VRSA (6.3% (95% CI: 3.14, 9.43) for MIC-based methods, and 18.4% (95% CI: 14.03, 22.79) for disk diffusion AST method) which clearly showed that disk diffusion AST method overestimates the pooled VRSA prevalence. The total number of S. aureus isolates was found to be the responsible variable for the existence of heterogeneity among studies (p = 0.033).
This study showed an alarmingly high pooled prevalence of VRSA necessitating routine screening, appropriate antibiotic usage, and robust infection prevention measures to manage MRSA infections and control the emergence of drug resistance. Furthermore, mainly attributable to the overestimation of VRSA burden while using disk diffusion method, there is an urgent need to improve the methods to determine vancomycin resistance in Ethiopia and incorporate MIC-based VRSA detection methods in routine clinical laboratory tests, and efforts should be directed at improving it nationally.
PROSPERO registration identification number: CRD42023422043.
耐万古霉素金黄色葡萄球菌被世界卫生组织列为“高度优先的抗生素耐药病原体”，对人类健康构成重大威胁。本系统评价和荟萃分析旨在估计埃塞俄比亚耐万古霉素金黄色葡萄球菌的总流行率。
本系统评价和荟萃分析按照系统评价和荟萃分析的首选报告项目报告。使用检索词和组合关键词，在文献数据库和灰色文献中广泛搜索了报道由于感染或携带来自人类临床标本而导致 VRSA 流行率的研究。使用 PubMed、Google Scholar、Wiley Online Library、African Journal Online、Scopus、Science Direct、Embase 和 ResearchGate 等电子数据库查找相关文章。此外，还使用 Joanna Briggs 研究所的质量评估工具评估了纳入研究的质量。使用 Stata 版本 14 软件进行统计分析。使用随机效应模型的森林图计算 VRSA 的总体汇总流行率和亚组分析。使用 Cochrane chi-square (I) 统计量评估异质性。在使用漏斗图和 Egger 检验评估发表偏倚后，进行了修剪和填充分析。此外，还进行了敏感性分析，以评估单个研究对汇总效应大小的影响。
在确定的 735 项研究中，有 31 项符合纳入标准的研究进行了荟萃分析，包括 14966 名研究参与者和 2348 株金黄色葡萄球菌分离株。VRSA 的总流行率为 14.52%（95%CI：11.59，17.44）。研究之间存在显著的高度异质性（I=93.0%，p<0.001）。基于 AST 方法的亚组分析显示，在西达玛地区 VRSA 的总流行率最高，为 47.74%（95%CI：17.79，77.69），其次是阿姆哈拉地区的 14.82%（95%CI：8.68，19.88），而奥罗莫地区的最低流行率为 8.07%（95%CI：4.09，12.06）。基于 AST 方法的亚组分析显示 VRSA 的总流行率存在显著差异（基于 MIC 方法为 6.3%（95%CI：3.14，9.43），基于纸片扩散 AST 方法为 18.4%（95%CI：14.03，22.79）），这清楚地表明纸片扩散 AST 方法高估了 VRSA 的总流行率。研究之间存在异质性的原因是总金黄色葡萄球菌分离株数量（p=0.033）。
本研究显示耐万古霉素金黄色葡萄球菌的总流行率令人震惊地高，需要进行常规筛查、适当使用抗生素和实施强有力的感染预防措施，以管理耐甲氧西林金黄色葡萄球菌感染并控制耐药性的出现。此外，主要由于在使用纸片扩散法时高估了 VRSA 负担，因此迫切需要改进在埃塞俄比亚确定万古霉素耐药性的方法，并在常规临床实验室检测中纳入基于 MIC 的 VRSA 检测方法，并努力在全国范围内提高其水平。
PROSPERO 注册标识号：CRD42023422043。
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