Department of Microbiology, University of Lagos, Akoka, Lagos, Nigeria.
School of Life Sciences, University of Warwick, Coventry, United Kingdom.
PLoS One. 2023 Nov 28;18(11):e0287762. doi: 10.1371/journal.pone.0287762. eCollection 2023.
Carbapenems are effective drugs against bacterial pathogens and resistance to them is considered a great public health threat, especially in notorious nosocomial pathogens like Acinetobacter baumannii and Pseudomonas aeruginosa. In this study, we aimed to determine the prevalence of carbapenem resistance in A. baumannii and P. aeruginosa infections in Sub-Saharan Africa. Databases (PubMed, Scopus, Web of Science, and African Journal Online) were systematically searched following the Preferred Reporting Items for Systematic review and meta-analysis protocols (PRISMA-P) 2020 statements for articles reporting carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) prevalence between 2012 and 2022. Pooled prevalence was determined with the random effect model and funnel plots were used to determine heterogeneity in R. A total of 47 articles were scanned for eligibility, among which 25 (14 for carbapenem-resistant A. baumannii and 11 for carbapenem-resistant P. aeruginosa) were included in the study after fulfilling the eligibility criteria. The pooled prevalence of CRPA in the present study was estimated at 8% (95% CI; 0.02-0.17; I2 = 98%; P <0.01). There was high heterogeneity (Q = 591.71, I2 = 98.9%; P<0.0001). In addition, this study's pooled prevalence of CRAB was estimated at 20% (95% CI; 0.04-0.43; I2 = 99%; P <0.01). There was high heterogeneity (Q = 1452.57, I2 = 99%; P<0.0001). Also, a funnel plot analysis of the studies showed high degree of heterogeneity. The carbapenemase genes commonly isolated from A. baumannii in this study include blaOXA23, blaOXA48, blaGES., blaNDM, blaVIM, blaOXA24, blaOXA58, blaOXA51, blaSIM-1, blaOXA40, blaOXA66, blaOXA69, blaOXA91, with blaOXA23 and blaVIM being the most common. On the other hand, blaNDM, blaVIM, blaIMP, blaOXA48, blaOXA51, blaSIM-1, blaOXA181, blaKPC, blaOXA23, blaOXA50 were the commonly isolated carbapenemase genes in P. aeruginosa, among which blaVIM and blaNDM genes were the most frequently isolated. Surveillance of drug-resistant pathogens in Sub-Saharan Africa is essential in reducing the region's disease burden. This study has shown that the region has significantly high multidrug-resistant pathogen prevalence. This is a wake-up call for policymakers to put in place measures to reduce the spread of these critical priority pathogens.
碳青霉烯类药物是对抗细菌病原体的有效药物，对它们的耐药性被认为是一个巨大的公共卫生威胁，尤其是在臭名昭著的医院病原体如鲍曼不动杆菌和铜绿假单胞菌中。在这项研究中，我们旨在确定撒哈拉以南非洲地区鲍曼不动杆菌和铜绿假单胞菌感染中碳青霉烯类药物耐药的流行率。根据系统评价和荟萃分析协议（PRISMA-P）2020 年的声明，我们对 2012 年至 2022 年间报告碳青霉烯类耐药鲍曼不动杆菌（CRAB）和碳青霉烯类耐药铜绿假单胞菌（CRPA）流行率的文章进行了数据库（PubMed、Scopus、Web of Science 和 African Journal Online）的系统搜索。使用随机效应模型确定汇总流行率，并使用漏斗图确定 R 中的异质性。总共扫描了 47 篇文章以确定其合格性，其中 25 篇（14 篇用于碳青霉烯类耐药鲍曼不动杆菌，11 篇用于碳青霉烯类耐药铜绿假单胞菌）在符合资格标准后被纳入研究。本研究中 CRPA 的汇总流行率估计为 8%（95%CI；0.02-0.17；I2 = 98%；P <0.01）。存在高度异质性（Q = 591.71，I2 = 98.9%；P<0.0001）。此外，本研究中 CRAB 的汇总流行率估计为 20%（95%CI；0.04-0.43；I2 = 99%；P <0.01）。存在高度异质性（Q = 1452.57，I2 = 99%；P<0.0001）。此外，研究的漏斗图分析显示出高度的异质性。本研究中从鲍曼不动杆菌中分离出的常见碳青霉烯酶基因包括 blaOXA23、blaOXA48、blaGES、blaNDM、blaVIM、blaOXA24、blaOXA58、blaOXA51、blaSIM-1、blaOXA40、blaOXA66、blaOXA69、blaOXA91，其中 blaOXA23 和 blaVIM 最为常见。另一方面，blaNDM、blaVIM、blaIMP、blaOXA48、blaOXA51、blaSIM-1、blaOXA181、blaKPC、blaOXA23、blaOXA50 是铜绿假单胞菌中常见的碳青霉烯酶基因，其中 blaVIM 和 blaNDM 基因最为常见。在撒哈拉以南非洲地区监测耐药病原体对于降低该地区的疾病负担至关重要。本研究表明，该地区具有显著较高的多药耐药病原体流行率。这是对政策制定者的一个警钟，需要采取措施减少这些关键优先病原体的传播。
