在埃塞俄比亚，耐美罗培南铜绿假单胞菌的流行率：一项系统评价和荟萃分析。

Prevalence of meropenem-resistant Pseudomonas Aeruginosa in Ethiopia: a systematic review and meta‑analysis.

机构信息

Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.

Department of Clinical Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.

出版信息

Antimicrob Resist Infect Control. 2024 Apr 10;13(1):37. doi: 10.1186/s13756-024-01389-2.

INTRODUCTION

Antimicrobial resistance (AMR) is a pressing global health concern, particularly pronounced in low-resource settings. In Ethiopia, the escalating prevalence of carbapenem-resistant Pseudomonas aeruginosa (P. aeruginosa) poses a substantial threat to public health.

METHODS

A comprehensive search of databases, including PubMed, Scopus, Embase, Hinari, and Google Scholar, identified relevant studies. Inclusion criteria encompassed observational studies reporting the prevalence of meropenem-resistant P. aeruginosa in Ethiopia. Quality assessment utilized JBI checklists. A random-effects meta-analysis pooled data on study characteristics and prevalence estimates, with subsequent subgroup and sensitivity analyses. Publication bias was assessed graphically and statistically.

RESULTS

Out of 433 studies, nineteen, comprising a total sample of 11,131, met inclusion criteria. The pooled prevalence of meropenem-resistant P. aeruginosa was 15% (95% CI: 10-21%). Significant heterogeneity (I = 83.6%) was observed, with the number of P. aeruginosa isolates identified as the primary source of heterogeneity (p = 0.127). Subgroup analysis by infection source revealed a higher prevalence in hospital-acquired infections (28%, 95% CI: 10, 46) compared to community settings (6%, 95% CI: 2, 11). Geographic based subgroup analysis indicated the highest prevalence in the Amhara region (23%, 95% CI: 8, 38), followed by Addis Ababa (21%, 95% CI: 11, 32), and lower prevalence in the Oromia region (7%, 95% CI: 4, 19). Wound samples exhibited the highest resistance (25%, 95% CI: 25, 78), while sputum samples showed the lowest prevalence. Publication bias, identified through funnel plot examination and Egger's regression test (p < 0.001), execution of trim and fill analysis resulted in an adjusted pooled prevalence of (3.7%, 95% CI: 2.3, 9.6).

CONCLUSION

The noteworthy prevalence of meropenem resistance among P. aeruginosa isolates in Ethiopia, particularly in healthcare settings, underscores the urgency of implementing strict infection control practices and antibiotic stewardship. Further research is imperative to address and mitigate the challenges posed by antimicrobial resistance in the country.

引言

抗菌药物耐药性（AMR）是一个紧迫的全球健康问题，在资源匮乏的环境中尤为明显。在埃塞俄比亚，碳青霉烯类耐药铜绿假单胞菌（P. aeruginosa）的流行率不断上升，对公共卫生构成了重大威胁。

方法

通过对包括 PubMed、Scopus、Embase、Hinari 和 Google Scholar 在内的数据库进行全面检索，确定了相关研究。纳入标准包括报告埃塞俄比亚美罗培南耐药铜绿假单胞菌流行率的观察性研究。使用 JBI 清单进行质量评估。采用随机效应荟萃分析汇总研究特征和流行率估计值，随后进行亚组和敏感性分析。通过图形和统计方法评估发表偏倚。

结果

在 433 项研究中，有 19 项研究共纳入了 11131 例患者，符合纳入标准。美罗培南耐药铜绿假单胞菌的总流行率为 15%（95%CI：10-21%）。观察到显著的异质性（I=83.6%），主要来源于铜绿假单胞菌分离株的数量（p=0.127）。按感染源进行的亚组分析显示，医院获得性感染的流行率较高（28%，95%CI：10, 46），而社区感染的流行率较低（6%，95%CI：2, 11）。基于地理位置的亚组分析显示，阿姆哈拉地区的流行率最高（23%，95%CI：8, 38），其次是亚的斯亚贝巴（21%，95%CI：11, 32），奥罗米亚地区的流行率较低（7%，95%CI：4, 19）。伤口样本的耐药率最高（25%，95%CI：25, 78），而痰样本的耐药率最低。通过漏斗图检查和 Egger 回归检验（p<0.001）发现存在发表偏倚，执行修剪和填充分析后，调整后的总流行率为（3.7%，95%CI：2.3, 9.6）。