Department of Microbiology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Sci Rep. 2024 Jul 15;14(1):16333. doi: 10.1038/s41598-024-64992-8.
Carbapenem-resistant Enterobacteriaceae (CRE) have diminished treatment options causing serious morbidities and mortalities. This systematic review and meta-analysis assessed the prevalence and associated factors of Enterobacteriaceae infections in clinical, livestock and environmental settings globally. The population intervention comparison and outcome strategy was used to enroll studies using the preferred reporting system for systematic review and meta-analysis to include only cross-sectional studies. Search engines used to retrieve articles included journal author name estimator, PubMed, Google Scholar and African Journals Online (AJOL). The Newcastle-Ottawa scale was used to assess the quality of studies. Sixteen articles from 2013 to 2023 in Africa, Asia, Europe and South America were studied. The pooled prevalence of CRE was 43.06% (95% CI 21.57-66.03). Klebsiella pneumoniae (49.40%), Escherichia coli (26.42%), and Enterobacter cloacae (14.24%) were predominant. Klebsiella pneumoniae had the highest resistance with the blaKPC-2 in addition to blaNDM, blaOXA-48, blaIMP and blaVIM. The blaKPC-2 genes occurrence was associated with environmental (P-value < 0.0001) and South American studies (P-value < 0.0001), but there was no difference in the trends over time (P-value = 0.745). This study highlights the high rates of CRE infections, particularly within blaKPC production. Monitoring and surveillance programs, research and infection control measures should be strengthened. Additionally, further studies are needed to explore the mechanisms driving the predominance of specific bacterial species and the distribution of resistance genes within this bacterial family.
耐碳青霉烯肠杆菌科（CRE）的治疗选择有限，导致严重的发病率和死亡率。本系统评价和荟萃分析评估了全球临床、家畜和环境环境中肠杆菌科感染的流行率和相关因素。采用人群干预比较和结局策略，使用系统评价和荟萃分析的首选报告系统纳入研究，仅包括横断面研究。用于检索文章的搜索引擎包括期刊作者姓名估计器、PubMed、Google Scholar 和非洲期刊在线（AJOL）。使用纽卡斯尔-渥太华量表评估研究质量。研究了来自 2013 年至 2023 年非洲、亚洲、欧洲和南美洲的 16 篇文章。CRE 的汇总患病率为 43.06%（95%CI 21.57-66.03）。肺炎克雷伯菌（49.40%）、大肠杆菌（26.42%）和阴沟肠杆菌（14.24%）是主要病原体。肺炎克雷伯菌的耐药性最高，除了 blaNDM、blaOXA-48、blaIMP 和 blaVIM 外，还携带 blaKPC-2。blaKPC-2 基因的发生与环境（P 值<0.0001）和南美洲研究（P 值<0.0001）有关，但随着时间的推移没有趋势差异（P 值=0.745）。本研究强调了 CRE 感染率较高，特别是在 blaKPC 产生方面。应加强监测和监测计划、研究和感染控制措施。此外，还需要进一步研究探索驱动特定细菌物种流行和该细菌家族内耐药基因分布的机制。
