Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.
Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia.
BMC Infect Dis. 2024 Aug 18;24(1):838. doi: 10.1186/s12879-024-09747-6.
The emergence and rapid spread of gram-negative bacteria resistant to carbapenems among newborns is concerning on a global scale. Nonetheless, the pooled estimate of gram-negative bacteria resistant to carbapenem that cause neonatal sepsis in developing nations remains unknown. Thus, this study aimed to determine the combined prevalence of gram-negative bacteria resistant to carbapenem in African newborns who were suspected of having sepsis.
All studies published from January 1, 2010, up to December 30, 2023, from PubMed, Science Direct, Scopus electronic databases, and the Google Scholar search engine were researched. Isolates tested for carbapenem from neonates with sepsis, English language papers conducted in Africa, and cross-sectional and cohort studies papers were included. Using PRISMA guidelines, we systematically reviewed and meta-analyzed studies that assessed the prevalence of carbapenem-resistant gram-negative bacteria. The "Joanna Briggs Institute" was used critically to evaluate the quality of the included studies. The data analysis was carried out using STATA™ version 17. Heterogeneity across the studies was evaluated using Q and I tests. The subgroup analysis was done and, funnel plot and Egger's regression test were used to detect publication bias. A sensitivity analysis was conducted.
All 36 studies were included in the meta-analysis and systematic review. The pooled prevalence of carbapenem resistance in Africa was 30.34% (95% CI 22.03-38.64%). The pooled estimate of gram-negative bacteria resistant to imipenem, and meropenem was 35.57% (95% CI 0.67-70.54%) and 34.35% (95% CI 20.04% - 48.67%), respectively. A. baumannii and Pseudomonas spp. had pooled prevalence of 45.9% (95% CI 33.1-58.7%) and 43.0% (95% CI 23.0-62.4%), respectively. Similarly, Pseudomonas spp. and A. baumannii also exhibited strong meropenem resistance, with a pooled prevalence of 29.2% (95% CI 4.8-53.5%) and 36.7% (95% CI 20.1-53.3%), respectively. E. coli and K. pneumoniae were the two most common isolates.
There should be urgent antimicrobial stewardship practices, strengthened surveillance systems and effective treatment for neonates with sepsis. There was remarkable variation in resistance across the continent.
全球范围内，新生婴儿中出现并迅速传播对碳青霉烯类药物具有抗药性的革兰氏阴性菌令人担忧。然而，发展中国家新生儿败血症中耐碳青霉烯类药物的革兰氏阴性菌的合并患病率仍不清楚。因此，本研究旨在确定在疑似患有败血症的非洲新生儿中，耐碳青霉烯类药物的革兰氏阴性菌的合并患病率。
从 PubMed、Science Direct、Scopus 电子数据库和 Google Scholar 搜索引擎中检索了 2010 年 1 月 1 日至 2023 年 12 月 30 日期间发表的所有研究。纳入了针对败血症新生儿进行碳青霉烯类药物检测的分离株、在非洲进行的英文论文、以及横断面和队列研究论文。使用 PRISMA 指南，我们系统地综述和荟萃分析了评估耐碳青霉烯类药物革兰氏阴性菌患病率的研究。使用“Joanna Briggs 研究所”对纳入研究的质量进行批判性评估。使用 STATA™ 版本 17 进行数据分析。使用 Q 和 I 检验评估研究之间的异质性。进行了亚组分析，并使用漏斗图和 Egger 回归检验来检测发表偏倚。进行了敏感性分析。
共有 36 项研究纳入荟萃分析和系统综述。非洲碳青霉烯类耐药的总体患病率为 30.34%（95%CI 22.03-38.64%）。耐亚胺培南和美罗培南的革兰氏阴性菌的汇总估计值分别为 35.57%（95%CI 0.67-70.54%）和 34.35%（95%CI 20.04%-48.67%）。鲍曼不动杆菌和铜绿假单胞菌的汇总患病率分别为 45.9%（95%CI 33.1-58.7%）和 43.0%（95%CI 23.0-62.4%）。同样，铜绿假单胞菌和美罗培南也表现出较强的耐药性，汇总患病率分别为 29.2%（95%CI 4.8-53.5%）和 36.7%（95%CI 20.1-53.3%）。大肠埃希菌和肺炎克雷伯菌是最常见的两种分离株。
应该采取紧急的抗菌药物管理实践、加强监测系统和对患有败血症的新生儿进行有效治疗。该大陆的耐药性存在显著差异。
