**标题**：在埃塞俄比亚 HIV 阳性个体中，多重耐药菌的负担：一项系统评价和荟萃分析。
Burden of multidrug-resistant bacteria among HIV-positive individuals in Ethiopia: A systematic review and meta-analysis.
机构信息
Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Immunology and Molecular Biology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
出版信息
PLoS One. 2024 Aug 26;19(8):e0309418. doi: 10.1371/journal.pone.0309418. eCollection 2024.
BACKGROUND
Multidrug-resistant (MDR) bacteria are a significant cause of severe infections, particularly in human immunodeficiency virus (HIV)-positive individuals because of their weakened immunity. Since there was no previous pooled representative data regarding the MDR bacteria among HIV-positive individuals in Ethiopia, this systematic review and meta-analysis is required.
METHODS
This study was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed using PubMed, Medline, EMBASE, Google Scholar, Hinari, Web of Science, Science Direct, and African Journals Online databases. Data were extracted using Microsoft Excel 2019 and analyzed using STATA version 11.0 software. A random-effects model was used to estimate the pooled effect size of outcome variables across studies with a 95% confidence interval. The I2 statistic was used to check for heterogeneity. The presence of publication bias was determined using a funnel plot and Egger's test with a p-value < 0.05 evidence of statistically significant bias.
RESULTS
The pooled prevalence of MDR was 58.02% (95% CI: 46.32-69.73%) with high heterogeneity (I2 = 97.1%, (p < 0.001). In subgroup analysis, the highest multi-drug resistance was observed in the Oromia region (80.95%), patients with multiple infections (82.35%), and studies identified both Gram-positive and Gram-negative bacteria (61.45%). Furthermore, the pooled prevalence of MDR bacteria colonizing HIV-positive individuals was 48.76%. Regarding MDR species, Enterococci (77.41%) and Pseudomonas spp. (84.60%) were commonly identified in individuals with HIV infection.
CONCLUSION
Our study indicates a high burden of MDR among HIV-positive individuals in Ethiopia. The Oromia region, HIV patients with multiple infections, Pseudomonas spp., and Enterococci showed the highest MDR in the subgroup analysis. Therefore, regional hospitals should implement strategies to tackle MDR such as vaccination program, appropriate use of antibiotics, and further study on the associated factors of MDR bacteria in HIV are required.
背景
多重耐药（MDR）细菌是严重感染的一个重要原因，特别是在人类免疫缺陷病毒（HIV）阳性个体中，因为他们的免疫力较弱。由于之前没有关于埃塞俄比亚 HIV 阳性个体中 MDR 细菌的综合代表性数据，因此需要进行这项系统评价和荟萃分析。
方法
本研究根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行。使用 PubMed、Medline、EMBASE、Google Scholar、Hinari、Web of Science、Science Direct 和 African Journals Online 数据库进行文献检索。使用 Microsoft Excel 2019 提取数据，并使用 STATA 版本 11.0 软件进行分析。使用随机效应模型估计研究间各结局变量的汇总效应大小，置信区间为 95%。使用 I2 统计量检查异质性。使用漏斗图和 Egger 检验来确定发表偏倚的存在，p 值<0.05 表示存在统计学显著偏倚。
结果
MDR 的合并患病率为 58.02%（95%CI：46.32-69.73%），存在高度异质性（I2=97.1%，（p<0.001）。在亚组分析中，奥罗米亚地区（80.95%）、多重感染的患者（82.35%）以及同时鉴定出革兰阳性和革兰阴性细菌的研究（61.45%）中观察到的多药耐药性最高。此外，MDR 细菌定植于 HIV 阳性个体的合并患病率为 48.76%。关于 MDR 物种，肠球菌（77.41%）和铜绿假单胞菌（84.60%）在 HIV 感染个体中常见。
结论
我们的研究表明，埃塞俄比亚 HIV 阳性个体中存在很高的 MDR 负担。在亚组分析中，奥罗米亚地区、多重感染的 HIV 患者、铜绿假单胞菌和肠球菌显示出最高的 MDR。因此，区域医院应实施策略来应对 MDR，例如疫苗接种计划、抗生素的合理使用，以及进一步研究 HIV 患者中 MDR 细菌的相关因素。
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