Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Institute of Biosciences, Department of Chemical and Biological Sciences, Sao Paulo State University, Sao Paulo, Brazil.
BMC Infect Dis. 2024 Oct 25;24(1):1202. doi: 10.1186/s12879-024-10110-y.
Nasopharyngeal carriage of S. pneumoniae is a global health problem that has been associated with the emergence of severe disease and pathogen dissemination in the community. However, summary data on the carriage rate, antimicrobial susceptibility profile, and determinant factors is lacking.
Articles were extensively searched in bibliographic databases and gray literature using entry terms or phrases. Studies meeting eligibility criteria were extracted in MS Excel and exported to STATA version 17 software for statistical analysis. A random-effects model was used to compute the pooled magnitude of the nasal carriage of S. pneumoniae and its multidrug resistance. The heterogeneity was quantified by using the I value. Publication bias was assessed using a funnel plot and Egger's test. Sensitivity analysis was done to assess the impact of a single study on the pooled effect size.
Of the 146 studies identified, 8 studies containing a total of 3223 children were selected for meta-analysis of the magnitude of the nasal carriage of S. pneumoniae and its multidrug resistance. The overall pooled prevalence of nasal carriage of S. pneumoniae and its MDR status in Ethiopian children was 32.77% (95%CI: 25.1, 40.44). and 31.22% (95%CI: 15.06, 46.84), respectively. The highest resistant pattern of S. pneumoniae was against tetracycline, which was 46.27% (95%CI: 37.75, 54.79), followed by 45.68% (95%CI: 34.43, 57.28) trimethoprim-sulfamethoxazole, while the least pooled prevalence was against chloramphenicol, which was 16.2% (95%CI: 9.44, 22.95). The pooled effect of age less than 5 years old (pooled OR = 1.97; 95% CI: 1.35, 2.88, P < 0.001), co-sleeping habit with others (pooled OR = 2.36; 95% CI: 1.77, 3.66; P < 0.001), sibling (pooled OR = 1.82; 95% CI: 1.14, 2.91, P = 0.01), history of hospitalization (pooled OR = 4.39; 95% CI: 1.86, 10.34, P = 0.001), and malnutrition (pooled OR = 2.18; 95% CI: 1.49, 3.19; P < 0.001) showed a statistical association with S. pneumoniae nasal carriage rate by using the random effect Sidik-Jonkman model.
The magnitude of the nasopharyngeal carriage rate and multi-drug resistance status of S. pneumoniae alarms the need for immediate interventions such as strengthening antimicrobial stewardship programs, undertaking national antimicrobial surveillance, one-health initiatives, and national immunization programs.
肺炎链球菌的鼻咽携带是一个全球性的健康问题，与严重疾病的出现和社区病原体传播有关。然而，关于携带率、抗菌药物敏感性谱和决定因素的综合数据仍然缺乏。
使用主题词或短语在文献数据库和灰色文献中广泛搜索文章。在 MS Excel 中提取符合入选标准的研究，并将其导出到 STATA 版本 17 软件中进行统计分析。使用随机效应模型计算肺炎链球菌鼻咽携带及其多重耐药性的汇总幅度。使用 I 值量化异质性。使用漏斗图和 Egger 检验评估发表偏倚。进行敏感性分析以评估单个研究对汇总效应大小的影响。
在确定的 146 项研究中，选择了 8 项包含 3223 名儿童的研究进行肺炎链球菌鼻咽携带及其多重耐药性幅度的荟萃分析。埃塞俄比亚儿童肺炎链球菌鼻咽携带及其 MDR 状况的总体汇总患病率分别为 32.77%（95%CI：25.1，40.44）和 31.22%（95%CI：15.06，46.84）。肺炎链球菌的最高耐药模式是对四环素，耐药率为 46.27%（95%CI：37.75，54.79），其次是对甲氧苄啶-磺胺甲恶唑的 45.68%（95%CI：34.43，57.28），而最低的耐药率是对氯霉素，耐药率为 16.2%（95%CI：9.44，22.95）。年龄小于 5 岁（汇总 OR=1.97；95%CI：1.35，2.88，P<0.001）、与他人共睡（汇总 OR=2.36；95%CI：1.77，3.66；P<0.001）、有兄弟姐妹（汇总 OR=1.82；95%CI：1.14，2.91，P=0.01）、有住院史（汇总 OR=4.39；95%CI：1.86，10.34，P=0.001）和营养不良（汇总 OR=2.18；95%CI：1.49，3.19；P<0.001）与肺炎链球菌鼻咽携带率呈统计学关联，使用随机效应 Sidik-Jonkman 模型。
肺炎链球菌鼻咽携带率和多重耐药状况的幅度令人警惕，需要立即采取干预措施，如加强抗菌药物管理计划、开展国家抗菌药物监测、开展一次健康倡议和国家免疫规划。
