Department of Medical Microbiology, University of Ghana Medical School, Korle Bu, P. O. Box KB 4236, Accra, Ghana.
BMC Infect Dis. 2024 Oct 29;24(1):1217. doi: 10.1186/s12879-024-09945-2.
Shigellosis continues to pose a significant public health problem in Africa; however, there is a lack of comprehensive knowledge regarding its prevalence, serogroup distribution, and antimicrobial resistance profiles. Therefore, the objective of this systematic review and meta-analysis was to determine the overall prevalence of Shigella, the distribution of species, and the patterns of antimicrobial resistance across Africa.
Following PRISMA guidelines, a systematic search strategy was conducted using the PubMed, Web of Science and Scopus databases from January 31, 2024 to February 10, 2024. The study quality was assessed using the Joanna Briggs Institute checklist, and data were analyzed using the R statistical language and the R package 'meta'. The random effects model was employed to estimate the pooled prevalence, while heterogeneity was assessed using the I statistic and prediction interval.
A total of 116 studies from 29 African countries were included in this meta-analysis, involving the examination of 99,510 samples. The overall pooled estimate of Shigella prevalence was determined to be 5.9% (95% CI: 4.9 - 7.0%). Regional prevalence showed prevalences of Southern Africa (6.9 [95% CI: 3.0 - 12.2%]), Northern Africa (6.7% [95% CI: 4.1 - 9.8%]), Eastern Africa (6.2% [95% CI: 4.9 - 7.6%]), Central Africa (4.5% [95% CI: 2.6 - 6.8%]) and Western Africa (4.0% [95% CI: 2.5 - 5.9%]). Shigella prevalence was found to be higher in children (6.6%, 95% CI: 3.2 - 11.1%) than in adults (3.6%, 95% CI: 1.6 - 6.3%). The most prevalent species was S. flexneri (53.6%, 95% CI: 46.1%-61.0%), followed by S. sonnei (11.5%, 95% CI: 7.7%-15.7%), S. dysenteriae (10.1%, 95% CI: 6.2 - 14.5%) and S. boydii (7.7%, 95% CI: 4.7 - 11.1%). Among the currently recommended first-line antibiotics, ciprofloxacin and ceftriaxone showed resistance prevalences of 10.0% (95% CI: 4.5%-16.9%) and 8.5% (95% CI: 2.4-16.9%) respectively.
This review highlights the burden of shigellosis in Africa. S. flexneri remains the most prevalent species associated with shigellosis cases with S. sonnei being the second most dominant. The antimicrobial resistance patterns observed in the study suggest local antimicrobial patterns in choosing antibiotics for the treatment of Shigellosis.
There is the need to explore alternative treatments for shigellosis with particular focus on vaccine development. There is also the need for more genomic epidemiology studies exploring the dissemination and risk of drug-resistant S. sonnei clones in Africa.
志贺菌病在非洲仍然是一个重大的公共卫生问题；然而，人们对其流行率、血清群分布和抗生素耐药谱缺乏全面的了解。因此，本系统评价和荟萃分析的目的是确定非洲志贺菌的总体流行率、物种分布以及抗生素耐药模式。
根据 PRISMA 指南，使用 PubMed、Web of Science 和 Scopus 数据库从 2024 年 1 月 31 日至 2024 年 2 月 10 日进行了系统搜索策略。使用 Joanna Briggs 研究所检查表评估研究质量，使用 R 统计语言和 R 包“meta”分析数据。使用随机效应模型估计汇总流行率，使用 I 统计量和预测区间评估异质性。
共有来自 29 个非洲国家的 116 项研究纳入了这项荟萃分析，共涉及 99510 个样本。志贺菌总体流行率的汇总估计为 5.9%（95%CI：4.9-7.0%）。区域流行率显示，南部非洲为 6.9%（95%CI：3.0-12.2%），北部非洲为 6.7%（95%CI：4.1-9.8%），东部非洲为 6.2%（95%CI：4.9-7.6%），中部非洲为 4.5%（95%CI：2.6-6.8%），西部非洲为 4.0%（95%CI：2.5-5.9%）。儿童（6.6%，95%CI：3.2-11.1%）的志贺菌流行率高于成人（3.6%，95%CI：1.6-6.3%）。最常见的物种是 S. flexneri（53.6%，95%CI：46.1%-61.0%），其次是 S. sonnei（11.5%，95%CI：7.7%-15.7%）、S. dysenteriae（10.1%，95%CI：6.2-14.5%）和 S. boydii（7.7%，95%CI：4.7-11.1%）。在目前推荐的一线抗生素中，环丙沙星和头孢曲松的耐药率分别为 10.0%（95%CI：4.5%-16.9%）和 8.5%（95%CI：2.4-16.9%）。
本综述强调了非洲志贺菌病的负担。S. flexneri 仍然是与志贺菌病相关的最常见物种，其次是 S. sonnei。研究中观察到的抗生素耐药模式表明，在选择治疗志贺菌病的抗生素时，当地有抗生素模式。
有必要探索志贺菌病的替代治疗方法，特别关注疫苗的开发。还需要更多的基因组流行病学研究来探索耐药性 S. sonnei 克隆在非洲的传播和风险。
