Abay Getahun Kahsay, Shfare Mebrahtu Teweldemedhin, Teklu Teklay Gebrecherkos, Kidane Kibriti Mehari, Gebremeskel Tsega Kahsay, Kahsay Atsebaha Gebrekidan, Gezae Kebede Embaye, Muthupandian Saravanan, Degene Tsehaye Asmelash
Department of Medical Microbiology & Immunology, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
Tigray Health Research Institute, Mekelle, Tigray, Ethiopia.
Eur J Med Res. 2025 Jan 7;30(1):14. doi: 10.1186/s40001-024-02267-8.
Worldwide, antimicrobial resistance (AMR) has grown to represent a serious threat to the diagnosis, management, and prevention of bacterial diseases. Due to their multidrug resistance attributes, the WHO has classified extended-spectrum-β-lactamase-producing Enterobacteriaceae (ESBL-PE)-associated infections as infections of critical significance, posing a serious risk to human health. Thus, the goal of this systematic review and meta-analysis was to assess the pooled prevalence of ESBL-PE and AMR among strains causing clinical infections in Africa.
In this systematic review and meta-analysis, two investigators independently made an electronic search in Google Scholar and PubMed databases using related keywords and corresponding "MeSH." terms for the PubMed. The accessed studies were screened, assessed for eligibility, and critically evaluated as per the PRISMA guidelines. The prevalence and 95% confidence intervals (CI) for ESBL-PE in Africa were evaluated using a random-effects model of a meta-analysis. As a visual and statistical way assessment, the funnel plot and Egger's test were utilized to assess the risk of bias or publication bias, with a statistically significant level of bias being determined at p < 0.05.
Twenty-six studies were included in the meta-analysis. Among the included studies done in Africa, the overall pooled proportion of ESBL-PE was reported to be 28% (95% CI 25-31%). ESBL-PE prevalence differed by region, the pooled estimates for East and North Africa were 29% (95% CI 20-38%) and 19% (95% CI 6-33%), respectively. The greatest sub-group analysis of pooled estimates among bacterial isolates was found in Klebsiella. pneumoniae, at 73% (95% CI 62-85%), while Proteus mirabilis had the lowest, at 40% (95% CI 1-81%).
In Africa, ESBL-PE is noticeably prevalent. The included studies demonstrated a significant variation in ESBL-PE resistance among the countries. This illustrates the necessity of actively monitoring antimicrobial resistance in Africa to develop interventions aimed at halting the spread of ESBL-PE.
在全球范围内，抗菌药物耐药性（AMR）已发展成为对细菌性疾病的诊断、治疗和预防的严重威胁。由于其多重耐药特性，世界卫生组织已将产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-PE）相关感染列为具有重大意义的感染，对人类健康构成严重风险。因此，本系统评价和荟萃分析的目的是评估非洲临床感染菌株中ESBL-PE和AMR的合并患病率。
在本系统评价和荟萃分析中，两名研究人员独立在谷歌学术和PubMed数据库中使用相关关键词以及PubMed对应的“医学主题词”进行电子检索。对检索到的研究进行筛选、评估其 eligibility，并根据PRISMA指南进行严格评价。使用荟萃分析的随机效应模型评估非洲ESBL-PE的患病率和95%置信区间（CI）。作为一种可视化和统计学评估方法，采用漏斗图和Egger检验来评估偏倚风险或发表偏倚，当p < 0.05时确定存在具有统计学意义的偏倚水平。
26项研究纳入荟萃分析。在非洲进行的纳入研究中，ESBL-PE的总体合并比例据报道为28%（95%CI 25 - 31%）。ESBL-PE患病率因地区而异，东非和北非的合并估计值分别为29%（95%CI 20 - 38%）和19%（95%CI 6 - 33%）。在细菌分离株中，合并估计值的最大亚组分析发现肺炎克雷伯菌中最高，为73%（95%CI 62 - 85%），而奇异变形杆菌最低，为40%（95%CI 1 - 81%）。
在非洲，ESBL-PE明显流行。纳入研究表明各国之间ESBL-PE耐药性存在显著差异。这说明了在非洲积极监测抗菌药物耐药性以制定旨在阻止ESBL-PE传播的干预措施的必要性。
