Asmare Zelalem, Tamrat Ephrem, Erkihun Mulat, Endalamaw Kirubel, Alelign Dagninet, Getie Molla, Sisay Assefa, Gashaw Yalewayker, Reta Melese Abate
Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia.
Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.
BMC Infect Dis. 2025 Apr 12;25(1):518. doi: 10.1186/s12879-025-10923-5.
Antimicrobial resistance (AMR) is a growing global health threat. Acinetobacter baumannii (A. baumannii) emerged as one of the most concerning critical priority pathogens due to its ability to develop resistance to multiple antimicrobial agents. In Ethiopia, the public health impact of AMR is increasingly significant, with A. baumannii responsible for a variety of infections. Although A. baumannii causes a range of infections in Ethiopian patients, the drug resistance status of the clinical isolates has not been thoroughly assessed. Therefore, this systematic review and meta-analysis aimed to determine the country-wide AMR of A. baumannii.
This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a search of articles on PubMed, Web of Science, Science Direct, Scopes electronic databases, Google Scholar search engine, and institutional repositories/libraries for studies published between 2015 and 2024. Eligible studies on A. baumannii-related infections and AMR in Ethiopia were assessed for quality using the Joanna Briggs Institute (JBI) criteria. Data on study characteristics were extracted, and statistical analyses, including heterogeneity (Invers of variance), publication bias (Eggers test), and subgroup analyses, were performed using STATA 17.0. A random effect model was used to compute the pooled prevalence of AMR.
This systematic review and meta-analysis of 26 Ethiopian studies (26,539 participants) found an A. baumannii prevalence of 3.99% (95% CI: 3.01-4.98%) and 9.13% of all bacterial infections (95% CI: 6.73-11.54%). The most common infections were surgical site infections, urinary tract infections, pneumonia, and sepsis. Pooled resistance to antibiotics varied, with amikacin showing the lowest resistance (20.27%) (95% CI: 11.51-29.03) and cefotaxime the highest (83.18) (95% CI: 71.87-94.48). A pooled multi-drug resistant (MDR) A. baumannii was found in 88.22% (95% CI: 82.28-94.15) of isolates, with regional and infection-type variations, particularly in higher prevalence in Oromia and Amhara regions and sepsis cases.
This systematic review underscores the alarming rise of antimicrobial resistance in A. baumannii, particularly against carbapenems. The findings highlight a high prevalence of MDR A. baumannii and widespread extended-spectrum beta-lactamase production, with notable regional variations in resistance patterns. These high resistance rates reinforce A. baumannii as a critical global health threat, necessitating urgent interventions such as enhanced antimicrobial stewardship programs, improved infection control measures, and the development of alternative treatment strategies. Healthcare professionals, policymakers, and researchers must collaborate to mitigate the clinical and public health impact of this pathogen.
This systematic review and meta-analysis was registered on PROSPERO (Registration ID: CRD42024623927).
抗菌药物耐药性（AMR）对全球健康构成的威胁日益严重。鲍曼不动杆菌因其对多种抗菌药物产生耐药性的能力，成为最受关注的关键优先病原体之一。在埃塞俄比亚，AMR对公共卫生的影响日益显著，鲍曼不动杆菌引发了多种感染。尽管鲍曼不动杆菌在埃塞俄比亚患者中引发了一系列感染，但临床分离株的耐药状况尚未得到全面评估。因此，本系统评价和荟萃分析旨在确定全国范围内鲍曼不动杆菌的AMR情况。
本系统评价和荟萃分析遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。我们在PubMed、科学网、Science Direct、Scopes电子数据库、谷歌学术搜索引擎以及机构知识库/图书馆中检索了2015年至2024年发表的研究文章。使用乔安娜·布里格斯研究所（JBI）标准对埃塞俄比亚有关鲍曼不动杆菌相关感染和AMR的合格研究进行质量评估。提取研究特征数据，并使用STATA 17.0进行统计分析，包括异质性（方差倒数）、发表偏倚（Egger检验）和亚组分析。采用随机效应模型计算AMR的合并患病率。
对26项埃塞俄比亚研究（26539名参与者）进行的本系统评价和荟萃分析发现，鲍曼不动杆菌的患病率为3.99%（95%CI：3.01 - 4.98%），占所有细菌感染的9.13%（95%CI：6.73 - 11.54%）。最常见的感染是手术部位感染、尿路感染、肺炎和败血症。抗生素的合并耐药率各不相同，阿米卡星的耐药率最低（20.27%）（95%CI：11.51 - 29.03），头孢噻肟的耐药率最高（83.18）（95%CI：71.87 - 94.48）。在88.22%（95%CI：82.28 - 94.15）的分离株中发现了合并多重耐药（MDR）鲍曼不动杆菌，存在地区和感染类型差异，特别是在奥罗米亚和阿姆哈拉地区以及败血症病例中患病率较高。
本系统评价强调了鲍曼不动杆菌抗菌药物耐药性的惊人上升，尤其是对碳青霉烯类药物的耐药性。研究结果突出了MDR鲍曼不动杆菌的高患病率和广泛的超广谱β-内酰胺酶产生，耐药模式存在显著的地区差异。这些高耐药率进一步证明鲍曼不动杆菌是全球健康的重大威胁，需要采取紧急干预措施，如加强抗菌药物管理计划、改进感染控制措施以及开发替代治疗策略。医疗保健专业人员、政策制定者和研究人员必须合作，以减轻这种病原体对临床和公共卫生的影响。
本系统评价和荟萃分析已在PROSPERO上注册（注册号：CRD42024623927）。
