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Prevalence of Vancomycin resistant enterococci (VRE) in Ethiopia: a systematic review and meta-analysis

BACKGROUND: The emergence of Vancomycin resistant enterococci (VRE) poses a major public health problem since it was first reported. Although the rising rates of VRE infections are being reported elsewhere in the worldwide; there is limited national pooled data in Ethiopia. Therefore, this study was...

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Autores principales: Melese, Addisu, Genet, Chalachew, Andualem, Tesfaye
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014939/
https://www.ncbi.nlm.nih.gov/pubmed/32046668
http://dx.doi.org/10.1186/s12879-020-4833-2
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author Melese, Addisu
Genet, Chalachew
Andualem, Tesfaye
author_facet Melese, Addisu
Genet, Chalachew
Andualem, Tesfaye
author_sort Melese, Addisu
collection PubMed
description BACKGROUND: The emergence of Vancomycin resistant enterococci (VRE) poses a major public health problem since it was first reported. Although the rising rates of VRE infections are being reported elsewhere in the worldwide; there is limited national pooled data in Ethiopia. Therefore, this study was aimed to estimate the pooled prevalence of VRE and antimicrobial resistance profiles of enterococci in Ethiopia. METHODS: Literature search was done at PubMed, EMBASE, Google scholar, African Journals online (AJOL) and Addis Ababa University repository following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Both published and unpublished studies reporting the prevalence of VRE until June 30, 2019 were included. Data were extracted using Microsoft Excel and copied to Comprehensive Meta-analysis (CMA 2.0) for analysis. Pooled estimate of VRE was computed using the random effects model and the 95% CIs. The level of heterogeneity was assessed using Cochran’s Q and I(2) tests. Publication bias was checked by visual inspection of funnel plots and Begg’s and/or Egger’s test. RESULTS: Twenty studies fulfilled the eligibility criteria and found with relevant data. A total of 831 enterococci and 71 VRE isolates were included in the analysis. The pooled prevalence of VRE was 14.8% (95% CI; 8.7–24.3; I(2) = 74.05%; P <  0.001). Compared to vancomycin resistance, enterococci had higher rate of resistance to Penicillin (60.7%), Amoxicillin (56.5%), Doxycycline (55.1%) and Tetracycline (53.7%). Relatively low rate of resistance was found for Daptomycin and Linezolid with a pooled estimate of 3.2% (95% CI, 0.5–19.7%) and 9.9% (95% CI, 2.8–29.0%); respectively. The overall pooled multidrug resistance (MDR) rate of enterococci was 60.0% (95% CI, 42.9–75.0%). CONCLUSION: The prevalence of VRE and drug resistant enterococci are on the rise in Ethiopia. Enterococcal isolates showed resistance to one or more of the commonly prescribed drugs in different or the same drug lines. Multidrug resistant (MDR) enterococci were also found. Although the rates were low, the emergence of resistance to Daptomycin and Linezolid is an alarm for searching new ways for the treatment and control of VRE infections. Adherence to antimicrobial stewardship, comprehensive testing and ongoing monitoring of VRE infections in the health care settings are required.
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spelling pubmed-70149392020-02-20 Prevalence of Vancomycin resistant enterococci (VRE) in Ethiopia: a systematic review and meta-analysis Melese, Addisu Genet, Chalachew Andualem, Tesfaye BMC Infect Dis Research Article BACKGROUND: The emergence of Vancomycin resistant enterococci (VRE) poses a major public health problem since it was first reported. Although the rising rates of VRE infections are being reported elsewhere in the worldwide; there is limited national pooled data in Ethiopia. Therefore, this study was aimed to estimate the pooled prevalence of VRE and antimicrobial resistance profiles of enterococci in Ethiopia. METHODS: Literature search was done at PubMed, EMBASE, Google scholar, African Journals online (AJOL) and Addis Ababa University repository following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Both published and unpublished studies reporting the prevalence of VRE until June 30, 2019 were included. Data were extracted using Microsoft Excel and copied to Comprehensive Meta-analysis (CMA 2.0) for analysis. Pooled estimate of VRE was computed using the random effects model and the 95% CIs. The level of heterogeneity was assessed using Cochran’s Q and I(2) tests. Publication bias was checked by visual inspection of funnel plots and Begg’s and/or Egger’s test. RESULTS: Twenty studies fulfilled the eligibility criteria and found with relevant data. A total of 831 enterococci and 71 VRE isolates were included in the analysis. The pooled prevalence of VRE was 14.8% (95% CI; 8.7–24.3; I(2) = 74.05%; P <  0.001). Compared to vancomycin resistance, enterococci had higher rate of resistance to Penicillin (60.7%), Amoxicillin (56.5%), Doxycycline (55.1%) and Tetracycline (53.7%). Relatively low rate of resistance was found for Daptomycin and Linezolid with a pooled estimate of 3.2% (95% CI, 0.5–19.7%) and 9.9% (95% CI, 2.8–29.0%); respectively. The overall pooled multidrug resistance (MDR) rate of enterococci was 60.0% (95% CI, 42.9–75.0%). CONCLUSION: The prevalence of VRE and drug resistant enterococci are on the rise in Ethiopia. Enterococcal isolates showed resistance to one or more of the commonly prescribed drugs in different or the same drug lines. Multidrug resistant (MDR) enterococci were also found. Although the rates were low, the emergence of resistance to Daptomycin and Linezolid is an alarm for searching new ways for the treatment and control of VRE infections. Adherence to antimicrobial stewardship, comprehensive testing and ongoing monitoring of VRE infections in the health care settings are required. BioMed Central 2020-02-11 /pmc/articles/PMC7014939/ /pubmed/32046668 http://dx.doi.org/10.1186/s12879-020-4833-2 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Melese, Addisu
Genet, Chalachew
Andualem, Tesfaye
Prevalence of Vancomycin resistant enterococci (VRE) in Ethiopia: a systematic review and meta-analysis
title Prevalence of Vancomycin resistant enterococci (VRE) in Ethiopia: a systematic review and meta-analysis
title_full Prevalence of Vancomycin resistant enterococci (VRE) in Ethiopia: a systematic review and meta-analysis
title_fullStr Prevalence of Vancomycin resistant enterococci (VRE) in Ethiopia: a systematic review and meta-analysis
title_full_unstemmed Prevalence of Vancomycin resistant enterococci (VRE) in Ethiopia: a systematic review and meta-analysis
title_short Prevalence of Vancomycin resistant enterococci (VRE) in Ethiopia: a systematic review and meta-analysis
title_sort prevalence of vancomycin resistant enterococci (vre) in ethiopia: a systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014939/
https://www.ncbi.nlm.nih.gov/pubmed/32046668
http://dx.doi.org/10.1186/s12879-020-4833-2
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