Multidrug resistance from a one health perspective in Ethiopia: A systematic review and meta-analysis of literature (2015–2020)

PURPOSE: The emergence of antimicrobial resistance is a major global health challenge and becoming an urgent priority for policymakers. There is a paucity of scientific studies presenting the multidrug resistance pattern from one health perspective in Ethiopia. Therefore, a systematic review and meta-analysis aimed to determine the pooled prevalence of multidrug resistance in bacteria from human, animal, food, and environmental sources. METHODS: In this systematic review and meta-analysis, an electronic search was made in PubMed & Google scholar using different keywords. The studies conducted in all areas of Ethiopia, published from 2015 to 2020 in peer-reviewed journals, English full-length papers were included. The meta-analysis was done on STATA version 14. The pooled prevalence of multidrug resistance for each bacterium was analysed using the random-effects model; Cochran Q statistics and the I(2) statistic was used to analyse heterogeneity and considered significant at p < 0.01. RESULTS: 81 studies were included in the systematic review and meta-analysis; 53 human studies, eight animal studies, and 16 environments/food studies. The meta-analysis included six species from gram-positive bacteria and 13 from gram-negative bacteria. S. aureus 53% (95%CI: 42–64%), Coagulase negative Staphylococci 68%(95%CI:53–82), Pseudomonas spp. 73%(95%CI:48–93%), E. coli 70% (95%CI:61–78%), Citrobacter spp. 71%(95%CI:54–87%), Klebsiella spp. 68% (54–80%), Enterobacter spp. 67% (48–83%) and Salmonella spp. 65% (95%CI:48–81%) were the common multidrug-resistant species of bacteria from two or more sources. CONCLUSION: In Ethiopia, the pooled prevalence of MDR is high in most bacterial species from humans, animals, food, and environmental sources. Staphylococcus, most members of the Enterobacteriaceae and Pseudomonas, are the standard MDR bacterial population involving all sources. Therefore, integrated policy and intervention measures should be implemented to reduce the emergence and spread of MDR bacteria for better animal and human health outcomes.