Dataset Information

Prevalence of Shigella species and its drug resistance pattern in Ethiopia: a systematic review and meta-analysis.

ABSTRACT:

Background

Shigella species are a major cause of dysentery and may attribute for death worldwide. Currently antibiotic resistance became the critical challenges for management of infectious disease. The aim was to conduct a systematic review and meta-analysis of Shigella species and its drug resistance pattern in Ethiopia.

Methods

A comprehensive literature search was conducted through internet searches using database of MEDLINE, PubMed, Google scholar, EMBASE, HINARI, Cochrane Library and reference lists of previous prevalence studies from January 1999 to November 2018. Results were presented in forest plot, tables and figures with 95% CI. The Cochrane Q test and I² test statistic were used to test heterogeneity across studies. The Pooled estimate of Shigella species and its drug resistance pattern was computed by a random effects model.

Results

The pooled prevalence of Shigella species in Ethiopia was 6.6% (95% CI 4.7-8.8). In the subgroup analysis, the highest prevalence was observed among patients in Health facility (8.5%, 95% CI 6.2-11.5) whereas the lowest prevalence was observed in Community based studies (1.6%, 95% CI 0.8-3.4). In addition, Shigella species were highly resistant to ampicillin, amoxicillin, erythromycin and multi-drug resistant (MDR) with the pooled resistance proportions of 83.1% (95% CI 75.7-88.6), 84.1% (95% CI 75.6-90.1), 86.5% (95% CI 70.9-94.4) and 83.2% (95% CI 77.1-87.9), respectively. On the other hand, comparably low resistance pattern was reported for ciprofloxacin 8.9% (95% CI 6.0-12.8), ceftriaxone 9.3% (95% CI 3.9-20.5), and norfloxacin 8.2% (95% CI 3.8-16.6) and gentamycin 17.3% (95% CI 11.2-25.9). Subgroup analyses indicated that study years were associated with a decreasing Shigella prevalence over time (p?=?0.002).

Conclusion

The pooled estimate showed high burden of Shigella infection and its high proportion of drug resistance pattern to ampicillin, amoxicillin and erythromycin in Ethiopia. Therefore, initiating and scale up of performing drug susceptibility test for each shigellosis case, educate the community and health care providers on appropriate use of antibiotics need to be considered and strengthened.

SUBMITTER: Hussen S

PROVIDER: S-EPMC6617577 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Publications

Prevalence of Shigella species and its drug resistance pattern in Ethiopia: a systematic review and meta-analysis.

Hussen Siraj S Mulatu Getamesay G Yohannes Kassa Zemenu Z

Annals of clinical microbiology and antimicrobials 20190709 1

<h4>Background</h4>Shigella species are a major cause of dysentery and may attribute for death worldwide. Currently antibiotic resistance became the critical challenges for management of infectious disease. The aim was to conduct a systematic review and meta-analysis of Shigella species and its drug resistance pattern in Ethiopia.<h4>Methods</h4>A comprehensive literature search was conducted through internet searches using database of MEDLINE, PubMed, Google scholar, EMBASE, HINARI, Cochrane Li ...[more]

PMID: 31288806

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Project description:BackgroundIn the last decades, medicines have had an unprecedented positive effect on health, leading to reduced mortality and disease burden and consequently to an improved quality of life. The rapid and ongoing spread of antimicrobial-resistant organisms threatens our ability to successfully treat a growing number of infectious diseases. In the absence of the development of new generations of antibiotic drugs, appropriate use of existing antibiotics is needed to ensure the long-term availability of effective treatment for bacterial infections. Irrational use of antibiotics is an ongoing global public health problem that deserves more attention. This review is conducted to evaluate the prevalence of inappropriate antibiotic utilization and resistance to antibiotics in Ethiopia.MethodsElectronic search in PubMed/MEDLINE and Google was used to find published literature with reference lists of relevant articles searched manually. Titles and abstracts were initially screened for eligibility. The full texts of articles judged to be eligible were reviewed if they meet the inclusion criteria. Data were extracted on important variables like the sample size, region of the study, the inappropriate antibiotic use, bacterial detection rate, multidrug resistance pattern, and more other variables. Microsoft Excel was used for data extraction. Quantitative analysis was performed using STATA version 11.ResultsThe electronic searches identified 193 articles of which 33 were found eligible. The random-effects model was used to provide point estimates (with 95% confidence interval (CI)) of bacterial detection rate, inappropriate antibiotic use, and multidrug resistance rate to account for heterogeneity. The pooled bacteria detection rate was 29.1 with 95% CI (16.6-41.7). The pooled prevalence of multidrug resistant strains identified was 59.7% (95% CI: 43.5-75.9). The pooled estimate of inappropriate antibiotic use was 49.2% (95% CI: 32.2-66.2). The pooled proportion of self-antibiotic prescription was 43.3% (95% CI: 15.7-70.9). Other reasons for inappropriate antibiotic use included a wrong indication, wrong duration, improper route of administration, use of leftover antibiotics from a family member, and immature discontinuation of antibiotics.Conclusion and recommendationsInappropriate antibiotic use is a huge problem in Ethiopia, and many bacteria were resistant to commonly used antibiotics and similarly, multidrug-resistant bacterial strains are numerous. Appropriate antibiotic use should be ensured by prohibiting over-the-counter sale of antibiotics and strengthening antimicrobial stewardship.

Project description:BackgroundThe burden of Klebsiella drug resistance to antimicrobials is a major public health concern worldwide; particularly the problem is severe in developing countries including Ethiopia. Therefore, the aim of this systematic review and meta-analysis is to establish the pooled estimate of Klebsiella drug resistance; and antimicrobial-specific resistance pattern among Klebsiella clinical isoaltes in Ethiopia.MethodsArticles were searched from PubMed, Google Scholar, and Science direct and grey literature from 2009 to 2019. Four authors have independently extracted data on the prevalence and antimicrobial resistance pattern of the isolates. Statistical analysis was conducted by using Open meta-analyst (version 3.13) and Comprehensive meta-analysis (version 3.3). The main outcome measures were the overall Klebsiella resistance; and drug-specific resistance patterns. A random-effects model was used to determine the pooled resistance prevalence with 95% confidence interval (CI), and significant heterogeneity was considered at p < 0.1; and I2 > 50% using DerSimonian and Laird method. In addition, subgroup analyses were conducted to improve the outcome.ResultWe obtained 174 potentially relevant studies through searching electronic databases, and finally, 35 eligible studies were included for meta-analysis. A total of 13,269 study samples participated, from which 1017 Klebsiella species were isolated. The overall Klebsiella resistance in Ethiopia was found to stand at 53.75% (95% CI: 48.35-58.94%). Based on the subgroup analyses; the highest (64.39%); and lowest (46.16%) values were seen in Southern Nations, Nationalities, and Peoples of Ethiopia; and Tigray regions respectively; and the highest Klebsiella resistance was reported to ampicillin (90.56%), followed by amoxicillin (76.01%) and trimethoprim-sulfamethoxazole (66.91%). A relatively low level of resistance rate was observed to amikacin (16.74%) and cefoxitin (29.73%).ConclusionThe pooled Klebsiella resistance was found to be considerably high (53.75%) to most of the essential antibiotics in Ethiopia. Klebsiella was highly resistant to ampicillin and amoxicillin but relatively lower to amikacin. Therefore, appropriate interventional strategies need to be taken to address the emerging resistance of Klebsiella species.

Project description:IntroductionWHO's 2019 report on HIV drug resistance (HIVDR) documents a high prevalence of pretreatment drug resistance (PDR) among populations initiating first-line antiretroviral therapy (ART) in low- and middle-income countries (LMIC). However, systematic evidence on the prevalence of PDR among key populations remains limited. We performed a systematic review to characterize levels of PDR in key population groups and compared them to levels of PDR in the "general population" across different geographical regions.MethodsTen electronic databases were searched for papers published until February 2019 that included predefined search terms. We included studies that reported the number of successfully tested genotypes and the number of genotypes with drug resistance mutations among antiretroviral therapy treatment naïve people, recently infected people, or people initiating first-line ART from key populations. To assess the prevalence of PDR for each key population, we pooled estimates using random-effects meta-analysis of proportions. Where possible, we computed the differences in the odds of PDR (any, and by drug class) present in each key population compared to the "general population". The I2 statistic (a measure of heterogeneity between studies) is reported.Results and discussionA total of 332 datasets (from 218 studies) and 63,111 people with successful HIVDR genotyping were included in the analysis. The pooled prevalence estimate of any PDR was high among men who have sex with men (13.0%, 95% CI 11.0 to 14.0%, I2 = 93.19), sex workers (17.0%, 95% CI 6.0 - 32.0, I2 = 87.31%) and people in prisons (18.0%, 95% CI 11.0 to 25.0, I2 = 70.18%), but less so among people who inject drugs (7.0%, 95% CI 5.0 to 10.0, I2 = 90.23). Overall, men who have sex with men were more likely to carry any PDR compared to the "general population," a finding which was statistically significant (odds ratio (OR) 1.28, 95% CI 1.13 - 1.46, I2 48.9%).ConclusionsHigh prevalence of PDR found in key populations highlights the need to increase access to effective first-line HIV treatment. The low prevalence of nucleotide reverse transcriptase inhibitor (NRTI) PDR suggests that current WHO recommendations for pre-exposure prophylaxis (PrEP) regimens will remain effective and can be scaled up to prevent new HIV infections in high-risk groups.

Project description:BackgroundClostridium difficile is the leading cause of infectious diarrhea that develops in patients after hospitalization during antibiotic administration. It has also become a big issue in community-acquired diarrhea. The emergence of hypervirulent strains of C. difficile poses a major problem in hospital-associated diarrhea outbreaks and it is difficult to treat. The antimicrobial resistance in C. difficile has worsened due to the inappropriate use of broad-spectrum antibiotics including cephalosporins, clindamycin, tetracycline, and fluoroquinolones together with the emergence of hypervirulent strains.ObjectiveTo estimate the pooled prevalence and antimicrobial resistance pattern of C. difficile derived from hospitalized diarrheal patients, a systematic review and meta-analysis was performed.MethodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to review published studies conducted. We searched bibliographic databases from PubMed, Scopus, Google Scholar, and Cochrane Library for studies on the prevalence and antimicrobial susceptibility testing on C. difficile. The weighted pooled prevalence and resistance for each antimicrobial agent was calculated using a random-effects model. A funnel plot and Egger's regression test were used to see publication bias.ResultsA total of 15 studies were included. Ten articles for prevalence study and 5 additional studies for antimicrobial susceptibility testing of C. difficile were included. A total of 1967/7852 (25%) C. difficile were isolated from 10 included studies for prevalence study. The overall weighted pooled proportion (WPP) of C. difficile was 30% (95% CI: 10.0-49.0; p<0.001). The analysis showed substantial heterogeneity among studies (Cochran's test = 7038.73, I2 = 99.87%; p<0.001). The weighed pooled antimicrobial resistance (WPR) were: vancomycin 3%(95% CI: 1.0-4.0, p<0.001); metronidazole 5%(95% CI: 3.0-7.0, p<0.001); clindamycin 61%(95% CI: 52.0-69.0, p<0.001); moxifloxacin 42%(95% CI: 29-54, p<0.001); tetracycline 35%(95% CI: 22-49, p<0.001); erythromycin 61%(95% CI: 48-75, p<0.001) and ciprofloxacin 64%(95% CI: 48-80; p< 0.001) using the random effect model.ConclusionsA higher weighted pooled prevalence of C. difficile was observed. It needs a great deal of attention to decrease the prevailing prevalence. The resistance of C. difficile to metronidazole and vancomycin was low compared to other drugs used to treat C. difficile infection. Periodic antimicrobial resistance monitoring is vital for appropriate therapy of C. difficile infection.

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Project description:Except individual studies with varying prevalence rates, there are no national prevalence studies conducted in prison settings in Ethiopia. Appropriate estimates of the disease is essential to formulate health service plans most fitted for prisoners. Therefore, this systematic review and meta-analysis was designed to pool the results of individual studies and estimate the prevalence of tuberculosis among prisoners in Ethiopia.MEDLINE/PubMed, Cochran library, and Google scholar databases were searched for potential studies on the prevalence of tuberculosis among prisoners in Ethiopia. A total of 177 titles were identified and 10 studies met the inclusion criteria. Descriptive and quantitative data of the included studies were presented in tables and forest plots. Potential sources of heterogeneity across studies were assessed using the Cochrane's Q and I2 tests. The MetaXL (version 5.3) was employed to compute the pooled prevalence of TB using the random effect model and 95% confidence interval.Based on the ten studies included in the meta-analysis, about 4086 prisoners were infected with tuberculosis (TB). The pooled prevalence of TB among prisoners was therefore 8.33% (95% CI; 6.28%-10.63%) and the pooled point prevalence was estimated at 888 per 100,000 prison population (95% CI; 531-1333). The prevalence of TB using microscopy alone was 6.59% (95% CI: 3.96-9.50%) whereas the prevalence of TB when microscopy is combined with either culture or molecular tests was 8.57% (95% CI: 4.94-12.6%).The pooled prevalence of tuberculosis among prisoners in Ethiopia is expectedly high. This high prevalence could explain the spread of TB within prisons and between prisoners and varies communities. Thus; attention should be given to prison settings to prevent the transmission and emergence of drug resistance TB both in inmates and general population. Further studies covering large scale prison population are needed to design effective diagnostic, treatment and preventive methods.

Dataset Information

Prevalence of Shigella species and its drug resistance pattern in Ethiopia: a systematic review and meta-analysis.

Background

Methods

Results

Conclusion

Publications

Prevalence of Shigella species and its drug resistance pattern in Ethiopia: a systematic review and meta-analysis.

Similar Datasets

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