High rate of extended-spectrum beta-lactamase-producing gram-negative infections and associated mortality in Ethiopia: a
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(2020) 9:128
REVIEW
Open Access
High rate of extended-spectrum betalactamase-producing gram-negative infections and associated mortality in Ethiopia: a systematic review and metaanalysis Tafese B. Tufa1,2,3*† , Andre Fuchs3,2†, Takele B. Tufa4, Loraine Stötter1,3, Achim J. Kaasch5,6, Torsten Feld1,3, Dieter Häussinger1,3 and Colin R. Mackenzie5
Abstract Background: Extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria have become a serious threat to global health. Their rapid spread is associated with high mortality due to ineffective antibiotic treatment. To date a regular surveillance of multidrug-resistant (MDR) pathogens in Ethiopia is not established. For this report, published data regarding ESBL-producing bacteria in different health facilities of Ethiopia were reviewed. Methods: This study collates data from published information on the rates and clinical implications of infection with ESBL-producing Gram-negative bacteria in Ethiopia. A systematic literature search was conducted using PubMed, PubMed Central, Medline, Science Direct and Google scholar from October 2018 to March 2019. Eligible studies were identified by applying quality criteria. The pooled proportion of ESBL-producing Gram-negative bacteria was estimated based on a random effect model. The publication bias and the variation in proportion estimates attributed to heterogeneity were assessed. Results: Fourteen studies with relevant data were included in the review. In total, 1649 Gram-negative bacteria isolated from 5191 clinical samples were included. The pooled proportion estimate of ESBL-producing Gramnegative bacteria was 50% (95% CI: 47.7–52.5%. Data showed a high level of heterogeneity (I2 = 95%, P < 0.01). ESBL rates varied by species; 65.7% (263/400) in Klebsiella spp., 48.4% (90/186) in Salmonella spp., and 47.0% (383/ 815) in E. coli. ESBL-encoding genes were reported in 81 isolates: 67 isolates harbored the CTX-M-1 group and 14 isolates TEM. The mortality associated with infections by bacteria resistant to third generation cephalosporins has rarely been investigated. However, two studies reported a mortality of 33.3% (1/3) and 100% (11/11). (Continued on next page)
* Correspondence: [email protected] † Tafese Beyene Tufa and Andre Fuchs contributed equally to this work. 1 Hirsch Institute of Tropical Medicine, P.O. Box 04, Asella, Ethiopia 2 College of Health Sciences, Arsi University, P.O. Box 04, Asella, Ethiopia Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a cr
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