Gram-Negative Bacteria Isolates and Their Antibiotic-Resistance Patterns in Patients with Wound Infection in Ethiopia: A Systematic Review and Meta-Analysis
Received 31 October 2020
Accepted for publication 17 December 2020
Published 29 January 2021 Volume 2021:14 Pages 277—302
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Professor Suresh Antony
Legese Chelkeba,1,2 Tsegaye Melaku,3,4 Teshale Ayele Mega1,2
1Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 2Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia; 4Jimma Medical Center, Institute of Health, Jimma University, Jimma, Ethiopia
Correspondence: Teshale Ayele Mega Tel +251913144738
Background: Antibiotic resistance (ABR) restricts the armamentarium of health-care providers against infectious diseases due to the emergence of multidrug resistance (MDR), especially in Gram-negative bacteria. This study aimed to determine pooled estimates of Gram-negative bacteria, their resistance profiles, and rates of MDR in patients with wound infection in Ethiopia.
Methods: Electronic databases such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science, and Google Scholar were searched. Original articles, available online from 1988 to 2020, addressing the prevalence and resistance patterns of Gram-negative bacteria in patients with wound infection and written in English were screened. The data were extracted using a format prepared in Microsoft Excel and exported to STATA 14.0 for the outcome analyses.
Results: The data of 15,647 wound samples, from 36 studies conducted in 5 regions of the country, were pooled. The overall pooled estimate of Gram-negative bacteria was 59% [95% CI: 52– 65%, I2 = 96.41%, p < 0.001]. The pooled estimate of Escherichia colirecovered from isolates of 5205 wound samples was 17% [95% CI: 14– 20%], followed by Pseudomonas aeruginosa, 11% [95% CI: 9– 14%], Klebsiella pneumonia, 11% [95% CI: 9– 13%], Proteus mirabilis, 8% [95% CI: 6– 10%], Acinetobacter species, 4% [95% CI: 2– 6%], Enterobacter species, 4% [95% CI: 3– 5%], and Citrobacter species, 3% [95% CI: 2– 4%]. Multidrug resistance prevalence estimates of E. coli, K. pneumonia, P. aeruginosa, P. mirabilis, Citrobacter species, Enterobacter species and Acinetobacter species were 76% [95% CI: 66– 86%], 84% [95% CI: 78– 91%], 66% [95% CI:43– 88%], 83% [95% CI:75– 91%], 87% [95% CI:78– 96%], 68% [95% CI:50– 87%] and 71% [95% CI:46– 96%], respectively.
Conclusion: There was high resistance in Gram-negative bacteria from wound specimens to commonly used antibiotics in Ethiopia. The data warrant the need of regular epidemiological surveillance of antimicrobial resistance and implementation of an efficient infection control program.
Keywords: antibiotic resistance, Gram-negative bacteria, wound infection, meta-analysis, systematic review, Ethiopia
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