PDF(Pubmed)
Abstract：
Carbapenems are effective drugs against bacterial pathogens and resistance to them is considered a great public health threat, especially in notorious nosocomial pathogens like Acinetobacter baumannii and Pseudomonas aeruginosa. In this study, we aimed to determine the prevalence of carbapenem resistance in A. baumannii and P. aeruginosa infections in Sub-Saharan Africa. Databases (PubMed, Scopus, Web of Science, and African Journal Online) were systematically searched following the Preferred Reporting Items for Systematic review and meta-analysis protocols (PRISMA-P) 2020 statements for articles reporting carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) prevalence between 2012 and 2022. Pooled prevalence was determined with the random effect model and funnel plots were used to determine heterogeneity in R. A total of 47 articles were scanned for eligibility, among which 25 (14 for carbapenem-resistant A. baumannii and 11 for carbapenem-resistant P. aeruginosa) were included in the study after fulfilling the eligibility criteria. The pooled prevalence of CRPA in the present study was estimated at 8% (95% CI; 0.02-0.17; I2 = 98%; P <0.01). There was high heterogeneity (Q = 591.71, I2 = 98.9%; P<0.0001). In addition, this study\'s pooled prevalence of CRAB was estimated at 20% (95% CI; 0.04-0.43; I2 = 99%; P <0.01). There was high heterogeneity (Q = 1452.57, I2 = 99%; P<0.0001). Also, a funnel plot analysis of the studies showed high degree of heterogeneity. The carbapenemase genes commonly isolated from A. baumannii in this study include blaOXA23, blaOXA48, blaGES., blaNDM, blaVIM, blaOXA24, blaOXA58, blaOXA51, blaSIM-1, blaOXA40, blaOXA66, blaOXA69, blaOXA91, with blaOXA23 and blaVIM being the most common. On the other hand, blaNDM, blaVIM, blaIMP, blaOXA48, blaOXA51, blaSIM-1, blaOXA181, blaKPC, blaOXA23, blaOXA50 were the commonly isolated carbapenemase genes in P. aeruginosa, among which blaVIM and blaNDM genes were the most frequently isolated. Surveillance of drug-resistant pathogens in Sub-Saharan Africa is essential in reducing the region\'s disease burden. This study has shown that the region has significantly high multidrug-resistant pathogen prevalence. This is a wake-up call for policymakers to put in place measures to reduce the spread of these critical priority pathogens.
摘要：
碳青霉烯类抗生素是对抗细菌病原体的有效药物，对它们的耐药性被认为是巨大的公共卫生威胁，尤其是臭名昭著的医院病原菌，如鲍曼不动杆菌和铜绿假单胞菌。在这项研究中,我们旨在确定撒哈拉以南非洲鲍曼不动杆菌和铜绿假单胞菌感染中碳青霉烯类耐药的患病率。数据库(PubMed,Scopus,WebofScience,和《非洲在线杂志》）在系统评价和荟萃分析方案（PRISMA-P）2020声明的首选报告项目之后进行了系统搜索，该报告报告了耐碳青霉烯鲍曼不动杆菌（CRAB）和耐碳青霉烯铜绿假单胞菌（CRPA）的文章在2012年至2022年之间的患病率。使用随机效应模型确定合并患病率，并使用漏斗图确定R的异质性。共扫描了47篇文章的合格性，其中25例(耐碳青霉烯类鲍曼不动杆菌14例,耐碳青霉烯类铜绿假单胞菌11例)在符合资格标准后纳入研究.本研究中CRPA的合并患病率估计为8%(95%CI;0.02-0.17;I2=98%;P<0.01)。异质性高(Q=591.71,I2=98.9%;P<0.0001)。此外,本研究的CRAB合并患病率估计为20%(95%CI;0.04-0.43;I2=99%;P<0.01)。异质性高(Q=1452.57,I2=99%;P<0.0001)。此外，研究的漏斗图分析显示高度异质性。本研究中通常从鲍曼不动杆菌中分离的碳青霉烯酶基因包括blaOXA23、blaOXA48、blaGES。,blaNDM,BlaVIM,blaOXA24，blaOXA58，blaOXA51，blaSIM-1，blaOXA40，blaOXA66，blaOXA69，blaOXA91，其中blaOXA23和blaVIM是最常见的。另一方面,blaNDM,BlaVIM,blaIMP,blaOXA48,blaOXA51,blaSIM-1,blaOXA181,blaKPC,blaOXA23，blaOXA50是铜绿假单胞菌中常见的碳青霉烯酶基因，其中blaVIM和blaNDM基因最常分离。监测撒哈拉以南非洲的耐药病原体对于降低该地区的疾病负担至关重要。这项研究表明，该地区的多重耐药病原体患病率很高。这给决策者敲响了警钟，要求他们采取措施减少这些关键的优先病原体的传播。
