背景:抗菌素耐药性(AMR)是一个紧迫的全球健康问题,在低资源环境中尤其明显。在埃塞俄比亚,耐碳青霉烯类铜绿假单胞菌(P.铜绿假单胞菌)对公众健康构成重大威胁。
方法:对数据库的全面搜索,包括PubMed,Scopus,Embase,Hinari,和谷歌学者,确定相关研究。纳入标准包括报告埃塞俄比亚耐美罗培南铜绿假单胞菌患病率的观察性研究。质量评估使用JBI清单。关于研究特征和患病率估计的随机效应荟萃分析汇总数据,随后进行亚组和敏感性分析。以图形和统计方式评估出版偏倚。
结果:在433项研究中,十九,包含总共11,131个样本,符合纳入标准。耐美罗培南铜绿假单胞菌的合并患病率为15%(95%CI:10-21%)。观察到显著的异质性(I2=83.6%),铜绿假单胞菌的数量被确定为异质性的主要来源(p=0.127)。按感染源进行的亚组分析显示,医院获得性感染的患病率更高(28%,95%CI:10,46)与社区环境(6%,95%CI:2,11)。基于地理的亚组分析表明,阿姆哈拉地区的患病率最高(23%,95%CI:8,38),其次是亚的斯亚贝巴(21%,95%CI:11,32),奥罗莫地区的患病率较低(7%,95%CI:4,19)。伤口样品表现出最高的电阻(25%,95%CI:25,78),而痰样本显示患病率最低。出版偏见,通过漏斗图检查和Egger回归检验确定(p<0.001),执行修剪和填充分析导致调整后的合并患病率为(3.7%,95%CI:2.3,9.6)。
结论:在埃塞俄比亚的铜绿假单胞菌中,美罗培南耐药率显著,特别是在医疗保健环境中,强调了实施严格的感染控制措施和抗生素管理的紧迫性。必须进行进一步的研究,以解决和减轻该国抗菌素耐药性带来的挑战。
BACKGROUND: Antimicrobial resistance (AMR) is a pressing global health concern, particularly pronounced in low-resource settings. In Ethiopia, the escalating prevalence of carbapenem-resistant Pseudomonas aeruginosa (P. aeruginosa) poses a substantial threat to public health.
METHODS: A comprehensive search of databases, including PubMed, Scopus, Embase, Hinari, and Google Scholar, identified relevant studies. Inclusion criteria encompassed observational studies reporting the prevalence of meropenem-resistant P. aeruginosa in Ethiopia. Quality assessment utilized JBI checklists. A random-effects meta-analysis pooled data on study characteristics and prevalence estimates, with subsequent subgroup and sensitivity analyses. Publication bias was assessed graphically and statistically.
RESULTS: Out of 433 studies, nineteen, comprising a total sample of 11,131, met inclusion criteria. The pooled prevalence of meropenem-resistant P. aeruginosa was 15% (95% CI: 10-21%). Significant heterogeneity (I2 = 83.6%) was observed, with the number of P. aeruginosa isolates identified as the primary source of heterogeneity (p = 0.127). Subgroup analysis by infection source revealed a higher prevalence in hospital-acquired infections (28%, 95% CI: 10, 46) compared to community settings (6%, 95% CI: 2, 11). Geographic based subgroup analysis indicated the highest prevalence in the Amhara region (23%, 95% CI: 8, 38), followed by Addis Ababa (21%, 95% CI: 11, 32), and lower prevalence in the Oromia region (7%, 95% CI: 4, 19). Wound samples exhibited the highest resistance (25%, 95% CI: 25, 78), while sputum samples showed the lowest prevalence. Publication bias, identified through funnel plot examination and Egger\'s regression test (p < 0.001), execution of trim and fill analysis resulted in an adjusted pooled prevalence of (3.7%, 95% CI: 2.3, 9.6).
CONCLUSIONS: The noteworthy prevalence of meropenem resistance among P. aeruginosa isolates in Ethiopia, particularly in healthcare settings, underscores the urgency of implementing strict infection control practices and antibiotic stewardship. Further research is imperative to address and mitigate the challenges posed by antimicrobial resistance in the country.