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. 2017 Aug 23:6:85.
doi: 10.1186/s13756-017-0243-7. eCollection 2017.

Resistance of Staphylococcus aureus to antimicrobial agents in Ethiopia: a meta-analysis

Serawit Deyno  1 , Sintayehu Fekadu  2 , Ayalew Astatkie  3
Affiliations

Resistance of Staphylococcus aureus to antimicrobial agents in Ethiopia: a meta-analysis

Serawit Deyno et al. Antimicrob Resist Infect Control. .

Abstract

Background: Emergence of antimicrobial resistance by Staphylococcus aureus has limited treatment options against its infections. The purpose of this study was to determine the pooled prevalence of resistance to different antimicrobial agents by S. aureus in Ethiopia.

Methods: Web-based search was conducted in the databases of PubMed, Google Scholar, Hinari, Scopus and the Directory of Open Access Journals (DOAJ) to identify potentially eligible published studies. Required data were extracted and entered into Excel spread sheet. Statistical analyses were performed using Stata version 13.0. The metaprop Stata command was used to pool prevalence values. Twenty-one separate meta-analysis were done to estimate the pooled prevalence of the resistance of S. aureus to twenty-one different antimicrobial agents. Heterogeneity among the studies was assessed using the I2 statistic and chi-square test. Publication bias was assessed using Egger's test. Because of significant heterogeneity amongst the studies, the random effects model was used to pool prevalence values.

Results: The electronic database search yielded 1317 studies among which 45 studies met our inclusion criteria. Our analyses demonstrated very high level of resistance to amoxicillin (77% [95% confidence interval (CI): 68%, 0.85%]), penicillin (76% [95% CI: 67%, 84%]), ampicillin (75% [95% CI: 65%, 85%]), tetracycline (62% [95% CI: 55%, 68%]), methicillin (47% [95% CI: 33%, 61%]), cotrimoxaziole (47% [95% CI: 40%, 55%]), doxycycline (43% [95% CI: 26%, 60%]), and erythromycin (41% [95% CI: 29%, 54%]). Relatively low prevalence of resistance was observed with kanamycin (14% [95% CI: 5%, 25%]) and ciprofloxacin (19% [95% CI: 13%, 26%]). The resistance level to vancomycin is 11% 995% CI: (4%, 20%). High heterogeneity was observed for each of the meta-analysis performed (I2 ranging from 79.36% to 95.93%; all p-values ≤0.01). Eggers' test did not show a significant publication bias for all antimicrobial agents except for erythromycin and ampicillin.

Conclusions: S. aureus in Ethiopia has gotten notoriously resistant to almost to all of antimicrobial agents in use including, penicillin, cephalosporins, tetracyclines, chloramphenicol, methicillin, vancomycin and sulphonamides. The resistance level to vancomycin is bothersome and requires a due attention. Continued and multidimensional efforts of antimicrobial stewardship program promoting rational use of antibiotics, infection prevention and containment of AMR are urgently needed.

Keywords: Antimicrobial resistance; Ethiopia; Meta-analysis; Staphylococcus aureus.

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Conflict of interest statement

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Not applicable.

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Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Flow diagram of retrieval of studies: Number of studies screened, assessed for eligibility, and included in the meta-analysis with reasons
Fig. 2
Fig. 2
Forest plot of the prevalence of S. aureus resistance to vancomycin
Fig. 3
Fig. 3
Forest plot of the prevalence of S. aureus resistance to methicillin
Fig. 4
Fig. 4
Forest plot of the prevalence of S. aureus resistance to amoxicillin
Fig. 5
Fig. 5
Forest plot of the prevalence of S. aureus resistance to ceftriaxone
Fig. 6
Fig. 6
Forest plot of the prevalence of S. aureus resistance to ciprofloxacin
Fig. 7
Fig. 7
Forest plot of the prevalence of S. aureus resistance to tetracycline
Fig. 8
Fig. 8
Forest plot of the prevalence of S. aureus resistance to sulphametaxazole-trimethoprim
Fig. 9
Fig. 9
Comparison of the prevalence of S. aureus resistance to different antimicrobial agents in Ethiopia
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