Microbial epidemiology and antimicrobial resistance patterns of wound infection in Ethiopia: a meta-analysis of laboratory-based cross-sectional studies

Abstract

Background: Wound infections are responsible for significant human morbidity and mortality worldwide. Specifically, surgical site infections are the third most commonly reported nosocomial infections accounting approximately a quarter of such infections. This systematic review and meta-analysis is, therefore, aimed to determine microbial profiles cultured from wound samples and their antimicrobial resistance patterns in Ethiopia.

Methods: Literature search was carried out through visiting electronic databases and indexing services including PubMed, MEDLINE, EMBASE, CINAHL, and Google Scholar. Original records, available online from 2000 to 2018, addressing the research question and written in English were identified and screened. The relevant data were extracted from included studies using a format prepared in Microsoft Excel and exported to STATA 15.0 software for analyses of outcome measures and subgrouping. Der-Simonian-Laird's random effects model was applied for pooled estimation of outcome measures at 95% confidence level. Comprehensive meta-analysis version-3 software was used for assessing publication bias across studies. The study protocol is registered on PROSPERO with reference number ID: CRD42019117638.

Results: A total of 21 studies with 4284 wound samples, 3012 positive wound cultures and 3598 bacterial isolates were included for systematic review and meta-analysis. The pooled culture positivity was found to be 70.0% (95% CI: 61, 79%). Regarding the bacterial isolates recovered, the pooled prevalence of S. aureus was 36% (95% CI: 29, 42%), from which 49% were methicillin resistant strains. The pooled estimate of E. coli isolates was about 13% (95% CI: 10, 16%) followed by P. aeruginosa, 9% (95% CI: 6, 12%), K. pneumoniae, 9% (95% CI: 6, 11%) and P. mirabilis, 8% (95% CI: 5, 11%). Compared to other antimicrobials, S. aureus has showed lower estimates of resistance against ciprofloxacin, 12% (95% CI: 8, 16%) and gentamicin, 13% (95% CI: 8, 18%). E. coli isolates exhibited the highest point estimate of resistance towards ampicillin (P = 84%; 95% CI: 76, 91%). Gentamicin and ciprofloxacin showed relatively lower estimates of resistance with pooled prevalence being 24% (95% CI: 16, 33%) and 27% (95% CI: 16, 37%), respectively. Likewise, P. aeruginosa showed the lowest pooled estimates of resistance against ciprofloxacin (P = 16%; 95% CI: 9, 24%).

Conclusion: Generally, the wound culture positivity was found very high indicating the likelihood of poly-microbial contamination. S. aureus is by far the most common bacterial isolate recovered from wound infection. The high estimate of resistance was observed among β-lactam antibiotics in all bacterial isolates. Ciprofloxacin and gentamicin were relatively effective in treating wound infections with poly-microbial etiology.

Keywords: Antimicrobial resistance; Bacteria; Ethiopia; Wound infections.

Fig. 1

PRISMA flow diagram depicting the selection process

Fig. 2

Forest plot depicting culture positivity among wound sample in Ethiopia

Fig. 3

Forest plot showing subgroup analysis of culture positivity based on wound sources

Fig. 4

Prevalence of S. aureus in wound samples

Fig. 5

Pooled estimate of CoNS in wound samples in Ethiopia

Fig. 6

Pooled estimates of E. coli in wound samples

Fig. 7

Forest plot depicting the pooled prevalence of P. aeruginosa in wound samples

Fig. 8

Pooled estimates of K. pneumoniae in wound samples

Fig. 9

Pooled estimate of P. mirabilis

Fig. 10

Funnel plot showing publication bias of included studies