Community-Acquired Antimicrobial Resistant Enterobacteriaceae in Central America: A One Health Systematic Review

Abstract

Community-acquired antimicrobial resistant Enterobacteriaceae (CA-ARE) are an increasingly important issue around the world. Characterizing the distribution of regionally specific patterns of resistance is important to contextualize and develop locally relevant interventions. This systematic review adopts a One Health framework considering the health of humans, animals, and the environment to describe CA-ARE in Central America. Twenty studies were identified that focused on antimicrobial resistance (AMR) in Enterobacteriaceae. Studies on CA-ARE in Central America characterized resistance from diverse sources, including humans (n = 12), animals (n = 4), the environment (n = 2), and combinations of these categories (n = 2). A limited number of studies assessed prevalence of clinically important AMR, including carbapenem resistance (n = 3), third generation cephalosporin resistance (n = 7), colistin resistance (n = 2), extended spectrum beta-lactamase (ESBL) production (n = 4), or multidrug resistance (n = 4). This review highlights significant gaps in our current understanding of CA-ARE in Central America, most notably a general dearth of research, which requires increased investment and research on CA-ARE as well as AMR more broadly.

Keywords: Central America; Enterobacteriaceae; One Health; antimicrobial resistance.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Flow Diagram for systematic literature review.

Figure 2

Community-acquired antimicrobial resistant Enterobacteriaceae (CA-ARE) studies included in the review by year, sample source and pathogen. * Bacterial species studied were not specifically defined beyond the family Enterobacteriaceae.

Figure 3

Phenotypic resistance to clinically important antimicrobials from the included studies on CA-ARE in Central America.Numbers in the x-axis correspond to the articles listed. Resistance rates are only shown for the most prevalent species as indicated in the Measure column of Table 1 though some studies tested multiple species for resistance. This figure excludes three of the articles that did not report percentages or prevalence: Liebana et al. 2004 [37] and Pasteran et al. 2012 [38] (case reports), and Pehrsson et al. 2016 [46] (resistomes). Three articles that did not study resistance to clinically important antimicrobials were also excluded from this figure: Shears et al. 1988 [32], Rodríguez et al. 2006 [43], Molina et al. 2016 [41]. In the above figure, * represents potential ESBL producers but not all studies tested for ESBL production; ** indicates that the bacterial species studied were not specifically defined beyond the family Enterobacteriaceae.