Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Mar 16;17(3):e0265271.
doi: 10.1371/journal.pone.0265271. eCollection 2022.

Prevalence and drug resistance patterns of Gram-negative enteric bacterial pathogens from diarrheic patients in Ethiopia: A systematic review and meta-analysis

Achenef Melaku Beyene  1 , Mucheye Gezachew  1 , Desalegn Mengesha  2 , Ahmed Yousef  3 , Baye Gelaw  1
Affiliations
Meta-Analysis

Prevalence and drug resistance patterns of Gram-negative enteric bacterial pathogens from diarrheic patients in Ethiopia: A systematic review and meta-analysis

Achenef Melaku Beyene et al. PLoS One. .

Abstract

Background: Diarrhoea is the leading cause of morbidity and mortality in the world particularly in developing countries and among vulnerable groups of the population. Gram-negative enteric bacterial pathogens (GNEBPs) are a group of organisms that reside mainly in the intestine and induce diarrhoea. Antimicrobial agents are usually the part of their treatment regimen. The therapeutic effect of antimicrobials is hindered by the emergence and spread of drug-resistant strains. The information regarding the prevalence and antimicrobial resistance patterns of GNEBPs in Ethiopia is limited and found in a scattered form.

Objectives: This study was designed to determine the pooled prevalence and drug resistance patterns of GNEBPs by meta-analysis of data from diarrhoeic patients in Ethiopia.

Method: A comprehensive literature search was conducted through internet searches using Google Scholar, PubMed, Science Direct, HINARI databases, and reference lists of previous studies. Published articles were included in the study based on priorly set inclusion and exclusion criteria. Results were presented in the forest plot, tables, and figures with a 95% confidence interval (CI). The inconsistency index (I2) test statistics was used to assess heterogeneity across studies. The pooled prevalence estimate of GNEBPs and their drug resistance patterns were computed by a random-effects model. Software for Statistics and Data Science (STATA) version 14 statistical software was used for the analysis.

Result: After removing those articles which did not fulfil the inclusion criteria, 43 studies were included in the analysis. Studies were conducted in 8 regions of the country and most of the published articles were from the Amhara region (30.23%) followed by Oromia (18.60%) and Southern Nations, Nationalities, and Peoples' region (SNNP) (18.60%). The pooled prevalence of GNEBPs was 15.81% (CI = 13.33-18.29). The funnel plot indicated the presence of publication bias. The pooled prevalence of GNEBPs in Addis Ababa, Amhara, SNNP, and Oromia regions were 20.08, 16.67, 12.12, and 11.61%, respectively. The pooled prevalence was 14.91, 18.03, and 13.46% among studies conducted from 2006-2010, 2011-2015, and 2016-2021, respectively and it was the highest (20.35%) in children having age less than or equal to 15 years. The pooled prevalence of Escherichia coli, Campylobacter spp., Shigella spp., and Salmonella enterica were 19.79, 10.76, 6.24, and 5.06%, respectively. Large proportions (60-90%) of the isolates were resistant to ampicillin, amoxicillin, tetracycline, and trimethoprim-sulphamethoxazole. The pooled prevalence of multidrug resistance (MDR) was 70.56% (CI = 64.56-76.77%) and MDR in Campylobacter spp., Shigella spp., E. coli, and S. enterica. were 80.78, 79.08, 78.20, and 59.46%, respectively.

Conclusion: The pooled estimate showed a high burden of GNEBPs infections and a high proportion of drug resistance characters to commonly used antimicrobial agents in Ethiopia. Therefore, performing drug susceptibility tests, establishing an antimicrobial surveillance system and confirmation by molecular techniques are needed.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. A flow diagram that shows the selection of articles for the analysis.
Fig 2
Fig 2. Percent of published articles in different regions of Ethiopia.
The country has 9 regions and two city administrations. Reports were from 8 of them which are indicated in the figure. Reports were not found from Afar, Somali, and Benishangul Gumuz regions during the period of data collection (SNNP = South Nation and Nationalities Region).
Fig 3
Fig 3. Age categories and percentage of published articles.
Fig 4
Fig 4. Forest plot of pooled prevalence estimates of Gram-negative enteric bacterial pathogens among diarrheic patients.
The middle solid vertical line represents the minimum possible prevalence value (0). The dashed line represents the mean pooled prevalence estimate. The black diamond at the centre of the grey box represents the point prevalence estimate of each study and the horizontal line indicates the 95% confidence interval of the estimates. The grey box shows the weight of each study contributing to the pooled prevalence estimate. The last row represents the overall pooled prevalence estimate with a 95% confidence interval.
Fig 5
Fig 5. Funnel plot for the prevalence of Gram-negative enteric bacterial pathogens among diarrheic patients.
See this image and copyright information in PMC

References

    1. Caramia G, Silvi S, Verdenelli MC, Magdalena M. Treatment of acute diarrhoea: past and now. Int J Enteric Pathog. 2015; 3: e28612. doi: 10.17795/ijep28612 - DOI
    1. WHO. WHO estimates of the global burden of foodborne diseases: foodborne disease burden epidemiology reference group 2007–2015. 2015. Available from: https://apps.who.int/iris/bitstream/handle/10665/199350/9789241565165_en....
    1. Girmay AM, Gari SR, Alemu BM, Martin R. Diarrheal disease and associated behavioural factors among food handlers in Addis Ababa, Ethiopia. AIMS Public Heal., 202; 7:100–113. doi: 10.3934/publichealth.2020010 - DOI - PMC - PubMed
    1. Kotloff KL. The burden and etiology of diarrheal illness in developing countries. Pediatr. Clin North Am. 2017; 64:799–814. doi: 10.1016/j.pcl.2017.03.006 - DOI - PubMed
    1. Troeger C, Blacker BF, Khalil IA, Rao PC, Cao S, Zimsen SR, et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of diarrhoea in 195 countries: A systematic analysis for the global burden of disease study 2016. Lancet Infect Dis. 2018; 18:1211–1228. doi: 10.1016/S1473-3099(18)30362-1 - DOI - PMC - PubMed

Substances