Abstract
Background The world prevalence of community and hospital-acquired extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is increasing tremendously. Bacteria harboring ESBLs are currently the number one critical pathogens posing a major threat to human health. Objective To provide a summary of molecular evidence on the prevalence of ESBL-producing Enterobacteriaceae (ESBL-E) and associated genes at community and hospital settings in East, Central, and Southern African countries. Methods We conducted a systematic literature search on PubMed and Google Scholar databases for the available molecular studies on ESBL-E in hospitals and community settings in East, Central, and Sothern Africa (ECSA). Published studies in English language involving gene characterization of ESBLs from human samples in hospital and community settings were included in the review, inception to November 2019. A random effect meta-analysis was performed to estimate the prevalence of ESBL-E. Results A total of 27 studies involving molecular characterization of resistance genes from 20,225 ESBL-E isolates were included in the analysis. Seventy-four percent of all studies were hospital based, 15% were based in community settings, and others were done in both hospital and community settings. Of all the studies, 63% reported E. coli as the dominant isolate among ESBL-E recovered from clinical samples and Klebsiella pneumoniae was reported dominant isolates in 33% of all studies. A random pooled prevalence of ESBL-E was 38% (95% CI = 24–53%), highest in Congo, 92% (95% CI = 90–94%), and lowest in Zimbabwe, 14% (95% CI = 9–20%). Prevalence was higher in hospital settings 41% (95% CI = 23–58%) compared to community settings 34% (95% CI = 8–60%). ESBL genes detected from clinical isolates with ESBL-E phenotypes in ECSA were those of Ambler molecular class A [1] that belongs to both functional groups 2be and 2d of Bush and Jacob classification of 2010 [2]. Majority of studies (n = 22, 81.5%) reported predominance of blaCTX-M gene among isolates, particularly CTX-M-15. Predictors of ESBL-E included increased age, hospital admissions, previous use of antibiotics, and paramedical use of herbs. Conclusion Few studies have been conducted at a molecular level to understand the genetic basis of increased resistance among members of ESBL-E in ECSA. Limited molecular studies in the ECSA region leave a gap in estimating the burden and risk posed by the carriage of ESBL genes in these countries. We found a high prevalence of ESBL-E most carrying CTX-M enzyme in ECSA with a greater variation between countries. This could be an important call for combined (regional or global) efforts to combat the problem of antimicrobial resistance (AMR) in the region. Antibiotic use and hospital admission increased the carriage of ESBL-E, while poor people contributed little to the increase of AMR due to lack of access and failure to meet the cost of healthcare compared to high income individuals.
Highlights
Pathogenic bacteria evolve to resist the actions of antimicrobials through acquired and intrinsic mechanisms including production of β-lactamase enzymes, which inactivates antibiotic and decreases its therapeutic value [1, 2]
Bacteria harboring ESBL enzymes are currently the number one critical pathogens posing a major threat to human health [6]. e spread and dissemination of infections caused by ESBL-producing Enterobacteriaceae (ESBL-E) are associated with increased morbidity and mortality, health care costs, the need for development of new wide-spectrum antimicrobials and lengthy hospital stay of infected patients
Molecular Tools Used for the Detection of ESBL Genes. ree molecular tools were used in all 27 studies to detect the presence of ESBL encoding genes among isolates. ese included microarray, polymerase chain reaction (PCR), and sequencing
Summary
Pathogenic bacteria evolve to resist the actions of antimicrobials through acquired and intrinsic mechanisms including production of β-lactamase enzymes, which inactivates antibiotic and decreases its therapeutic value [1, 2]. E spread and dissemination of infections caused by ESBL-E are associated with increased morbidity and mortality, health care costs, the need for development of new wide-spectrum antimicrobials and lengthy hospital stay of infected patients. Recent increased recovery of ESBL-E from community and environmental samples [14,15,16], especially E. coli commonly causing community acquired urinary tract infections (UTIs) [17], indicates a probability of the shift of importation of ESBL-producing bacteria to hospitals rather than vice versa. E spread of community acquired ESBL carrying pathogens is accelerated by between-persons transmission of ESBL bacteria in the communities. Detailed studies describing the ESBL-E reservoirs and transmission routes in diverse settings are still limited
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