Abstract
BackgroundThe emergence of Vancomycin resistant enterococci (VRE) poses a major public health problem since it was first reported. Although the rising rates of VRE infections are being reported elsewhere in the worldwide; there is limited national pooled data in Ethiopia. Therefore, this study was aimed to estimate the pooled prevalence of VRE and antimicrobial resistance profiles of enterococci in Ethiopia.MethodsLiterature search was done at PubMed, EMBASE, Google scholar, African Journals online (AJOL) and Addis Ababa University repository following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Both published and unpublished studies reporting the prevalence of VRE until June 30, 2019 were included. Data were extracted using Microsoft Excel and copied to Comprehensive Meta-analysis (CMA 2.0) for analysis. Pooled estimate of VRE was computed using the random effects model and the 95% CIs. The level of heterogeneity was assessed using Cochran’s Q and I2 tests. Publication bias was checked by visual inspection of funnel plots and Begg’s and/or Egger’s test.ResultsTwenty studies fulfilled the eligibility criteria and found with relevant data. A total of 831 enterococci and 71 VRE isolates were included in the analysis. The pooled prevalence of VRE was 14.8% (95% CI; 8.7–24.3; I2 = 74.05%; P < 0.001). Compared to vancomycin resistance, enterococci had higher rate of resistance to Penicillin (60.7%), Amoxicillin (56.5%), Doxycycline (55.1%) and Tetracycline (53.7%). Relatively low rate of resistance was found for Daptomycin and Linezolid with a pooled estimate of 3.2% (95% CI, 0.5–19.7%) and 9.9% (95% CI, 2.8–29.0%); respectively. The overall pooled multidrug resistance (MDR) rate of enterococci was 60.0% (95% CI, 42.9–75.0%).ConclusionThe prevalence of VRE and drug resistant enterococci are on the rise in Ethiopia. Enterococcal isolates showed resistance to one or more of the commonly prescribed drugs in different or the same drug lines. Multidrug resistant (MDR) enterococci were also found. Although the rates were low, the emergence of resistance to Daptomycin and Linezolid is an alarm for searching new ways for the treatment and control of VRE infections. Adherence to antimicrobial stewardship, comprehensive testing and ongoing monitoring of VRE infections in the health care settings are required.
Highlights
The emergence of Vancomycin resistant enterococci (VRE) poses a major public health problem since it was first reported
Among the 6017 study participants included, 831 enterococci were isolated and tested with a variety of antimicrobials; of which 71 isolates were resistant to vancomycin
In our analysis ; resistance to Daptomycin and Linezolid was observed in about 3.2 and 9.9% of enterococcal isolates, respectively. It requires strong studies, our analysis indicated that these drugs may select vancomycin resistant strains in some potentially pathogenic enterococci through antibiotic selection pressure as they showed some sort of resistance to Daptomycin and Linezolid
Summary
The emergence of Vancomycin resistant enterococci (VRE) poses a major public health problem since it was first reported. VRE are among the most common resistant pathogens frequently causing healthcare associated infections and a growing concern for health care professionals [1,2,3,4]. Enterococci are gram-positive bacterial flora of the intestinal tract of humans, animals and birds [5,6,7] Despite their commensal characteristics, they cause serious nosocomial infections in humans including urinary tract, bloodstream infections and endocarditis [8]. Enterococci are able to form biofilms that contribute to the virulence, resistance to antibiotics and phagocytosis making their eradication extremely difficult [9, 10]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
