Abstract
Antimicrobial resistance in companion animals is a major public health concern worldwide due to the animals’ zoonotic potential and ability to act as a reservoir for resistant genes. We report on the first use of meta-analysis and a systematic review to analyze the prevalence of vancomycin-resistant Enterococcus (VRE) in companion animals. Databases such as MedLib, PubMed, Web of Science, Scopus, and Google Scholar were searched. The information was extracted by two independent reviewers and the results were reviewed by a third. Two reviewers independently assessed the study protocol using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist and the study quality using the Joanna Briggs Institute (JBI) critical appraisal checklist for prevalence data. OpenMeta analyst and comprehensive meta-analysis (CMA) were used for the meta-analysis. The random effect model was used, and publication bias was assessed using the Eggers test and funnel plot. Between-study heterogeneity was assessed, and the sources were analyzed using the leave-one-out meta-analysis, subgroup analysis and meta-regression. Twenty-two studies met the eligibility criteria, but because some studies reported the prevalence of VRE in more than one companion animal, they were considered as individual studies, and 35 studies were therefore added to the final meta-analysis. Sampling period of the included studies was from 1995–2018. Of the 4288 isolates tested in the included studies, 1241 were VRE. The pooled prevalence of VRE in companion animals was estimated at 14.6% (95% CI; 8.7–23.5%; I2 = 97.10%; p < 0.001). Between-study variability was high (t2 = 2.859; heterogeneity I2 = 97.10% with heterogeneity chi-square (Q) = 1173.346, degrees of freedom (df) = 34, and p < 0.001). The funnel plot showed bias, which was confirmed by Eggers test (t-value = 3.97165; p = 0.00036), and estimates from the leave-one-out forest plot did not affect the pooled prevalence. Pooled prevalence of VRE in dogs and cats were 18.2% (CI = 9.4–32.5%) and 12.3%, CI = 3.8–33.1%), respectively. More studies were reported in Europe than in any other continent, with most studies using feces as the sample type and disc diffusion as the detection method. With the emergence of resistant strains, new antimicrobials are required in veterinary medicine.
Highlights
Enterococcus occurs in the intestinal flora of most humans and animals and is mainly found in habitats polluted by human and animal defecation [1,2]
Of the 250 studies screened for eligibility, 220 were excluded as they did not meet any of the inclusion criteria
There is ample evidence suggesting the existence of drug-resistant bacteria in companion animals as well as their transmissibility to humans
Summary
Enterococcus occurs in the intestinal flora of most humans and animals and is mainly found in habitats polluted by human and animal defecation [1,2]. Enterococcus has evolved as a significant nosocomial and community-acquired pathogen due to its ability to develop resistance to antimicrobials, especially vancomycin [3]. Enterococcal-resistant strains were thought to have emerged as a result of human antimicrobials use and their use as growth promoters in the livestock industry [5]. A good example is the use of avoparcin, which has been used as a feed additive to support livestock growth in Europe, including Turkey [6,7,8]. Avoparcin and vancomycin belongs to the same glycopeptide family of antibiotics. This avoparcin was banned in Europe in 1997, but its effect still persists, resulting in the selection of vancomycin-resistant Enterococcus in farms and in animal gut [9]
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