Vancomycin resistant enterococcus (VRE) in Ethiopia: A systematic review and meta-analysis

Abstract

Background: Emergence of vancomycin resistant enterococci (VRE) become a major 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. The rising proportions of VRE infections are being reported worldwide. This study aims at assessing the burden of VRE and the antimicrobial susceptibility profiles of enterococci in Ethiopia Methods and materials: Literature 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) guidelines/checklists. Both published and unpublished studies reporting the prevalence of VRE were included. Data were extracted and copied to CMA 2.0 for analysis. Pooled estimate of VRE was computed using the random effects model at 95% CIs. The level of heterogeneity was assessed by I2 and publication bias was checked by funnel plots supported by Begg's and Egger's test. Results: Twenty studies fulfilled the eligibility criteria and found with relevant data. A total of 831 enterococci and 71 VRE isolates were included. The pooled prevalence of VRE was 14.8% (95% CI; 8.7–24.3). 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%). Conclusion: High proportion of VRE and drug resistant enterococci are emerging in Ethiopia. Enterococcal isolates showed resistance to one or more of drug of choices in different or same drug lines. High resistance to commonly used antibiotics and MDR enterococci were observed. Although rate was low, the emergence of resistance to daptomycin and linezolid is an alarm for searching new ways for the treatment control of VRE infections.