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

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.

Occurrence and distribution of Listeria monocytogenes and other Listeria species in ready-to-eat and raw meat products

The present study was undertaken to estimate the occurrence and distribution of Listeria monocytogenes and other Listeria species in ready-to-eat food items (pasteurized milk, cheese, ice cream, and cakes) and raw meat products (minced beef, pork, and chicken carcasses). A total of 711 randomly selected samples were collected from supermarkets and pastry shops in Addis Ababa, Ethiopia. Listeria monocytogenes and other Listeria species were isolated and identified according to the techniques recommended by the International Organization for Standardization (ISO 11290-1). Serotyping of L. monocytogenes strains was carried out at the French Food Safety Agency (AFSSA), Ploufragan, France. Of the 711 food samples examined, 189 (26.6%) were Listeria positive of which 34 (4.8%) were L. monocytogenes. Pork was the most contaminated with Listeria species (62.5%) followed by minced beef (47.7%), ice cream (42.7%), soft cheese (16.8%), chicken carcasses (16.0%), and cakes (12.1%). All pasteurized milk and cottage cheese samples examined were Listeria negative. Listeria monocytogenes strains were isolated in ready-to-eat food items consisting of ice cream (11.7%), cakes (6.5%), and soft cheese (3.9%) and in meat products ranging from 3.7% to 5.1%. Among the 34 isolates of L. monocytogenes serotyped, serotypes 4b/4e (n = 32), 4c, and 4e (n = 2) were identified. The presence of L. monocytogenes in some ready-to-eat food items could pose public health hazards to the consumer, particularly to the high-risk group of the population.