Gram-negative bacteria isolates and their antibiotic-resistance patterns in patients with wound infection in Ethiopia: A systematic review and meta-analysis

Abstract

Background: Antibiotic resistance (ABR) restricts the armamentarium of health-care pro-viders against infectious diseases due to the emergence of multidrug resistance (MDR), especially in Gram-negative bacteria. This study aimed to determine pooled estimates of Gram-negative bacteria, their resistance profiles, and rates of MDR in patients with wound infection in Ethiopia. Methods: Electronic databases such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science, and Google Scholar were searched. Original articles, available online from 1988 to 2020, addressing the prevalence and resistance patterns of Gram-negative bacteria in patients with wound infection and written in English were screened. The data were extracted using a format prepared in Microsoft Excel and exported to STATA 14.0 for the outcome analyses. Results: The data of 15,647 wound samples, from 36 studies conducted in 5 regions of the country, were pooled. The overall pooled estimate of Gram-negative bacteria was 59% [95% CI: 52–65%, I2 = 96.41%, p < 0.001]. The pooled estimate of Escherichia colirecovered from isolates of 5205 wound samples was 17% [95% CI: 14–20%], followed by Pseudomonas aeruginosa, 11% [95% CI: 9–14%], Klebsiella pneumonia, 11% [95% CI: 9–13%], Proteus mirabilis, 8% [95% CI: 6–10%], Acinetobacter species, 4% [95% CI: 2–6%], Enterobacter species, 4% [95% CI: 3–5%], and Citrobacter species, 3% [95% CI: 2–4%]. Multidrug resistance prevalence estimates of E. coli, K. pneumonia, P. aeruginosa, P. mirabilis, Citrobacter species, Enterobacter species and Acinetobacter species were 76% [95% CI: 66–86%], 84% [95% CI: 78–91%], 66% [95% CI:43–88%], 83% [95% CI:75–91%], 87% [95% CI:78–96%], 68% [95% CI:50–87%] and 71% [95% CI:46–96%], respectively. Conclusion: There was high resistance in Gram-negative bacteria from wound specimens to commonly used antibiotics in Ethiopia. The data warrant the need of regular epidemiological surveillance of antimicrobial resistance and implementation of an efficient infection control program.