Prevalence of antimicrobial resistance and its clinical implications in Ethiopia: a systematic review

Derbew Fikadu Berhe; Getachew Tesfaye Beyene; Berhanu Seyoum; Meseret Gebre; Kassa Haile; Mulugeta Tsegaye; Minyahil Tadesse Boltena; Emawayish Tesema; Taddele Cherinet Kibret; Mulatu Biru; Dawd S Siraj; Daniel Shirley; Rawleigh Howe; Alemseged Abdissa

doi:10.1186/s13756-021-00965-0

Prevalence of antimicrobial resistance and its clinical implications in Ethiopia: a systematic review

Antimicrob Resist Infect Control. 2021 Dec 3;10(1):168. doi: 10.1186/s13756-021-00965-0.

Affiliations

¹ College of Health Sciences, School of Pharmacy, Mekelle University, Mekelle, Ethiopia.
² Armauer Hansen Research Institute, P.O. Box: 1005, Addis Ababa, Ethiopia.
³ Armauer Hansen Research Institute, P.O. Box: 1005, Addis Ababa, Ethiopia. berhanu.seyoum@ahri.gov.et.
⁴ Department of Internal Medicine, ALERT Hospital, Addis Ababa, Ethiopia.
⁵ Department of Statistics, Addis Ababa University, Addis Ababa, Ethiopia.
⁶ Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin, University of Wisconsin- Madison, Madison, USA.

Abstract

Background: Antimicrobial resistance is one of the major public health challenges in Ethiopia. However, there is no comprehensive summary of existing AMR data in the country.

Aim: To determine the prevalence of antimicrobial resistance and its clinical implications in Ethiopia.

Methods: A systematic literature search was performed on the PubMed/Medline database. Original studies on antimicrobial resistance conducted in Ethiopia between 1st January 2009 and 31st July 2019 were included. The outcome measure was the number of isolates resistant to antimicrobial agents in terms of specific pathogens, and disease condition. Data was calculated as total number of resistant isolates relative to the total number of isolates per specific pathogen and medication.

Results: A total of 48,021 study participants enrolled from 131 original studies were included resulting in 15,845 isolates tested for antimicrobial resistance. The most common clinical sample sources were urine (28%), ear, nose, and throat discharge collectively (27%), and blood (21%). All the studies were cross-sectional and 83% were conducted in hospital settings. Among Gram-positive bacteria, the reported level of resistance to vancomycin ranged from 8% (Enterococcus species) to 20% (S. aureus). E. coli, K. pneumoniae and P. aeruginosa were the most common Gram-negative pathogens resistant to key antimicrobial agents described in the national standard treatment guideline and were associated with diverse clinical conditions: urinary tract infections, diarrhea, surgical site infections, pneumonia, ocular infections, and middle ear infections.

Conclusion: Overall, there is a high prevalence of antimicrobial resistance in Ethiopia. Empirical treatment of bacterial infections needs to be guided by up-to-date national guidelines considering local antimicrobial susceptibility patterns. Equipping diagnostic laboratories with culture and drug susceptibility testing facilities, and establishing a strong antimicrobial stewardship program should be high priorities.

Keywords: Antibacterial resistance; Antibiotic resistance; Drug resistance; Ethiopia; Systematic review.

Publication types

Systematic Review

MeSH terms

Anti-Bacterial Agents / pharmacology*
Bacterial Infections / drug therapy
Bacterial Infections / epidemiology*
Drug Resistance, Multiple, Bacterial*
Ethiopia / epidemiology
Gram-Negative Bacteria / drug effects*
Gram-Negative Bacterial Infections / epidemiology*
Gram-Negative Bacterial Infections / microbiology
Gram-Positive Bacteria / drug effects*
Gram-Positive Bacterial Infections / epidemiology*
Gram-Positive Bacterial Infections / microbiology
Humans
Microbial Sensitivity Tests
Prevalence

Substances

Anti-Bacterial Agents