Prevalence of carbapenem resistance in Acinetobacter baumannii and Pseudomonas aeruginosa in sub-Saharan Africa: A systematic review and meta-analysis

Margaret Toluwalayo Arowolo; Oluwatosin Qawiyy Orababa; Morufat Oluwatosin Olaitan; Bisola Victoria Osibeluwo; Utibeima Udo Essiet; Olajumoke Hanah Batholomew; Oluwaseyi Gbotoluwa Ogunrinde; Oluwaseyi Aminat Lagoke; Jeffrey Difiye Soriwei; Olanrewaju David Ishola; Onyinye Maryann Ezeani; Aminat Oyeronke Onishile; Elizabeth Olumodeji

doi:10.1371/journal.pone.0287762

Prevalence of carbapenem resistance in Acinetobacter baumannii and Pseudomonas aeruginosa in sub-Saharan Africa: A systematic review and meta-analysis

Margaret Toluwalayo Arowolo^*, Oluwatosin Qawiyy Orababa, Morufat Oluwatosin Olaitan, Bisola Victoria Osibeluwo, Utibeima Udo Essiet, Olajumoke Hanah Batholomew, Oluwaseyi Gbotoluwa Ogunrinde, Oluwaseyi Aminat Lagoke, Jeffrey Difiye Soriwei, Olanrewaju David Ishola, Onyinye Maryann Ezeani, Aminat Oyeronke Onishile, Elizabeth Olumodeji

^*Corresponding author for this work

Bristol Medical School (THS)

Research output: Contribution to journal › Article (Academic Journal) › peer-review

23 Citations (Scopus)

Abstract

Carbapenems are effective drugs against bacterial pathogens and resistance to them is considered a great public health threat, especially in notorious nosocomial pathogens like Acinetobacter baumannii and Pseudomonas aeruginosa. In this study, we aimed to determine the prevalence of carbapenem resistance in A. baumannii and P. aeruginosa infections in Sub-Saharan Africa. Databases (PubMed, Scopus, Web of Science, and African Journal Online) were systematically searched following the Preferred Reporting Items for Systematic review and meta-analysis protocols (PRISMA-P) 2020 statements for articles reporting carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) prevalence between 2012 and 2022. Pooled prevalence was determined with the random effect model and funnel plots were used to determine heterogeneity in R. A total of 47 articles were scanned for eligibility, among which 25 (14 for carbapenem-resistant A. baumannii and 11 for carbapenem-resistant P. aeruginosa) were included in the study after fulfilling the eligibility criteria. The pooled prevalence of CRPA in the present study was estimated at 8% (95% CI; 0.02–0.17; I² = 98%; P <0.01). There was high heterogeneity (Q = 591.71, I² = 98.9%; P<0.0001). In addition, this study’s pooled prevalence of CRAB was estimated at 20% (95% CI; 0.04–0.43; I² = 99%; P <0.01). There was high heterogeneity (Q = 1452.57, I² = 99%; P<0.0001). Also, a funnel plot analysis of the studies showed high degree of heterogeneity. The carbapenemase genes commonly isolated from A. baumannii in this study include bla_OXA23, bla_OXA48, bla_GES., bla_NDM, bla_VIM, bla_OXA24, bla_OXA58, bla_OXA51, bla_SIM-1, bla_OXA40, bla_OXA66, bla_OXA69, bla_OXA91, with bla_OXA23 and bla_VIM being the most common. On the other hand, bla_NDM, bla_VIM, bla_IMP, bla_OXA48, bla_OXA51, bla_SIM-1, bla_OXA181, bla_KPC, bla_OXA23, bla_OXA50 were the commonly isolated carbapenemase genes in P. aeruginosa, among which bla_VIM and bla_NDM genes were the most frequently isolated. Surveillance of drug-resistant pathogens in Sub-Saharan Africa is essential in reducing the region’s disease burden. This study has shown that the region has significantly high multidrug-resistant pathogen prevalence. This is a wake-up call for policymakers to put in place measures to reduce the spread of these critical priority pathogens.

Original language	English
Article number	e0287762
Journal	PLOS ONE
Volume	18
Issue number	11
DOIs	https://doi.org/10.1371/journal.pone.0287762
Publication status	Published - 28 Nov 2023

Bibliographical note

Publisher Copyright:
© 2023 Arowolo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Arowolo, M. T., Orababa, O. Q., Olaitan, M. O., Osibeluwo, B. V., Essiet, U. U., Batholomew, O. H., Ogunrinde, O. G., Lagoke, O. A., Soriwei, J. D., Ishola, O. D., Ezeani, O. M., Onishile, A. O., & Olumodeji, E. (2023). Prevalence of carbapenem resistance in Acinetobacter baumannii and Pseudomonas aeruginosa in sub-Saharan Africa: A systematic review and meta-analysis. PLOS ONE, 18(11), Article e0287762. https://doi.org/10.1371/journal.pone.0287762

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title = "Prevalence of carbapenem resistance in Acinetobacter baumannii and Pseudomonas aeruginosa in sub-Saharan Africa: A systematic review and meta-analysis",

abstract = "Carbapenems are effective drugs against bacterial pathogens and resistance to them is considered a great public health threat, especially in notorious nosocomial pathogens like Acinetobacter baumannii and Pseudomonas aeruginosa. In this study, we aimed to determine the prevalence of carbapenem resistance in A. baumannii and P. aeruginosa infections in Sub-Saharan Africa. Databases (PubMed, Scopus, Web of Science, and African Journal Online) were systematically searched following the Preferred Reporting Items for Systematic review and meta-analysis protocols (PRISMA-P) 2020 statements for articles reporting carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) prevalence between 2012 and 2022. Pooled prevalence was determined with the random effect model and funnel plots were used to determine heterogeneity in R. A total of 47 articles were scanned for eligibility, among which 25 (14 for carbapenem-resistant A. baumannii and 11 for carbapenem-resistant P. aeruginosa) were included in the study after fulfilling the eligibility criteria. The pooled prevalence of CRPA in the present study was estimated at 8\% (95\% CI; 0.02–0.17; I2 = 98\%; P <0.01). There was high heterogeneity (Q = 591.71, I2 = 98.9\%; P<0.0001). In addition, this study{\textquoteright}s pooled prevalence of CRAB was estimated at 20\% (95\% CI; 0.04–0.43; I2 = 99\%; P <0.01). There was high heterogeneity (Q = 1452.57, I2 = 99\%; P<0.0001). Also, a funnel plot analysis of the studies showed high degree of heterogeneity. The carbapenemase genes commonly isolated from A. baumannii in this study include blaOXA23, blaOXA48, blaGES., blaNDM, blaVIM, blaOXA24, blaOXA58, blaOXA51, blaSIM-1, blaOXA40, blaOXA66, blaOXA69, blaOXA91, with blaOXA23 and blaVIM being the most common. On the other hand, blaNDM, blaVIM, blaIMP, blaOXA48, blaOXA51, blaSIM-1, blaOXA181, blaKPC, blaOXA23, blaOXA50 were the commonly isolated carbapenemase genes in P. aeruginosa, among which blaVIM and blaNDM genes were the most frequently isolated. Surveillance of drug-resistant pathogens in Sub-Saharan Africa is essential in reducing the region{\textquoteright}s disease burden. This study has shown that the region has significantly high multidrug-resistant pathogen prevalence. This is a wake-up call for policymakers to put in place measures to reduce the spread of these critical priority pathogens.",

author = "Arowolo, \{Margaret Toluwalayo\} and Orababa, \{Oluwatosin Qawiyy\} and Olaitan, \{Morufat Oluwatosin\} and Osibeluwo, \{Bisola Victoria\} and Essiet, \{Utibeima Udo\} and Batholomew, \{Olajumoke Hanah\} and Ogunrinde, \{Oluwaseyi Gbotoluwa\} and Lagoke, \{Oluwaseyi Aminat\} and Soriwei, \{Jeffrey Difiye\} and Ishola, \{Olanrewaju David\} and Ezeani, \{Onyinye Maryann\} and Onishile, \{Aminat Oyeronke\} and Elizabeth Olumodeji",

note = "Publisher Copyright: {\textcopyright} 2023 Arowolo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2023",

month = nov,

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doi = "10.1371/journal.pone.0287762",

language = "English",

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Arowolo, MT, Orababa, OQ, Olaitan, MO, Osibeluwo, BV, Essiet, UU, Batholomew, OH, Ogunrinde, OG, Lagoke, OA, Soriwei, JD, Ishola, OD, Ezeani, OM, Onishile, AO & Olumodeji, E 2023, 'Prevalence of carbapenem resistance in Acinetobacter baumannii and Pseudomonas aeruginosa in sub-Saharan Africa: A systematic review and meta-analysis', PLOS ONE, vol. 18, no. 11, e0287762. https://doi.org/10.1371/journal.pone.0287762

Prevalence of carbapenem resistance in Acinetobacter baumannii and Pseudomonas aeruginosa in sub-Saharan Africa: A systematic review and meta-analysis. / Arowolo, Margaret Toluwalayo; Orababa, Oluwatosin Qawiyy; Olaitan, Morufat Oluwatosin et al.
In: PLOS ONE, Vol. 18, No. 11, e0287762, 28.11.2023.

Research output: Contribution to journal › Article (Academic Journal) › peer-review

TY - JOUR

T1 - Prevalence of carbapenem resistance in Acinetobacter baumannii and Pseudomonas aeruginosa in sub-Saharan Africa

T2 - A systematic review and meta-analysis

AU - Arowolo, Margaret Toluwalayo

AU - Orababa, Oluwatosin Qawiyy

AU - Olaitan, Morufat Oluwatosin

AU - Osibeluwo, Bisola Victoria

AU - Essiet, Utibeima Udo

AU - Batholomew, Olajumoke Hanah

AU - Ogunrinde, Oluwaseyi Gbotoluwa

AU - Lagoke, Oluwaseyi Aminat

AU - Soriwei, Jeffrey Difiye

AU - Ishola, Olanrewaju David

AU - Ezeani, Onyinye Maryann

AU - Onishile, Aminat Oyeronke

AU - Olumodeji, Elizabeth

N1 - Publisher Copyright: © 2023 Arowolo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2023/11/28

Y1 - 2023/11/28

N2 - Carbapenems are effective drugs against bacterial pathogens and resistance to them is considered a great public health threat, especially in notorious nosocomial pathogens like Acinetobacter baumannii and Pseudomonas aeruginosa. In this study, we aimed to determine the prevalence of carbapenem resistance in A. baumannii and P. aeruginosa infections in Sub-Saharan Africa. Databases (PubMed, Scopus, Web of Science, and African Journal Online) were systematically searched following the Preferred Reporting Items for Systematic review and meta-analysis protocols (PRISMA-P) 2020 statements for articles reporting carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) prevalence between 2012 and 2022. Pooled prevalence was determined with the random effect model and funnel plots were used to determine heterogeneity in R. A total of 47 articles were scanned for eligibility, among which 25 (14 for carbapenem-resistant A. baumannii and 11 for carbapenem-resistant P. aeruginosa) were included in the study after fulfilling the eligibility criteria. The pooled prevalence of CRPA in the present study was estimated at 8% (95% CI; 0.02–0.17; I2 = 98%; P <0.01). There was high heterogeneity (Q = 591.71, I2 = 98.9%; P<0.0001). In addition, this study’s pooled prevalence of CRAB was estimated at 20% (95% CI; 0.04–0.43; I2 = 99%; P <0.01). There was high heterogeneity (Q = 1452.57, I2 = 99%; P<0.0001). Also, a funnel plot analysis of the studies showed high degree of heterogeneity. The carbapenemase genes commonly isolated from A. baumannii in this study include blaOXA23, blaOXA48, blaGES., blaNDM, blaVIM, blaOXA24, blaOXA58, blaOXA51, blaSIM-1, blaOXA40, blaOXA66, blaOXA69, blaOXA91, with blaOXA23 and blaVIM being the most common. On the other hand, blaNDM, blaVIM, blaIMP, blaOXA48, blaOXA51, blaSIM-1, blaOXA181, blaKPC, blaOXA23, blaOXA50 were the commonly isolated carbapenemase genes in P. aeruginosa, among which blaVIM and blaNDM genes were the most frequently isolated. Surveillance of drug-resistant pathogens in Sub-Saharan Africa is essential in reducing the region’s disease burden. This study has shown that the region has significantly high multidrug-resistant pathogen prevalence. This is a wake-up call for policymakers to put in place measures to reduce the spread of these critical priority pathogens.

AB - Carbapenems are effective drugs against bacterial pathogens and resistance to them is considered a great public health threat, especially in notorious nosocomial pathogens like Acinetobacter baumannii and Pseudomonas aeruginosa. In this study, we aimed to determine the prevalence of carbapenem resistance in A. baumannii and P. aeruginosa infections in Sub-Saharan Africa. Databases (PubMed, Scopus, Web of Science, and African Journal Online) were systematically searched following the Preferred Reporting Items for Systematic review and meta-analysis protocols (PRISMA-P) 2020 statements for articles reporting carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) prevalence between 2012 and 2022. Pooled prevalence was determined with the random effect model and funnel plots were used to determine heterogeneity in R. A total of 47 articles were scanned for eligibility, among which 25 (14 for carbapenem-resistant A. baumannii and 11 for carbapenem-resistant P. aeruginosa) were included in the study after fulfilling the eligibility criteria. The pooled prevalence of CRPA in the present study was estimated at 8% (95% CI; 0.02–0.17; I2 = 98%; P <0.01). There was high heterogeneity (Q = 591.71, I2 = 98.9%; P<0.0001). In addition, this study’s pooled prevalence of CRAB was estimated at 20% (95% CI; 0.04–0.43; I2 = 99%; P <0.01). There was high heterogeneity (Q = 1452.57, I2 = 99%; P<0.0001). Also, a funnel plot analysis of the studies showed high degree of heterogeneity. The carbapenemase genes commonly isolated from A. baumannii in this study include blaOXA23, blaOXA48, blaGES., blaNDM, blaVIM, blaOXA24, blaOXA58, blaOXA51, blaSIM-1, blaOXA40, blaOXA66, blaOXA69, blaOXA91, with blaOXA23 and blaVIM being the most common. On the other hand, blaNDM, blaVIM, blaIMP, blaOXA48, blaOXA51, blaSIM-1, blaOXA181, blaKPC, blaOXA23, blaOXA50 were the commonly isolated carbapenemase genes in P. aeruginosa, among which blaVIM and blaNDM genes were the most frequently isolated. Surveillance of drug-resistant pathogens in Sub-Saharan Africa is essential in reducing the region’s disease burden. This study has shown that the region has significantly high multidrug-resistant pathogen prevalence. This is a wake-up call for policymakers to put in place measures to reduce the spread of these critical priority pathogens.

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Prevalence of carbapenem resistance in Acinetobacter baumannii and Pseudomonas aeruginosa in sub-Saharan Africa: A systematic review and meta-analysis

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