Extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria have become a serious threat to global health. Their rapid spread is associated with high mortality due to ineffective antibiotic treatment. To date a regular surveillance of multidrug-resistant (MDR) pathogens in Ethiopia is not established. For this report, published data regarding ESBL-producing bacteria in different health facilities of Ethiopia were reviewed. This study collates data from published information on the rates and clinical implications of infection with ESBL-producing Gram-negative bacteria in Ethiopia. A systematic literature search was conducted using PubMed, PubMed Central, Medline, Science Direct and Google scholar from October 2018 to March 2019. Eligible studies were identified by applying quality criteria. The pooled proportion of ESBL-producing Gram-negative bacteria was estimated based on a random effect model. The publication bias and the variation in proportion estimates attributed to heterogeneity were assessed. Fourteen studies with relevant data were included in the review. In total, 1649 Gram-negative bacteria isolated from 5191 clinical samples were included. The pooled proportion estimate of ESBL-producing Gram-negative bacteria was 50% (95% CI: 47.7–52.5%. Data showed a high level of heterogeneity (I2 = 95%, P < 0.01). ESBL rates varied by species; 65.7% (263/400) in Klebsiella spp., 48.4% (90/186) in Salmonella spp., and 47.0% (383/815) in E. coli. ESBL-encoding genes were reported in 81 isolates: 67 isolates harbored the CTX-M-1 group and 14 isolates TEM. The mortality associated with infections by bacteria resistant to third generation cephalosporins has rarely been investigated. However, two studies reported a mortality of 33.3% (1/3) and 100% (11/11). In this meta-analysis, the pooled prevalence of ESBL-producing pathogens is alarmingly high. Data on mortality rates is scarce. This highlights the need for establishing and upgrading clinical microbiology laboratories in Ethiopia for routine antibiotic susceptibility testing and extended surveillance of multidrug resistance.

中文翻译：

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埃塞俄比亚高倍谱产生β-内酰胺酶的革兰氏阴性菌感染和相关死亡率：系统评价和荟萃分析。

产生广谱β-内酰胺酶（ESBL）的革兰氏阴性细菌已成为对全球健康的严重威胁。由于抗生素治疗无效，它们的迅速传播与高死亡率相关。迄今为止，埃塞俄比亚尚未建立对耐多药（MDR）病原体的常规监视。在本报告中，回顾了有关埃塞俄比亚不同卫生机构中产生ESBL细菌的公开数据。这项研究从埃塞俄比亚产生ESBL的革兰氏阴性细菌感染的发生率和临床意义中收集了公开信息的数据。从2018年10月至2019年3月，使用PubMed，PubMed Central，Medline，Science Direct和Google Scholar进行了系统的文献检索。通过应用质量标准确定了合格的研究。基于随机效应模型估算产生ESBL的革兰氏阴性细菌的合并比例。评估了出版偏差和归因于异质性的比例估计的变化。该评价包括十四项具有相关数据的研究。总共从5191个临床样本中分离出1649株革兰氏阴性菌。产ESBL革兰氏阴性菌的混合比例估计为50％（95％CI：47.7–52.5％。数据显示高度异质性（I2 = 95％，P <0.01）。ESBL率因物种而异； 65.7克雷伯菌属中的百分比（263/400），沙门氏菌中的百分比为48.4％（90/186），大肠杆菌中为47.0％（383/815），据报道在81个分离株中有ESBL编码基因：67个分离株带有CTX-M-1组和14株TEM分离株。很少研究与第三代头孢菌素耐药性细菌感染有关的死亡率。但是，两项研究报告的死亡率分别为33.3％（1/3）和100％（11/11）。在这项荟萃分析中，产生ESBL的病原体的合并患病率惊人地高。关于死亡率的数据很少。这凸显了在埃塞俄比亚建立和升级临床微生物学实验室以进行常规抗生素药敏试验和扩展对多药耐药性监测的必要性。