Background. The world prevalence of community and hospital-acquired extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is increasing tremendously. Bacteria harboring ESBLs are currently the number one critical pathogens posing a major threat to human health. Objective. To provide a summary of molecular evidence on the prevalence of ESBL-producing Enterobacteriaceae (ESBL-E) and associated genes at community and hospital settings in East, Central, and Southern African countries. Methods. We conducted a systematic literature search on PubMed and Google Scholar databases for the available molecular studies on ESBL-E in hospitals and community settings in East, Central, and Sothern Africa (ECSA). Published studies in English language involving gene characterization of ESBLs from human samples in hospital and community settings were included in the review, inception to November 2019. A random effect meta-analysis was performed to estimate the prevalence of ESBL-E. Results. A total of 27 studies involving molecular characterization of resistance genes from 20,225 ESBL-E isolates were included in the analysis. Seventy-four percent of all studies were hospital based, 15% were based in community settings, and others were done in both hospital and community settings. Of all the studies, 63% reported E. coli as the dominant isolate among ESBL-E recovered from clinical samples and Klebsiella pneumoniae was reported dominant isolates in 33% of all studies. A random pooled prevalence of ESBL-E was 38% (95% CI = 24–53%), highest in Congo, 92% (95% CI = 90–94%), and lowest in Zimbabwe, 14% (95% CI = 9–20%). Prevalence was higher in hospital settings 41% (95% CI = 23–58%) compared to community settings 34% (95% CI = 8–60%). ESBL genes detected from clinical isolates with ESBL-E phenotypes in ECSA were those of Ambler molecular class A [1] that belongs to both functional groups 2be and 2d of Bush and Jacob classification of 2010 [2]. Majority of studies (n = 22, 81.5%) reported predominance of blaCTX-M gene among isolates, particularly CTX-M-15. Predictors of ESBL-E included increased age, hospital admissions, previous use of antibiotics, and paramedical use of herbs. Conclusion. Few studies have been conducted at a molecular level to understand the genetic basis of increased resistance among members of ESBL-E in ECSA. Limited molecular studies in the ECSA region leave a gap in estimating the burden and risk posed by the carriage of ESBL genes in these countries. We found a high prevalence of ESBL-E most carrying CTX-M enzyme in ECSA with a greater variation between countries. This could be an important call for combined (regional or global) efforts to combat the problem of antimicrobial resistance (AMR) in the region. Antibiotic use and hospital admission increased the carriage of ESBL-E, while poor people contributed little to the increase of AMR due to lack of access and failure to meet the cost of healthcare compared to high income individuals.

中文翻译：

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东部、中部和南部非洲社区和医院环境中产 ESBL 肠杆菌科细菌耐药性的遗传决定因素：对患病率的系统评价和荟萃分析

背景。社区和医院获得性产超广谱β-内酰胺酶 (ESBL)肠杆菌科的全球流行率正在急剧上升。携带 ESBLs 的细菌目前是对人类健康构成重大威胁的第一大关键病原体。客观。提供关于产 ESBL肠杆菌科(ESBL-E) 和相关基因在东非、中非和南部非洲国家的社区和医院环境中流行的分子证据摘要。方法. 我们对 PubMed 和 Google Scholar 数据库进行了系统的文献检索，以寻找在东部、中部和南部非洲 (ECSA) 的医院和社区环境中可用的 ESBL-E 分子研究。发表的英文研究涉及医院和社区环境中人类样本的 ESBLs 基因表征，纳入审查，从 2019 年 11 月开始。进行随机效应荟萃分析以估计 ESBL-E 的患病率。结果。共有 27 项研究涉及来自 20,225 个 ESBL-E 分离株的抗性基因的分子特征，被纳入分析。所有研究中有 74% 是基于医院的，15% 是基于社区环境的，还有一些是在医院和社区环境中进行的。在所有研究中，63% 报告大肠杆菌作为从临床样本中回收的 ESBL-E 中的主要分离株，据报道，肺炎克雷伯菌在所有研究中占 33% 的主要分离株。ESBL-E 的随机汇总患病率为 38% (95% CI = 24–53%)，刚果最高，为 92% (95% CI = 90–94%)，津巴布韦最低，为 14% (95% CI = 9–20%）。医院环境中的患病率为 41%（95% CI = 23–58%），而社区环境中的患病率为 34%（95% CI = 8–60%）。从 ECSA 中具有 ESBL-E 表型的临床分离株中检测到的 ESBL 基因属于 Ambler 分子 A 类 [1]，属于 2010 年布什和雅各布分类的功能组 2be 和 2d [2]。大多数研究 ( n  = 22, 81.5%) 报告了bla的优势分离株中的 CTX-M 基因，特别是 CTX-M-15。ESBL-E 的预测因素包括年龄增加、住院、以前使用抗生素和辅助医疗使用草药。结论. 很少有研究在分子水平上进行，以了解 ECSA 中 ESBL-E 成员耐药性增加的遗传基础。ECSA 地区有限的分子研究在估计这些国家携带 ESBL 基因所带来的负担和风险方面留下了空白。我们发现在 ECSA 中携带 CTX-M 酶的 ESBL-E 的流行率很高，各国之间的差异更大。这可能是一个重要的呼吁，需要联合（区域或全球）努力解决该地区的抗微生物药物耐药性（AMR）问题。抗生素的使用和住院增加了 ESBL-E 的携带，而与高收入人群相比，由于缺乏获取途径和无法支付医疗费用，穷人对 AMR 的增加贡献不大。