Prevalence of phenotypic drug resistance profiles and multi-drug-resistant Pseudomonas and Acinetobacter species recovered from clinical specimens in Ethiopia: a systematic review and meta-analysis.

BACKGROUND

Antimicrobial-resistant Pseudomonas and Acinetobacter species are emerging as serious public health risks, both globally and in resource-limited countries such as Ethiopia. These microorganisms cause serious, life-threatening infections and are becoming increasingly resistant to commonly prescribed antibiotics. The high prevalence and resistance patterns of these bacteria need immediate action to inform treatment guidelines, increase infection control measure, and develop effective public health policies. This systematic review and meta-analysis aimed to assess the prevalence of phenotypic drug resistance profiles and multi-drug-resistant Pseudomonas and Acinetobacter species recovered from clinical specimens in Ethiopia.

METHODS

This systematic review and meta-analysis, which followed PRISMA principles, analyzed data from PubMed, Scopus, and Google Scholar to determine the prevalence and antibiotic resistance trends of Pseudomonas and Acinetobacter species in Ethiopia. Eligible studies were extracted by using Microsoft Excel and exported to STATA version 17 for analysis. The pooled prevalence was estimated using a random-effects model, and heterogeneity was examined using the I statistic. Publication bias was investigated using funnel plot analysis and Egger's test, and sensitivity analysis was used to assess the impact of individual studies on the total pooled findings.

RESULT

Of the 1,375 studies identified, 187 were eligible for qualitative analysis, leading to the inclusion of 65 studies in the meta-analysis. This analysis encompassed a total of 1,264 isolates, with 364 identified as Pseudomonas and Acinetobacter species. The systematic review revealed a pooled prevalence of 19.12% (95% CI: 14.86-23.38) for Pseudomonas species and 12.46% (95% CI: 5.82-19.10) for Acinetobacter species. The combined prevalence of both pathogens was 25.31 (95% CI: 18.61-32.00) with substantial heterogeneity (I = 93.6%, p < 0.001). across the studies. Pseudomonas exhibited high resistance rates to amoxicillin-clavulanic Acid (83.73%) and tetracycline (89.15%), while Acinetobacter showed 87.21% resistance to tetracycline and 79.72% to ceftriaxone. The overall pooled prevalence of MDR Pseudomonas species was 72.73% (95% CI: 67.02-78.44), and for Acinetobacter species, it reached 84.69% (95% CI: 78.78-90.59), respectively. Moreover, the pooled prevalence of MDR for both species isolated from clinical samples in Ethiopia was 74.79% (95% CI: 70.14-79.43), with significant heterogeneity (I = 99.7%, p < 0.001) across the studies.

CONCLUSION

The pooled prevalence of Pseudomonas and Acinetobacter species and their antibiotic resistance were alarmingly high in clinical samples in Ethiopia. These findings highlight the crucial need for more antimicrobial surveillance, stronger stewardship programs, and targeted research to combat the growing threat of resistance. Strategic public health policies are required to decrease these pathogens.