Global Prevalence of Vancomycin-resistant Enterococcus in Wildlife: The First Meta-Analysis and Systematic Review

Abstract

Purpose: Wildlife's role in the spread of antibiotic resistance has received insufficient attention. We report the first meta-analysis and systematic review in analyzing the prevalence of Vancomycin-resistant Enterococcus in wildlife. Methods & Materials: Databases such as, PubMed, Scopus and Google Scholar were searched. Data was extracted by two independent reviewers and the results were reviewed by a third. Two reviewers independently assessed the study protocol using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist and the study quality using the Joanna Briggs Institute (JBI) critical appraisal checklist for prevalence data. Comprehensive meta-analysis version 2 was used for the meta-analysis. The random effect model was used, publication bias was assessed using the Eggers test, funnel plot and the Trim-and-Fill method. Sources of heterogeneity were analyzed using the leave-one-out meta-analysis, subgroup analysis, and meta-regression. Results: Twenty-five studies met the eligibility criteria, but because a study reported the prevalence of VRE in more than one type of wildlife, they were considered as individual studies and 26 studies were therefore added to the final meta-analysis. Of the 3845 isolates tested in the included studies, 312 were VRE. The pooled prevalence of VRE in wildlife was estimated at 6.6% (95% CI; 4.0–10.5%; I2 = 93.011%; P < 0.001). Between-study variability was high (t2 = 1.519; heterogeneity I2 = 93.011% with heterogeneity chi-square (Q) = 357.717, df = 25, and P < 0.001). The funnel plot showed bias which was confirmed by Egger's test (t-value = 4.850; P = 0.00006), and estimates from the leave-one-out forest plot did not affect the pooled prevalence. Seven study was missed and fall at the right side of the pooled estimate by the Trim-and-Fill method. Pooled prevalence of VRE in wild mammals and wild birds were 6.9% (CI=3.7-12.5%) and 6.3% (CI=3.0-12.7%) respectively. More studies were reported from Portugal with a pooled prevalence of 5.0% (CI; 2.8-8.8%). Agar dilution and feces were utilized most in the detection and sampling of VRE respectively. Only sample type (P = 0.04) is a predictor of heterogeneity among the variables. Conclusion: Increased surveillance of VRE in wildlife is required.