High prevalence of carbapenem-resistant Enterobacterales (CRE) in human samples from Nigeria: A systematic review and meta-analysis
Ahmad Adebayo Irekeola,
Rafidah Hanim Shueb,
Engku Nur Syafirah Engku Abd Rahman,
Hafeez Abiola Afolabi,
Yusuf Wada,
Abdirahman Hussein Elmi,
Muath Abdu Hakami,
Sfeeah Mofareah Alghzwani,
Osman AE. Elnoubi,
Ahmad A. Alshehri
Affiliations
Ahmad Adebayo Irekeola
Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia; Microbiology Unit, Department of Biological Sciences, College of Natural and Applied Sciences, Summit University Offa, Offa, PMB 4412, Kwara State, Nigeria
Rafidah Hanim Shueb
Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia; Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia; Corresponding author. Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia.
Engku Nur Syafirah Engku Abd Rahman
Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
Hafeez Abiola Afolabi
Department of General Surgery, School of Medical Sciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
Yusuf Wada
Department of Zoology, Faculty of Life Sciences, Ahmadu Bello University, Zaria, 810107, Nigeria
Abdirahman Hussein Elmi
Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia; Department of Medical Laboratory Sciences, Faculty of Medicine and Health Sciences, Jamhuriya University of Science and Technology, Mogadishu, Somalia
Muath Abdu Hakami
Microbiology Laboratory, Najran Armed Forces Hospital, Najran 108966, Saudi Arabia
Sfeeah Mofareah Alghzwani
Histopathology Laboratory, Najran Armed Forces Hospital, Najran 108966, Saudi Arabia
Osman AE. Elnoubi
Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia; Microbiology Unit, Department of Biological Sciences, College of Natural and Applied Sciences, Summit University Offa, Offa, PMB 4412, Kwara State, Nigeria; Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia; Department of General Surgery, School of Medical Sciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia; Department of Zoology, Faculty of Life Sciences, Ahmadu Bello University, Zaria, 810107, Nigeria; Department of Medical Laboratory Sciences, Faculty of Medicine and Health Sciences, Jamhuriya University of Science and Technology, Mogadishu, Somalia; Microbiology Laboratory, Najran Armed Forces Hospital, Najran 108966, Saudi Arabia; Histopathology Laboratory, Najran Armed Forces Hospital, Najran 108966, Saudi Arabia; Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Najran University, P.O. Box 1988, Najran, Saudi Arabia
Ahmad A. Alshehri
Corresponding author.; Department of Medical Microbiology and Parasitology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia; Microbiology Unit, Department of Biological Sciences, College of Natural and Applied Sciences, Summit University Offa, Offa, PMB 4412, Kwara State, Nigeria; Institute for Research in Molecular Medicine (INFORMM), Health Campus, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia; Department of General Surgery, School of Medical Sciences, Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia; Department of Zoology, Faculty of Life Sciences, Ahmadu Bello University, Zaria, 810107, Nigeria; Department of Medical Laboratory Sciences, Faculty of Medicine and Health Sciences, Jamhuriya University of Science and Technology, Mogadishu, Somalia; Microbiology Laboratory, Najran Armed Forces Hospital, Najran 108966, Saudi Arabia; Histopathology Laboratory, Najran Armed Forces Hospital, Najran 108966, Saudi Arabia; Department of Clinical Laboratory Sciences, Faculty of Applied Medical Sciences, Najran University, P.O. Box 1988, Najran, Saudi Arabia
Objectives: The rise in Carbapenem-resistant Enterobacterales (CRE) is perturbing. To curb the menace of CRE, a comprehensive understanding of its prevalence and epidemiology is crucial. As varying reports abound, the true prevalence of CRE in Nigeria remains unknown. Here, we conducted a systematic review and meta-analysis following standard guidelines to assess the situation of CRE in Nigeria. Methods: We searched electronic databases including Pubmed, ScienceDirect, Scopus, Web of Science, and Google Scholar for articles providing information on CRE in Nigeria. The data gathered were analyzed using OpenMeta Analyst and Comprehensive Meta-Analysis software. The random-effect model was employed to calculate pooled resistance to carbapenem antibiotics. Results: From 321 retrieved records, 57 were finally included. The studies were predominantly from the South-West region (n = 19). Escherichia coli and Klebsiella pneumoniae were the most frequently tested Enterobacterales among the included studies. The pooled prevalence estimate for imipenem resistance among CRE was 11.2 % (95 % CI: 7.9–15.7). Meropenem resistance had an estimate of 13.5 % (95 % CI: 9.1–19.6), whereas ertapenem and doripenem were estimated at 17.0 % (95 % CI: 9.9–27.7) and 37.9 % (95 % CI: 15.0–67.8), respectively. High heterogeneity (I2>85 %, p < 0.001) was observed for the estimates. The highest resistance rate to imipenem (28.4 %), meropenem (37.2 %) and ertapenem (46.5 %) were observed for the South-South region. Based on specific CRE genera, Morganella sp. was the most resistant (37.0 %) while Escherichia sp. was the least (9.4 %). Our analyses also revealed a progressive increase in resistance to carbapenem antibiotics over the years. Conclusion: This study highlights carbapenem resistance as a concern in Africa's most populous nation, underscoring the need for proactive measures to address and mitigate the threat of CRE.
