Systematic review and meta-analysis of integrated studies on antimicrobial resistance genes in Africa-A One Health perspective

Nora A Escher; Abdifatah M Muhummed; Jan Hattendorf; Pascale Vonaesch; Jakob Zinsstag

doi:10.1111/tmi.13642

Systematic review and meta-analysis of integrated studies on antimicrobial resistance genes in Africa-A One Health perspective

Trop Med Int Health. 2021 Oct;26(10):1153-1163. doi: 10.1111/tmi.13642. Epub 2021 Jul 12.

Authors

Nora A Escher^{1

2

3}, Abdifatah M Muhummed^{1

2

4}, Jan Hattendorf^{1

2}, Pascale Vonaesch^{1

2}, Jakob Zinsstag^{1

2}

Affiliations

¹ Swiss Tropical and Public Health Institute, Basel, Switzerland.
² University of Basel, Basel, Switzerland.
³ Department of Biology, Swiss Federal Institute of Technology, Zurich, Switzerland.
⁴ Jigjiga University, Jigjiga, Ethiopia.

Abstract

Background: Increasing antimicrobial resistance (AMR) raises serious health and financial concerns. However, the main drivers of the emergence, spread and subsequent colonisation of resistant bacterial strains between humans, animals and the environment are still poorly understood.

Objective: The aim of this review was to identify molecular studies on AMR in One Health settings in Africa and to determine the prevalence of antimicrobial resistance genes in humans, animals and the environment. Due to the very low number of studies including environmental samples, the meta-analysis only includes data obtained from animals and humans.

Methods: The PubMed, Web of Science and Scopus databases were searched, identifying 10 464 publications on AMR in Africa from January 1st, 2000 until June 1st, 2020. Inclusion criteria were: (i) Integrated studies assessing AMR simultaneously in an animal-human, animal-environment, human-environment or animal-human-environment context, (ii) Genotypic characterisation of AMR and (iii) temporal and spatial relationship between samples from humans and animals. Statistical random-effects model meta-analysis was performed.

Results: Overall, 18 studies met our eligibility criteria and were included in this review. Six studies investigated Escherichia coli and Salmonella spp. (N = 6). The most prevalent AMR genes in animals included sul1 (36.2%), sul2 (32.0%), tetA (31.5%), strB (30.8%) and blaTEM (30.0%), whereas sul2 (42.4%), tetA (42.0%), strB (34.9%), blaTEM (28.8%) and sul1 (27.8%) were most prevalent in humans. We observed no clear pattern for a higher prevalence in either the animal or the human reservoir.

Conclusion: To date, data on AMR in a One Health perspective in Africa are scarce. Prospective and longitudinal studies using an integrated One Health approach assessing the environment, animals and humans at the same time are needed to better understand the main drivers of AMR sharing in Africa.

Keywords: Africa; One Health; animals; antimicrobial resistance; environment; humans; systematic review and meta-analysis.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Africa / epidemiology
Animals
Anti-Bacterial Agents / pharmacology*
Bacteria / drug effects*
Bacterial Infections / epidemiology*
Bacterial Infections / microbiology*
Drug Resistance, Bacterial
Humans
One Health*

Substances

Anti-Bacterial Agents