Extended-spectrum β-lactamases producing Enterobacteriaceae (ESBL-PE) prevalence in Nepal: A systematic review and meta-analysis

Christina Khadka; Manita Shyaula; Gopiram Syangtan; Shrijana Bista; Reshma Tuladhar; Anjana Singh; Dev Raj Joshi; Lok R Pokhrel; Prabin Dawadi

doi:10.1016/j.scitotenv.2023.166164

Extended-spectrum β-lactamases producing Enterobacteriaceae (ESBL-PE) prevalence in Nepal: A systematic review and meta-analysis

Sci Total Environ. 2023 Nov 25:901:166164. doi: 10.1016/j.scitotenv.2023.166164. Epub 2023 Aug 10.

Authors

Christina Khadka¹, Manita Shyaula¹, Gopiram Syangtan², Shrijana Bista¹, Reshma Tuladhar¹, Anjana Singh³, Dev Raj Joshi¹, Lok R Pokhrel⁴, Prabin Dawadi¹

Affiliations

¹ Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal.
² Shi-Gan International College of Science and Technology, Tribhuvan University, Kathmandu, Nepal.
³ Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal; Faculty of Science, Nepal Academy of Science and Technology, Khumaltar, Lalitpur, Nepal.
⁴ Department of Public Health, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA. Electronic address: pokhrell18@ecu.edu.

PMID: 37572913
DOI: 10.1016/j.scitotenv.2023.166164

Abstract

An alarming increase in the occurrence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) has threatened the treatment and management of bacterial infections. This systematic review and meta-analysis aimed to provide a quantitative estimate of the prevalence of ESBL among the members of the Enterobacteriaceae family by analyzing the community-based and clinical studies published between 2011 and 2021 from Nepal and determine if ESBL-PE correlates with multidrug resistance (MDR). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed for systematic review and meta-analysis and the articles' quality was assessed using the Newcastle-Ottawa scale. Of the 2529 articles screened, 65 articles were systematically reviewed, data extracted, and included in in-depth meta-analysis. The overall pooled prevalence of ESBL-producers in Enterobacteriaceae was 29 % (95 % CI: 26-32 %) with high heterogeneity (I² = 96 %, p < 0.001). Escherichia coli was the predominant ESBL-producing member of the Enterobacteriaceae family, followed by Citrobacter spp. and Klebsiella spp. The prevalence of ESBL-PE increased from 18.7 % in 2011 to 29.5 % in 2021. A strong positive correlation (r = 0.98) was observed between ESBL production and MDR in Enterobacteriaceae. ESBL-PE isolates showed high resistance to ampicillin, cephalosporins, and amoxicillin-clavulanic acid, and bla_CTX-M type was the most reported gene variant among ESBL-PE. In conclusion, this study demonstrated an increased prevalence of ESBL-PE in Nepal over the last decade, and such isolates showed a high level of MDR against the β-lactams and non-β-lactam antibiotics. Tackling the rising antibiotic resistance (AR) and MDR in ESBL-PE would require concerted efforts from all stakeholders to institute effective infection control programs in the community and clinical settings.

Keywords: ESBL; Enterobacteriaceae; Infection control programs; Meta-analysis; Multidrug resistance; Nepal; Systematic review.

Publication types

Review