Molecular epidemiological exploration of carbapenem-resistant Enterobacteriaceae in Africa from One Health perspective: A systematic review
DOI:
https://doi.org/10.66585/ohmi.2025.1.0002Schlagwörter:
Africa, Antimicrobial resistance, Carbapenem-resistant Enterobacteriaceae, Critical priority bacteria, One HealthAbstract
Carbapenem‑resistant Enterobacteriaceae (CRE) are associated with high morbidity and mortality in humans due to very limited therapeutic options. This systematic review examines the prevalence and geographic distribution of CRE, as well as the associated genetic factors at the human-animal-environment interface in Africa. To extract information for this study, the Medical Subject Headings (MeSH) technique was used to identify studies that employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, with a focus on original research articles. Additionally, this systematic review employed the CoCoPop (conditions, context, and population) framework to identify relevant articles. Search engines used to retrieve articles included Web of Science, Google Scholar, Scopus, ResearchGate, and PubMed. By August 2025, only eight articles from Africa met the search criteria and were included in the analysis. The observed prevalence of CRE across the heterogeneous studies was 18.58%. The animal domain exhibited the highest CRE prevalence (9.89%), followed by the human (6.06%) and environmental (2.63%) domains. Escherichia coli (58.35%) and Klebsiella pneumoniae (28.28%) were the predominant spp. among the reported CRE isolates. The highest gene prevalence was observed for blaOXA-48 (42%), followed by blaKPC (33%) and blaOXA-66 (9.78%). Geographically, North Africa had the highest prevalence (55.78%), followed by Eastern Africa (29.82%), whereas Southern Africa had the lowest prevalence (3.08%). Our study emphasizes the significant burden of CRE infections and genes, as well as their spread across human, animal, and environmental sectors in Africa. The simultaneous presence of CRE in these areas indicates potential interfaces, but current evidence does not permit a definitive assignment of specific transmission routes. Surveillance programs, research, infection prevention, and control measures from a One Health perspective should be implemented to inform interventions.
Literaturhinweise
1. Liu CM, Stegger M, Aziz M, Johnson TJ, Waits K, Nordstrom L, et al. Escherichia coli ST131-H22 as a foodborne uropathogen. mBio. 2018;9(4). https://doi.org/10.1128/mBio.00470-18
2. De Oliveira DMP, Forde BM, Kidd TJ, Harris PNA, Schembri MA, Beatson SA, et al. Antimicrobial resistance in ESKAPE pathogens. Clin Microbiol Rev. 2020;33(3). https://doi.org/10.1128/
cmr.00181-19
3. Tarakdjian J, Capello K, Pasqualin D, Santini A, Cunial G, Scollo A, et al. Antimicrobial use on Italian pig farms and its relationship with husbandry practices. Animals. 2020;10(3). https://doi.org/10.3390 /ani10030417
4. Ranjbar R, Alam M. Antimicrobial resistance collaborators (2022). Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Evid Based Nurs. 2023. https://doi.org/10.1136
/ebnurs-2022-103540
5. O’Neill J. Antimicrobial resistance: Tackling a crisis for the health and wealth of nations. Review on Antimicrobial Resistance. 2016. Available at: https://iiif.wellcomecollection.org/file/b28552179AM
R%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations.pdf Accessed 21 Aug 2024.
6. Alhaji NB, Aliyu MB, Ghali-Mohammed I, Odetokun IA. Survey on antimicrobial usage in local dairy cows in North-central Nigeria: Drivers for misuse and public health threats. PLoS One. 2019;14(12):e0224949. https://doi.org/10.1371/journal.pone.022
4949
7. Elton L, Thomason MJ, Tembo J, Velavan TP, Pallerla SR, Arruda LB, et al. Antimicrobial resistance preparedness in sub-Saharan African countries. Antimicrob Resist Infect Control. 2020;9(1):145. https://doi.org/10.1186/s13756-020-00800-y
8. Mouiche MMM, Mazra M, Moffo F, Mpouam SE, Ngoujigne AI, Feussom KJM, et al. Veterinary drugs market in Cameroon: Regulations, organization, and distribution channels. Bull Anim Health Prod Afr. 2018;66:591-605.
9. WHO. Guidelines on use of medically important antimicrobials in food-producing animals: Web annex A: Evidence base. World Health Organization. (No. WHO/NMH/FOS/FZD/17.2). The World Health Organization, Geneva. 2017. Available at: https://apps.who.int/iris/
bitstream/handle/10665/259241/WHO-NMH-FOS-?sequence=1. Accessed 21 Aug 2024.
10. Collignon P, Aarestrup FM, Irwin R, McEwen S. Human deaths and third-generation cephalosporin use in poultry, Europe. Emerg Infect Dis. 2013;19(8):1339-40. https://doi.org/10.3201/eid.1908.12068
1
11. Anderson REV, Boerlin P. Carbapenemase-producing Enterobacteriaceae in animals and methodologies for their detection. Can J Vet Res. 2020;84(1):3-17.PMID: 31920216
12. Irrgang A, Tausch SH, Pauly N, Grobbel M, Kaesbohrer A, Hammerl JA. First detection of GES-5-producing Escherichia coli from livestock-an increasing diversity of carbapenemases recognized from German pig production. Microorganisms. 2020;8(10); https://doi.or
g/10.3390/microorganisms8101593
13. Levi G, Lurie-Weinberger M, Keren-Paz A, Andremont AO, Schwartz D, Carmeli Y. Unraveling the diversity of co-colonization by CPE. Microorganisms. 2022;10(7). https://doi.org/10.3390/microorgani
sms10071292
14. Köck R, Daniels-Haardt I, Becker K, Mellmann A, Friedrich AW, Mevius D, et al. Carbapenem-resistant Enterobacteriaceae in wildlife, food-producing, and companion animals: A systematic review. Clin Microbiol Infect. 2018;24(12):1241-50. https://doi.org/10.1016/j.cmi.2018.04.004
15. WHO. World Health Organization (WHO) bacterial priority pathogens list, 2024: Bacterial pathogens of public health importance to guide research, development, and strategies, prevent and control antimicrobial resistance. 2024. Available at: https://iris.who.int/bitstream/handle/10665/376776/9789240093461-eng.pdf?sequence=1&isAllowed=y. Accessed 21 August 2024.
16. Gupta N, Limbago BM, Patel JB, Kallen AJ. Carbapenem-resistant Enterobacteriaceae: Epidemiology and prevention. Clin Infect Dis. 2011;53(1):60-7. https://doi.org/10.1093/cid/cir202
17. Ramírez-Castillo FY, Guerrero-Barrera AL, Avelar-González FJ. An overview of carbapenem-resistant organisms from food-producing animals, seafood, aquaculture, companion animals, and wildlife. Front Vet Sci. 2023;10:1158588. https://doi.org/10.3389/fvets.202
3.1158588
18. Taggar G, Attiq Rheman M, Boerlin P, Diarra MS. Molecular epidemiology of carbapenemases in Enterobacteriales from humans, animals, food and the environment. Antibiotics (Basel). 2020;9(10). https://doi.org/10.3390/antibiotics9100693
19. Ma J, Song X, Li M, Yu Z, Cheng W, Yu Z, et al. Global spread of carbapenem-resistant Enterobacteriaceae: Epidemiological features, resistance mechanisms, detection and therapy. Microbiol Res. 2023;266:127249. https://doi.org/10.1016/j.micres.2022. 127249
20. Makharita RR, El-Kholy I, Hetta HF, Abdelaziz MH, Hagagy FI, Ahmed AA, Algammal AM. Antibiogram and genetic characterization of carbapenem-resistant gram-negative pathogens incriminated in healthcare-associated infections. Infect Drug Resist. 2020;13:3991-4002. https://doi.org/10.2147/idr.S276975
21. Feng J, Xiang Q, Ma J, Zhang P, Li K, Wu K, et al. Characterization of carbapenem-resistant Enterobacteriaceae cultured from retail meat products, patients, and porcine excrement in China. Front Microbiol. 2021;12:743468. https://doi.org/10.3389/fmicb.2021.7
43468
22. Montezzi LF, Campana EH, Corrêa LL, Justo LH, Paschoal RP, da Silva IL, et al. Occurrence of carbapenemase-producing bacteria in coastal recreational waters. Int J Antimicrob Agents. 2015;45(2):174-7. https://doi.org/10.1016/j.ijantimicag.2014.10.0
16
23. Vougat-Ngom R, Jajere SM, Ayissi GJ, Tanyienow A, Moffo F, Watsop HM, et al. Unveiling the landscape of resistance against high priority critically important antimicrobials in food-producing animals across Africa: A scoping review. Prev Vet Med. 2024;226:106173. https://doi.org/10.1016/j.prevetmed.2024.1061
73
24. Manenzhe RI, Zar HJ, Nicol MP, Kaba M. The spread of carbapenemase-producing bacteria in Africa: A systematic review. J Antimicrob Chemother. 2015;70(1):23-40. https://doi.org/10.1093
/jac/dku356
25. Mitgang EA, Hartley DM, Malchione MD, Koch M, Goodman JL. Review and mapping of carbapenem-resistant Enterobacteriaceae in Africa: Using diverse data to inform surveillance gaps. Int J Antimicrob Agents. 2018;52(3):372-84. https://doi.org/10.1016/j.i
jantimicag.2018.05.019
26. WHO. The One Health definition and principles developed by One Health high level expert panel. World Health Organization, updated on July 24, 2023. 9P. 2023 Available at: https://www.who.int/publi
cations/m/item/one-health-definitions-and-principles. Accessed 21 August 2024.
27. Velazquez-Meza ME, Galarde-López M, Carrillo-Quiróz B, Alpuche-Aranda CM. Antimicrobial resistance: One Health approach. Vet World. 2022;15(3):743-9. https://doi.org/10.14202/vetworld.2022
.743-749
28. Mohamed HS, Galal L, Hayer J, Benavides JA, Bañuls AL, Dupont C, et al. Genomic epidemiology of carbapenemase-producing Gram-negative bacteria at the human-animal-environment interface in Djibouti city, Djibouti. Sci Total Environ. 2023;905:167160. https://doi.org/10.1016/j.scitotenv.2023.167160
29. Ramsamy Y, Mlisana KP, Amoako DG, Abia ALK, Ismail A, Allam M, et al. Mobile genetic elements-mediated Enterobacterales-associated carbapenemase antibiotic resistance genes propagation between the environment and humans: A One Health South African study. Sci Total Environ. 2022;806(3):150641. https://doi.org/10.1016/j.scit
otenv.2021.150641
30. Tuhamize B, Asiimwe BB, Kasaza K, Sabiiti W, Holden M, Bazira J. Klebsiella pneumoniae carbapenamases in Escherichia coli isolated from humans and livestock in rural south-western Uganda. PLoS One. 2023;18(7):e0288243. https://doi.org/10.1371/journal.pone.
0288243
31. Ramadan H, Gupta SK, Sharma P, Ahmed M, Hiott LM, Barrett JB, et al. Circulation of emerging NDM-5-producing Escherichia coli among humans and dogs in Egypt. Zoonoses Public Health. 2020;67(3):324-9. https://doi.org/10.1111/zph.12676
32. Ngbede EO, Adekanmbi F, Poudel A, Kalalah A, Kelly P, Yang Y, et al. Concurrent resistance to carbapenem and colistin among Enterobacteriaceae recovered from human and animal sources in Nigeria is associated with multiple genetic mechanisms. Front Microbiol. 2021;12:740348. https://doi.org/10.3389/fmicb.2021.7
40348
33. Galal L, Mohamed HS, Dupont C, Conquet G, Carriere C, Aboubaker MH, et al. Circulation of hypervirulent carbapenem-resistant Klebsiella pneumoniae in humans and fish in Djibouti. J Antimicrob Chemother. 2024;79(8):2068-71. https://doi.org/10.1093/jac/dka
e144
34. Mairi A, Pantel A, Ousalem F, Sotto A, Touati A, Lavigne JP. OXA-48-producing Enterobacterales in different ecological niches in Algeria: Clonal expansion, plasmid characteristics, and virulence traits. J Antimicrob Chemother. 2019;74(7):1848-55. https://doi.or
g/10.1093/jac/dkz146
35. Hamza D, Dorgham S, Ismael E, El-Moez SIA, Elhariri M, Elhelw R, et al. Emergence of β-lactamase- and carbapenemase- producing Enterobacteriaceae at integrated fish farms. Antimicrob Resist Infect Control. 2020;9(1):67. https://doi.org/10.1186/s13756-020-00736-3
36. Soliman EA, Saad A, Abd El Tawab AA, Elhofy FI, Rizk AM, Elkhayat M, et al. Exploring AMR and virulence in Klebsiella pneumoniae isolated from humans and pet animals: A complement of phenotype by WGS-derived profiles in a One Health study in Egypt. One Health. 2024;19:100904. https://doi.org/10.1016/j.onehlt.2024.100904
37. Tuhamize B, Bazira J. Carbapenem-resistant Enterobacteriaceae in the livestock, humans, and environmental samples around the globe: A systematic review and meta-analysis. Sci Rep. 2024;14(1):16333. https://doi.org/10.1038/s41598-024-64992-8
38. Kelly AM, Mathema B, Larson EL. Carbapenem-resistant Enterobacteriaceae in the community: A scoping review. Int J Antimicrob Agents. 2017;50(2):127-34. https://doi.org/10.1016/j.i
jantimicag.2017.03.012
39. van Loon K, Voor In 't Holt AF, Vos MC. A Systematic review and meta-analyses of the clinical epidemiology of carbapenem-resistant Enterobacteriaceae. Antimicrob Agents Chemother. 2018;62(1). https://doi.org/10.1128/aac.01730-17
40. Pavez M, Vieira C, de Araujo MR, Cerda A, de Almeida LM, Lincopan N, et al. Molecular mechanisms of membrane impermeability in clinical isolates of Enterobacteriaceae exposed to imipenem selective pressure. Int J Antimicrob Agents. 2016;48(1):78-85. https://doi.org/10.1016/j.ijantimicag.2016.04.016
41. Paschoal RP, Campana EH, de SCL, Picão RC. Predictors of carbapenemase-producing bacteria occurrence in polluted coastal waters. Environ Pollut. 2020;264:114776. https://doi.org/10.1016/
j.envpol.2020.114776
42. Gong X, Zhang J, Su S, Fu Y, Bao M, Wang Y, et al. Molecular characterization and epidemiology of carbapenem non-susceptible Enterobacteriaceae isolated from the Eastern region of Heilongjiang Province, China. BMC Infect Dis. 2018;18(1):417. https://doi.org/1
0.1186/s12879-018-3294-3
43. Haller L, Chen H, Ng C, Le TH, Koh TH, Barkham T, et al. Occurrence and characteristics of extended-spectrum β-lactamase- and carbapenemase- producing bacteria from hospital effluents in Singapore. Sci Total Environ. 2018;615:1119-25. https://doi.org/10
.1016/j.scitotenv.2017.09.217
44. Suay-García B, Pérez-Gracia MT. Present and future of carbapenem-resistant Enterobacteriaceae (CRE) infections. Antibiotics (Basel). 2019;8(3). https://doi.org/10.3390/antibiotics8030122
45. Nordmann P, Poirel L. The difficult-to-control spread of carbapenemase producers among Enterobacteriaceae worldwide. Clin Microbiol Infect. 2014;20(9):821-30. https://doi.org/10.1111/
1469-0691.12719
46. Tilahun M, Kassa Y, Gedefie A, Ashagire M. Emerging carbapenem-resistant Enterobacteriaceae infection, its epidemiology and novel treatment options: A review. Infect. Drug Resist. 2021;14:4363-74. https://doi.org/10.2147/idr.S337611
47. Partridge SR. Resistance mechanisms in Enterobacteriaceae. Pathology. 2015;47(3):276-84. https://doi.org/10.1097/pat.00000
00000000237
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