A systematic review and meta-analysis of integrated studies on antimicrobial resistance in Vietnam, with a focus on Enterobacteriaceae, from a One Health perspective

Prevalence and antimicrobial resistance of Campylobacter jejuni and Campylobacter coli over time in Thailand under a One Health approach: A systematic review and meta-analysis

Campylobacter spp. are major food-borne zoonotic pathogens impacting food safety worldwide. Thailand is one of the countries facing with a significant burden of Campylobacter infections and is recognized as a hotspot of AMR. Our study applied a systematic review and meta-analysis, using a One Health perspective, to investigate the prevalence and AMR of Campylobacter jejuni (C. jejuni) and Campylobacter coli (C. coli) over time in Thailand, from 1985 to 2023. Based on the PRISMA guidelines, a literature search using PubMed, ScienceDirect, and Google Scholar to identify the articles reporting prevalence, sequence types (STs), antimicrobial susceptibility, and resistance genes of Campylobacter spp. in humans, animals, food, and environmental samples was performed. Eighty-one articles were retrieved for systematic review, with 33 reporting Campylobacter spp. prevalence and 20 containing AMR data collected for meta-analysis. The highest prevalence of C. jejuni was found in chickens (43.6 %) and chicken products (31.4 %), followed by ducks (16.7 %), the general human population with diarrhea (15.9 %), children with diarrhea (10.7 %). C. coli was also prevalent in chickens (12.6 %) and chicken products (10.4 %). C. jejuni prevalence decreased by 14.8 % among children with diarrhea (p = 0.006), but increased by 16.7 % in chicken products (p = 0.007). Sixty-two STs were identified, with ST 574, ST 1075, ST 51 being the most prevalent STs recorded. Five STs, including ST 50, ST 51, ST 354, ST 464, and ST 574, were reported in both humans and chickens. The AMR levels were highest against quinolones, ranging 75.4 %-94.8 % in human-related categories and 71.6 %-88.7 % in chicken-related categories. Notably, ciprofloxacin-resistant and nalidixic acid-resistant C. jejuni strains collected from chickens increased by 11.9 % (p = 0.004) and 16.1 % (p = 0.027), respectively. Thirteen resistance genes/mutations were reported, with the phenotypic resistance linked to gyrA mutations and tet(O) genes. The high prevalence and increasing trend of AMR in C. jejuni and C. coli underscore the critical need for One Health surveillance to address the rising AMR challenge posed by these pathogens in Thailand.

A Systematic Review and Meta-Analysis on the Presence of Escherichia coli O157:H7 in Africa from a One Health Perspective

This systematic review aimed to assess the prevalence of Escherichia coli O157:H7 using a One Health approach, integrating data from human, animal, and environmental sources across Africa. Following PRISMA guidelines, studies reporting on E. coli O157:H7 in human, animal, and environment samples from African countries were retrieved from PubMed, Scopus, Web of Science, and Google Scholar. All data were analyzed using a binary random-effects model by the DerSimonian-Laird method at a 95% confidence interval. Out of 1757 publications generated, 56 from 9 countries including Ethiopia (17/56), South Africa (13/56), Nigeria (10/56), Egypt (9/56), Ghana (2/56), Tanzania (2/56), Benin (1/56), Namibia (1/56), and Senegal (1/56) were included. The pooled prevalence of E. coli O157:H7 was 4.7%, with the highest prevalence observed among animal samples (5.4%) followed by the environmental and human samples (3.4 and 2.8%, respectively). The pooled prevalence of antibiotic resistance was observed to be 96.5%, 82.8%, 76.8%, 70.7%, 62.1%, 50.4%, and 40.2% for cefoxitin, ampicillin, cefuroxime, nitrofurantoin, amikacin, amoxiclav, and ciprofloxacin, respectively. This distribution highlights the interconnectedness between animals, the environment, and human populations in the transmission and persistence of this pathogen and the need to implement a suitable and appropriate One Health pathogenic and antimicrobial resistance surveillance system in the African region.

Phenotypic and genotypic landscape of antibiotic resistance through One Health approach in Sri Lanka: A systematic review

OBJECTIVES

Antibiotic resistance (ABR) constitutes a significant burden to economies in developing countries. In the 'One-Health' concept, ABR in human, animals, and environment is interconnected. The aim of this study was to critically appraise literature on ABR in all three domains in One Health, within the Sri Lankan geographical context.

METHODS

The protocol was registered with PROSPERO and followed PRISMA 2020 guidelines. A comprehensive electronic literature search was conducted in PubMed, Scopus, Web of Science databases and grey literature via Google Scholar. Out of 298 abstracts, 37 articles were selected following screening. A risk of bias assessment was conducted using Joanna Briggs Institute tools. Following blinded data extraction, descriptive data analysis and narrative synthesis were performed.

RESULTS

This review included studies published between 2016-2023. Of the included studies, 17 (45.9%) reported data on samples obtained from humans, 9 (24.3%) from animals, and 6 (16.2%) from environmental sources, two studies (5.4%) from humans and animals, one study on animal and environment; whereas two studies including all three domains. ABR of 32 different bacteria (Gram negative⸺17, Gram positive⸺14) was retrieved; E. coli was the most frequently studied bacteria followed by MRSA and ESBL. For E. coli, a median resistance over 50% was reported for sulfamethoxazole (88.8%), trimethoprim (79.1%), ampicillin (60%) and tetracycline (50.3%) with the highest resistance for erythromycin (98%). Of a total of 21 antibiotic-resistance genes in E. coli, the highest genotypic resistance was for tet-A (48.5%).

CONCLUSIONS

A comprehensive description of ABR for a total of 32 bacteria, 62 antibiotics and 46 ABR genes is presented. This review discusses the contemporary ABR landscape in Sri Lanka through the One Health lens, highlighting key methodological and empirical research gaps.

Epidemiology and antimicrobial resistance patterns of urinary tract infection: insights and strategies from a 5-year serial cross-sectional study in Vietnam

Background

Urinary tract infection (UTI) is one of the most common bacterial infections in clinical practice. Given the rapid increase in antimicrobial resistance and the scarcity of new antibiotics, along with the absence of individual antibiogram testing in some countries, there is an urgent need for robust surveillance systems.

Objective

This study aimed to provide evidence for the surveillance of resistance, a crucial component in developing national UTI treatment guidelines and guiding empirical therapy decisions.

Design

This study utilized a retrospective, serial cross-sectional design.

Methods

Antimicrobial surveillance was conducted using data collected from January 1, 2017 to December 31, 2021. A total of 2595 patients with UTIs were recruited for this study. From these patients, 2004 bacterial isolates were identified and subjected to epidemiological and antibiotic resistance analyses.

Results

Escherichia coli (E. coli, 42.7%), Pseudomonas aeruginosa (P. aeruginosa, 11.9%), and Klebsiella pneumoniae (K. pneumoniae, 10.9%) were identified as the predominant causes of UTIs. E. coli isolates demonstrated a high level of sensitivity (80%-90%) to carbapenems (imipenem, ertapenem, and meropenem), aminoglycosides (amikacin), piperacillin/tazobactam, cefoperazone/sulbactam, and fosfomycin. The antibiotic resistance rates of K. pneumoniae strains consistently exceeded 50%, except for amikacin, ertapenem, imipenem, meropenem, and fosfomycin. Notably, all K. pneumoniae strains isolated from patients with UTIs were resistant to ampicillin. During the coronavirus disease pandemic, the E. coli and K. pneumoniae isolates exhibited reduced antibiotic resistance compared to the pre-pandemic period. The resistance rate of P. aeruginosa isolates remained consistently high (60%-70%).

Conclusion

Amikacin, ertapenem, imipenem, meropenem, and fosfomycin are promising treatment options for enterobacterial UTIs. However, their efficacy against P. aeruginosa is limited. This study revealed alarmingly high rates of primary etiological pathogen resistance to commonly prescribed empirical therapies for UTIs. These findings provide crucial data for optimizing national guidelines and implementing personalized treatment strategies to enhance the effectiveness of UTI treatments.

Tetracycline Resistance among Escherichia coli Isolates from Broilers in Iran: A Systematic Review and Meta-Analysis

Background

Avian colibacillosis are infections caused by Avian Pathogenic Escherichia coli which causes high morbidity, high mortality, and significant economic losses. Antibiotics such as tetracycline are an important treatment choice for colibacillosis in Iran. However, the irrational use of antibiotics has caused high antibiotic resistance. The aim of this study was to estimate the tetracycline resistance rate among E. coli isolates from broilers in Iran.

Methods

PubMed, Scopus, Web of Science, Google Scholar, Islamic World Science Citation, Scientific Information Database, and MagIran databases were searched from 2013 and 2023. Risk of bias assessment was assessed with Appraisal tool for Cross-Sectional Studies. For meta-analysis, a random effects model with Freeman-Tukey double arcsine transformation was used. Subgroup analysis for the year of publication and sensitivity analysis to assess the influence of individual studies were conducted and a province-level map of point estimates was drawn.

Results

Among 13 included studies, the pooled tetracycline resistance was 85% (95% CI: 76-92%) and I-squared was 94.29%. In subgroup analysis, resistance rate was higher for articles published in 2018-2023 (91%) compared to articles published in 2013-2017 (76%), but heterogeneity between groups was not statistically-significant (P=0.12). sensitivity analysis showed that the omission of individual studies caused no apparent change. The province-level map showed that most of the studies belonged to northern parts of Iran with Ardabil (99.65%) having the highest value.

Conclusion

Resistance against tetracycline in E. coli isolates from broilers in Iran is alarming. The sensible use of tetracycline is advised.

Non-typhoidal Salmonella in humans in India, Vietnam, Bangladesh and Sri Lanka: a systematic review

Objectives

Non-typhoidal Salmonella (NTS) commonly causes a self-limiting illness but invasive disease (iNTS) can be life-threatening. Antimicrobial resistance (AMR) increases the risk of mortality. This systematic review aimed to estimate the proportion of NTS isolated in those attending healthcare services, serovar burden, AMR, serovar-specific AMR, and case fatality rate (CFR) in India, Bangladesh, Sri Lanka and Vietnam.

Methods

The review included quantitative studies on NTS and AMR from 1980 to 2020 but excluded studies unrelated to humans or selected countries. Data were extracted from articles identified from Ovid SP, Web of Science, Wiley Cochrane Library, Elsevier Scopus and WHO Global Index Medicus. The Joanna Briggs Institute Critical Appraisal Tools Checklist for Prevalence Studies was used for risk-of-bias assessment. Meta-analyses were performed for the proportion of NTS isolated, the proportion of specific serovars isolated, percentage of AMR and CFR.

Results

Six thousand and twenty-six isolates (79 serovars) were identified from 73 studies, with Salmonella enterica serovar Typhimurium being the most common. Of the 73 selected studies, 46% were hospital/laboratory surveillance studies, examining the aetiology of invasive or non-invasive infections. The pooled proportion estimate for non-iNTS was 2.1% (95% CI: 1.2%-3.2%) and for iNTS was 0.3% (95% CI: 0.1%-0.5%). The pooled CFR was 14.9% (95% CI: 4.0%-29.6%). Pooled resistance estimates for ampicillin, ceftriaxone, chloramphenicol, ciprofloxacin, co-trimoxazole, nalidixic acid and azithromycin were calculated. MDR iNTS was less prevalent in India [22.3% (95% CI: 0.0%-66.8%)] than in Vietnam [41.2% (95% CI: 33.6%-49.3%)]. Heterogeneity of studies was high as the majority were observational surveillance studies.

Conclusions

Despite data scarcity in some countries, this review highlights the continued contribution of NTS infection to disease burden, compounded by high AMR rates.

A review and meta-analysis of non-typhoidal Salmonella in Vietnam: Challenges to the control and antimicrobial resistance traits of a neglected zoonotic pathogen

Non-typhoidal Salmonella (NTS) is a food-borne zoonotic pathogen with important implications for human health. Despite its importance, the burden of NTS infections in Vietnam is unknown. We conducted a systematic review and a meta-analysis to describe the prevalence and phenotypic antimicrobial resistance (AMR) for NTS over time in Vietnam. Following PRISMA guidelines, we identified 72 studies from PubMed and Google Scholar containing data relevant to 'Salmonella', 'Salmonellosis', and 'Vietnam', or 'Viet Nam'. Of those, forty-two papers reporting prevalence of NTS, and twenty-six including data on phenotypic resistance were selected for meta-analysis. The prevalence of NTS ranged from 2% to 5% in humans and from 30% to 41% in samples from animals and the farm/slaughterhouse environment. Between 2000 and 2020 we observed a 27.3% (p = 0.044) increase in absolute terms in prevalence among individuals with enteric diseases and a 12.0% (p = 0.047) increase in aquaculture/seafood samples. The most commonly serovars identified across studies included S. Weltevreden (12.0%), followed by S. Typhimurium (10.1%), S. Derby (6.4%), S. London (5.8%), S. Anatum (4.4%), S. Rissen (3.9%), S. Enteritidis (3.7%), S. Albany (3.3%) and S. 4,[5],12:i:- (3.0%). Over the same period, there was an increasing trend in the pooled AMR prevalence for quinolones (15.6% relative increase), 3rd-, 4th-, and 5th-generation cephalosporins (23.7%), penicillins (16.1%), tetracyclines (12.9%), sulfonamides (8.8%), amphenicol (17.8%), and multidrug resistance (11.4%) (all p ≤ 0.014). A broad range of AMR genes (ARGs) were detected in both human and animal populations. The observed prevalence and AMR trends in Vietnam underscore the need of adopting a One Health strategy encompassing surveillance systems, research initiatives, and awareness campaigns to effectively address the challenges posed by NTS.

A systematic review and meta-analysis of the global prevalence and relationships among Burkholderia pseudomallei sequence types isolated from humans, animals, and the environment

Background and Aim

Burkholderia pseudomallei, a highly pathogenic bacterium responsible for melioidosis, exhibits ecological ubiquity and thrives within soil and water reservoirs, posing significant infection risks to humans and animals through direct contact. The aim of this study was to elucidate the genetic diversity and prevalence patterns of B. pseudomallei sequence types (STs) across a global spectrum and to understand the relationships between strains isolated from different sources.

Materials and Methods

We performed a systematic review and meta-analysis in this study. Extensive research was carried out across three comprehensive databases, including PubMed, Scopus, and ScienceDirect with data collected from 1924 to 2023.

Results

A total of 40 carefully selected articles contributed 2737 B. pseudomallei isolates attributed to 729 distinct STs and were incorporated into the systematic review. Among these, ST46 emerged as the most prominent, featuring in 35% of the articles and demonstrating a dominant prevalence, particularly within Southeast Asia. Moreover, ST51 consistently appeared across human, animal, and environmental studies. Subsequently, we performed a meta-analysis, focusing on nine specific STs: ST46, ST51, ST54, ST70, ST84, ST109, ST289, ST325, and ST376. Surprisingly, no statistically significant differences in their pooled prevalence proportions were observed across these compartments for ST46, ST70, ST289, ST325, and ST376 (all p > 0.69). Conversely, the remaining STs, including ST51, ST54, ST84, and ST109, displayed notable variations in their prevalence among the three domains (all p < 0.04). Notably, the pooled prevalence of ST51 in animals and environmental samples surpassed that found in human isolates (p < 0.01).

Conclusion

To the best of our knowledge, this study is the first systematic review and meta-analysis to investigate the intricate relationships between STs and their sources and contributes significantly to our understanding of B. pseudomallei diversity within the One Health framework.

Salmonella Typhimurium with Eight Tandem Copies of blaNDM-1 on a HI2 Plasmid

Carbapenem-resistant Salmonella has recently aroused increasing attention. In this study, a total of four sequence type 36 Salmonella enterica subsp. enterica serovar Typhimurium (S. Typhimurium) isolates were consecutively isolated from an 11-month-old female patient with a gastrointestinal infection, of which one was sensitive to carbapenems and three were resistant to carbapenems. Via antibiotic susceptibility testing, a carbapenemases screening test, plasmid conjugation experiments, Illumina short-reads, and PacBio HiFi sequencing, we found that all four S. Typhimurium isolates contained a blaCTX-M-14-positive IncI1 plasmid. One carbapenem-sensitive S. Typhimurium isolate then obtained an IncHI2 plasmid carrying blaNDM-1 and an IncP plasmid without any resistance genes during the disease progression. The blaNDM-1 gene was located on a new 30 kb multiple drug resistance region, which is flanked by IS26 and TnAs2, respectively. In addition, the ST_F0903R isolate contained eight tandem copies of the ISCR1 unit (ISCR1-dsbD-trpF-ble-blaNDM-1-ISAba125Δ1), but an increase in MICs to carbapenems was not observed. Our work further provided evidence of the rapid spread and amplification of blaNDM-1 through plasmid. Prompting the recognition of carbapenem-resistant Enterobacterales and the initiation of appropriate infection control measures are essential to avoid the spread of these organisms.

Antimicrobial resistance and biofilm formation of Escherichia coli in a Vietnamese Pangasius fish processing facility

This study aimed to investigate the occurrence, antibiotic resistance, and biofilm formation of Escherichia coli in the Vietnamese Pangasius fish processing facility. Among 144 samples including Pangasius fish, wash water, food contact surfaces, and personnel gloves, 18 E. coli isolates was detected and characterized. The E. coli was detected most frequently in wash water samples (22%, 8/36), followed by Pangasius fish (18%, 8/45). According to the antibiotic susceptibility test by the disc diffusion method, isolates showed the highest resistance against sulfamethoxazole/trimethoprim (45%), followed by tetracycline (39%), whereas all the E. coli isolates were susceptible to meropenem and fosfomycin. Notably, 39% of the isolates (7/18) were found to be multidrug resistant while no E. coli isolates were confirmed as extended-spectrum β-lactamase producers by the double-disk synergy test. The potency to form biofilm on the polystyrene surface of E. coli isolates indicated that 44% of the isolates (8/18) were classified as weak, 39% (7/18) as moderate, and 17% (3/18) as strong biofilm formers. Interestingly, multidrug resistant E. coli isolates were observed in moderate and strong biofilm producers. Additionally, either slightly acidic hypochlorous water with 40 mg/L of available chlorine or sodium hypochlorite with 100 mg/L of available chlorine exhibited a significant reduction in biofilm mass and biofilm cells of E. coli isolates. This study may provide helpful information about the actual state of E. coli isolates for effective control in the fish processing plant.