Prevalence of multidrug-resistant and extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacilli: A meta-analysis report in Ethiopia

  • Mengistu Abayneh School of Medical Laboratory Sciences, Mizan-Tepi University, Mizan-Aman - Ethiopia
  • Teshale Worku School of Medical Laboratory Sciences, Mizan-Tepi University, Mizan-Aman - Ethiopia
Keywords: Ethiopia, Extended-spectrum beta-lactamase, Gram negative, Multidrug resistance


Multidrug-resistant (MDR) extended-spectrum beta-lactamase (ESBL)-producing bacterial isolates have emerged as a global threat to human health. Little is known about the overall prevalence of multidrug resistance profile and ESBL-producing gram-negative bacilli (GNB) in Ethiopia. Therefore, this meta-analysis was performed to produce proportional estimates of multidrug resistance and ESBL-producing GNB in Ethiopia.

A web-based search was conducted in PubMed, Google Scholar, Research Gate, Scopus and other databases. Articles published till 2019 on the prevalence and antimicrobial resistance profiles of ESBL-producing GNB in Ethiopia were included in the study. Relevant data were extracted and statistical analysis was performed using comprehensive meta-analysis version 3.3.0 software. Publication bias was analyzed and presented with funnel plots.

In this meta-analysis, the overall proportional estimate of ESBL-producing GNB was 48.9% (95% confidence interval [CI]: 0.402, 0.577). The pooled proportional estimates of ESBL-producing Klebsiella pneumoniae, Escherichia coli and other GNB were 61.8%, 41.2% and 42.9%, respectively. Regarding antimicrobial resistance profiles against selected drugs, the pooled proportional estimates of resistance against amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole, cefotaxime, ceftazidime, tetracycline, gentamicin and ciprofloxacin was 79.0%, 78.4%, 78.0%, 72.4%, 72.7%, 58.9% and 43.8%, respectively. The pooled proportional estimates of MDR isolates were found to be 82.7% (95% CI: 0.726, 0.896), which are relatively high as compared to other countries. This highlights a need for active surveillance systems which can help understand the actual epidemiology of ESBL, aid in formulating national guidelines for proper screening of ESBL and support developing standardized approaches for managing patients colonized with ESBL


Dhillon RH, Clark J. ESBLs: a clear and present danger? Hindawi Publ Corp. 2012;11.

Byarugaba DK. Antimicrobial resistance in developing countries Springer, 2009;15-27.

Erku DA, Mekuria AB, Belachew SA. Inappropriate use of antibiotics among communities of Gondar town, Ethiopia: a threat to the development of antimicrobial resistance. Antimicrob Resist Infect Control. 2017;6:112. Crossref

Gebretekle GB, Serbessa MK. Exploration of over the counter sales of antibiotics in community pharmacies of Addis Ababa, Ethiopia: pharmacy professionals’ perspective. Antimicrob Resist Infect Control. 2016;5:2. Crossref

European Centre for Disease Prevention and Control. Systematic review of the effectiveness of infection control measures to prevent the transmission of extended-spectrum beta-lactamase-producing Enterobacteriaceae through cross-border transfer of patients. Stockholm: ECDC 2014. Crossref

Morosini MI, García-Castillo M, Coque TM, et al. Antibiotic co-resistance in ESBL-producing Enterobacteriaceae and in vitro activity of tigecycline. Antimicrob Agents Chemother. 2006;50(8):2695-2699.

Cantón R, Novais A, Valverde A, et al. Prevalence and spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae in Europe. Clin Microbiol Infect. 2008;14 Suppl 1:144-153.

Shamsrizi P, Gladstone BP, Carrara E, et al. Variation of effect estimates in the analysis of mortality and length of hospital stay in patients with infections caused by bacteria-producing extended-spectrum beta-lactamases: a systematic review and meta-analysis. BMJ Open. 2020;10:e030266. Crossref

Paterson DL, Bonomo RA. Extended-spectrum β-lactamases: a clinical update. Clin Microbiol Rev. 2005;18(4):657-686.

Giske CG, Monnet DL, Cars O, Carmeli Y, ReAct-Action on Antibiotic Resistance. Clinical and economic impact of common multidrug-resistant gram-negative bacilli. Antimicrob Agents Chemother. 2008;52(3):813-821

Bonnet R. Growing group of extended-spectrum beta-lactamases: the CTX-M enzymes. Antimicrob Agents Chemother. 2004;48(1):1-14.

Villegas M V, Kattan JN, Quinteros MG, Casellas JM. Prevalence of extended-spectrum b-lactamases in South America. Clin Microbiol Infect. European Society of Clinical Microbiology and Infectious Diseases; 2008;14:154-158.

Hawkey PM. Prevalence and clonality of extended-spectrum beta-lactamases in Asia. Clin Microbiol Infect. 2008;14:159-165.

Bradford PA. Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Am Soc Microbiol. 2001;14(4):933-951.

Tham J, Melander E, Walder M, Edquist PJ, Odenholt I. Prevalence of faecal ESBL carriage in the community and in a hospital setting in a county of Southern Sweden. Eur J Clin Microbiol Infect Dis. 2011;10:1159-1162

Malta M, Cardoso LO, Bastos FI, Magnanini MM, Silva CM. STROBE initiative: guidelines on reporting observational studies. Saude Publica. 2010;44(3):559-565. Crossref

Desta K, Woldeamanuel Y, Azazh A, et al. High gastrointestinal colonization rate with extended-spectrum β-lactamase-producing Enterobacteriaceae in hospitalized patients: emergence of carbapenemase-producing K. pneumoniae in Ethiopia. PLoS One. 2016;11(8):e0161685. Crossref

Teklu DS, Negeri AA, Legese MH, Bedada TL, Woldemariam HK, Tullu KD. Extended-spectrum beta-lactamase-production and multi-drug resistance among Enterobacteriaceae isolated in Addis Ababa, Ethiopia. Antimicrob Resist Infect Control. 2019; 8:39. Crossref

Moges F, Eshetie S, Abebe W, et al. High prevalence of extended-spectrum beta-lactamase-producing gram-negative pathogens from patients attending Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Amhara region. PLoS One. 2019;14(4):e0215177. Crossref

Legese MH, Weldearegay MG, Asrat D. Extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae among Ethiopian children. Infect Drug Resist. 2017;10:27-34. Crossref

Engda T, Moges F, Gelaw A, Eshete S, Mekonnen F. Prevalence and antimicrobial susceptibility patterns of extended spectrum beta-lactamase producing Entrobacteriaceae in the University of Gondar Referral Hospital environments, northwest Ethiopia. BMC Res Notes. 2018;11:335. Crossref

Gashaw M, Berhane M, Bekele S, et al. Emergence of high drug resistant bacterial isolates from patients with health care associated infections at Jimma University medical center: a cross sectional study. Antimicrob Resist Infect Control. 2018;7:138. Crossref

Mulualem Y, Kasa T, Mekonnen Z, Suleman S. Occurrence of extended spectrum beta (beta)-lactamases in multi-drug resistant Escherichia coli isolated from a clinical setting in Jimma University Specialized Hospital, Jimma, and Southwest Ethiopia. East Afr J Public Health. 2012;9(2):58-61. PMID: 23139958.

Zeynudin A, Pritsch M, Schubert S, et al. Prevalence and antibiotic susceptibility pattern of CTX-M type extended-spectrum β-lactamases among clinical isolates of gram-negative bacilli in Jimma, Ethiopia. BMC Infect Dis.2018;18:524. Crossref

Eshetie S, Unakal C, Gelaw A, Ayelign B, Endris M, Moges F. Multidrug resistant and carbapenemase producing Enterobacteriaceae among patients with urinary tract infection at referral Hospital, Northwest Ethiopia. Antimicrob Resist Infect Control. 2015;4:12. Crossref

Beyene G, Nair S, Asrat D, Mengistu Y, Engers H, Wain J. Multidrug resistant Salmonella Concord is a major cause of salmonellosis in children in Ethiopia. J Infect DevCtries. 2011;5:023-033. Crossref

Abera B, Kibret M, Mulu W. Extended-spectrum beta (β)-lactamases and antibiogram in Enterobacteriaceae from clinical and drinking water sources from Bahir Dar City, Ethiopia. PLoS One. 2016;11(11):e0166519. Crossref

Seid J, Asrat D. Occurrence of extended spectrum beta-lactamse enzymes in clinical isolates of Klebsiella species from Harar region, eastern Ethiopia. Acta Trop. 2005;95(2);143-148. Crossref

Abayneh M, Tesfaw G, Abdissa A. Isolation of extended-spectrum β-lactamase-(ESBL) - producing E. coli and K. pneumoniae from patients with community-onset urinary tract infections in Jimma University Specialized Hospital, Southwest Ethiopia. Can J Infect Dis Med Microbiol. 2018;2018:4846159. Crossref

Siraj SM, Ali S, Wondafrash B. Extended-spectrum-lactamase production and antimicrobial resistance in Klebsiellapneumoniae and Escherichia coli among inpatients and outpatients of Jimma University Specialized Hospital, South-west, Ethiopia. Afr J Microbiol Res. 2014;8(43):3687-3694.

Mulisa G, Selassie L, Jarso G, Shiferew T, Zewdu A. Prevalence of extended spectrum beta-lactamase producing Enterobacteriaceae: a cross sectional study at Adama Hospital, Adama, Ethiopia. J Emerg Infect DisPatho. 2016;1(1):102.

Bitew A. High prevalence of multi-drug resistance and extended spectrum beta-lactamase- production in non-fermenting gram-negative bacilli in Ethiopia. Infect Dis Res Treat. 2019;12:1-7.

Beyene D, Bitew A, Fantew S, Mihret A, Evans M. Multidrug-resistant profile and prevalence of extended spectrum β-lactamase and carbapenemase- production in fermentative gram-negative bacilli recovered from patients and specimens referred to National Reference Laboratory, Addis Ababa, Ethiopia. PLoS One. 2019;14(9):e0222911. Crossref

Sonda T, Kumburu H, van Zwetselaar M, et al. Meta-analysis of proportion estimates of extended-spectrum-beta-lactamase-producing Enterobacteriaceae in East Africa hospitals. Antimicrob Resist Infect Control.2016;5:18. Crossref

Abrar S, Hussain S, Khan RA, Ul Ain N, Haider H, Riaz S. Prevalence of extended-spectrum-β-lactamase-producing Enterobacteriaceae: first systematic meta-analysis report from Pakistan. Antimicrob Resist Infect Control. 2018;7:26. Crossref

Tansarli GS, Poulikakos P, Kapaskelis A, Falagas ME. Proportion of extended-spectrum b-lactamase (ESBL)-producing isolates among Enterobacteriaceae in Africa: evaluation of the evidence—systematic review. J Antimicrob Chemother. 2014;69:1177-1184. Crossref

Mansouri F, Sheibani H, Masroor MJ, Afsharian M. Extended‐spectrum beta‐lactamase (ESBL)‐producing Enterobacteriaceae and urinary tract infections in pregnant/postpartum women: a systematic review and meta‐analysis. Int J Clin Pract. 2019;37(12). Crossref

Zhang J, Zheng B, Zhao L, et al. Nationwide high prevalence of CTX-M and an increase of CTX-M-55 in Escherichia coli isolated from patients with community-onset infections in Chinese county hospitals. BMC Infect Dis. 2014;14:659-663.

Obeng-Nkrumah N, Twum-Danso K, Krogfelt K, Newman MJ. High levels of extended-spectrum beta-lactamases in a major teaching hospital in Ghana: the need for regular monitoring and evaluation of antibiotic resistance. Am J Trop Med Hyg. 2013;89:960-964.

Magoué CL, Melin P, Gangoué-Piéboji J, Okomo Assoumou M-C, Boreux R, De Mol P. Prevalence and spread of extended-spectrum β-lactamase-producing Enterobacteriaceae in Ngaoundere, Cameroon. Clin Microbiol Infect. 2013;19:416-420.

Girlich D, Bouihat N, Poirel L, Benouda A, Nordmann P. High rate of faecal carriage of extended-spectrum β-lactamase and OXA-48 carbapenemase-producing Enterobacteriaceae at a university hospital in Morocco. Clin Microbiol Infect. 2014;20:350-354.

Hoban DJ, Lascols C, Nicolle LE, et al. Antimicrobial susceptibility of Enterobacteriaceae, including molecular characterization of extended-spectrum beta-lactamase-producing species, in urinary tract isolates from hospitalized patients in North America and Europe: results from the SMART study. Diagn Microbiol Infect Dis. Elsevier Inc. 2012;74(1):62-67. Crossref

Yang Q, Xu YC, Kiratisin P, Dowzicky MJ. Antimicrobial activity among gram-positive and gram-negative organisms collected from the Asia-Pacific region as part of the Tigecycline Evaluation and Surveillance Trial: comparison of 2015 results with previous years. Diagn Microbiol Infect Dis. 2017;89:314-323.

Hawser SP, Bouchillon SK, Hoban DJ, Badal RE, Hsueh PR, Paterson DL. Emergence of high levels of extended-spectrum-beta-lactamase-producing gram-negative bacilli in the Asia-Pacifc region: data from the Study for Monitoring Antimicrobial Resistance Trends (SMART) program, 2007. Antimicrob Agents Chemother. 2009;53:3280-3284.

Lu PL, Liu YC, Toh HS, et al. Epidemiology and antimicrobial susceptibility profiles of Gram-negative bacteria causing urinary tract infections in the Asia-Pacific region: 2009-2010 results from the Study for Monitoring Antimicrobial Resistance Trends (SMART). Int J Antimicrob Agents. 2012;40:S37-S43.

Lewis JM, Lester R, Garner P, Feasey NA. Gut mucosal colonisation with extended-spectrum beta-lactamase producing Enterobacteriaceae in sub-Saharan Africa: a systematic review and meta-analysis [version 2; peer- review: 2 approved]: Wellcome Open Res. 2020;4:160. Crossref

Muhie OA. Antibiotic use and resistance pattern in Ethiopia: systematic review and meta-analysis. Int J Microbiol. 2019, Article ID 2489063, 8 pages. Crossref

Pavez M, Troncoso C, Irma Osses I, et al. High prevalence of CTX-M-1 group in ESBL-producing Enterobacteriaceae infection in intensive care units in southern Chile. Braz J Infect Dis. 2019;23(2):102-110.

Moges F, Endris M, Belyhun Y, Worku W. Isolation and characterization of multiple drug resistance bacterial pathogens from waste water in hospital and non-hospital environments, Northwest Ethiopia. BMC Res Notes. 2014;7:215. Published 2014 Apr 5. Crossref

Rodríguez-Baño J, Gutiérrez-Gutiérrez B, Machuca I, Pascual A. Treatment of infections caused by extended-spectrum-beta-lactamase-, AmpC-, and carbapenemase-producing Enterobacteriaceae. Clin Microbiol Rev. 2018;31:e00079-17. Crossref

Harris P, Paterson D, Rogers B. Facing the challenge of multidrug-resistant gram-negative bacilli in Australia. MJA. 2015;202(5). Crossref

Seboxa T, Amogne W, Abebe W, et al. High mortality from blood stream infection in Addis Ababa, Ethiopia, is due to antimicrobial resistance. PLoS One. 2015;10(12):e0144944. Crossref

Flokas M, Karanika S, Alevizakos M, Mylonakis E. Prevalence of ESBL-producing Enterobacteriaceae in pediatric blood-stream infections: a systematic review and meta-analysis. PLoS One. 2017;12(1). Crossref

How to Cite
Abayneh M, Worku T. Prevalence of multidrug-resistant and extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacilli: A meta-analysis report in Ethiopia. DTI [Internet]. 5Oct.2020 [cited 20Jan.2021];14(1):16-5. Available from: