Antibiotic‑resistance in medically important bacteria isolated from commercial herbal medicines in Africa from 2000 to 2021: a systematic review and meta‑analysis
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Antimicrobial Resistance & Infection Control
Abstract
Antimicrobial resistance is swiftly increasing all over the world. In Africa, it manifests more in pathogenic
bacteria in form of antibiotic resistance (ABR). On this continent, bacterial contamination of commonly used
herbal medicine (HM) is on the increase, but information about antimicrobial resistance in these contaminants is
limited due to fragmented studies. Here, we analyzed research that characterized ABR in pathogenic bacteria isolated
from HM in Africa since 2000; to generate a comprehensive understanding of the drug-resistant bacterial contamination
burden in this region.
Methods: The study was conducted according to standards of the Preferred Reporting Items for Systematic Reviews
and Meta-analyses (PRISMA). We searched for articles from 12 databases. These were: PubMed, Science Direct, Scifinder
scholar, Google scholar, HerbMed, Medline, EMBASE, Cochrane Library, International Pharmaceutical Abstracts,
Commonwealth Agricultural Bureau Abstracts, African Journal Online, and Biological Abstracts. Prevalence and ABR
traits of bacterial isolates, Cochran’s Q test, and the I2
statistic for heterogeneity were evaluated using MedCalcs
software. A random-effects model was used to determine the pooled prevalence of ABR traits. The potential sources
of heterogeneity were examined through sensitivity analysis, subgroup analysis, and meta-regression at a 95% level of
significance.
Findings: Eighteen studies met our inclusion criteria. The pooled prevalence of bacterial resistance to at least one
conventional drug was 86.51% (95% CI = 61.247–99.357%). The studies were highly heterogeneous (I2 = 99.17%;
p < 0.0001), with no evidence of publication bias. The most prevalent multidrug-resistant species was Escherichia coli
(24.0%). The most highly resisted drug was Ceftazidime with a pooled prevalence of 95.10% (95% CI = 78.51–99.87%),
while the drug-class was 3rd
generation cephalosporins; 91.64% (95% CI = 78.64–96.73%). None of the eligible studies
tested isolates for Carbapenem resistance. Extended Spectrum β-lactamase genes were detected in 89 (37.2%) isolates,
mostly Salmonella spp., Proteus vulgaris, and K. pneumonia. Resistance plasmids were found in 6 (5.8%) isolates;
the heaviest plasmid weighed 23,130 Kilobases, and Proteus vulgaris harbored the majority (n = 5; 83.3%). Conclusions: Herbal medicines in Africa harbor bacterial contaminants which are highly resistant to conventional
medicines. This points to a potential treatment failure when these contaminants are involved in diseases causation.
More research on this subject is recommended, to fill the evidence gaps and support the formation of collaborative
quality control mechanisms for the herbal medicine industry in Africa.
Description
Keywords
Africa, Antimicrobial resistance, Bacterial contamination, Herbal medicine, Meta-analysis, Systematic review
Citation
Walusansa, A., Asiimwe, S., Nakavuma, J., Ssenku, J., Katuura, E., Kafeero, H., ... & Kakudidi, E. K. (2022). Antibiotic-resistance in medically important bacteria isolated from commercial herbal medicines in Africa from 2000 to 2021: a systematic review and meta-analysis. Antimicrobial Resistance & Infection Control, 11(1), 1-20. https://doi.org/10.1186/s13756-022-01054-6