Molecular Epidemiology and Mechanisms of Antibiotic Resistance in Gram-positive Bacteria in Africa: A Systematic Review and Meta-Analysis from a One Health Perspective

ABSTRACT A systematic review and meta-analysis of antibiotic-resistant Gram-positive bacteria in Africa, showing the molecular epidemiology of resistant species from animal, human and environmental sources, is lacking. Thus, the current burden, type, and sources of Gram-positive bacterial resistance and their dissemination routes from farm to fork is absent. To fill this One Health information gap, we systematically searched PubMed, Web of Science and African Journals Online for English research articles reporting on the resistance mechanisms and clonality of resistant Gram-positive bacteria in Africa within 2007 to 2018. The review and all statistical analysis were undertaken with 130 included articles. From our analyses, the same resistant Gram-positive bacterial clones, resistance genes, and mobile genetic elements (MGEs) are circulating in humans, animals and the environment. The resistance genes, mecA, erm( B), erm (C), tet (M), tet (K), tet (L), vanB, vanA, vanC, and tet (O), were found in isolates from humans, animals and the environment. Commonest clones and mobile genetic elements identified from all three sample sources included Staphylococcus aureus ST5 (n=208 isolates), ST 8 (n=116 isolates), ST 80 (n=123 isolates) and ST 88 (n=105 isolates), and IS 16 (n=18 isolates), Tn 916 (n=60 isolates) and SCC mec (n=202 isolates). Resistance to penicillin (n=4 224 isolates, 76.2%), erythromycin (n=3 552 isolates, 62.6%), ampicillin (n=1 507 isolates, 54.0%), sulfamethoxazole/trimethoprim (n=2 261 isolates, 46.0%), tetracycline (n=3 054 isolates, 42.1%), vancomycin (n=1 281 isolates, 41.2%), streptomycin (n=1 198 isolates, 37.0%), rifampicin (n=2 645 isolates, 33.1%), ciprofloxacin (n=1 394 isolates, 30.5%), clindamycin (n=1 256 isolates, 29.9%) and gentamicin (n=1 502 isolates, 27.3%) ( p -value <0.0001) were commonest. Mean resistance rates of 14.2% to 98.5% were recorded in 20 countries within the study period, which were mediated by clonal, polyclonal and horizontal transmission of resistance genes. A One Health approach to research, surveillance, molecular epidemiology, and antibiotic stewardship to contain ABR should be prioritized.