title: Meta-analysis of proportion estimates of Extended-Spectrum-Beta-Lactamase-producing Enterobacteriaceae in East Africa hospitals.
abstract: BACKGROUND
  A high proportion of Extended-Spectrum-Beta-Lactamase (ESBL) producing Enterobacteriaceae is causing common infections in all regions of the world. The burden of antibiotic resistance due to ESBL in East Africa is large but information is scarce and thus it is unclear how big the problem really is. To gain insight into the magnitude and molecular epidemiology of ESBL-producing Enterobacteriaceae in East Africa a literature search was performed in PubMed on 31 July 2015 to retrieve articles with relevant information on ESBL.
  
  
  RESULTS
  Meta-analysis was performed to determine overall proportion estimate of ESBL-producing Enterobacteriaceae. A total of 4076 bacterial isolates were included in the analysis. The overall pooled proportion of ESBL-producing Enterobacteriaceae among included surveys done in East African hospitals was found to be 0.42 (95 % CI: 0.34-0.50). Heterogeneity (I(2)) between countries' proportions in ESBL was significantly high (96.95 % and p < 0.001). The frequently detected genes encoding ESBL were CTX-M, TEM, SHV and OXA while the most infrequent reported genes were KPC and NDM.
  
  
  CONCLUSIONS
  The available studies show a very wide variation in resistance due to ESBL between countries. This highlights a need for active surveillance systems which can help understand the actual epidemiology of ESBL, aid in formulating national or regional guidelines for proper screening of ESBL, and support developing standardized approaches for managing patients colonized with ESBL.
authors.affiliation: Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania ; Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Tolbert
authors.initials: T
authors.lastname: Sonda
authors.affiliation: Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania ; Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Happiness
authors.initials: H
authors.lastname: Kumburu
authors.affiliation: Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
authors.forename: Marco
authors.initials: M
authors.lastname: van Zwetselaar
authors.affiliation: Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark ; Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Alifrangis
authors.affiliation: Centre for Biological Sequence Analysis, Technical University of Denmark, Copenhagen, Denmark.
authors.forename: Ole
authors.initials: O
authors.lastname: Lund
authors.affiliation: Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania ; Kilimanjaro Christian Medical University College, Moshi, Tanzania.
authors.forename: Gibson
authors.initials: G
authors.lastname: Kibiki
authors.affiliation: Centre for Genomic Epidemiology, Technical University of Denmark, Copenhagen, Denmark.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Aarestrup
keywords: Antibiotic resistance; ESBL; East Africa; Enterobacteriaceae; Extended-Spectrum-Beta-Lactamase