Prevalence of Vancomycin-Resistant Enterococcus (VRE) in Poultry in Malaysia: The First Meta-Analysis and Systematic
Yusuf Wada1,2, Ahmad A Irekeola1,3, Rafidah H Shueb1
1Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia.
Abstract:
Databases such as PubMed, Scopus and Google Scholar were searched. Data extraction and assessment of study protocol was done by two independent reviewers and the results were reviewed by a third. OpenMeta analyst and comprehensive meta-analysis (CMA) were used for the meta-analysis. The random effect model was used, publication bias and between-study heterogeneity was assessed. Seventeen studies were added to the final meta-analysis. Studies were sampled from 2000-2018 and of the 8684 isolates tested, 2824 were VRE. The pooled prevalence of VRE among poultry in Malaysia was estimated at 24.0% (95% CI; 16.7-33.1%; I2 = 98.14%; p < 0.001). Between-study variability was high (t2 = 0.788; heterogeneity I2 = 98.14% with heterogeneity chi-square (Q) = 858.379, degrees of freedom (df) = 16, and p < 0.001). The funnel plot showed bias which was confirmed by Egger's test and estimates from the leave-one-out forest plot did not affect the pooled prevalence. Pooled prevalence of VRE in chickens and ducks were 29.2% (CI = 18.8-42.5%) and 11.2%, CI = 9.0-14.0%) respectively. Enterococcus faecalis was reported most with more studies being reported in Peninsular Malaysia Central region and used antibiotic disc diffusion as detection method. Increased surveillance of VRE in poultry in Malaysia is required.
Insights
The pooled prevalence of vancomycin-resistant Enterococci (VRE) in Malaysian poultry was 24.0%. This meta-analysis highlights the urgent need for increased VRE surveillance in poultry populations across Malaysia.
Area of Science:
- Veterinary Microbiology
- Antimicrobial Resistance
- Public Health
Background:
- Vancomycin-resistant Enterococci (VRE) pose a significant threat to public health due to their resistance to a critical antibiotic.
- Poultry serves as a potential reservoir and transmission route for VRE, necessitating an understanding of its prevalence in food animals.
- Limited data exists on the overall prevalence of VRE in poultry within Malaysia.
Purpose of the Study:
- To conduct a meta-analysis to estimate the pooled prevalence of VRE in poultry in Malaysia.
- To identify potential sources of heterogeneity and publication bias in existing studies.
- To provide evidence-based recommendations for future surveillance and control strategies.
Main Methods:
- A systematic search of databases including PubMed, Scopus, and Google Scholar was performed.
- Data extraction and quality assessment were conducted by two independent reviewers, with a third reviewer resolving discrepancies.
- Meta-analysis was performed using OpenMeta-Analyst and Comprehensive Meta-Analysis (CMA) software, employing a random-effects model to assess pooled prevalence and heterogeneity.
Main Results:
- Seventeen studies published between 2000 and 2018, analyzing 8684 isolates, were included.
- The pooled prevalence of VRE in Malaysian poultry was estimated at 24.0% (95% CI: 16.7-33.1%), with high heterogeneity (I² = 98.14%).
- Pooled prevalence in chickens was 29.2% and in ducks was 11.2%. *Enterococcus faecalis* was the most frequently reported species, and antibiotic disc diffusion was the common detection method.
Conclusions:
- A substantial prevalence of VRE exists in Malaysian poultry, indicating a potential public health concern.
- High inter-study variability suggests differences in methodologies, geographical distribution, or bacterial strains across studies.
- Enhanced surveillance programs for VRE in poultry are crucial for effective monitoring and control in Malaysia.
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