A One-Health Perspective on Enterococcus in Ghana: A Review and Meta-Analysis

Area of Science:

• Microbiology and Public Health
• One Health Research
• Antimicrobial Resistance Surveillance

Background:

• Enterococcus species are normal microbiota but cause severe infections, particularly hospital-adapted strains.
• Data on Enterococcus dynamics, prevalence, and resistance patterns in Ghana are scarce.
• Existing research often lacks a One Health perspective, limiting understanding of transmission.

Purpose of the Study:

• To conduct the first systematic review and meta-analysis on Enterococcus in Ghana within a One Health framework.
• To assess the prevalence and antimicrobial resistance patterns of Enterococcus.
• To identify research gaps in One Health approaches for Enterococcus in Ghana.

Main Methods:

• Systematic review and meta-analysis of studies from PubMed/MEDLINE, Scopus, and Web of Science.
• PRISMA 2020 guidelines followed for study selection and data extraction.
• Random-effects model used to pool prevalence and antimicrobial resistance data.

Main Results:

• Sixty-nine studies were included, with nineteen eligible for meta-analysis.
• Pooled prevalence of Enterococcus was 6.76%; adjusted vancomycin-resistance isolates were 0.06%.
• Antibiotic resistance rates were comparable between human and animal studies, higher in animals; Ciprofloxacin (1.30%) and Cloxacillin (17.46%) showed lowest and highest resistance, respectively.

Conclusions:

• The review highlights a significant research gap and a human-centric bias in One Health studies on Enterococcus in Ghana.
• Current data is insufficient to fully understand Enterococcus transmission dynamics across human, animal, and environmental interfaces.
• Integrating genomic approaches, especially environmental genomics, is crucial for resolving transmission pathways and informing effective antimicrobial resistance control strategies.