Antimicrobial Resistance Through the Lens of One Health in Ethiopia: A Review of the Literature Among Humans, Animals, and the Environment.
Ayako Wendy Fujita, Kaitlyn Werner, Jesse T Jacob, Rea Tschopp, Gezahegne Mamo, Adane Mihret, Alemseged Abdissa, Russell Kempker, Paulina A Rebolledo
Author Information
Ayako Wendy Fujita: Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States. Electronic address: afujita@emory.edu.
Kaitlyn Werner: Emory University, Rollins School of Public Health, Atlanta, GA, United States.
Jesse T Jacob: Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States.
Rea Tschopp: Armauer Hansen Research Institute, Addis Ababa, Ethiopia; Swiss Tropical and Public Health Institute, Basel, Switzerland.
Gezahegne Mamo: Addis Ababa University, College of Veterinary Medicine and Agriculture, Department of Microbiology, Immunology and Veterinary Public Health, Addis Ababa, Ethiopia.
Adane Mihret: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
Alemseged Abdissa: Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
Russell Kempker: Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States.
Paulina A Rebolledo: Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia, United States.
OBJECTIVES: We aimed to review and describe antimicrobial resistance (AMR) prevalence in humans, animals, and the environment in Ethiopia. METHODS: We conducted a structured review of literature on AMR in humans, animals, and the environment in Ethiopia from 2016-2020. We reported the pooled prevalence of AMR of bacterial pathogens in all 3 sectors. RESULTS: We included 43 articles in our review. Only 5 studies evaluated AMR across multiple sectors. The most common bacteria in humans were Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus. High prevalence of resistance to third-generation cephalosporins, fluoroquinolones, and sulfamethoxazole-trimethoprim were seen in gram-negative organisms, often with >50% prevalence of resistance. Highest resistance rates were seen in humans, followed by environmental isolates. Salmonella spp. exhibited higher rates of resistance than previously reported in the literature. We found methicillin-resistant S. aureus (MRSA) in approximately half of S. aureus from the environment and a third from human isolates. Few studies evaluated AMR across all 3 sectors. CONCLUSION: Our review demonstrated high prevalence of AMR among bacteria in humans, animals, and the environment in Ethiopia. Integrating a One Health approach into AMR surveillance as part of Ethiopia's national surveillance program will inform future implementation of One Health interventions.
