Prevalence of bacterial ear infections and multidrug resistance patterns among ear infection suspected patients in Ethiopia: a systematic review and meta-analysis

Abstract

Otitis media is an inflammation of the middle ear that affects both adults and children, leading to hearing loss and impacting intellectual performance, especially in developing countries. Key factors contributing to its development include lack of vaccination, inadequate breastfeeding, overcrowding, and malnutrition. Major bacterial pathogens involved are Pseudomonas aeruginosa, Staphylococcus aureus, Proteus mirabilis, Klebsiella pneumoniae, Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.This systematic review and meta-analysis revealed the pooled prevalence of bacterial ear infections and multidrug resistance in Ethiopia. Thorough searches were conducted across electronic databases and grey literature using precise entry terms or phrases. Eligible studies were compiled into MS Excel and imported into STATA version 14 software for statistical analysis. The collective prevalence of bacterial ear infections and multidrug resistance patterns were calculated using a random-effect model, with heterogeneity assessed via the I2 value. Publication bias was examined using a funnel plot and Egger’s test. Sensitivity analysis was performed to gauge the impact of individual studies on the overall effect size. Seventy studies met the criteria for qualitative analysis, with 14 selected for the meta-analysis. These studies reported a total of 3,667 bacterial isolates. The prevalence of bacterial ear infections varied significantly, ranging from 28.2% to 98.2% across individual studies. In this systematic review and meta-analysis, the pooled prevalence of bacterial ear infections in Ethiopia was found to be 73.39% (95% CI: 65.15–81.63), demonstrating substantial heterogeneity (I2 = 98.5%, p < 0.001). Additionally, the pooled prevalence of multidrug resistance among bacterial ear infections was 72.45% (95% CI: 66.86–78.04). The most frequently identified isolate was Staphylococcus aureus, with a pooled prevalence of 68.87% (95% CI: 13.94–123.79), followed closely by Proteus spp. at 68.55% (95% CI: 3.15–140.26), Pseudomonas aeruginosa at 48.15% (95% CI: 1.84–94.45), and Escherichia coli at 37.15% (95% CI: 14.03–88.34). The pooled prevalence of bacterial ear infections in Ethiopia is alarmingly high, accompanied by significant levels of multidrug resistance. These findings highlight the urgent need to reevaluate empirical treatment strategies due to the rising antimicrobial resistance.