Cholera is linked to penury, making low- and middle-income countries (LMICs) particularly vulnerable to outbreaks. In this systematic review, we analyzed the drivers contributing to these outbreaks, focusing on the epidemiology of cholera in LMICs. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO (ID: CRD42024591613). We searched PubMed, Scopus, Web of Science, and Google Scholar to include studies on cholera outbreaks that occurred in LMICs from 1 January 2014 to 21 September 2024. Studies on outbreaks outside LMICs and focusing on sporadic cases were excluded. The risk of bias among included studies was assessed using a modified Downes et al. appraisal tool. Thematic analysis was used to synthesize the qualitative data, and meta-analyses to estimate the pooled prevalence. From 1662 records, 95 studies met inclusion criteria, primarily documenting outbreaks in Africa (74%) and Asia (26%). Contaminated water was the main route of disease transmission. The pooled fatality prevalence was 1.3% (95% CI: 1.1–1.6), and the detection rate among suspected cases was 57.8% (95% CI: 49.2–66.4). Vibrio cholerae O1 was the dominant serogroup while Ogawa was the dominant serotype. All studies reporting biotypes indicated El Tor. Although the isolates were 100% susceptible to ofloxacin, levofloxacin, norfloxacin, cefuroxime, and doxycycline, they were also fully resistant to amikacin, sulfamethoxazole, trimethoprim, and furazolidone. The persistence of cholera outbreaks in destitute areas with limited access to clean water and sanitation emphasizes the need for socioeconomic improvements, infrastructure development, and ongoing surveillance to support timely responses and achieve long-term prevention.

Background: Antimicrobial resistance (AMR) has become precarious, warranting investments in antimicrobial discovery. Aim: To investigate the antibacterial activity of rosemary essential oil (REO), alone and in combination with selected conventional antibiotics. Methods: REO was subjected to antimicrobial susceptibility testing (including minimum bactericidal concentration (MBC) and minimum inhibitory concentration (MIC) determination) and investigation of anti-pre-biofilm and antibiofilm activities. Results: The phytochemical composition of the REO was eucalyptol (42.68%), bornanone (33.20%), endo-borneol (9.37%), α-terpeneol (7.95%), linalool (2.10%), bornyl acetate (1.81%), caryophyllene (1.09%), 4-terpeneol (0.94%), and anethole (0.87%). The antibacterial inhibition zones generally increased with increasing REO concentration (i.e., 10, 20, 50, 100, and 200 mg/mL). The MIC and MBC ranges of REO for all bacteria were 3.13–6.25 mg/mL and 3.12–12.5 mg/mL, respectively. The MICs (in µg/mL) of ciprofloxacin, chloramphenicol, streptomycin, tetracycline, and ampicillin, respectively, were Escherichia coli (0.98, 3.92, 1.96, 7.81, and 250), Klebsiella pneumoniae (1.25, 7.81, 125, 7.81, and 1000), MRSA (62.5, 7.81, 3.91, 7.81, and 250), Streptococcus mutans and Bacillus subtilis (125, 15.68, 250, 31.25, and 1000), Pseudomonas aeruginosa (125, 31.25, 500, 31.25, and 1000), and Salmonella Typhi (0.98, 15.68, 125, 1.96, and 1000). The MBC-MIC ratios of REO against all bacteria were in the range 1–2, indicating bactericidal effects. Mainly synergy (FICI = 0.16–0.37) was observed between REO and the conventional antibiotics. The IC50 values (in µg/mL) of REO against the bacteria, pre-biofilm vs. biofilm formation, were E. coli (1342.00 vs. 4.00), K. pneumoniae (106.00 vs. 3.00), MRSA (134.00 vs. 6.00), S. mutans (7259.00 vs. 7.00), B. subtilis (120.00 vs. 7.00), P. aeruginosa (4989.00 vs. 7.00), and S. Typhi (10.00 vs. 2.00). Conclusions: Rosemary essential oil had significant bactericidal effects on the bacteria tested, and its MIC and MBC values were low. Overall, it was synergistic with known conventional antibiotics and, thus, has encouraging prospects in combination therapy involving conventional antibiotics, even in the treatment of infections with multidrug-resistant bacteria, including biofilm-forming ones.

This systematic review and meta-analysis aimed to quantify mortality associated with MRSA clones and evaluate the contribution of specific molecular features to outcome variation. Databases including PubMed, Scopus, Web of Science, and Google Scholar were searched for studies reporting mortality among patients with MRSA infection and associated molecular typing data, including clonal complex, sequence type and SCCmec type. Results were presented in thematic narratives, tables and figures. A random-effects meta-analysis was performed to estimate pooled mortality and prevalence proportions. Twenty-seven included studies reported on MRSA isolates from 12 different countries. The overall pooled mortality was 22.47% (95% CI: 17.31-28.07), with the highest mortality observed in Europe. Among MRSA clonal complexes, the highest mortality was observed among CC5 (50.75%), followed by CC8 (37.56%). Although ST72 (66.16%) was the most prevalent sequence type, the highest mortality rates were observed in ST764 (38.74%) and ST1 (38.72%). SCCmec type IV (36.95%) was dominant but had a lower mortality rate (18.71%) compared to types II (39.09%) and III (27.52%). The clear dominance and lethality of specific lineages affirm the clinical utility of molecular diagnostics in guiding treatment and predicting outcomes. These insights call for an expansion of MRSA typing programs in hospital laboratories and national surveillance systems.

Cholera persists in Ghana due to sanitation challenges. This systematic review aims to synthesize data on the prevalence, antimicrobial resistance, risk factors and community knowledge of cholera in Ghana. Extensive literature searches were conducted in PubMed, Scopus, ScienceDirect, Web of Science and African Journal Online. After screening, we included 33 studies, assessing their quality using the Joanna Briggs Institute checklist. Random effects meta-analysis and subgroup analysis were conducted using RStudio. The pooled prevalence of cholera was 18.42%. Based on subgroups, the highest prevalence was reported in studies that combined rectal swabs and stool samples (57.58%), involved human populations (31.79%) and were conducted in the Greater Accra–Ashanti region (64.52%). Cotrimoxazole had the highest resistance rates (75–100%) and gentamicin the lowest (1–11%). Multidrug resistance ranged between 68% and 100%. There were reports of individual resistance genes to some antibiotics (strA, floR and dfrA1). Case fatality and mortality rates were 3.40% and 2.7%, respectively. Risk factors such as eating street-vended food and proximity to refuse dumps were also reported. Cholera persists in Ghana with high drug resistance rates and regional prevalence variations. Strengthening surveillance, improving sanitation and regulating antibiotics are critical to mitigating outbreaks and resistance spread.