Antimicrobial resistance prevalence of Escherichia coli and Staphylococcus aureus amongst bacteremic patients in Africa: a systematic review

Erastus Hanganeni Haindongo; Diana Ndakolo; Marius Hedimbi; Olli Vainio; Antti Hakanen; Jaana Vuopio

doi:10.1016/j.jgar.2022.11.016

Antimicrobial resistance prevalence of Escherichia coli and Staphylococcus aureus amongst bacteremic patients in Africa: a systematic review

J Glob Antimicrob Resist. 2023 Mar:32:35-43. doi: 10.1016/j.jgar.2022.11.016. Epub 2022 Dec 14.

Authors

Erastus Hanganeni Haindongo¹, Diana Ndakolo², Marius Hedimbi³, Olli Vainio⁴, Antti Hakanen⁵, Jaana Vuopio⁵

Affiliations

¹ School of Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Windhoek, Namibia; Institute of Biomedicine, University of Turku, Turku, Finland. Electronic address: ehaindongo@unam.na.
² School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia; Pharmaceutical Services, Ministry of Health and Social Services, Namibia.
³ School of Medicine, Faculty of Health Sciences and Veterinary Medicine, University of Namibia, Windhoek, Namibia; Graduate School of Business and Postgraduate, International University of Management, Namibia.
⁴ Institute of Biomedicine, University of Turku, Turku, Finland.
⁵ Institute of Biomedicine, University of Turku, Turku, Finland; Clinical Microbiology Laboratory, Turku University Hospital, Turku, Finland.

PMID: 36526264
DOI: 10.1016/j.jgar.2022.11.016

Abstract

Objectives: Antimicrobial resistance (AMR) is a global concern among infectious diseases. Bloodstream infections can potentially become life-threatening if they become untreatable with conventional antimicrobials. This review aims to provide an understanding of the AMR prevalence and trends of common bacteremic pathogens, namely Escherichia coli and Staphylococcus aureus in the World Health Organization (WHO) Africa region.

Methods: PubMed and Google Scholar were searched using relevant keywords for published human studies (excluding case reports and reviews) reporting bacteremic AMR data on the pathogens of interest between 2008 and 2019. Two reviewers independently screened the articles against a pre-defined eligibility criterion. Data extraction and analysis were achieved with different platforms: Covidence, Excel, R version 3.6.3, and QGIS v3.4.5. The pooled prevalence, 95% confidence intervals, and I² index (a measure of heterogeneity) were calculated for the various pathogen-antibiotic combinations.

Results: Five hundred sixty-two papers were retrieved, with 27 papers included in the final analysis. Only 23.4% (11/47) of member states of the WHO African region had reports on AMR in bacteremia. The Clinical and Laboratory Standards Institute (CLSI) (78.5%) was the most common standard used in the region. For E. coli, the pooled resistance was: cefotaxime (42%), imipenem (4%), meropenem (0%), and colistin (0%). For S. aureus, the calculated pooled resistance was cloxacillin (34%), oxacillin (12%), and vancomycin (0%). There was a high degree of variation across studies (I² > 90%).

Conclusion: The pooled resistance rates indicate a concerning degree of methicillin-resistant and Extended Spectrum-ß-lactamase-producing pathogens. The paucity of AMR data also presents challenges for a comprehensive understanding of the situation in the region. Continent-wide and standardized surveillance efforts therefore need strengthening.

Keywords: Antimicrobial resistance; Bacteremia; Escherichia coli; Extended spectrum-ß-lactamase; Methicillin resistance; Staphylococcus aureus.

Publication types

Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Africa / epidemiology
Anti-Bacterial Agents / pharmacology
Anti-Bacterial Agents / therapeutic use
Bacteremia* / drug therapy
Bacteremia* / epidemiology
Drug Resistance, Bacterial
Escherichia coli
Humans
Prevalence
Staphylococcal Infections* / drug therapy
Staphylococcal Infections* / epidemiology
Staphylococcus aureus

Substances

Anti-Bacterial Agents