Prevalence Of carbapenem resistance inAcinetobacter baumaniiandPseudomonas aeruginosain sub-Saharan Africa: a systematic review and meta-analysis

Abstract

ABSTRACTBackgroundCarbapenems are drugs of last resort and resistance to them is considered a great public health threat, especially in notorious nosocomial pathogens likeAcinetobacter baumanniiandPseudomonas aeruginosa. In this study, we aimed to determine the prevalence of carbapenem resistance inA. baumanniiandP. aeruginosainfections in Sub-Saharan Africa.MethodsDatabases (PubMed, Scopus, Web of Science, and African Journal Online) were systematically searched following the Preferred Reporting Items for Systematic review and meta-analysis protocols (PRISMA-P) 2020 statements for articles reporting carbapenem-resistantAcinetobacter baumannii(CRAB) and carbapenem-resistantPseudomonas aeruginosa(CRPA) prevalence between 2012 and 2022. Pooled prevalence was determined with the random effect model in R.ResultsA total of 47 articles were scanned for eligibility, among which 25 (14 for carbapenem-resistantA. baumaniiand 11 for carbapenem-resistantP. aeruginosa) were included in the study after fulfilling the eligibility criteria. The pooled prevalence of CRPA in the present study was estimated at 8% (95% CI; 0.02 – 0.17; I2=98%; P <0.01). There was high heterogeneity (Q=591.71, I2=98.9%; P<0.0001). The pooled prevalence of CRAB in the present study was estimated at 20% (95% CI; 0.04 – 0.43; I2=99%; P <0.01). There was high heterogeneity (Q=1452.57, I2=99%; P<0.0001). Carbapenem-resistantA. baumanniiprevalence based on sample source gave estimates of 24% (95% CI; 6 – 49; I2=99%; P<0.01). The carbapenamse genes commonly isolated fromA. baumaniiin this study includeblaOXA23,blaOXA48,blaGES.,blaNDM,blaVIM,,blaOXA24,blaOXA58,blaOXA51,blaSIM-1,blaOXA40,blaOXA66,blaOXA69,blaOXA91, withblaOXA23andblaVIMbeing the most common. On the other hand, blaNDM,blaVIM, blaIMP,, blaOXA48, blaOXA51,blaSIM-1,blaOXA181,blaKPC,blaOXA23,blaOXA50were the commonly isolated carbapenemase genes inP. aeruginosa, among which blaVIMand blaNDMgenes were the most frequently isolated.ConclusionSurveillance of drug-resistant pathogens in sub-Saharan Africa is essential in reducing the disease burden in the region and this study has shown that the region has significantly high multi-drug resistant pathogen prevalence. This is a wake-up call for policymakers to put in place measures to reduce the spread of these critical priority pathogens.