Antimicrobial resistance in Africa: a systematic review

Abstract

BackgroundAntimicrobial resistance (AMR) is widely acknowledged as a global problem, yet in many parts of the world its magnitude is still not well understood. This review, using a public health focused approach, aimed to understand and describe the current status of AMR in Africa in relation to common causes of infections and drugs recommended in WHO treatment guidelines.MethodsPubMed, EMBASE and other relevant databases were searched for recent articles (2013–2016) in accordance with the PRISMA guidelines. Article retrieval and screening were done using a structured search string and strict inclusion/exclusion criteria. Median and interquartile ranges of percent resistance were calculated for each antibiotic-bacterium combination.ResultsAMR data was not available for 42.6% of the countries in the African continent. A total of 144 articles were included in the final analysis. 13 Gram negative and 5 Gram positive bacteria were tested against 37 different antibiotics. Penicillin resistance in Streptococcus pneumoniae was reported in 14/144studies (median resistance (MR): 26.7%). Further 18/53 (34.0%) of Haemophilus influenza isolates were resistant to amoxicillin. MR of Escherichia coli to amoxicillin, trimethoprim and gentamicin was 88.1%, 80.7% and 29.8% respectively. Ciprofloxacin resistance in Salmonella Typhi was rare. No documented ceftriaxone resistance in Neisseria gonorrhoeae was reported, while the MR for quinolone was 37.5%. Carbapenem resistance was common in Acinetobacter spp. and Pseudomonas aeruginosa but uncommon in Enterobacteriaceae.ConclusionOur review highlights three important findings. First, recent AMR data is not available for more than 40% of the countries. Second, the level of resistance to commonly prescribed antibiotics was significant. Third, the quality of microbiological data is of serious concern. Our findings underline that to conserve our current arsenal of antibiotics it is imperative to address the gaps in AMR diagnostic standardization and reporting and use available information to optimize treatment guidelines.Electronic supplementary materialThe online version of this article (10.1186/s12879-017-2713-1) contains supplementary material, which is available to authorized users.

Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study

“…Similar to a systematic review and meta-analysis on HAIs in developing countries, gram-negative bacillary infections in both urinary and respiratory tract infections are the most recorded bacterial isolates in our study [10]. Again, other studies on antibiotic resistance in the African region noted similar spectrum of bacterial isolates found in our study [14]. Unlike a systematic review on ESBL-producing organisms in Africa [28], a high rate of ESBL-producing gramnegative bacteria was detected in this study (58.0% vs 22.8%).…”

“…Even though sub-Saharan African countries have committed to control antibiotic resistance in their countries [12], due to a lack of resources and other pressing issues there is, as yet, little effort at scaling up activities on prevention and control of antibiotic resistance. In the WHO African region, only Ethiopia and South Africa had a national antimicrobial resistance plans in place and neither of the countries in this region has a national antimicrobial surveillance system [13].Further compounding the problem is the limited availability of data on antibiotic resistance by a large number of African countries [14]. In a systematic review of the burden of antimicrobial resistance in West Africa, Sierra Leone was singled out among other countries due to paucity of the AR data available [15].…”

Care seeking behaviour and aspects of quality of care by caregivers for children under five with and without pneumonia in Ibadan, Nigeria

“…This finding is of significant concern, as high rates of antibiotic prescribing for those with cough/cold is likely to drive antimicrobial resistance and to increase health care costs unnecessarily. The increasing problem of antimicrobial resistance is a major problem within Nigeria and across Africa [18,19]. This study is in a location which is similar to other urban sites in Nigeria and throughout Africa.…”

Molecular epidemiology and mechanisms of antibiotic resistance inEnterococcusspp.,Staphylococcusspp., andStreptococcusspp. in Africa: a systematic review from a One Health perspective

“…recently reported 100% and 93.8% MDR rates in S. aureus and Enterococcus spp., respectively . Thus, the relatively high resistance and infection rate of S. aureus compared with other Gram‐positive bacteria in Africa cannot be overemphasized . The clonal diversity of MRSA in humans in Africa has been described in a single systematic review.…”