Antimicrobial resistance in West Africa: a systematic review and meta-analysis

Abstract

Growing data suggest that antimicrobial-resistant bacterial infections are common in low- and middle-income countries. This review summarises the microbiology of key bacterial syndromes encountered in West Africa and estimates the prevalence of antimicrobial resistance (AMR) that could compromise first-line empirical treatment. We systematically searched for studies reporting on the epidemiology of bacterial infection and prevalence of AMR in West Africa within key clinical syndromes. Within each syndrome, the pooled proportion and 95% confidence interval were calculated for each pathogen-antibiotic pair using random-effects models. Among 281 full-text articles reviewed, 120 met the eligibility criteria. The majority of studies originated from Nigeria (70; 58.3%), Ghana (15; 12.5%) and Senegal (15; 12.5%). Overall, 43 studies (35.8%) focused on urinary tract infections (UTI), 38 (31.7%) on bloodstream infections (BSI), 27 (22.5%) on meningitis, 7 (5.8%) on diarrhoea and 5 (4.2%) on pneumonia. Children comprised the majority of subjects. Studies of UTI reported moderate to high rates of AMR to commonly used antibiotics including evidence of the emergence of cephalosporin resistance. We found moderate rates of AMR among common bloodstream pathogens to typical first-line antibiotics including ampicillin, cotrimoxazole, gentamicin and amoxicillin/clavulanate. Among S. pneumoniae strains isolated in patients with meningitis, levels of penicillin resistance were low to moderate with no significant resistance noted to ceftriaxone or cefotaxime. AMR was common in this region, particularly in hospitalized patients with BSI and both outpatient and hospitalized patients with UTI. This raises concern given the limited diagnostic capability and second-line treatment options in the public sector in West Africa.

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

“…Comparing our analysis to other recent systematic reviews in Africa and the recent WHO Global Antimicrobial Resistance Surveillance System (GLASS) report, there is close alignment and specific differences. For instance, in five West African countries, Bernabé et al .…”

“…Comparing our analysis to other recent systematic reviews in Africa and the recent WHO Global Antimicrobial Resistance Surveillance System (GLASS) report, there is close alignment and specific differences. For instance, in five West African countries, Bernabé et al . reported 82.7% (95%, CI = 66.9–94.5) resistance to PEN, 44.7% (95%, CI = 29.5–60.3) resistance to SXT, 30.6% (95%, CI = 11.3–54.0) resistance to cloxacillin, 23.0% (95%, CI 4.7–49.1) resistance to CIP, and 19.6% (95%, CI = 10.1–31.2) resistance to ERY.…”

“…Several reviews have documented the high prevalence of antibiotic resistance in Gram‐positive bacteria in Africa. For instance, varying antibiotic resistance has been recorded among bloodstream infections caused by S. aureus in humans from Ghana, Gambia, Burkina Faso, Niger, and Togo . MRSA prevalence ranging from 9.4% to 13.5% has been reported in sepsis and meningitis infections, while S. aureus is responsible for causing sepsis and pneumonia at resistance rates of 90%, 29%, and 20% to ampicillin (AMP), gentamycin (GEN), and cloxacillin, respectively, among children in Africa .…”

Self-Medication with Antibiotics, Attitude and Knowledge of Antibiotic Resistance among Community Residents and Undergraduate Students in Northwest Nigeria

“…With increased access to the internet and regular adverts of pharmaceutical products on television in Nigeria, young people are highly prone to self-medication with antibiotics. In sub Saharan Africa, ABR to common clinical isolates is on the increase, including in Nigeria [13,14]. Estimates suggests that 700,000 lives are lost annually to ABR, and it is projected to lead to mortality of at least 10 million lives by 2050 [15].…”

Molecular Epidemiology and Mechanisms of Antibiotic Resistance in Gram-positive Bacteria in Africa: A Systematic Review and Meta-Analysis from a One Health Perspective

“…Excellent reviews addressing antimicrobial resistance in some GPB and Gram-Negative ones in Africa have been published 4,39-44 However, reviews discussing the molecular epidemiology and mechanisms of ABR in GPB such as Staphylococcus spp., Streptococcus spp. and Enterococcus spp.…”