Journal Article Systematic Review Ahead of print
PubMed: 42056901 DOI: 10.1186/s12879-026-13458-5
Antimicrobial resistance in bloodstream infections in West Africa: a systematic review and meta-analysis.
BMC Infect Dis
Authors: Ephraim Ehidiamen Ibadin, Komla Mawunyo Dossouvi, Richard Omoregie, Fábio Parra Sellera, Nosakhare Lawrence Idemudia, Stella Ifeanyi Smith
Affiliations
- Medical Microbiology Division, Medical Laboratory Services, University of Benin Teaching Hospital, Benin City, Nigeria.
- Department of Microbiology and Genomics, Global Health Research Institute of Lomé, Lomé, Togo.
- Medical Microbiology Division, Medical Laboratory Services, University of Benin Teaching Hospital, Benin City, Nigeria.
- Department of Internal Medicine, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, Brazil.
- School of Veterinary Medicine, Metropolitan University of Santos, Santos, Brazil.
- Molecular Biology and Biotechnology Department, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria.
- Department of Biological Sciences, Mountain Top University, Prayer City, Ogun State, Nigeria.
Abstract
BACKGROUND
Early and efficient management of bloodstream infections (BSIs) reduces the risk of complications and death. Therefore, it is crucial to identify antimicrobials with good activity against bacteria isolated from BSIs. This study aimed to determine the bacterial pathogens involved in BSIs, pooled antimicrobial resistance (AMR) rate, AMR phenotype rates, and the evolution of AMR over the years in West Africa.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA 2020) were used, and the protocol for this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database with the registration identification number (CRD420251064773). Keywords were used to conduct a systematic literature review of electronic databases such as Google Scholar, African Journals Online, PubMed, ResearchGate, Embase, and Scopus. Data analyses were conducted using Stata/MP 17.0, and a random-effects model was used to estimate pooled estimates.
RESULTS
Twenty-three research articles, including samples collected between 2003 and 2022, were selected for this study. The prevalence of BSIs was 13.1% (95% CI: 12.8-13.3) (6,864 blood culture-positive out of the 52,566 patients screened for BSIs). A total of 4,992 bacteria were isolated, including 3,219 Gram-negative bacteria (GNB) and 1,773 Gram-positive bacteria (GPB). The pooled AMR rates of 20 antimicrobials were obtained, and the highest were for ampicillin [73% (95% CI: 66, 80)] and trimethoprim-sulfamethoxazole [72% (95% CI: 63, 80)]. The lowest pooled AMR rates were observed for the carbapenems [10% (95% CI: 1, 25)] and clindamycin [15% (95% CI: 6, 27)]. GNB were more resistant to ampicillin (P = 0.003) and amoxicillin-clavulanate (P = 0.002) than GPB, and the pooled prevalence of multidrug-resistant bacteria (MDR) was 53% (95% CI: 30, 75). There were significant upward trends for ciprofloxacin (P = 0.007), carbapenems (P = 0.010), ofloxacin (P = 0.013), and third-generation cephalosporins (3GCs) (P = 0.032) when comparing the pooled AMR rates of 2004-2013 to those of 2014-2022.
CONCLUSION
Carbapenems and clindamycin showed relatively low resistance rates, but high study heterogeneity and limited data warrant caution in their empiric use. Overall, the findings highlight the need to prioritize local antibiograms and strengthen antimicrobial stewardship to address rising AMR in West Africa.
CLINICAL TRIAL
Not applicable.
MeSH
Clindamycin, Blood, Ampicillin, Sepsis, Prevalence, Ofloxacin, Bacteria, Communicable Diseases, Carbapenems, Infections