Antimicrobial resistance among clinical Enterobacterales isolated from humans in Senegal: a systematic review and meta-analysis from 1987 to 2022

Abstract

The mitigation of antimicrobial resistance (AMR) has become a priority in every part of the world. Understanding AMR dynamics in Senegal is crucial for updating empirical antimicrobial treatments, adapting public health policies, and guiding future research. Therefore, this study conducted a systematic review and meta-analysis of clinical Enterobacterales resistance to 15 antimicrobials, determine AMR trends, and report the genetic determinants of AMR reported in Enterobacterales strains isolated from humans in Senegal over the past four decades. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA 2020) were used and the protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database with registration number (CRD420251007413). Data analyses were conducted using Stata software, version 17.0, and consisted of a random-effects model analysis to estimate pooled AMR rates, publication bias assessments, and meta-regression analysis. Thirty-nine research articles met the inclusion criteria and were selected for this study. A total of 7911 Enterobacterales strains were studied. These strains were isolated between 1987 and 2022, mainly from urine [23 studies; 61% (95% CI: 45, 74)], blood [15 studies; 39% (95% CI: 26, 55)], and stool [15 studies; 39% (95% CI: 26, 55)]. The overall pooled AMR rates ranged from 3% (95% CI: 1, 5) for carbapenems to 66% (95% CI: 53, 77) for trimethoprim-sulfamethoxazole (SXT). Drastic upward trends were reported for all 15 antimicrobials tested, except for amikacin, chloramphenicol, and tetracycline, for which stable AMR trends were observed. The Klebsiella isolates presented the highest AMR rates, followed by E. coli, Shigella, and Salmonella isolates. Genetic determinants of resistance to beta-lactams, fluoroquinolones, aminoglycosides, trimethoprim, macrolides, nucleoside antibiotics, and tetracycline were reported in Senegal. In addition, class 1 and 2 integrons were reported and carried mostly aadA1, aadA2, dfrA7, dfrA1, and sat as cassettes. Carbapenems, amikacin, fosfomycin, and chloramphenicol could be considered good for the treatment of severe infections. In addition, there is a need to adjust empirical antimicrobial treatment guidelines in Senegal and implement whole-genome sequencing-based surveillance methods. Recommendations should include the implementation of prevention and infection control policies and the exploration of alternative therapies. Not applicable.