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

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.