Bacterial neonatal sepsis, antimicrobial resistance, and risk factors among neonates in Ethiopia: a systematic review and meta-analysis

Abstract

Background: Antimicrobial resistance and bacterial neonatal sepsis are major threats causing high morbidity and mortality among neonates in developing countries, including in Ethiopia. Given the lack of comprehensive and synthesized evidence on the magnitude of the bacterial profile, neonatal sepsis, and antimicrobial resistance among neonates, this systematic review and meta-analysis were initiated to address this gap. Objective: The aim of this meta-analysis aims to assess the prevalence, antimicrobial resistance patterns, and risk factors of neonatal sepsis in Ethiopian neonates. Design: Systematic review and meta-analysis were conducted among Ethiopian neonates. Data source and methods: Preferred reporting item for systematic review and meta-analysis ( PRISMA) was used to screen the identified studies. We conducted a systematic search of various electronic databases including PubMed/MEDLINE, Cochrane Library, African Journals Online (AJOL), Web of Science, Grey literature and Google Scholar. The data were extracted in Microsoft Excel using a standardized data extraction format by two authors. The analysis was carried out with STATA version 17. To detect heterogeneity across studies, the I 2 and the Cochrane Q test statistics were computed. To determine the overall pooled prevalence, a random-effect meta-analysis model was used. This systematic review and meta-analysis were performed according to the updated guidelines, rigorous meta-analytical methodologies to ensure accuracy and reliability. Results: Of 9013 retrieved articles, 20 studies containing 11,754 neonates with a total of 3168 bacterial isolates (837 Gram-positive, 2328 Gram-negative). The predominant bacteria identified were: Klebsiella pneumoniae (1343), Escherichia coli (854), Staphylococcus aureus (356), other Klebsiella spp (234), CoNS (192), Acinetobacter species (172), GBS (164). The overall pooled prevalence of bacterial neonatal sepsis and multi-drug resistance (MDR) were 29.92% (25.79–34.05) and 66.20 (55.43–76.97). The subgroup analysis of this systematic review further revealed that the highest prevalence was observed in Oromia (31.62%) and Amhara (31.56%). The isolated bacteria were more resistant to penicillin groups, cephalosporins, and aminoglycosides. Preterm birth AOR = 8.2, 95%CI: 1.12–15.77), premature rupture of membranes (AOR = 4.8, 95%CI: 3.17–12.77), history of urinary tract infection at antenatal care (AOR = 33.21, 95%; 3.2–63.21), and low birth weight (AOR = 13.73, 95%CI: 4.48–31.95) were significantly associated with bacterial neonatal sepsis. Conclusion: Bacterial neonatal sepsis and MDR have been relatively high. Preterm birth, premature rupture of membranes, history of urinary tract infection at antenatal care, and low birth weight were significantly associated. Implementing antimicrobial stewardship and regular surveillance to control antimicrobial resistance is vital for informing region-specific antibiotic use. Furthermore, early diagnosis and proactive screening for risk factors are key to preventing neonatal sepsis and decreasing its overall burden.