Bloodstream infections in Cameroon: a systematic review and meta-analysis

Abstract

Bloodstream infections (BSIs) are significantly associated with morbidity and mortality worldwide, and particularly in low-resource settings. We determined the prevalence of BSIs, profile, and antimicrobial resistance of the causing bacteria in Cameroon. PubMed, Google Scholar and ScienceDirect databases were searched to identify relevant studies. The random or fixed effect model was used depending on the level of heterogeneity among studies for pooling estimates after the variance was stabilised through the Freeman-Tukey double arcsine transformation. Begg’s and Egger’s tests were used to quantify publication bias. The protocol was registered in PROSPERO (CRD42023482760). The analysis of 5,680 blood cultures from ten studies revealed an overall bacterial BSI prevalence of 25.2% (95% CI: 18.1-33.2%) and 17.2% (11.6-23.7%) when the potential contaminants were removed. The leading BSI-causing bacteria were Escherichia coli , Klebsiella species, and Staphylococcus aureus . We found significant resistance to clinically relevant antibiotics, particularly to extended-spectrum cephalosporins in E. coli , Klebsiella species and Acinetobacter species, whereas resistance rates were lowest against carbapenems. Staphylococci displayed resistance rates above 30% to all tested antibiotics. WHO bacterial priority pathogens occupied a greater proportion of the overall BSI-driven bacteria. This study reports a substantial prevalence of BSI and resistance to the commonly used antibiotics. It also points out the lack of compliance with international guidelines in microbiological analysis. This highlights the need to empower laboratories’ capacities and conduct BSI surveillance across the country to develop more targeted strategies for the prevention, management and treatment of BSIs. • Analysis of 5,680 blood cultures revealed a 25.2% prevalence of bacterial bloodstream infections in Cameroon, primarily caused by Escherichia coli , Klebsiella spp., and Staphylococcus aureus. • Significant resistance to extended-spectrum cephalosporins was observed in Escherichia coli , Klebsiella spp., and Acinetobacter spp. Staphylococci displayed resistance rates of more than 30% to all tested antibiotics. • WHO priority pathogens, including carbapenem-resistant Acinetobacter , third-generation cephalosporin-resistant Enterobacterales , carbapenem-resistant Enterobacterales , fluoroquinolone-resistant Salmonella and methicillin-resistant Staphylococcus aureus, occupied a greater proportion of the overall bacteria causing bloodstream infections.