Prevalence and antimicrobial resistance of Klebsiella pneumoniae among neonates with sepsis in Ethiopia: A systematic review and meta-analysis

Abstract

Neonatal sepsis remains a leading cause of morbidity and mortality in Ethiopia. Klebsiella pneumoniae is its leading cause. Evidence on its prevalence and resistance patterns among septic neonates in Ethiopia is limited. This systematic review and meta-analysis aimed to estimate the pooled prevalence and antimicrobial resistance profile of K. pneumoniae in neonates. Following PRISMA 2020 guidelines, the study was registered in PROSPERO ( CRD420251116707 ). PubMed, Hinari, African Journals Online, EMBASE, and Google Scholar were used. STATA version 17 software was used for statistical analysis. A random-effects model was used to estimate pooled effect sizes. Heterogeneity among the included studies was assessed using Galbraith, Cochran’s Q test, and I 2 statistic. Subgroup analysis, sensitivity analysis, and meta-regression were conducted to identify the source of heterogeneity. Publication bias was evaluated using a funnel plot and Egger’s test. Twenty-three studies including 6,679 culture-confirmed neonatal sepsis cases were analyzed, the pooled prevalence of K. pneumoniae w as 24.93% (95% CI:19.82, 30.04) with high heterogeneity (I 2 = 96.25%). Prevalence was reported Amhara (20.80). Cohort studies reported higher prevalence than cross-sectional studies. Studies published after 2021 reported a pooled prevalence of ( 27.77%). Resistance was observed to commonly used antibiotics, including ampicillin, cefotaxime, ceftazidime, ceftriaxone, and gentamicin, which may indicate the presence of extended-spectrum β-lactamase (ESBL)-producing strains. In addition, resistance to meropenem was reported in some studies, raising concern about the possible emergence and spread of carbapenem-resistant K. pneumoniae . No strong evidence of publication bias, although Egger’s test was borderline, and interpretation is limited due to high heterogeneity. K. pneumoniae is a major cause of neonatal sepsis in Ethiopia with high resistance to commonly used antibiotics, highlighting the need for strengthened surveillance, antimicrobial stewardship, and targeted treatment strategies. Future research should explore heterogeneity drivers, resistance mechanisms through molecular characterization, and the clinical impact of resistance on neonatal outcomes such as mortality and treatment failure. Not applicable.