Burden of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae among Cancer Patients in Africa: A Systematic Review and Meta-Analysis

Background : Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) exacerbate infections in cancer patients, in settings where antimicrobial resistance threatens health outcomes. This study estimated the prevalence of ESBL-PE among cancer patients in Africa from 2010 to 2024.

We searched PubMed, Embase, Web of Science, CINAHL, and Global Health for observational studies reporting ESBL-PE prevalence in cancer patients. Studies published in English from 2010 to 2024 were included. Two reviewers independently screened studies, extracted data using standardized forms, and assessed quality using the Newcastle-Ottawa Scale. Pooled prevalence was calculated using a random-effects model in RStudio v4.4.2, with heterogeneity assessed by I² statistics and publication bias by funnel plots and Egger’s test.

Twelve studies from nine African countries, involving 565 patients (305 events) and 687 samples (338 events), were included. The pooled prevalence was 49.9% (95% CI: 23.1%-76.9%, I² = 91.8%, p < 0.001) at the patient level and 48.1% (95% CI: 31.7%-65.0%, I² = 84.0%, p < 0.001) at the sample level. Escherichia coli and Klebsiella pneumoniae predominated, with high resistance to cephalosporins (median: 89.5%-90%) and fluoroquinolones but preserved carbapenem efficacy. Publication bias was evident, and heterogeneity persisted after sensitivity analysis.

The high ESBL-PE prevalence in African cancer patients signals a critical public health issue, necessitating enhanced surveillance, antimicrobial stewardship, and intentional infection control measures. - Received: - Version Posted: