Prevalence Of carbapenem resistance inAcinetobacter baumaniiandPseudomonas aeruginosain sub-Saharan Africa: a systematic review and meta-analysis

ABSTRACT Background Carbapenems are drugs of last resort and resistance to them is considered a great public health threat, especially in notorious nosocomial pathogens like Acinetobacter baumannii and Pseudomonas aeruginosa . In this study, we aimed to determine the prevalence of carbapenem resistance in A. baumannii and P. aeruginosa infections in Sub-Saharan Africa. Methods Databases (PubMed, Scopus, Web of Science, and African Journal Online) were systematically searched following the Preferred Reporting Items for Systematic review and meta-analysis protocols (PRISMA-P) 2020 statements for articles reporting carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) prevalence between 2012 and 2022. Pooled prevalence was determined with the random effect model in R. Results A total of 47 articles were scanned for eligibility, among which 25 (14 for carbapenem-resistant A. baumanii and 11 for carbapenem-resistant P. aeruginosa ) were included in the study after fulfilling the eligibility criteria. The pooled prevalence of CRPA in the present study was estimated at 8% (95% CI; 0.02 – 0.17; I 2 =98%; P <0.01). There was high heterogeneity (Q=591.71, I 2 =98.9%; P<0.0001). The pooled prevalence of CRAB in the present study was estimated at 20% (95% CI; 0.04 – 0.43; I 2 =99%; P <0.01). There was high heterogeneity (Q=1452.57, I 2 =99%; P<0.0001). Carbapenem-resistant A. baumannii prevalence based on sample source gave estimates of 24% (95% CI; 6 – 49; I 2 =99%; P<0.01). The carbapenamse genes commonly isolated from A. baumanii in this study include bla OXA23, bla OXA48 , bla GES. , bla NDM, bla VIM ,, bla OXA24 , bla OXA58 , bla OXA51 , bla SIM-1 , bla OXA40 , bla OXA66 , bla OXA69 , bla OXA91 , with bla OXA23 and bla VIM being the most common. On the other hand, bla NDM, bla VIM , bla IMP ,, bla OXA48 , bla OXA51 , bla SIM-1 , bla OXA181 , bla KPC , bla OXA23 , bla OXA50 were the commonly isolated carbapenemase genes in P. aeruginosa , among which bla VIM and bla NDM genes were the most frequently isolated. Conclusion Surveillance of drug-resistant pathogens in sub-Saharan Africa is essential in reducing the disease burden in the region and this study has shown that the region has significantly high multi-drug resistant pathogen prevalence. This is a wake-up call for policymakers to put in place measures to reduce the spread of these critical priority pathogens.