SynthesisBMC infectious diseases2025
An insight into the antibiotic resistance profiles of ESKAPE pathogens isolated from humans in Africa: a systematic review and meta-analysis.
Synthesis in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens exhibited widespread resistance to multiple antibiotic classes. This study investigated the prevalence of antibiotic resistance (ABR) amongst ESKAPE pathogens in humans in Africa. MATERIALS AND
methodsThe systematic review protocol was registered in the International Prospective Register of Systematic Reviews [ID no: CRD42024552173]. A systematic review of the English literature was conducted to collect and analysed data on the prevalence of antibiotic resistance (ABR) caused by ESKAPE pathogens in Africa, covering the period from January 2014 to February 2024. They were provided from three databases (PubMed, Web of Science and ScienceDirect). A total of 268 studies were retrieved and at the end of the screening, 31 full texts were eligible for inclusion in the meta-analysis.
resultsThe overall pooled prevalence estimate (PPE) of ESKAPE pathogens in Africa revealed the following distribution: S. aureus (23.1%), K. pneumoniae (20.9%), E. faecium (9.8%), and Enterobacter spp. (5.3%). The prevalence of ABR in ESKAPE pathogens was reported in 12.9% (7/54) countries from various regions of Africa, and the random-effects models showed that Enterobacter spp. documented more resistance against amoxicillin-clavulanate with a pooled prevalence estimate (PPE) of 95.3% (95%CI: 79.8–99.2), E. faecium antibiotic resistance was higher against tetracycline with a PPE of 47.0% (95%CI: 2.3–97.0). Furthermore, PPE of K. pneumoniae resistance against trimethoprim-sulfamethoxazole was 40.7% (95%CI: 12.6–76.6), whilst S. aureus was mostly resistant against ceftriaxone with a PPE of 94.5% (95%CI: 82.0–98.5). Thirteen studies reported 1532 isolates with multidrug resistance to at least three antibiotic classes, yielding PPE of 64.1%. Interestingly, this meta-analysis revealed that the blaCTX-M gene had the highest prevalence (37.6%) among the examined genes, followed by the mecA gene (31.5%), and the blaTEM gene, which was reported in only three studies with a PPE of 13.0%.
conclusionThere is a significant knowledge gap in published studies on ABR among ESKAPE pathogens in most African countries. This observation calls for consolidated efforts to conduct research on this subject in the continent, perhaps with support from regional organizations and the African Union. CLINICAL TRIAL: Not applicable.
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