Prevalence of carbapenem-resistant gram-negative bacteria among neonates suspected for sepsis in Africa: a systematic review and meta-analysis.

Aug 19, 2024

Experts: Assefa Sisay,Zelalem Asmare,Getinet Kumie,Yalewayker Gashaw,Ermias Getachew,Agenagnew Ashagre,Marye Nigatie,Sisay Ayana,Tadesse Misganaw,Zelalem Dejazmach,Wagaw Abebe,Solomon Gedfie,Selamyhun Tadesse,Muluken Gashaw,Abdu Jemal,Woldeteklehymanot Kassahun,Atitegeb Abera Kidie,Biruk Beletew Abate,Chalie Mulugeta,Abebaw Alamrew,Melese Abate Reta

The emergence and rapid spread of gram-negative bacteria resistant to carbapenems among newborns is concerning on a global scale. Nonetheless, the pooled estimate of gram-negative bacteria resistant to carbapenem that cause neonatal sepsis in developing nations remains unknown. Thus, this study aimed to determine the combined prevalence of gram-negative bacteria resistant to carbapenem in African newborns who were suspected of having sepsis.
All studies published from January 1, 2010, up to December 30, 2023, from PubMed, Science Direct, Scopus electronic databases, and the Google Scholar search engine were researched. Isolates tested for carbapenem from neonates with sepsis, English language papers conducted in Africa, and cross-sectional and cohort studies papers were included. Using PRISMA guidelines, we systematically reviewed and meta-analyzed studies that assessed the prevalence of carbapenem-resistant gram-negative bacteria. The “Joanna Briggs Institute” was used critically to evaluate the quality of the included studies. The data analysis was carried out using STATA™ version 17. Heterogeneity across the studies was evaluated using Q and I tests. The subgroup analysis was done and, funnel plot and Egger’s regression test were used to detect publication bias. A sensitivity analysis was conducted.
All 36 studies were included in the meta-analysis and systematic review. The pooled prevalence of carbapenem resistance in Africa was 30.34% (95% CI 22.03-38.64%). The pooled estimate of gram-negative bacteria resistant to imipenem, and meropenem was 35.57% (95% CI 0.67-70.54%) and 34.35% (95% CI 20.04% – 48.67%), respectively. A. baumannii and Pseudomonas spp. had pooled prevalence of 45.9% (95% CI 33.1-58.7%) and 43.0% (95% CI 23.0-62.4%), respectively. Similarly, Pseudomonas spp. and A. baumannii also exhibited strong meropenem resistance, with a pooled prevalence of 29.2% (95% CI 4.8-53.5%) and 36.7% (95% CI 20.1-53.3%), respectively. E. coli and K. pneumoniae were the two most common isolates.
There should be urgent antimicrobial stewardship practices, strengthened surveillance systems and effective treatment for neonates with sepsis. There was remarkable variation in resistance across the continent.

© 2024. The Author(s).

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ABOUT THE EXPERTS

Assefa Sisay,Zelalem Asmare,Getinet Kumie,Yalewayker Gashaw,Ermias Getachew,Agenagnew Ashagre,Marye Nigatie,Sisay Ayana,Tadesse Misganaw,Zelalem Dejazmach,Wagaw Abebe,Solomon Gedfie,Selamyhun Tadesse,Muluken Gashaw,Abdu Jemal,Woldeteklehymanot Kassahun,Atitegeb Abera Kidie,Biruk Beletew Abate,Chalie Mulugeta,Abebaw Alamrew,Melese Abate Reta

Assefa Sisay

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia. asefasisay23@gmail.com.

Zelalem Asmare

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Getinet Kumie

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Yalewayker Gashaw

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Ermias Getachew

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Agenagnew Ashagre

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Marye Nigatie

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Sisay Ayana

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Tadesse Misganaw

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Zelalem Dejazmach

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Wagaw Abebe

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Solomon Gedfie

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Selamyhun Tadesse

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Muluken Gashaw

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Abdu Jemal

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Woldeteklehymanot Kassahun

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Atitegeb Abera Kidie

Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Biruk Beletew Abate

Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Chalie Mulugeta

Department of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Abebaw Alamrew

Department of Midwifery, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Melese Abate Reta

Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia.

Research Centre for Tuberculosis and Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, Prinshof 0084, South Africa.