Extended-spectrum beta-lactamases resistance in Klebsiella pneumoniae in sub-Saharan Africa: a systematic review and meta-analysis

BackgroundExtended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae is a critical priority pathogen for which there is a need for new antimicrobials and poses a great public health threat to many parts of the world including sub-Saharan Africa (SSA). This study aims to determine the prevalence of ESBL-resistant K. pneumoniae in SSA and the predominant ESBL genes in the region. MethodsDatabases such as PubMed, Scopus, Web of Science, Africa Journal Online, and Google Scholar were searched for eligible articles based on preset eligibility criteria. After screening of titles, abstracts, and full texts, a meta-analysis using a random-effect model was conducted on the eligible studies to determine the overall and subgroup prevalence of ESBL-producing K. pneumoniae in SSA. FindingsThis meta-analysis included 119 eligible studies from 25 SSA countries in all SSA subregions. The overall prevalence of ESBL-resistant K. pneumoniae in SSA is estimated to be 8{middle dot}6% [95% CI: 6{middle dot}4-11]. South Africa (18{middle dot}5%) and Central Africa (4{middle dot}6%) subregions have the highest and lowest prevalence of ESBL-producing K. pneumoniae in the region, respectively. Additionally, South Africa (23{middle dot}3%), Kenya (23%), and Nigeria (11{middle dot}1%) are countries with the top three prevalence of ESBL-resistant K. pneumoniae in the region. Animal samples were also seen to have the highest prevalence compared to clinical and environmental samples in this study. Lastly, CTX-M-15 was the most reported ESBL gene in SSA. InterpretationAlthough this study reports a low pooled prevalence of ESBL-resistant K. pneumoniae in SSA, some countries in the region have a high burden of this drug-resistant strain. Additionally, some countries in the region lack data on this drug-resistant strain, thus putting other parts of the region at risk due to the porous borders and immigration between the countries in the region. FundingThere was no funding for this study