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Antibiotic resistance in West Africa: a systematic review and meta-analysis | Journal Article / Review | MSF Science Portal
Journal Article
|Review

Antibiotic resistance in West Africa: a systematic review and meta-analysis

Bernabe KJ, Langendorf C, Ford NP, Ronat JB
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Abstract
Growing data suggest that antimicrobial-resistant bacterial infections are common in low- and middle-income countries. This review summarises the microbiology of key bacterial syndromes encountered in West Africa and estimates the prevalence of antimicrobial resistance (AMR) that could compromise first-line empirical treatment. We systematically searched for studies reporting on the epidemiology of bacterial infection and prevalence of AMR in West Africa within key clinical syndromes. Within each syndrome, the pooled proportion and 95% confidence interval were calculated for each pathogen-antibiotic pair using random-effects models. Among 281 full-text articles reviewed, 120 met the eligibility criteria. The majority of studies originated from Nigeria (70; 58.3%), Ghana (15; 12.5%) and Senegal (15; 12.5%). Overall, 43 studies (35.8%) focused on urinary tract infections (UTI), 38 (31.7%) on bloodstream infections (BSI), 27 (22.5%) on meningitis, 7 (5.8%) on diarrhoea and 5 (4.2%) on pneumonia. Children comprised the majority of subjects. Studies of UTI reported moderate to high rates of AMR to commonly used antibiotics including evidence of the emergence of cephalosporin resistance. We found moderate rates of AMR among common bloodstream pathogens to typical first-line antibiotics including ampicillin, cotrimoxazole, gentamicin and amoxicillin/clavulanate. Among S. pneumoniae strains isolated in patients with meningitis, levels of penicillin resistance were low to moderate with no significant resistance noted to ceftriaxone or cefotaxime. AMR was common in this region, particularly in hospitalized patients with BSI and both outpatient and hospitalized patients with UTI. This raises concern given the limited diagnostic capability and second-line treatment options in the public sector in West Africa.

Countries

Ghana Nigeria Senegal

Subject Area

antibiotic resistanceantimicrobial resistance

Languages

English
DOI
10.1016/j.ijantimicag.2017.07.002
Published Date
10 Jul 2017
PubMed ID
28705671
Journal
International Journal of Antimicrobial Agents
Volume | Issue | Pages
Volume 50, Issue 5, Pages 629-639
Issue Date
2017-11-01
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