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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.
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.
Background: Bloodstream infections are known to cause considerable disability and death among hospitalized patients worldwide. Blood culture is the single most important procedure for bacterial isolation and detection. The aim of the present study was to determine the bacteriological and mycological prole of BSI and their antibiotic susceptibility patterns among clinically suspected cases. A retrospective study wasMethods: conducted over a period of 2 years from August 2018 to August 2020. Blood culture bottles received from patients of all ages and both sexes with suspected history of fever of unknown origin were put up in BacT/Alert 3D system. The bottles which agged positive were sub-cultured on Blood agar and MacConkey agar from which identication and antibiotic susceptibility of the isolates was performed using the Vitek-2 system. The reporting of the antibiotic susceptibilities was as per CLSI. From a total 7230 blood cultures, growth was observed in 1256 samplesResults: (1256/7230 17.37%). Only 681 isolates (681/1256 9.41%) were considered pathogenic, out of which 587 were Gram-negative bacilli (587/681 86.19%), 74 were Gram-positive cocci (74/681 10.86%) and the remaining 20 were fungal isolates (20/681 2.93%). Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus were the main pathogens isolated. A MDR pattern was observed primarily in K. pneumoniae, Acinetobacter spp. and Enterococcus spp. with other Gram-positive cocci susceptible to vancomycin and linezolid and the Gram-negative bacilli showed sensitivity to imipenem followed by amikacin. Our ndings underscore the need of periodic surveillance of blood cultureConclusion: isolates for etiologic agents, their antibacterial and antifungal susceptibility patterns that will inuence appropriate empirical treatm
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