Aetiology of invasive bacterial infection and antimicrobial resistance in neonates in sub-Saharan Africa: a systematic review and meta-analysis in line with the STROBE-NI reporting guidelines

Abstract

Background Aetiological data for neonatal infections are essential to inform policies and programme strategies, but such data are scarce from sub-Saharan Africa. We therefore completed a systematic review and meta-analysis of available data from the African continent since 1980, with a focus on regional differences in aetiology and antimicrobial resistance (AMR) in the past decade (2008-18). Methods We included data for microbiologically confirmed invasive bacterial infection including meningitis and AMR among neonates in sub-Saharan Africa and assessed the quality of scientific reporting according to Strengthening the Reporting of Observational Studies in Epidemiology for Newborn Infection (STROBE-NI) checklist. We calculated pooled proportions for reported bacterial isolates and AMR. Findings We included 151 studies comprising data from 84 534 neonates from 26 countries, almost all of which were hospital-based. Of the 82 studies published between 2008 and 2018, insufficient details were reported regarding most STROBE-NI items. Regarding culture positive bacteraemia or sepsis, Staphylococcus aureus, Klebsiella spp, and Escherichia coli accounted for 25% (95% CI 21-29), 21% (16-27), and 10% (8-10) respectively. For meningitis, the predominant identified causes were group B streptococcus 25% (16-33), Streptococcus pneumoniae 17% (9-6), and S aureus 12% (3-25). Resistance to WHO recommended β-lactams was reported in 614 (68%) of 904 cases and resistance to aminoglycosides in 317 (27%) of 1176 cases. Interpretation Hospital-acquired neonatal infections and AMR are a major burden in Africa. More population-based neonatal infection studies and improved routine surveillance are needed to improve clinical care, plan health systems approaches, and address AMR. Future studies should be reported according to standardised reporting guidelines, such as STROBE-NI, to aid comparability and reduce research waste.

Antimicrobial resistance preparedness in sub-Saharan African countries

“…These range from a lack of infrastructural and institutional capacities, lack of investment and human resources, underutilisation of available data and scarce dissemination to regulatory bodies [5,7]. Routine AMR surveillance continues to be based on local hospital data, small cohort studies in neonatal and adult wards, routine laboratory samples taken from patients with suspected infection and health-care associated infections [8,9]. Major data gaps remain on the issue of AMR in Africa including the actual burden of AMR in the community, hospital settings, animals and the environment, as well as microbial acquisition of AMR, transmission patterns, genotypic evolution of antimicrobial resistance mechanisms, clonal spread and asymptomatic carriage.…”

Neonatal sepsis at Mulago national referral hospital in Uganda: Etiology, antimicrobial resistance, associated factors and case fatality risk

“…However, the pathogen profile differs depending on the region. There is a predominance of gram negative pathogens and low prevalence of GBS in south Asia and sub-Saharan African compared to the high GBS prevalence in high income countries[ 10 , 11 , 13 ]. Surveillance of the etiology of neonatal sepsis and resistance patterns of the causative bacteria is critically important in informing the empirical treatment of neonatal sepsis and in guiding the development of preventive strategies, including the development and deployment of vaccines.…”

Etiology of Pediatric Meningitis in West Africa Using Molecular Methods in the Era of Conjugate Vaccines against Pneumococcus, Meningococcus, and Haemophilus influenzae Type b

“…51 Group B Streptococcus meningitis was also detected and found predominantly among neonates, which is consistent with previous findings. 14,52 This study has several limitations. First, this study used sentinel-based disease surveillance.…”

“… 51 Group B Streptococcus meningitis was also detected and found predominantly among neonates, which is consistent with previous findings. 14 , 52 …”