Bacterial Bloodstream Infections in Cameroon: A Systematic Review and Meta-Analysis of Prevalence and Antibiotic Resistance

Abstract

Background:The paucity of data on the epidemiology of bloodstream infection (BSI) in developing countries hampers its effective prevention and management. This review sought to provide the current prevalence, bacteriological and antimicrobial resistance profiles of bacteria implicated in BSI in Cameroon.Methods:PubMed and Google Scholar databases were searched to identify relevant articles. Data was analysed using comprehensive meta-analysis software. The I2was used to evaluate heterogeneity between studies, funnel plot and Egger's test to evaluate publication bias and random-effects analysis models to calculate pooled prevalence.Results:The 10 eligible studies were carried out in only two of the 10 regions of Cameroon and investigated 4,223 participants, of whom 920 were children under two years old. The overall pooled prevalence of bacterial BSI was 26.36% (95% CI= 17.51%-37.64%).Klebsiellaspp. (28.20%; 95%CI= 2.80%-63.60%),Escherichia coli(18.94%; 95%CI= 13.02%-26.72%) andStaphylococcus aureus(14.40%; 95%CI= 8.31%-23.81%) were the most incriminated bacteria species.E. coliandKlebsiellaspp. displayed the highest resistance to amoxicillin (82.6%; 95%CI= 63.3%-92.9 vs 86.4%; 95%CI= 55.9%-97.0%), amoxicillin + clavulanic acid (71.7%; 95%CI= 0.44%-89.2% vs 73.1%; 95%CI= 38.7%-92.1%) and trimethoprim/sulfamethoxazole (76.2%; 95%CI= 51.3%-90.7% vs 69.5%; 95%CI= 52.3-82.6%) respectively. However, meropenem (26.7%; 95%CI= 20.8%-33.7%) and fosfomycin (14.9%; 95%CI= 9.1%-23.4%) were the least resistant inE. coliandKlebsiellaspp. respectively.Staphylococcus aureusshowed high resistance to penicillin (84.4%; 95%CI= 68.1%-93.2%), erythromycin (41.5%; 95%CI= 28.0%-56.5%) and oxacillin (37.4%; 95%CI= 8.8%-78.7%) and low resistance to rifampicin (2.9%; 95%CI= 0.6%-13.4%), fusidic acid (8.1%; 95%CI= 3.4%-18.0%) and vancomycin (13.6%; 95%CI= 2.2%-52.9%).Conclusion:This study reports a high prevalence of bacterial BSIs in Cameroon and the high resistance of these bacteria to common antibiotics. There is a pressing need to conduct BSI surveillance studies in all regions of Cameroon to generate data for evidence-based measures regarding BSI prevention and management.Keywords:Bloodstream infection, epidemiology,Enterobacterales, antibiotic resistance, Cameroon.