Carbapenem resistance in West Africa: a systematic review

Abstract

OBJECTIVES: The World Health Organization (WHO) has reported carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter baumannii (CRAb), and carbapenem-resistant Pseudomonas aeruginosa (CRPa) as critical priority pathogens for human health. Therefore, this study aimed to review clinical carbapenem resistance systematically and comprehensively in West Africa. DATA SOURCES: A total of 102 research articles on carbapenem resistance from the sixteen countries forming the West African region were included in this review. DATA SYNTHESIS: Carbapenem-resistant bacteria (CRB) were isolated mainly from urine 73/300 (24.3%) and pus/wounds of patients 69/300 (23%). The mean prevalence of CRB in West Africa was 4.6% (1902/41635), ranging from 1.6% to 18.6%. CRB identified were mainly Escherichia spp. (34/130; 26.1%), Klebsiella spp. (27/130, 20.8%), Pseudomonas spp. (26/130, 20%), and Acinetobacter spp. (25/130; 19.2%). Bacteria isolated in West African countries produced carbapenemases that belong to the four Ambler classes and include 13 types. The bla OXA-type (34/104; 32.7%), bla NDM (31/104; 29.8%), and bla VIM (13/104; 12.5%) were the most common carbapenemase genes. These genes are carried by plasmids, composite transposons, and integrons. The Kirby-Bauer disc diffusion method (74/172; 43.0%), PCR (38/172; 22.1%), and whole genome sequencing (17/172; 9.9%) were the most common methods for carbapenem resistance detection. The most reported alternative antibiotics active against CRB were amikacin, colistin, and fosfomycin. CONCLUSION: There is an urgent need to take synergistic action to delay, as much as possible, the occurrence of CRB epidemics in West Africa.