Prevalence of carbapenem resistance in Acinetobacter baumannii and Pseudomonas aeruginosa in sub-Saharan Africa: A systematic review and meta-analysis

Background: Carbapenems are drugs of last resort and resistance to them is considered a great public health threat, especially in notorious nosocomial pathogens like Acinetobacter baumannii and Pseudomonas aeruginosa. In this study, we aimed to determine the prevalence of carbapenem resistance in A. baumannii and P. aeruginosa infections in Sub Saharan Africa. Methods: Databases (PubMed, Scopus, Web of Science, and African Journal Online) were systematically searched following the Preferred Reporting Items for Systematic review and meta analysis protocols (PRISMA-P) 2020 statements for articles reporting carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) prevalence between 2012 and 2022. Pooled prevalence was determined with the random effect model in R. Results: A total of 47 articles were scanned for eligibility, among which 25 (14 for carbapenem-resistant A. baumanii and 11 for carbapenem-resistant P. aeruginosa) were included in the study after fulfilling the eligibility criteria. The pooled prevalence of CRPA in the present study was estimated at 8% (95% CI; 0.02 to 0.17; I2=98%; P <0.01). There was high heterogeneity (Q=591.71, I2=98.9%; P<0.0001). The pooled prevalence of CRAB in the present study was estimated at 20% (95% CI; 0.04 to 0.43; I2=99%; P <0.01). There was high heterogeneity (Q=1452.57, I2=99%; P<0.0001). Carbapenem-resistant A. baumannii prevalence based on sample source gave estimates of 24% (95% CI; 6 to 49; I2=99%; P<0.01). The carbapenamse genes commonly isolated from A. baumanii in this study include blaOXA23, blaOXA48, blaGES., blaNDM, blaVIM, , blaOXA24, blaOXA58, blaOXA51, blaSIM-1, blaOXA40, blaOXA66, blaOXA69, blaOXA91, with blaOXA23 and blaVIM being the most common. On the other hand, blaNDM, blaVIM, blaIMP,, blaOXA48, blaOXA51, blaSIM-1, blaOXA181, blaKPC, blaOXA23, blaOXA50 were the commonly isolated carbapenemase genes in P. aeruginosa, among which blaVIM and blaNDM genes were the most frequently isolated. Conclusion: Surveillance of drug-resistant pathogens in sub-Saharan Africa is essential in reducing the disease burden in the region and this study has shown that the region has significantly high multidrug resistant pathogen prevalence. This is a wakeup call for policymakers to put in place measures to reduce the spread of these critical priority pathogens.