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      Antimicrobial resistance in West Africa: a systematic review and meta-analysis.

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          Abstract

          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.

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          Author and article information

          Journal
          Int. J. Antimicrob. Agents
          International journal of antimicrobial agents
          Elsevier BV
          1872-7913
          0924-8579
          Nov 2017
          : 50
          : 5
          Affiliations
          [1 ] Doctors Without Borders, New York, NY, USA.
          [2 ] Epicentre, Paris, France.
          [3 ] University of Cape Town, Cape Town, South Africa.
          [4 ] Médecins Sans Frontières, Paris, France.
          [5 ] Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1000 W. Carson Street, Box 466, Torrance, CA 90509, USA. Electronic address: ramurphy@gmail.com.
          Article
          S0924-8579(17)30274-1
          10.1016/j.ijantimicag.2017.07.002
          28705671
          9c47dab4-1a63-4d63-9535-baa6f3b6533b
          History

          Antimicrobial agents,West Africa,Drug resistance
          Antimicrobial agents, West Africa, Drug resistance

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