Prevalence of carbapenem-resistant gram-negative bacteria among neonates suspected for sepsis in Africa: a systematic review and meta-analysis.

BACKGROUND: The emergence and rapid spread of gram-negative bacteria resistant to carbapenems among newborns is concerning on a global scale. Nonetheless, the pooled estimate of gram-negative bacteria resistant to carbapenem that cause neonatal sepsis in developing nations remains unknown. Thus, this study aimed to determine the combined prevalence of gram-negative bacteria resistant to carbapenem in African newborns who were suspected of having sepsis. METHODS: All studies published from January 1, 2010, up to December 30, 2023, from PubMed, Science Direct, Scopus electronic databases, and the Google Scholar search engine were researched. Isolates tested for carbapenem from neonates with sepsis, English language papers conducted in Africa, and cross-sectional and cohort studies papers were included. Using PRISMA guidelines, we systematically reviewed and meta-analyzed studies that assessed the prevalence of carbapenem-resistant gram-negative bacteria. The "Joanna Briggs Institute" was used critically to evaluate the quality of the included studies. The data analysis was carried out using STATA™ version 17. Heterogeneity across the studies was evaluated using Q and I 2 tests. The subgroup analysis was done and, funnel plot and Egger's regression test were used to detect publication bias. A sensitivity analysis was conducted. RESULTS: All 36 studies were included in the meta-analysis and systematic review. The pooled prevalence of carbapenem resistance in Africa was 30.34% (95% CI 22.03-38.64%). The pooled estimate of gram-negative bacteria resistant to imipenem, and meropenem was 35.57% (95% CI 0.67-70.54%) and 34.35% (95% CI 20.04% - 48.67%), respectively. A. baumannii and Pseudomonas spp. had pooled prevalence of 45.9% (95% CI 33.1-58.7%) and 43.0% (95% CI 23.0-62.4%), respectively. Similarly, Pseudomonas spp. and A. baumannii also exhibited strong meropenem resistance, with a pooled prevalence of 29.2% (95% CI 4.8-53.5%) and 36.7% (95% CI 20.1-53.3%), respectively. E. coli and K. pneumoniae were the two most common isolates. CONCLUSION: There should be urgent antimicrobial stewardship practices, strengthened surveillance systems and effective treatment for neonates with sepsis. There was remarkable variation in resistance across the continent.

Antimicrobial resistance profile of Pseudomonas aeruginosa clinical isolates from healthcare-associated infections in Ethiopia: A systematic review and meta-analysis.

BACKGROUND: Antimicrobial-resistant (AMR) bacterial infection is a significant global threat to the healthcare systems. Pseudomonas aeruginosa, the leading infectious agent in the healthcare setting is now one of the major threats due to AMR. A comprehensive understanding of the magnitude of AMR, particularly highly public health important pathogens such as P. aeruginosa, is necessary for the management of infections based on local information. OBJECTIVE: This systematic review and meta-analysis aimed to determine the country-wide AMR of P. aeruginosa. METHODS: Systematic searches were performed to retrieve articles from PubMed, Scopus, Web of Science, ScienceDirect electronic databases, Google Scholar search engine, and repository registrars from 2015 to 31st December 2023. Twenty-three studies that provided important data on AMR in P. aeruginosa were systematically reviewed and analyzed to determine the country-wide magnitude of P. aeruginosa AMR profile from healthcare-associated infections. AMR of P. aeruginosa to 10 different antibiotics were extracted separately into Microsoft Excel and analyzed using STATA 17.0. Cohen's kappa was computed to determine the agreement between reviewers, the Inverse of variance (I2) was used to evaluate heterogeneity across studies, and Egger's test to identify publication bias. A random effect model was used to determine the pooled resistance to each antibiotic. Subgroup analysis was performed by infection type and year of publication. RESULTS: This systematic review and meta-analysis revealed that the pooled prevalence of P. aeruginosa in clinical specimens associated with HAI was 4.38%(95%CI: 3.00-5.76). The pooled prevalence of AMR in P. aeruginosa for different antibiotics varies, ranging from 20.9% (95%CI: 6.2-35.8) for amikacin to 98.72% (95%CI: 96.39-101.4) for ceftriaxone. The pooled resistance was higher for ceftriaxone (98.72%), Trimethoprim-sulfamethoxazole (75.41), and amoxicillin-clavulanic acid (91.2). In contrast relatively lower AMR were observed for amikacin (20.9%) and meropenem (28.64%). The pooled multi-drug resistance (MDR) in P. aeruginosa was 80.5% (95%CI: 66.25-93.84). Upon subgroup analysis by infection types and year of publication, P. aeruginosa isolated from healthcare-associated infections exhibited higher resistance to ceftazidime (94.72%) compared to isolates from mixed types of healthcare-associated infections (70.84%) and surgical site infections (57.84%). Antimicrobial resistance in gentamicin was higher during the periods of 2018-2020 (73.96%), while comparatively lower during 2021-2023 (42.69%) and 2015-2017 (29.82%). CONCLUSIONS: Significantly high AMR and MDR were observed from this systematic review and meta-analysis. AMR obtained from this systematic review and meta-analysis urges the need for improved infection control, antimicrobial stewardship practices, and strengthened surveillance systems to control the spread of AMR and ensure effective treatment of P. aeruginosa infections. PROTOCOL REGISTRATION: This systematic review and meta-analysis was registered on PROSPERO (Registration ID: CRD42024518145).

Magnitude of anemia and undernutrition among HIV-infected children who took HAART: a retrospective follow-up study.

BACKGROUND: Human immunodeficiency virus (HIV) is a virus that affects the immune system, the body's natural defence system. It is a virus spreading through certain body fluids that attacks the body's immune system, specifically the Cluster of Differentiation 4 (CD4) T-cells. Anemia is a common manifestation of pediatric HIV infection and is a significant negative predictor of survival. Moreover, undernutrition is the underlying cause of death among 35% of children aged under 5 years, and it has been negatively implicated with antiretroviral therapy (ART) outcomes, particularly in developing countries. The aim of this study was to determine the magnitude of anemia and undernutrition among HIV-infected children within the first year of ART initiation at University of Gondar comprehensive specialized hospital ART clinic. METHODS: Records of 200 children aged <15 years old who were on ART at the University of Gondar comprehensive specialized hospital from 2005 to 2017 were retrospectively reviewed in 2017. Baseline characteristics and one-year flow-up data after ART initiation were extracted from the medical records. Anemic status was determined based on the hemoglobin (Hb) level in accordance with World Health Organization (WHO) guideline. The nutritional status was calculated based on anthropometric measurements. Generalized Estimating Equation (GEE) was fitted to identify factors associated with anemia and undernutrition. Odds ratio with the corresponding 95% Confidence interval (CI) was reported. RESULTS: Of the total children, 75 (37.5%) (95% CI: 30.73-44.27%) were anemic at the baseline of ART initiation. The magnitude of anemia has shown a persistent decline from the baseline to 12th months of ART initiation. At ART initiation, the magnitude of undernutrition was high, 64% (95% CI: 57.3-70.7%). Similarly, the magnitude of undernutrition showed decrement during a one year ART initiation period. Stunting was the most common type of undernutrition at baseline (49.5%), 6 months (44%), 9 months (41%), and 12 months (39%) of ART initiation. Baseline CD4 count, Baseline WHO clinical stage and age at enrollment to the care were significantly associated with anemia within the first year of ART initiation. CONCLUSION: Despite a decline in the first year of ART initiation, anemia and undernutrition were public health problems in HIV-infected children. Hence, for HIV-infected children taking HAART, emphasis should be given to manage anemia and undernutrition within the first year of ART initiation.