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Background <p>The ESKAPE (<i>Enterococcus faecium</i>, <i>Staphylococcus aureus</i>, <i>Klebsiella pneumoniae</i>, <i>Acinetobacter baumannii</i>, <i>Pseudomonas aeruginosa</i>, and <i>Enterobacter</i> species) pathogens exhibited widespread resistance to multiple antibiotic classes. This study investigated the prevalence of antibiotic resistance (ABR) amongst ESKAPE pathogens in humans in Africa.</p> Materials and methods <p>The systematic review protocol was registered in the International Prospective Register of Systematic Reviews [ID no: CRD42024552173]. A systematic review of the English literature was conducted to collect and analysed data on the prevalence of antibiotic resistance (ABR) caused by ESKAPE pathogens in Africa, covering the period from January 2014 to February 2024. They were provided from three databases (PubMed, Web of Science and ScienceDirect). A total of 268 studies were retrieved and at the end of the screening, 31 full texts were eligible for inclusion in the meta-analysis.</p> Results <p>The overall pooled prevalence estimate (PPE) of ESKAPE pathogens in Africa revealed the following distribution: <i>S. aureus</i> (23.1%), <i>K. pneumoniae</i> (20.9%), <i>E. faecium</i> (9.8%), and <i>Enterobacter</i> spp. (5.3%). The prevalence of ABR in ESKAPE pathogens was reported in 12.9% (7/54) countries from various regions of Africa, and the random-effects models showed that <i>Enterobacter</i> spp. documented more resistance against amoxicillin-clavulanate with a pooled prevalence estimate (PPE) of 95.3% (95%CI: 79.8–99.2), <i>E. faecium</i> antibiotic resistance was higher against tetracycline with a PPE of 47.0% (95%CI: 2.3–97.0). Furthermore, PPE of <i>K. pneumoniae</i> resistance against trimethoprim-sulfamethoxazole was 40.7% (95%CI: 12.6–76.6), whilst <i>S. aureus</i> was mostly resistant against ceftriaxone with a PPE of 94.5% (95%CI: 82.0–98.5). Thirteen studies reported 1532 isolates with multidrug resistance to at least three antibiotic classes, yielding PPE of 64.1%. Interestingly, this meta-analysis revealed that the <i>bla</i><sub>CTX-M</sub> gene had the highest prevalence (37.6%) among the examined genes, followed by the <i>mec</i>A gene (31.5%), and the <i>bla</i><sub>TEM</sub> gene, which was reported in only three studies with a PPE of 13.0%.</p> Conclusion <p>There is a significant knowledge gap in published studies on ABR among ESKAPE pathogens in most African countries. This observation calls for consolidated efforts to conduct research on this subject in the continent, perhaps with support from regional organizations and the African Union.</p> Clinical Trial <p>Not applicable.</p>

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An insight into the antibiotic resistance profiles of ESKAPE pathogens isolated from humans in Africa: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月22日

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  • Ntelekwane George Khasapane,
  • Sebolelo Jane Nkhebenyane,
  • Kgaugelo Edward Lekota,
  • Oriel Thekisoe,
  • Tsepo Ramatla

摘要

Background

The ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens exhibited widespread resistance to multiple antibiotic classes. This study investigated the prevalence of antibiotic resistance (ABR) amongst ESKAPE pathogens in humans in Africa.

Materials and methods

The systematic review protocol was registered in the International Prospective Register of Systematic Reviews [ID no: CRD42024552173]. A systematic review of the English literature was conducted to collect and analysed data on the prevalence of antibiotic resistance (ABR) caused by ESKAPE pathogens in Africa, covering the period from January 2014 to February 2024. They were provided from three databases (PubMed, Web of Science and ScienceDirect). A total of 268 studies were retrieved and at the end of the screening, 31 full texts were eligible for inclusion in the meta-analysis.

Results

The overall pooled prevalence estimate (PPE) of ESKAPE pathogens in Africa revealed the following distribution: S. aureus (23.1%), K. pneumoniae (20.9%), E. faecium (9.8%), and Enterobacter spp. (5.3%). The prevalence of ABR in ESKAPE pathogens was reported in 12.9% (7/54) countries from various regions of Africa, and the random-effects models showed that Enterobacter spp. documented more resistance against amoxicillin-clavulanate with a pooled prevalence estimate (PPE) of 95.3% (95%CI: 79.8–99.2), E. faecium antibiotic resistance was higher against tetracycline with a PPE of 47.0% (95%CI: 2.3–97.0). Furthermore, PPE of K. pneumoniae resistance against trimethoprim-sulfamethoxazole was 40.7% (95%CI: 12.6–76.6), whilst S. aureus was mostly resistant against ceftriaxone with a PPE of 94.5% (95%CI: 82.0–98.5). Thirteen studies reported 1532 isolates with multidrug resistance to at least three antibiotic classes, yielding PPE of 64.1%. Interestingly, this meta-analysis revealed that the blaCTX-M gene had the highest prevalence (37.6%) among the examined genes, followed by the mecA gene (31.5%), and the blaTEM gene, which was reported in only three studies with a PPE of 13.0%.

Conclusion

There is a significant knowledge gap in published studies on ABR among ESKAPE pathogens in most African countries. This observation calls for consolidated efforts to conduct research on this subject in the continent, perhaps with support from regional organizations and the African Union.

Clinical Trial

Not applicable.