Prevalence of Antimicrobial Resistance in Klebsiella pneumoniae in the South African Populations: A Systematic Review and Meta-Analysis of Surveillance Studies

Abstract

Antimicrobial resistance (AMR) poses a critical global health threat, with Klebsiella pneumoniae emerging as a high-priority pathogen due to escalating resistance rates. This systematic review and meta-analysis evaluated the AMR profiles of K. pneumoniae isolates from South Africa, a resource-limited setting where AMR burdens remain understudied. A comprehensive search of PubMed, Web of Science, and Google Scholar (January 2000 to June 2024) identified studies reporting resistance data. Nineteen studies comprising 9402 isolates were included, and data were analyzed using random-effects models. Pooled resistance prevalence was highest for amoxicillin (69.3%; 95% CI: 64.1%–74.1%), followed by second-generation cephalosporins (70.9%; 95% CI: 65.3%–75.8%), trimethoprim-sulfamethoxazole (57.8%; 95% CI: 52.4%–63.0%), and carbapenems, with imipenem resistance at 33.2% (95% CI: 28.5%–38.3%). Significant heterogeneity was observed (I² > 90%, p < 0.001), likely due to differences in study populations such as clinical versus environmental isolates, and regional prescribing practices. Publication bias was detected (Egger's test: p = 1.45 × 10⁻¹⁴), indicating possible underreporting of small-scale studies with null findings. These findings highlight alarming resistance rates to first-line antibiotics in South Africa and underscore the urgent need for multisectoral interventions. Priority actions should include standardized AMR surveillance to harmonize data collection, expanded antimicrobial stewardship programs particularly in high-resistance settings such as hospitals, and greater investment in novel therapies targeting carbapenem-resistant strains. Addressing methodological heterogeneity and minimizing publication bias in future research will be critical to strengthening the evidence base for informed policymaking.