Prevalence of AmpC beta-lactamase producing Escherichia coli and Klebsiella pneumoniae in Africa: a systematic review and meta-analysis.

Abstract

Background: The emergence of AmpC beta-lactamase (AmpC) poses a significant challenge in the context of antimicrobial resistance (AMR). AmpC confers resistance to narrow- and broad- spectrum cephalosporins, beta-lactam/beta-lactamase inhibitor combinations and aztreonam making it clinically relevant and presenting a formidable threat to effective therapeutic interventions. Thus, the aim of this study was to assess magnitude of AmpC producing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) in Africa.

Methods: Articles were extensively searched in bibliographic databases and grey literature using entry terms and combinations key words. Electronic databases such as PubMed, Scopus, Science Direct, Embase, and other online sources such as African Journal Online, Google Scholar, and ResearchGate were used to find relevant articles. Furthermore, the Joanna Briggs Institute quality appraisal tool was used to assess the quality of the included studies. Studies meeting eligibility criteria were extracted in MS Excel and exported to STATA version 14 software for statistical analysis. A random-effects model was used to compute the pooled prevalence of AmpC producing E. coli and K. pneumoniae. Heterogeneity was quantified by using the Cochrane Q test and I² statistics. Publication bias was assessed using a funnel plot and Egger's test. Additionally, sensitivity analysis was conducted to assess the impact of a single study on the pooled effect size.

Result: Of the 2,619 studies identified, 25 studies were eligible for quantitative analysis, involving a total of 11,908 E. coli, and 4,654 K. pneumoniae isolates. The overall pooled prevalence of AmpC producing E. coli and K. pneumoniae in Africa was 18.79% (95% CI: 15.00, 22.58). The pooled prevalence of AmpC producing E. coli and K. pneumoniae were 15.32% (95% CI: 12.03, 18.61) and 17.25% (95% CI: 13.18, 21.32), respectively. There was significant heterogeneity among studies (I² = 99.0%, p < 0.001). Our study depicted that Egypt had the highest pooled prevalence of AmpC producing E. coli and K. pneumoniae with 28.91% (14.74, 43.08) and 27.84% (8.47, 47.21) respectively. Furthermore, studies conducted after 2020 showed the highest pooled prevalence of AmpC producing E. coli 28.29% (11.78, 44.80) and K. pneumoniae 29.04% (13.13, 44.85) while lowest pooled prevalence of AmpC producing E. coli 6.28% (95% CI: 2.99, 9.58) and K. pneumoniae 5.41% (95% CI: 1.73, 9.09) was observed among studies conducted before the year 2016.

Conclusion: This study showed an increase in AmpC producing E. coli and K. pneumoniae in Africa over the past 20 years. Therefore, regular identification of AmpC, infection prevention control, strengthening of the antimicrobial resistance surveillance system and an effective antibiotic policy are required to combat the antibiotics resistance in Africa.

Prospero registration identification number: CRD42024501640.