Ciprofloxacin resistance in community and hospital-acquired urinary tract infections: a systematic review and meta-analysis from African population

Background: Since the introduction of fluorinated derivatives (fluoroquinolones) in the 1980s, these agents, especially ciprofloxacin, have become standard treatment for various bacterial infections, including urinary tract infections (UTIs). Frequently, in developing countries UTIs are treated empirically due to limited capacity of the culture and sensitivity testing in most health facilities. Despite the high usage, there is a scarcity of data regarding ciprofloxacin resistance/susceptibility pattern among uropathogens isolated in Africa. This study aimed to conduct a systematic review to ascertain the rate of ciprofloxacin resistance among uropathogens in Africa and identify the most common fluoroquinolone-resistant uropathogens in the region. 

Methods: We used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to search the PubMed, Embase and Scopus databases, as well as grey literature search, for articles reporting on the antibiotic susceptibility of uropathogens in African countries between January 2010 and December 2023. 

Results: A total of 2940 articles were screened resulting to 44 relevant studies that were included, from three regions of Africa; East, West and North Africa. Majority of the studies were from East Africa (35/44; 79.5%) whilst North Africa contributed few numbers of studies (3/44; 6.8%). The overall rate of uropathogens resistant to ciprofloxacin in Africa was 34% (95%, CI = 0.27–0.40) which was from isolates obtained from various study populations, including the general population (24/44; 54.5%, pregnant women (8/44; 18.1%), children (7/44; 15.9%) and HIV infected individuals (5/44; 11.4%). Resistance to ciprofloxacin was high in North Africa (56%; 95% CI 0.27–0.85) compared to other African regions. Enterococci pathogens exhibited higher ciprofloxacin resistance, 47% (95% CI 0.21–0.75) compared to other bacteria isolates. 

Conclusion: This review has shown significant resistance of uropathogens to ciprofloxacin, which is often the primary treatment for urinary tract infections in numerous African countries. Variability in resistance patterns among countries highlights the pressing requirement for coordinated surveillance throughout the region and emphasizes the importance of tailored interventions based on the local data. It is essential to conduct regular epidemiological monitoring of antibiotic resistance and establish effective infection control and antimicrobial stewardship programs in the African regions. 

Trial registration: PROSPERO identification number: CRD42023471255.