TY - JOUR
T1 - The aetiology and antimicrobial resistance of bacterial maternal infections in Sub-Saharan Africa—a systematic review and meta-analysis
AU - Chapuma, Chikondi
AU - Twabi, Hussein H.
AU - Monk, Edward J.M.
AU - Jafali, James
AU - Weeks, Andrew
AU - Beales, Emily
AU - Kulapani, David
AU - Selemani, Apatsa
AU - Nliwasa, Marriott
AU - Gadama, Luis
AU - Nyirenda, Tony
AU - Msefula, Chisomo
AU - Dunlop, Catherine
AU - Lissauer, Samantha
AU - Feasey, Nick
AU - Van der Veer, Charlotte
AU - Lissauer, David
PY - 2024/9/14
Y1 - 2024/9/14
N2 - BackgroundUnderstanding the aetiological organisms causing maternal infections is crucial to inform antibiotic treatment guidelines, but such data are scarce from Sub-Saharan Africa (SSA). We performed this systematic review and meta-analysis to address this gap.MethodsMicrobiologically confirmed maternal infection data were collected from PubMed, Embase, and African Journals online databases. The search strategy combined terms related to bacterial infection, pregnancy, postnatal period, observational studies, SSA. Exclusion criteria included colonization, asymptomatic infection, and screening studies. Pooled proportions for bacterial isolates and antimicrobial resistance (AMR) were calculated. Quality and completeness of reporting were assessed using the Newcastle–Ottawa and STROBE checklists.FindingsWe included 14 papers comprising data from 2,575 women from four sources (blood, urine, surgical wound and endocervical). Mixed-growth was commonly reported at 17% (95% CI: 12%-23%), E. coli from 11%(CI:10%-12%), S. aureus from 5%(CI: 5%-6%), Klebsiella spp. at 5%(CI: 4%- 5%) and Streptococcus spp. at 2%(CI: 1%-2%). We observed intra-sample and inter-sample heterogeneity between 88–92% in all meta-analyses. AMR rates were between 19% -77%, the highest with first-line beta-lactam antibiotics. Convenience sampling, and limited reporting of laboratory techniques were areas of concern.InterpretationWe provide a comprehensive summary of microbial aetiology of maternal infections in SSA and demonstrate the paucity of data available for this region. We flag the need to review the current local and international empirical treatment guidelines for maternal bacterial infections in SSA because there is high prevalence of AMR among common causative bacteria.
AB - BackgroundUnderstanding the aetiological organisms causing maternal infections is crucial to inform antibiotic treatment guidelines, but such data are scarce from Sub-Saharan Africa (SSA). We performed this systematic review and meta-analysis to address this gap.MethodsMicrobiologically confirmed maternal infection data were collected from PubMed, Embase, and African Journals online databases. The search strategy combined terms related to bacterial infection, pregnancy, postnatal period, observational studies, SSA. Exclusion criteria included colonization, asymptomatic infection, and screening studies. Pooled proportions for bacterial isolates and antimicrobial resistance (AMR) were calculated. Quality and completeness of reporting were assessed using the Newcastle–Ottawa and STROBE checklists.FindingsWe included 14 papers comprising data from 2,575 women from four sources (blood, urine, surgical wound and endocervical). Mixed-growth was commonly reported at 17% (95% CI: 12%-23%), E. coli from 11%(CI:10%-12%), S. aureus from 5%(CI: 5%-6%), Klebsiella spp. at 5%(CI: 4%- 5%) and Streptococcus spp. at 2%(CI: 1%-2%). We observed intra-sample and inter-sample heterogeneity between 88–92% in all meta-analyses. AMR rates were between 19% -77%, the highest with first-line beta-lactam antibiotics. Convenience sampling, and limited reporting of laboratory techniques were areas of concern.InterpretationWe provide a comprehensive summary of microbial aetiology of maternal infections in SSA and demonstrate the paucity of data available for this region. We flag the need to review the current local and international empirical treatment guidelines for maternal bacterial infections in SSA because there is high prevalence of AMR among common causative bacteria.
KW - Aetiology
KW - Antimicrobial resistance
KW - Bacterial
KW - Maternal infections
KW - Sub-Saharan Africa
U2 - 10.1186/s12879-024-09855-3
DO - 10.1186/s12879-024-09855-3
M3 - Review article
SN - 1471-2334
VL - 24
SP - e974
JO - BMC Infectious Diseases
JF - BMC Infectious Diseases
IS - 1
M1 - 978
ER -