Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Sep 5;13(1):14655.
doi: 10.1038/s41598-023-41882-z.

Bacterial profile and antimicrobial resistance patterns of infected diabetic foot ulcers in sub-Saharan Africa: a systematic review and meta-analysis

Fiseha Wadilo Wada  1   2   3 , Michael Fekadu Mekonnen  4 , Edlawit Desta Sawiso  5 , Sitotaw Kolato  6   7 , Lideta Woldegiorgis  8 , Gemechu Kebede Kera  9 , Ziad El-Khatib  10   11 , Akililu Alemu Ashuro  6 , Mulatu Biru  12 , Minyahil Tadesse Boltena  6   13
Affiliations
Meta-Analysis

Bacterial profile and antimicrobial resistance patterns of infected diabetic foot ulcers in sub-Saharan Africa: a systematic review and meta-analysis

Fiseha Wadilo Wada et al. Sci Rep. .

Abstract

The number of diabetic foot ulcer patients is substantially increasing, with the rapidly rising burden of diabetic mellitus in sub-Saharan Africa. The data on the regional prevalence of diabetic foot ulcer infecting bacteria and their antimicrobial resistance patterns is crucial for its proper management. This systematic review and meta-analysis determined the pooled prevalence of bacterial profiles and antimicrobial resistance patterns of infected diabetic foot ulcers in sub-Saharan Africa. A comprehensive search of the literature was performed on CINAHL, EMBASE, Google Scholar, PubMed, Scopus, and Web of Science databases. Critical appraisal was done using the Joanna Briggs Institute's tool for prevalence studies. A pooled statistical meta-analysis was conducted using STATA Version 17.0. The I2 statistics and Egger's test were used to assess the heterogeneity and publication bias. The pooled prevalence and the corresponding 95% confidence interval of bacterial profiles and their antimicrobial resistance patterns were estimated using a random effect model. Eleven studies with a total of 1174 study participants and 1701 bacteria isolates were included. The pooled prevalence of the most common bacterial isolates obtained from DFU were S. aureus (34.34%), E. coli (21.16%), and P. aeruginosa (20.98%). The highest pooled resistance pattern of S. aureus was towards Gentamicin (57.96%) and Ciprofloxacin (52.45%). E.coli and K. Pneumoniae showed more than a 50% resistance rate for the most common antibiotics tested. Both gram-positive and gram-negative bacteria were associated with diabetic foot ulcers in sub-Saharan Africa. Our findings are important for planning treatment with the appropriate antibiotics in the region. The high antimicrobial resistance prevalence rate indicates the need for context-specific effective strategies aimed at infection prevention and evidence-based alternative therapies.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
PRISMA flow diagram of included studies: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. https://doi.org/10.1136/bmj.n71.
Figure 2
Figure 2
Forest plot showing the pooled prevalence of Staphylococcus aureus isolates from DFU samples in sub-Saharan Africa.
Figure 3
Figure 3
Forest plot showing the pooled prevalence of E. coli isolates from DFU samples in sub-Saharan Africa.
Figure 4
Figure 4
Forest plot showing the pooled prevalence of Pseudomonas aeruginosa isolates from DFU samples in sub-Saharan Africa.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Armstrong DG, Boulton AJ, Bus SA. Diabetic foot ulcers and their recurrence. N. Engl. J. Med. 2017;376:2367–2375. doi: 10.1056/NEJMra1615439. - DOI - PubMed
    1. Atlas, D. International diabetes federation. In IDF Diabetes Atlas, 7th edn. Brussels, Belgium: International Diabetes Federation 33, 2 (2015).
    1. Zhang P, et al. Global epidemiology of diabetic foot ulceration: A systematic review and meta-analysis. Ann. Med. 2017;49:106–116. doi: 10.1080/07853890.2016.1231932. - DOI - PubMed
    1. Ugwu E, et al. Burden of diabetic foot ulcer in Nigeria: Current evidence from the multicenter evaluation of diabetic foot ulcer in Nigeria. World J. Diabetes. 2019;10:200. doi: 10.4239/wjd.v10.i3.200. - DOI - PMC - PubMed
    1. Abbas, Z. G. The Diabetic Foot Worldwide: sub‐Saharan Africa. The foot in diabetes, 51–60 (2020).

Substances