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Meta-Analysis
. 2025 Jul 1;25(1):843.
doi: 10.1186/s12879-025-11276-9.

Extended-spectrum beta-lactam-resistant Klebsiella pneumoniae in sub-Saharan Africa: a systematic review and meta-analysis from a One Health perspective

Morufat Oluwatosin Olaitan #  1 , Oluwatosin Qawiyy Orababa #  2 , Rukayya Bushola Shittu  3 , Adams Alabi Oyediran  4 , Gift Maureen Obunukwu  4 , Margaret Toluwalayo Arowolo  5 , Ayomikun Emmanuel Kade  2   5 , Khalid Ibrahim Yahaya  6 , Rildwan Alaba Yusuff  7
Affiliations
Meta-Analysis

Extended-spectrum beta-lactam-resistant Klebsiella pneumoniae in sub-Saharan Africa: a systematic review and meta-analysis from a One Health perspective

Morufat Oluwatosin Olaitan et al. BMC Infect Dis. .

Abstract

Background: Extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae is a critical priority pathogen for which there is a need for new antimicrobials and poses a great public health threat to many parts of the world including sub-Saharan Africa (SSA). This study aims to determine the prevalence of ESBL-producing K. pneumoniae in SSA using a one health perspective, and the predominant ESBL genes in the region.

Methods: Databases such as PubMed, Scopus, Web of Science, Africa Journal Online, and Google Scholar were searched for eligible articles based on pre-set eligibility criteria. After screening of titles, abstracts, and full texts, a meta-analysis using a random-effect model was conducted on the eligible studies to determine the overall and subgroup prevalence of ESBL-producing K. pneumoniae in SSA.

Results: This meta-analysis included 119 eligible studies from 25 SSA countries in all SSA subregions. The overall prevalence of ESBL-producing K. pneumoniae in SSA is estimated to be 8.6% [95% CI: 6.4-11]. South Africa (18.5%) and Central Africa (4.6%) subregions have the highest and lowest prevalence of ESBL-producing K. pneumoniae in the region, respectively. Additionally, South Africa (23.3%), Kenya (23%), and Nigeria (11.1%) are the top three countries with ESBL-K. pneumoniae. Animal samples were also seen to have the highest prevalence compared to clinical and environmental samples in this study. Lastly, blaCTX-M-15 was the most reported ESBL gene in SSA.

Conclusion: The widespread presence of resistant strains in certain regions poses a significant risk of inter-country transmission, highlighting the need for collaborative regional surveillance and control efforts.

Keywords: Klebsiella pneumoniae; Antibiotic resistance; ESBL epidemiology; One Health; Public Health; Sub-Saharan Africa.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA Flow diagram of search and screening strategy
Fig. 2
Fig. 2
Classification of included studies based on sub-region (A), sample type (B), and country (C)
Fig. 3
Fig. 3
Forest plot of overall prevalence of ESBL-producing K. pneumoniae from sub-Saharan Africa
Fig. 4
Fig. 4
Forest plot showing subgroup analysis of ESBL-producing K. pneumoniae based on subregions in sub-Saharan Africa
Fig. 5
Fig. 5
Forest plot showing subgroup analysis of ESBL-producing K. pneumoniae based on sample source in sub-Saharan Africa
Fig. 6
Fig. 6
ESBL-producing Klebsiella pneumoniae prevalence in 13 sub-Saharan African countries
See this image and copyright information in PMC

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