Bacterial profile and antimicrobial resistance patterns among pediatrics patients with suspected bloodstream infections in Ethiopia: a systematic review and meta-analysis

Abstract

Background: Bloodstream infection (sepsis) represents a systemic inflammatory response to systemic infection by bacteria, fungi, and viruses that can lead to severe complications and death. The therapeutic management to reduce mortality and morbidity associated with sepsis is difficult due partly to (re)emergence of antimicrobial resistance. The choice of empirical antibiotics, therefore, partly depends on the pattern of local/national antibiotic resistance. This systematic review and meta-analysis aimed to determine the prevalence of bacteremia among pediatric patients with suspected bloodstream infections in Ethiopia, based on culture-confirmed bacterial isolates.

Methods: A comprehensive search of PubMed, Google Scholar, and grey literature was conducted for studies published between January 2010 and April 2024 on bacterial bloodstream infections and antimicrobial resistance. Laboratory-based observational studies reporting bacterial isolates and resistance patterns were included. Data from 23 eligible studies were extracted independently, organized in Excel, and analyzed using Stata version 14. Pooled prevalence estimates were calculated using a random-effects model. Heterogeneity was assessed via the I² statistic, publication bias through funnel plots and Egger's test, and sensitivity analysis evaluated the influence of individual studies.

Results: The pooled prevalence of bacterial bloodstream infections (BSIs) among pediatric patients in Ethiopia was 30.66% (95% CI: 27.18-34.15), underscoring a serious public health concern. The most frequently isolated pathogens were Klebsiella species (30.6%), coagulase-negative staphylococci (CoNS), and Staphylococcus aureus, with Gram-negative bacteria comprising 56.65% of isolates. The overall pooled prevalence of multidrug resistance (MDR) was alarmingly high at 80.54%, with 100% resistance observed in both Klebsiella and Acinetobacter species. Subgroup analyses revealed MDR rates of 81.9% in general wards, 78.35% in NICUs, 82.07% among children, and 78.86% among neonates. Regionally, MDR prevalence ranged from 76.7% in Tigray to 91.3% in Addis Ababa, Amhara, and Oromia-highlighting a critical challenge for sepsis treatment and antimicrobial stewardship in Ethiopian pediatric care settings.

Conclusion: The findings underscore the urgent need for robust antimicrobial stewardship and enhanced surveillance to combat the growing threat of AMR in pediatric BSIs in Ethiopia. Strengthening routine antimicrobial susceptibility testing, improving healthcare infrastructure, and raising public awareness on responsible antibiotic use are critical. Targeted interventions are essential to guide effective treatment, prevent therapeutic failure, and reduce sepsis-related mortality.

Keywords: Antimicrobial; Bacteria; Prevalence; Sepsis.

Fig. 1

PRISMA flow diagram illustrating the process of selecting eligible studies for the systematic review and meta-analysis

Fig. 2

Forest plot showing the pooled prevalence of bacterial blood stream infections among pediatrics in Ethiopia, 2025

Fig. 3

Forest plot showing the overall pooled prevalence of MDR in Ethiopia

Fig. 4

Funnel plot on the prevalence of bacterial blood stream infections in Ethiopia illustrating the presence of publication bias

Fig. 5

Egger’s test graph depicting no publication bias