The Aetiology and Antimicrobial Resistance of Bacterial Maternal Infections in Sub-Saharan Africa-a Systematic Review and Meta-analysis

Overview

Journal BMC Infect Dis

Publisher Biomed Central

Specialty Infectious Diseases

Date 2024 Sep 14

PMID 39277737

Authors

Chikondi Chapuma

Hussein H Twabi

Edward J M Monk

James Jafali

Andrew Weeks

Emily Beales

David Kulapani

Apatsa Selemani

Marriott Nliwasa

Luis Gadama

Tony Nyirenda

Chisomo Msefula

Catherine Dunlop

Samantha Lissauer

Nicholas Feasey

Charlotte van der Veer

David Lissauer

Affiliations

Soon will be listed here.

Abstract

Background: Understanding 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.

Methods: Microbiologically 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.

Findings: We 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.

Interpretation: We 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.

Funding: This research was supported by the NIHR-Professorship/NIHR300808 and the Wellcome-Strategic-award /206545/Z/17/Z.

Trial Registration: Prospero ID CRD42021238515.

Citing Articles

Maternal mortality following caesarean section in a low-resource setting: a National Malawian Surveillance Study.

Riches J, Chimwaza Y, Magreta Chakhame B, Milln J, Twabi H, Bilesi R BMJ Glob Health. 2024; 9(11).

PMID: 39581635 PMC: 11590827. DOI: 10.1136/bmjgh-2024-016999.

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