review · PLOS Global Public Health
Bacterial infections affecting wounds, skin, soft tissue, and surgical sites present a critical healthcare challenge across Central, Eastern, Southern, and Western Africa. A review of fifty-nine regional studies evaluated the prevalence and antimicrobial resistance patterns of five common bacterial species. Staphylococcus aureus was the most frequently detected pathogen, present in nearly a third of sampled infections, followed by Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii. High levels of resistance were recorded across all identified bacteria. Methicillin resistance occurred in over forty percent of Staphylococcus aureus samples. Escherichia coli and Klebsiella pneumoniae exhibited extensive resistance to amoxicillin-clavulanic acid and substantial resistance to aminoglycosides. Additionally, at least twenty percent of Pseudomonas aeruginosa and Acinetobacter baumannii isolates resisted anti-pseudomonal carbapenems. Many isolated pathogens match the resistance profiles prioritised globally for urgent treatment development, while local microbiological diagnostic capacity remains limited.
Antimicrobial resistance is linked to high mortality across sub-Saharan Africa, where wound and surgical site infections are widespread. High resistance to first-line and critical reserve antibiotics leaves healthcare providers with limited treatment options. Documenting these patterns helps guide effective clinical therapy, informs hospital protocols, and emphasises the need to strengthen regional laboratory diagnostic capacity to stop drug-resistant infections from spreading.
The findings highlight critical targets for developers of novel antimicrobial therapeutics, wound care products, and rapid point-of-care diagnostics tailored to African clinical settings. These applications address high-priority pathogens identified by the World Health Organisation, such as carbapenem-resistant bacteria and MRSA. While the review itself delivers epidemiological baseline data rather than a commercial product, it provides essential evidence to guide pharmaceutical and medical device innovators seeking to validate therapies against prevalent regional resistance profiles.
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Antimicrobial resistance (AMR) is a major global threat and AMR-attributable mortality is particularly high in Central, Eastern, Southern and Western Africa. The burden of clinically infected wounds, skin and soft tissue infections (SSTI) and surgical site infections (SSI) in these regions is substantial. This systematic review reports the extent of AMR from sampling of these infections in Africa, to guide treatment. It also highlights gaps in microbiological diagnostic capacity. PubMed, MEDLINE and Embase were searched for studies reporting the prevalence of Staphylococcus aureus, Eschericheria coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii in clinically infected wounds, SSTI and SSI in Central, Eastern, Southern or Western Africa, and studies reporting AMR from such clinical isolates. Estimates for proportions were pooled in meta-analyses, to estimate the isolation prevalence of each bacterial species and the proportion of resistance observed to each antibiotic class. The search (15th August 2022) identified 601 articles: 59 studies met our inclusion criteria. S. aureus was isolated in 29% (95% confidence interval [CI] 25% to 34%) of samples, E. coli in 14% (CI 11% to 18%), K. pneumoniae in 11% (CI 8% to 13%), P. aeruginosa in 14% (CI 11% to 18%) and A. baumannii in 8% (CI 5% to 12%). AMR was high across all five species. S. aureus was resistant to methicillin (MRSA) in >40% of isolates. E. coli and K. pneumoniae were both resistant to amoxicillin-clavulanic acid in ≥80% of isolates and resistant to aminoglycosides in 51% and 38% of isolates respectively. P. aeruginosa and A. baumannii were both resistant to anti-pseudomonal carbapenems (imipenem or meropenem) in ≥20% of isolates. This systematic review found that a large proportion of the organisms isolated from infected wounds, SSTI and SSI in Africa displayed resistance patterns of World Health Organisation (WHO) priority pathogens for critical or urgent antimicrobial development.
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DOI: 10.1371/journal.pgph.0003077
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