Prevalence and bacteriological profile of pathogens causing neonatal sepsis in Tanzania: a systematic review with meta-analysis

Abstract

Neonatal sepsis is the significant cause of morbidity and mortality in low- and middle-income countries (LMICs) such as Tanzania, where 99% of global neonatal deaths occur. Epidemiological data regarding the causative agents and their resistance profiles can guide clinical practice and prevention strategies. A systematic review and meta-analysis was conducted to determine the prevalence, pathogens and the outcome of neonatal sepsis in Tanzania. We conducted a systematic literature search using online databases such as PubMed/ Medline, Embase, Cochrane, Google Scholar, and Web of Science to identify peer-reviewed publications from January 2010 until May 2023. The data were analysed to determine the effect size using risk ratios (RR) and their 95% confidence interval (CI). We included twelve hospital-based studies from 559 records, of which nine were prospective in design. The overall prevalence of microbiological confirmed neonatal sepsis in Tanzania was 33% (95% CI 22–44, p < 0.001). The most prevalent pathogen was Staphylococcus haemolyticus 23.7% (95% CI 20.57–27.02%) followed by Klebsiella spp. 19.3% (95% CI 9.2% to 32%, I2 98%). The resistance of pathogens to first-line (ampicillin plus gentamicin) and second-line (ceftriaxone) treatments were almost similar (RR:1.12 (95% CI: 1.09–1.16; I² = 79.5%, p < 0.001). The pathogens were more resistant to third-generation cephalosporins compared to meropenem with the overall pooled relative risk (RR) of 1.84 (95% CI: 1.77–1.91). Death occurred in 15.1% (95% CI 5.39–28.44) of the affected neonates. There was considerable heterogeneity among all analyses which may result from the different facilities where the studies were sampled. Furthermore, a sampling bias with the majority of studies being from tertiary hospital settings, may result in overestimating the burden of antimicrobial resistance (AMR). AMR and neonatal sepsis mortality remain a significant challenge. It is crucial to consider the early and optimal points for interventions to manage neonatal sepsis’s prevalence and outcomes. Revised recommendations for effective first-line antibiotics in the management of neonatal and infant sepsis in Tanzania are urgently needed. Further research is needed to come up with rapid and robust diagnostics to guide treatment and reduce unnecessary antibiotic use.