article · BMC Infectious Diseases
A systematic review and meta-analysis evaluated the prevalence of carbapenem-resistant Klebsiella pneumoniae across African clinical settings. Analysing thirty-one studies published between 2011 and 2023, the investigation found reported resistance rates ranging widely from 0 percent to 100 percent. Extremely high variability between studies indicated that a single pooled figure cannot reliably represent the continent. When all studies were pooled, the estimated prevalence was 68.4 percent, but this dropped to 29.6 percent when studies reporting complete resistance were removed. This divergence highlights how outbreak-driven reports and datasets enriched for resistant cases skew overarching figures. Rather than demonstrating a uniform continental burden, the findings establish profound epidemiological differences across African facilities, driven partly by uneven surveillance capacity, diverse methodologies, and local outbreak dynamics.
Carbapenem-resistant Klebsiella pneumoniae poses a critical threat to global health, especially in vulnerable hospitalised patients. Understanding that resistance rates vary dramatically across African health centres prevents public health officials from relying on misleading continental averages. It highlights the urgent necessity for standardised surveillance methods and targeted infection prevention rather than assuming uniform resistance levels across all facilities.
The abstract does not indicate a direct commercial application pathway. However, the demonstrated variability in resistance rates provides epidemiological evidence that could inform diagnostic developers and surveillance software providers seeking to design tools adapted to fragmented testing environments. Such public health surveillance applications remain at an early analytical stage and would require further operational development before real-world clinical implementation.
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Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a critical global antimicrobial resistance threat, yet continental-level synthesis of its epidemiology in Africa remains limited. Reported prevalence varies markedly across African settings, raising concern that pooled estimates may obscure substantial heterogeneity driven by outbreak amplification, methodological diversity, and uneven surveillance capacity. We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines to estimate CRKP prevalence in Africa while evaluating between-study heterogeneity, methodological influences, and bloodstream infection (BSI)–specific burden. Electronic databases were searched from 2010 to 2026. The review protocol was prospectively registered in PROSPERO (CRD420261390170). Studies reporting species-specific CRKP prevalence from African clinical settings were included. Random-effects meta-analysis using Freeman–Tukey transformation with Hartung–Knapp adjustment was performed, with additional binomial–normal (logit) modelling to address extreme proportions (0% and 100%). Sensitivity analyses excluded studies reporting complete resistance. Thirty-one studies (2011–2023) were included. CRKP prevalence estimates varied markedly across studies, ranging from 0% to 100%, with extreme between-study heterogeneity (I² = 99.6%) and a wide prediction interval indicating substantial variability across African clinical settings. CRKP prevalence varied markedly across studies, ranging from 0% to 100%, with extreme heterogeneity (I² = 99.6%) and a wide prediction interval (~ 6%–98%). Because this heterogeneity indicated that a single pooled estimate was unlikely to represent a typical African setting, sensitivity analyses were prioritized. After excluding studies reporting complete resistance (100%), the pooled prevalence was 29.6% (95% CI: 14.2%–47.4%), whereas inclusion of all studies yielded a pooled prevalence of 68.4% (95% CI: 53.2%–81.7%). The substantial difference between estimates demonstrates strong influence from outbreak-driven and resistance-enriched datasets. The principal finding of this study is the profound epidemiological heterogeneity of CRKP across African settings rather than a single representative continental prevalence.
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DOI: 10.1186/s12879-026-14375-3
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