Antimicrobial resistance of Enterobacterales in Central Africa: a systematic review and meta-analysis

A recent systematic review and meta-analysis of studies from Central Africa (covering 2008-2024) found that roughly 22% of Enterobacterales (common gut bacteria like E. coli and K. pneumoniae) carry extended-spectrum β-lactamase (ESBL) resistance—about 41% in healthy carriers and 10% in clinical infection samples. The study also reports high resistance rates to commonly used antibiotics (such as cotrimoxazole: 63-81%; amoxicillin/clavulanic acid: 43-63%; ciprofloxacin: 24-33%), while resistance to lesser-used agents like nitrofurantoin (12-18%) and amikacin (13-19%) remains relatively low. Crucially, there were almost no data for WHO Reserve antibiotic classes (e.g., carbapenems, newer β-lactam/β-lactamase inhibitors, fosfomycin). The authors conclude that the region’s weak diagnostic and surveillance capacity, widespread empirical antibiotic use, and insufficient infection prevention interventions greatly hamper AMR containment efforts.