Antimicrobial Resistance in the Central African Region: A Review

Background: The impact of antimicrobial resistance (AMR) has placed it among one of the top public health problems worldwide. AMR has increased the global infectious disease burden and put a greater strain on health systems. This review sought to contribute more evidence on this issue of AMR in the Central African Region, by determining the overall bacterial pathogens resistance rate and pathogen specific resistance rate with respect to antimicrobial agents common in the region. Methods: Pubmed and other relevant databases were searched using the Boolean strategy. We reviewed articles from 2008 to 2018 and in accordance with an adapted PRISMA guideline. Article retrieval and screening were done using a structured search inclusion/exclusion criteria. Median and interquartile ranges of percentage resistance were calculated for each antibiotic-bacterium combination. Results: Limited AMR data was available for Central African countries with no reported data for Burundi. A total of 30 articles were included in the final analysis. The most commonly reported bacterium was Salmonella spp that has been reported from 16 studies with median resistance rate of 45.5 (IQR 9.1-81.0). It was also observed that bacterium Staphylococcus aureus had the highest resistance rate with a median resistance of 90 (IQR 86.4-95.2). In general, median resistance rate higher above 50% were observed for the following bacteria; Staphylococcus aureus, Shigella spp, Klebsiella spp, Enterococci, E. Coli and Acinetobacter spp.  Conclusion: The review highlights two important findings: first, there is a huge gap of data regarding Antimicrobial resistance in the Central African Region. Second, a high level of drug resistance exists for commonly prescribed Antimicrobial drugs in the Central African region. We recommend the standardization and quality of microbiological identification and susceptibility/resistance testing methods as well as surveillance of AMR to be improved to allow national and international organizations, to monitor the extent of the AMR problem. All of the identified areas of concern need urgent attention by the global health community in order to halt the public health threat associated with spreading AMR.