Update on prevalence and antimicrobial resistance of Staphylococcus aureus and Pseudomonas aeruginosa isolated from diabetic foot ulcers in Africa: a systematic review and meta-analysis

Abstract

Diabetes mellitus is increasing in Africa, and diabetes-related amputations exacerbated by diabetic foot infection are also prevalent with Staphylococcus aureus and Pseudomonas aeruginosa two priority pathogens playing key roles. Understanding the local epidemiology and antimicrobial resistance profiles of these dominant pathogens is crucial for appropriate antibiotic therapy. This systematic review and meta-analysis aim to contribute valuable insights that can guide the management of diabetic foot ulcer-related infections in Africa by comprehensively analyzing the available literature on the prevalence and antimicrobial resistance profiles of Staphylococcus aureus and Pseudomonas aeruginosa in infected diabetic foot ulcers across Africa. We conducted a continent-based literature search utilizing PubMed and Scopus databases on June 11th, 2023, to identify studies conducted in Africa among persons with diabetic foot ulcers that reported isolating bacteria from the foot ulcers. The main concepts related to this research, “diabetic foot ulcers”, “diabetic foot infections”, “bacteria” and “Africa” were expanded with their synonyms and combined using Boolean operators (AND, OR) to formulate the final search query. The selection and inclusion of studies followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Our review revealed that approximately 4124 bacteria have been isolated from diabetic foot ulcers across 13 African countries. Staphylococcus aureus is the dominant species with a random effect pooled prevalence of 19.9% (95%CI: [16.19–23.84%]; I2 = 88.56% [82.26–92.62%]) followed by Pseudomonas aeruginosa with 11.8% (95%CI: [8.67–15.23%]; I2 = 89.95% [84.67–93.41%]). Methicillin-resistant Staphylococcus aureus (MRSA) pooled 12.9% (95%CI: [3.99–25.89%]; I2 = 95.47% [93.68–96.75%]). Multidrug-resistant S.aureus and P. aeruginosa pooled prevalence is 26.4% (95%CI: [17.84–36.06%]; I2 = 71.16% [49.34–83.58%]) and 41.8% (95%CI: [27.38–56.91%]; I2 = 78.48% [60.80–88.18%]), respectively. Staphylococcus aureus dominates diabetic foot ulcer (DFU) isolates in Africa contrary to the prevailing assertion about Pseudomonas aeruginosa. However, multidrug resistance among both species is high emphasizing the need for antimicrobial stewardship and utilization of other wound management protocols such as topical silver sulfadiazine (SSD) for the duo.