Molecular epidemiology of Pseudomonas aeruginosa in Africa: A systematic review and Meta-analysis

Background Pseudomonas aeruginosa is an opportunistic pathogen that has been reported to cause a variety of nosocomial infections, partly due to its high levels of antimicrobial resistance. With limited genomic surveillance at hand, knowledge about high-risk clones and epidemiological trends in Africa has been hindered. This systematic review and meta-analysis aimed to investigate the clonal diversity of P. aeruginosa in Africa, focusing on the prevalence and geographic spread of globally recognized high-risk clones. Objective To synthesize molecular evidence on P. aeruginosa circulating in Africa, to describe clonal diversity, estimate the prevalence of high-risk clones, and their antimicrobial resistance characteristics. Methods A literature search was conducted across PubMed, Web of Science, African Journal Online, and Scopus to retrieve studies mainly on the phenotypic and genotypic characteristics of P. aeruginosa in Africa. This study did not limit the literature by publication date. A random-effects meta-analysis model was used to estimate pooled resistance rates, and subgroup analyses were performed for specific antibiotic classes and high-risk clones (HRCs) This systematic review and meta-analysis was registered in PROSPERO database (ID: CRD420251071203). Results From the initial search, 794 records were obtained, out of which 28 studies from 13 African countries met the inclusion criteria. The pooled resistance rate across all antibiotic classes was 54.4% (95% CI: 45.6–63.0), with resistance reaching 100% for tetracyclines and glycylcyclines. While non-HRCs were more prevalent (67.54%, 95% CI: 53.79–80.01), the prevalence of the HRCs was also substantial at 32.46% (95% CI: 19.99–46.21). The eBURST analysis revealed 127 sequence types in 30 clonal complexes. Egypt and Algeria contributed the highest diversity and frequency of HRCs of P. aeruginosa , with ST244 (47.84%, 95% CI 20.99–75.31) being the most prevalent HRC, followed by ST773 at 31.48%. Conclusion The widespread detection of HRCs such as ST244 and ST773 in most regions in Africa highlights a critical need to enhance genomic surveillance and implement systematic monitoring of antimicrobial resistance (AMR).