Ahmed Mohamed Mohamoud1*, Associate Professor G. R. Neel1, Dr. Chinyere Amyamwu1, Dr. Osman Ibe2, Yahye Ahmed Abdi2

Background: Staphylococcus aureus is a major cause of bloodstream infections (BSIs) globally, with increasing rates of multidrug resistance posing a significant threat to public health, especially in Africa. The molecular mechanisms underlying antibiotic resistance in Staphylococcus aureus are diverse and poorly characterized in many African regions. Objective: This systematic review aimed to evaluate the molecular characterization of antibiotic resistance genes in Staphylococcus aureus isolates from bloodstream infections in Africa. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science databases for studies published between 2010 and 2024. Eligible studies were those reporting molecular detection of resistance genes in Staphylococcus aureus isolated from bloodstream infection in African countries. Data were extracted on study design, country, sample size, resistance genes detected, and resistance profiles. The review followed PRISMA guidelines, and risk of bias was assessed using a modified JBI checklist for molecular studies. Results: Out of 267 identified articles, 12 studies met the inclusion criteria. Most were cross-sectional and hospital-based, covering countries such as Egypt, Uganda, Ghana, Nigeria, Ethiopia, South Africa, and Tunisia. The most commonly identified resistance genes included mecA, ermA, ermB, ermC, blaZ, tetK, and tetM. A high prevalence of multidrug-resistant Staphylococcus aureus strains was reported, with methicillin resistance (MRSA) being predominant at many sites. Conclusion: The molecular evidence demonstrates a high burden of antibiotic resistance genes in Staphylococcus aureus bloodstream infections in African hospitals. This underscores the urgent need for molecular surveillance, antimicrobial stewardship, and policy interventions to combat the spread of multidrug-resistant Staphylococcus aureus in the region.