The role of Pseudomonas aeruginosa in surgical site infections in Sub-Saharan Africa

Abstract

Surgical Site Infections remain a significant burden in healthcare settings, contributing to prolonged hospital stays, increased healthcare costs, and increased morbidity and mortality rates. Among the various pathogens implicated in these infections, Pseudomonas aeruginosa remains a particularly formidable bacterium due to its intrinsic resistance to many antibiotics and its ability to acquire additional resistance mechanisms. Despite this incidence, there is a geographical limitation of surveillance programs on this pathogen continues to cripple infection control and prevention in sub-Saharan Africa, crippling surveillance data on the infection management. We aimed at understanding the role of Pseudomonas aeruginosa (PA) on the seemingly growing and concerning infections of surgical site in sub-Saharan Africa (SSA). This study adopted systematic review and meta-analysis design in line with PRISMA guidelines. For data collection, therefore, we systematically searched PubMed and other relevant databases for articles (2015-2023) relevant to antimicrobial resistance (AMR) and predominance of Pseudomonas aeruginosa (PA) in sub-Saharan Africa (SSA). We examined 26 relevant articles out of 225 that matched the initial search. A standardized data extraction form was developed to capture relevant information from the selected studies. Data collected from the studies included were synthesized narratively and reported through Systematic Reviews and Meta Analyses (PRISMA). Through an in-depth analysis of the relevant literature, the low number of studies in the region focused on PA and AMR. Nevertheless, the relatively few studies demonstrate the high rates of PA involvement in surgical site infections. The studies further show high levels of multi-drug resistance and points to subsequent nosocomial clinical outcomes. In conclusion, the study underscores the burden posed by PA in SSA, highlighting on the prevalence, multi-drug resistance and virulence. Clearly, its surveillance remains geographically limited especially in the regions that are underrepresented. The study recommends that infections prevention and control programs (IPCs) be strengthened, that antimicrobial stewardship be sensitised to regulate antibiotic use, and that surveillance and research on PA be expanded in SSA.