Surveillance and Resistance Patterns of Healthcare-Associated Infections in the WHO African Region: Implications for Stewardship

A systematic review of 95 studies (2011–2024) across the WHO African Region finds that fragmented healthcare-associated infection (HAI) surveillance produces substantial uncertainty in regional antimicrobial resistance (AMR) estimates. Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae were the most frequently reported HAI pathogens (≈53.7%, 43.2%, and 32.6%, respectively), and resistance profiles are dominated by extended‑spectrum beta‑lactamase (ESBL)–producing Enterobacteriaceae and methicillin‑resistant Staphylococcus aureus (MRSA), creating a high baseline of treatment complexity.

Because 96.8% of included studies were local in scope, the evidence base remains concentrated in isolated facility snapshots rather than region‑level synthesis. That pattern constrains reliable empiric‑therapy guidance and obscures priorities for national infection‑control investments; at the facility level, the lack of regional context translates into concrete clinical risk and limits coordinated outbreak response.

The pathogen distribution confirms a clear hierarchy—S. aureus most reported, then E. coli and K. pneumoniae—and resistance mechanisms cluster around beta‑lactamase production and methicillin resistance (ESBL and MRSA).

Surveillance methods were dominated by local, phenotypic approaches: phenotypic techniques accounted for about 70.5% of laboratory methods while genotypic or genomic methods were rare (≈3.1%). Reliance on phenotypic testing reduces precision in identifying resistance mechanisms, limits resolution for linking cases during outbreaks, and impedes interfacility comparability for trend analysis. Critical gaps include broader geographic coverage, standardized case definitions, and expanded adoption of molecular diagnostics to enable accurate tracking and cross‑site comparisons.

These findings point directly to consolidated national surveillance and laboratory strengthening as the most direct route to improved AMR management and safer empiric care across the region. Priority actions are clear: consolidate and standardize surveillance systems, scale molecular diagnostics, and align reporting to reduce regional AMR uncertainty and better inform empiric choices.