Burden of extended-spectrum beta-lactamase-producing Enterobacteriaceae among cancer patients in Africa: a systematic review and meta-analysis

Background : Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) exacerbate infections in cancer patients, in settings where antimicrobial resistance threatens health outcomes. This study estimated the prevalence of ESBL-PE among cancer patients in Africa from 2010 to 2024. Methods: We searched PubMed, Embase, Web of Science, CINAHL, and Global Health for observational studies reporting ESBL-PE prevalence in cancer patients. Studies published in English from 2010 to 2024 were included. Two reviewers independently screened studies, extracted data using standardized forms, and assessed quality using the Newcastle-Ottawa Scale. Pooled prevalence was calculated using a random-effects model in RStudio v4.4.2, with heterogeneity assessed by I² statistics and publication bias by funnel plots and Egger’s test. Results: Twelve studies from nine African countries, involving 565 patients (305 events) and 687 samples (338 events), were included. The pooled prevalence was 49.9% (95% CI: 23.1%-76.9%, I² = 91.8%, p < 0.001) at the patient level and 48.1% (95% CI: 31.7%-65.0%, I² = 84.0%, p < 0.001) at the sample level. Escherichia coli and Klebsiella pneumoniae predominated, with high resistance to cephalosporins (median: 89.5%-90%) and fluoroquinolones but preserved carbapenem efficacy. Publication bias was evident, and heterogeneity persisted after sensitivity analysis. Conclusions: The high ESBL-PE prevalence in African cancer patients signals a critical public health issue, necessitating enhanced surveillance, antimicrobial stewardship, and intentional infection control measures.