Prevalence and pathogen profiles of bacteremia in neonates hospitalized for clinical Sepsis in Ethiopia: a systematic review and meta-analysis.

BACKGROUND

Bacteremia is prevalent in neonates, largely attributed to factors inherent in the neonatal period. However, the prevalence of proven bacteremia in Ethiopian neonates has not been previously synthesized. Accordingly, this systematic review and meta-analysis aimed to analyze the prevalence of bacteremia and pathogen profiles in neonates hospitalized for clinical sepsis in Ethiopia.

METHODS

This systematic review and meta-analysis followed the preferred reporting items for systematic review and meta-analysis (PRISMA) 2020. The literature search was conducted across five databases including PubMed, Google Scholar, Web of Science, Science Direct, and Research for Life spanning from January 2015 to July 2023. The search strategy used MeSH terms and involved screening titles and abstracts, reviewing full-text articles, and including only observational studies published in English within the specified timeframe. Data extraction and quality assessment were performed by three experienced reviewers using a validated data collection tool and the Joanna Briggs Institute quality assessment tool, respectively. The prevalence of neonatal bacteremia was determined through a random effects model, with heterogeneity among studies assessed using the Q statistic and the I statistic. Publication bias was evaluated using a funnel plot and Egger's regression test, and STATA version 16.0 was used for all analysis at 95% confidence level.

RESULTS

A meta-analysis of nine studies revealed a bacteremia prevalence of 40.0% (95% CI: 34.0-46.0%). Subgroup analysis indicated variations in prevalence based on regions and study designs, with Oromia at 44.0% (95% CI: 28.0, 61.0%) and Amhara at 39.0% (95% CI: 27.0, 51.0%). Longitudinal studies exhibited a higher prevalence (47.0%, 95% CI: 27.0-68.0%) compared to cross-sectional designs (38.0%, 95% CI: 32.0-44.0%). Gram-negative bacteria were identified as the predominant etiological agents, representing 59.5% (95% CI: 56.8-62.3%) of cases. Among the bacterial species, Staphylococcus aureus emerged as the most prevalent (20.0%, 95% CI: 18.0%, 22.0%), followed by coagulase-negative staphylococci and Klebsiella pneumoniae, each contributing to 17.0% (95% CI: 15.0%, 20.0%) of bacteremia cases.

CONCLUSION

The study revealed a significant high prevalence of bacteremia, with differences noted across regions and study designs. Key pathogens identified were Staphylococcus aureus, Klebsiella pneumoniae and coagulase-negative staphylococci. It is advisable to implement surveillance systems, targeted prevention strategies, diagnostic stewardship, and further research on regional variations and bacterial profiles to effectively enhance the ominous future.