Global Patterns Of Microbial Prevalence And Antibiotic Resistance: A Literature Review Highlighting Research Gaps In The Free State And Northern Cape Provinces Of South Africa

Abstract

Hospital-acquired infections (HAIs) are a growing public health challenge in Sub-Saharan Africa, particularly among hospitalized patients where bacteria account for the majority of microbial infections. Gram-negative bacteria (GNB), especially Enterobacteriaceae, are the most commonly observed drug-resistant pathogens in healthcare settings. Multi-drug resistant Enterobacteriaceae (MRDE) infections are associated with poor clinical outcomes and high mortality, especially in low- and middle-income countries. Studies show significant variability in resistance patterns across hospitals, with some reporting up to 57.3% MDR and 3.5% XDR strains of Enterobacteriaceae. Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) also present an increasing threat, with prevalence rates ranging from 0.7% in Malawi to 75.8% in Egypt. Notably, mortality was higher in ESBL-positive patients (47.3%) compared to ESBL-negative patients (22.4%). Additionally, infections with Carbapenem-resistant Enterobacteriaceae (CRE) have demonstrated the highest 30-day mortality rate (63.8%) among resistant organisms. In South Africa, the emergence of multidrug-resistant organisms such as MRSA, CRAB, and CRE further exacerbates the burden of HAIs. Despite these alarming trends, there is a lack of comprehensive data on microbial prevalence and antibiotic susceptibility patterns in regional hospitals of the Free State and Northern Cape provinces. This literature review highlights these critical gaps and underscores the urgent need for localized studies to inform effective infection control and antibiotic stewardship strategies