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

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dc.contributor.authorZamarano, Henry
dc.contributor.authorMusinguzi, Benson
dc.contributor.authorTwinomujuni, Muzafaru
dc.contributor.authorKhakasa, Catherine
dc.contributor.authorMwesigye, Vicent
dc.contributor.authorMuhwezi, Ivan
dc.contributor.authorMulogo, Edgar Mugema
dc.contributor.authorNatumanya, Deborah
dc.contributor.authorKawuma, Simon
dc.contributor.authorOrikiriza, Patrick
dc.contributor.authorIramiot, Jacob Stanley
dc.date.accessioned2026-06-20T23:08:41Z
dc.date.available2026-06-20T23:08:41Z
dc.date.issued2026-06-12
dc.descriptionThis systematic review and meta-analysis, which reports a 49.4% pooled prevalence of ESBL-PE among African cancer patients, provides direct evidence supporting SDG 3.3 (combating communicable diseases) and SDG 3.8 (universal health coverage) by quantifying antimicrobial resistance as a significant threat to quality cancer care. The findings are consistent with Uganda's NDP IV Human Capital Development objective and the Health and Nutrition Programme, offering essential baseline data to reinforce infection control and antimicrobial resistance (AMR) surveillance systems. The study guides policy actions such as expanding AMR surveillance to vulnerable populations, improving infection prevention in oncology units, and implementing antimicrobial stewardship. These measures are vital for strengthening health system resilience and advancing sustainable development in Uganda.
dc.description.abstractBackground. 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 1 January 2010 to 31 December 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 1 January 2010 to 31 December 2024 were included. Two reviewers independently screened studies, extracted data using standardized forms and assessed the quality of articles using the Newcastle–Ottawa Scale. Pooled prevalence was calculated using a random-effects model in RStudio v4.4.2, with heterogeneity assessed with the I² statistic and publication bias assessed with funnel plots and Egger’s test. Results. Twelve studies from 9 African countries, involving a total of 1,252 cancer patients and 643 identified events, were included. The pooled prevalence of ESBL-PE was 49.4% (95% CI: 36.0–62.9%, I²=88.3%, P<0.001). Escherichia coli and Klebsiella pneumoniae predominated. There was no evidence of publication bias based on funnel plot symmetry, Egger’s test (t=−0.35, P=0.73) and trim-and-fill analysis (no studies imputed; adjusted estimate unchanged). Heterogeneity was substantial (I²=88.3%) with a wide 95% prediction interval (22.7–76.5%). Leave-one-out sensitivity analysis confirmed estimate stability (~49%) with persistently high heterogeneity (I² range: 81.4–89.4%). 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.
dc.identifier.citationZamarano, H., Musinguzi, B., Twinomujuni, M., Khakasa, C., Mwesigye, V., Muhwezi, I., ... & Iramiot, J. S. (2026). Burden of extended-spectrum beta-lactamase-producing Enterobacteriaceae among cancer patients in Africa: a systematic review and meta-analysis. Access Microbiology, 8(6), 001120-v4.
dc.identifier.issn2516-8290
dc.identifier.urihttps://dir.muni.ac.ug/handle/20.500.12260/999
dc.language.isoen
dc.publisherMicrobiology Society
dc.subjectAfrica
dc.subjectCancer
dc.subjectEnterobacteriocae
dc.subjectExtended-spectrum beta-lactamase
dc.titleBurden of extended-spectrum beta-lactamase- producing Enterobacteriaceae among cancer patients in Africa: a systematic review and meta-analysis
dc.typeArticle

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