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 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.