METHODOLOGICAL CHALLENGES OF ESTIMATING THE DISEASE BURDEN OF MRSA-ASSOCIATED SEPSIS IN NICU, A SYSTEMATIC REVIEW

Authors

  • Seraphine Nkie Esemu Author
  • Jean Paul Assam Assam Author
  • Hortense Gonsu Kamga Author
  • Nicholas Tendongfor Author
  • Donatien Serge Mbaga Author
  • Cyprien Kengne Ndé Author
  • Jean Thierry Ebogo Belobo Author
  • Jane-Francis Tatah Kihla Akoachere Author
  • Nene Kaah Keneh Author
  • Arnol Bowo Ngandji Author
  • Lucy Mande Ndip Author

Abstract

Objectives: This systematic review aimed to assess the burden of methicillin-resistant Staphylococcus aureus (MRSA)-associated neonatal sepsis (NS) in neonatal intensive care units (NICUs). We examined MRSA-related mortality and described resistance patterns of MRSA strains in NICUs. Materials and Methods: We searched four databases up to 2023 for observational studies on MRSA or antimicrobial resistance in neonates with culture-confirmed sepsis in NICUs. Studies included all sepsis types, diagnostic methods, and neonatal characteristics. We extracted data on study features, MRSA prevalence, resistance, and mortality. We used a random-effects model for pooled proportions, with subgroup analyses by sepsis type and WHO region, and assessed heterogeneity using the I² statistic.
Results: We included 37 studies published between 2000 and 2021 from 23
countries These studies reported 2948 cases of culture-confirmed NS with
MRSA prevalence ranged from 0.0 to 32.2% across studies. Among 2948 total NS cases, the pooled MRSA proportion was 8.8% (95% CI: 4.5–14.1; I² = 94.2%). The pooled MRSA proportion in early-onset neonatal sepsis was 2.7% (95% CI: 1.3– 4.6; I² = 0%). The pooled MRSA proportion in late-onset neonatal sepsis was 4.6% (95% CI: 2.1–7.8; I² = 90.3%). Two studies reported 6 deaths among 14 MRSA-positive neonates from a total cohort of 184 infants. In Egypt and Saudi Arabia, MRSA strains showed resistance to multiple antibiotic classes, including aminoglycosides, chloramphenicols, drug combinations, fluoroquinolones, lincosamides, macrolides, penicillins, rifamycins, and cephalosporins (both second and third generation).
Conclusion and recommendations: These findings highlight the role of MRSA as a significant cause of neonatal sepsis. High resistance rates in some settings may compromise empirical treatment strategies. There is an urgent need to strengthen surveillance and antimicrobial stewardship in neonatal care. Standardized methods in future studies will improve comparability and support global policy on neonatal infection management.

Author Biographies

  • Seraphine Nkie Esemu

    Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon, Laboratory for Emerging Infectious Diseases, University of Buea, P.O. Box 63, Buea, Cameroon

  • Jean Paul Assam Assam

    Department of Microbiology, The University of Yaounde I, P.O. Box 337, Yaounde, Cameroon

  • Hortense Gonsu Kamga

    Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, P.O. Box 337, Yaounde, Cameroon

  • Nicholas Tendongfor

    Department of Public Health and Hygiene, University of Buea, P.O. Box 63, Buea, Cameroon

  • Donatien Serge Mbaga

    Department of Microbiology, The University of Yaounde I, P.O. Box 337, Yaounde,Cameroon

  • Cyprien Kengne Ndé

    Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, P.O. Box 1459, Douala, Cameroon

  • Jean Thierry Ebogo Belobo

    Center for Research in Health and Priority Pathologies, Institute of Medical Research and Medicinal Plants Studies, P.O. Box 6163, Yaounde, Cameroon

  • Jane-Francis Tatah Kihla Akoachere

    Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon, Roland Ndip Ndip, Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea,Cameroon

  • Nene Kaah Keneh

    Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon, Laboratory for Emerging Infectious Diseases, University of Buea, P.O. Box 63, Buea, Cameroon

  • Arnol Bowo Ngandji

    Department of Microbiology, The University of Yaounde I, P.O. Box 337, Yaounde, Cameroon

  • Lucy Mande Ndip

    Department of Microbiology and Parasitology, University of Buea, P.O. Box 63, Buea, Cameroon, Laboratory for Emerging Infectious
    Diseases, University of Buea, P.O. Box 63, Buea, Cameroon

References

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Published

2025-10-31

Issue

Vol. 102 No. 6 (2025): East African Medical Journal Vol.102 No. 6 (2025)

Section

Review