Prevalence of Ocular Infections and the Burden of Multidrug-Resistant Bacteria in Africa: A Systematic Review and Meta-Analysis — Oak Academic Publishing
Research ArticleOpen AccessGoogle Scholar indexed
Prevalence of Ocular Infections and the Burden of Multidrug-Resistant Bacteria in Africa: A Systematic Review and Meta-Analysis
Laboratory of Ecology and Management of Sahelo-Saharan Biodiversity, Faculty of Science and Technology, André Salifou University of Zinder, Zinder, Niger
,
Laboratory of Ecology and Management of Sahelo-Saharan Biodiversity, Faculty of Science and Technology, André Salifou University of Zinder, Zinder, Niger
,
Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
,
Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
,
Tropical Microbiology Laboratory, Faculty of Science and Technology, Abdou Moumouni University of Niamey, Niamey, Niger
,
Clinical Research and Health System Laboratory, Faculty of Health Sciences, André Salifou University of Zinder, Zinder, Niger
,
Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
,
Laboratory of Ecology and Management of Sahelo-Saharan Biodiversity, Faculty of Science and Technology, André Salifou University of Zinder, Zinder, Niger
1 Laboratory of Ecology and Management of Sahelo-Saharan Biodiversity, Faculty of Science and Technology, André Salifou University of Zinder, Zinder, Niger
2 Laboratory of Ecology and Management of Sahelo-Saharan Biodiversity, Faculty of Science and Technology, André Salifou University of Zinder, Zinder, Niger
3 Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
4 Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
5 Tropical Microbiology Laboratory, Faculty of Science and Technology, Abdou Moumouni University of Niamey, Niamey, Niger
6 Clinical Research and Health System Laboratory, Faculty of Health Sciences, André Salifou University of Zinder, Zinder, Niger
7 Faculty of Health Sciences, Abdou Moumouni University of Niamey, Niamey, Niger
8 Laboratory of Ecology and Management of Sahelo-Saharan Biodiversity, Faculty of Science and Technology, André Salifou University of Zinder, Zinder, Niger
Ocular infections represent a major public health challenge in Africa, where data on their epidemiology and antimicrobial resistance (AMR) remain fragmentary. This study aimed to synthesize available data on the prevalence, microbial aetiology, and antimicrobial resistance profiles of ocular infections in Africa. This systematic review and meta-analysis were conducted via PubMed, Google Scholar, and AJOL (2000-2025). Pooled prevalence was estimated using a random-effects model. Heterogeneity was assessed using the I 2 statistic. Fifteen studies (5004 specimens) from five African countries were included. The pooled prevalence of ocular infections was 65% (95% CI: 58% - 71%), with significant heterogeneity (I 2 = 97%). Regional prevalence was 61% in East Africa and 74% in West Africa. Gram-positive cocci predominated (69.6%), with Staphylococcus aureus (39.6%) and coagulase-negative staphylococci (CoNS) (18.6%). Multidrug resistance (MDR) rates were high: CoNS (63.5%; 95% CI: 58.7% - 68.1%), Klebsiella pneumoniae (76%; 95% CI: 56.6% - 88.5%), Escherich ia coli (60.6%), and S. aureus (54.7%). Temporal analysis revealed a decline in S. aureus and the emergence of CoNS and K. pneumoniae . Ocular infections in Africa exhibited high prevalence and alarming multidrug resistance rates, exceeding global estimates, particularly for CoNS and K. pneumoniae . These findings underscore the urgency of continental surveillance programs and targeted interventions.
Watson, S., Cabrera-Aguas, M. and Khoo, P. (2018) Common Eye Infections. Aust ralian Prescriber , 41, 67-72. https://doi.org/10.18773/austprescr.2018.016
Zhang, Z., Cao, K., Liu, J., Wei, Z., Xu, X. and Liang, Q. (2022) Pathogens and Antibiotic Susceptibilities of Global Bacterial Keratitis: A Meta-Analysis. A ntibiotics , 11, Article No. 238. https://doi.org/10.3390/antibiotics11020238
Teweldemedhin, M., Gebreyesus, H., Atsbaha, A.H., Asgedom, S.W. and Saravanan, M. (2017) Bacterial Profile of Ocular Infections: A Systematic Review. BMC Ophthalmology , 17, Article No. 212. https://doi.org/10.1186/s12886-017-0612-2
Asbell, P.A., Sanfilippo, C.M., Sahm, D.F. and DeCory, H.H. (2020) Trends in Antibiotic Resistance among Ocular Microorganisms in the United States from 2009 to 2018. JAMA Ophthalmology , 138, 439-450. https://doi.org/10.1001/jamaophthalmol.2020.0155
Bertret, C., Knoeri, J., Leveziel, L., Bourcier, T., Brignole-Baudouin, F., Merabet, L., et al . (2024) Predisposing Factors, Clinical and Microbiological Insights of Bacterial Keratitis: Analysis of 354 Cases from a Leading French Academic Centre. British Journal of Ophthalmology , 109, 15-20. https://doi.org/10.1136/bjo-2024-325261
Bashir, G., Shah, A., Rashid, S., et al . (2005) Bacterial and Fungal Profile of Corneal Ulcers—A Prospective Study. Indian Journal of Pathology and Microbiology , 48, 273-277.
Orlans, H.O., Hornby, S.J. and Bowler, I.C.J.W. (2011) In Vitro Antibiotic Susceptibility Patterns of Bacterial Keratitis Isolates in Oxford, UK: A 10-Year Review. Eye , 25, 489-493. https://doi.org/10.1038/eye.2010.231
Solomon, Z., Anberbir, S., Churiso, G., Mitiku, A., Bogale, A., Gebrie, H., et al . (2025) Bacterial Spectrum and Antimicrobial Resistance Patterns of External Ocular Infections among Patients Attending Dilla University General Hospital Ophthalmic Clinic, Southern Ethiopia. Canadian Journal of Infectious Diseases and Medical Microbiol ogy , 2025, Article ID: 5593194. https://doi.org/10.1155/cjid/5593194
Bale, B.I., Elebesunu, E.E., Manikavasagar, P., Agwuna, F.O., Ogunkola, I.O., Sow, A.U., et al . (2023) Antibiotic Resistance in Ocular Bacterial Infections: An Integrative Review of Ophthalmic Chloramphenicol. Tropical Medicine and Health , 51, Article No. 15. https://doi.org/10.1186/s41182-023-00496-x
Sohrabi, C., Franchi, T., Mathew, G., Kerwan, A., Nicola, M., Griffin, M., et al . (2021) PRISMA 2020 Statement: What’s New and the Importance of Reporting Guidelines. International Journal of Surgery , 88, Article ID: 105918. https://doi.org/10.1016/j.ijsu.2021.105918
Moola, S., Munn, Z., Tufanaru, C., Aromataris, E., Sears, K., Sfetic, R., et al . (2020) Chapter 7: Systematic Reviews of Etiology and Risk. In: Aromataris, E. and Munn, Z., Eds., JBI Manual for Evidence Synthesis , JBI.
Abebe, T., Teklemariam, Z., Shume, T., Mekuria, S., Urgesa, K. and Weldegebreal, F. (2023) Bacterial Profile of External Ocular Infections, Its Associated Factors, and Antimicrobial Susceptibility Pattern among Patients Attending Karamara Hospital, Jigjiga, Eastern Ethiopia. International Journal of Microbiology , 2023, Article ID: 8961755. https://doi.org/10.1155/2023/8961755
Adeyeba, O.A., Anorue, M.C., Adefioye, O.A., et al . (2010) Conjunctivitis among Children in a Teaching Hospital in the South-West of Nigeria: Role of Staphylococcus aureus as an Aetiologic Agent and Its Antibiogram. African Journal of Microbiology Research , 4, 1945-1948.
Ahmed, K.S., Bhayal, B.K., Eman, D., et al . (2022) Identification of Bacterial Profiles, Common Associated Risk Factors, and Antimicrobial Susceptibility Patterns of Bacterial Keratitis in Community Hospitals of Asmara, Eritrea. Ethio pian Medical Journal , 60, 245-256.
Ayehubizu, Z., Mulu, W. and Biadglegne, F. (2021) Common Bacterial Causes of External Ocular Infections, Associated Risk Factors and Antibiotic Resistance among Patients at Ophthalmology Unit of Felege Hiwot Referral Hospital, Northwest Ethiopia: A Cross-Sectional Study. Journal of Ophthalmic Inflammation and Infection , 11, Article No. 7. https://doi.org/10.1186/s12348-021-00238-2
Barakat, G.I.I., Kamal, Y.N. and Sultan, A.M. (2019) Could Aflatoxin B1 Production by Asp ergillus flavus Affect the Severity of Keratitis: An Experience in Two Tertiary Health Care Centers, Egypt. European Journal of Clinical Microbiology & Infectious Diseases , 38, 2021-2027. https://doi.org/10.1007/s10096-019-03636-6
Belyhun, Y., Moges, F., Endris, M., Asmare, B., Amare, B., Bekele, D., et al . (2018) Ocular Bacterial Infections and Antibiotic Resistance Patterns in Patients Attending Gondar Teaching Hospital, Northwest Ethiopia. BMC Research Notes , 11, Article No. 597. https://doi.org/10.1186/s13104-018-3705-y
Getahun, E., Gelaw, B., Assefa, A., Assefa, Y. and Amsalu, A. (2017) Bacterial Pathogens Associated with External Ocular Infections Alongside Eminent Proportion of Multidrug Resistant Isolates at the University of Gondar Hospital, Northwest Ethiopia. BMC Ophthalmology , 17, Article No. 151. https://doi.org/10.1186/s12886-017-0548-6
Teweldemedhin, M., Saravanan, M., Gebreyesus, A. and Gebreegziabiher, D. (2017) Ocular Bacterial Infections at Quiha Ophthalmic Hospital, Northern Ethiopia: An Evaluation According to the Risk Factors and the Antimicrobial Susceptibility of Bacterial Isolates. BMC Infectious Diseases , 17, Article No. 207. https://doi.org/10.1186/s12879-017-2304-1
Iyamu, E. and Enabulele, O. (2003) A Survey on Ophthalmia Neonatorum in Benin City, Nigeria (Emphasis on Gonococcal Ophthalmia). The Online Journal of Health and Allied Sciences , 2, 1-6.
Neway, S., Desta, K., Dessie, W., et al . (2019) Bacterial Profile and Antimicrobial Susceptibility Patterns from External Ocular Infections and Associated Risk Factors at the All Africa Leprosy Rehabilitation and Training Center (ALERT), Addis Ababa, Ethiopia. Ethiopian Medical Journal , Supplement 1, 67-77.
Diriba, K., Kassa, T., Alemu, Y. and Bekele, S. (2020) In Vitro Biofilm Formation and Antibiotic Susceptibility Patterns of Bacteria from Suspected External Eye Infected Patients Attending Ophthalmology Clinic, Southwest Ethiopia. International Journal of Microbiology , 2020, Article ID: 8472395. https://doi.org/10.1155/2020/8472395
Woreta, A.N., Kebede, H.B., Tilahun, Y., Teklegiorgis, S.G. and Abegaz, W.E. (2022) Antibiotic Susceptibility Pattern and Bacterial Spectrum among Patients with External Eye Infections at Menelik II Referral Hospital in Addis Ababa, Ethiopia. Infection and Drug Resistance , 15, 765-779. https://doi.org/10.2147/idr.s352098
Mohammed, A.A., Ali, M.M. and Zenebe, M.H. (2020) Bacterial Etiology of Ocular and Periocular Infections, Antimicrobial Susceptibility Profile and Associated Factors among Patients Attending Eye Unit of Shashemene Comprehensive Specialized Hospital, Shashemene, Ethiopia. BMC Ophthalmology , 20, Article No. 124. https://doi.org/10.1186/s12886-020-01398-w
Rukyaa, J., Temba, L., Kachira, P., Mwanansao, C. and Seni, J. (2024) Prevalence and Antimicrobial Susceptibility Patterns of Bacteria Colonizing the External Ocular Surfaces of Patients Undergoing Ocular Surgeries at Bugando Medical Center in Mwanza, Tanzania. BMC Research Notes , 17, Article No. 193. https://doi.org/10.1186/s13104-024-06851-3
Okesola, A.O. and Salako, A.O. (2011) Microbiological Profile of Bacterial Conjunctivitis in Ibadan, Nigeria. Annals of Ibadan Postgraduate Medicine , 8, 20-24. https://doi.org/10.4314/aipm.v8i1.63953
Woldemariam, M., Aklilu, A., Manilal, A., Mengistu, M., Tadesse, D., Siraj, M., et al . (2024) Microbial Profile and Associated Factors of External Ocular Bacterial and Fungal Infections in Arba Minch General Hospital: A Cross-Sectional Study. Scientifi c Reports , 14, Article No. 28744. https://doi.org/10.1038/s41598-024-77723-w
Newman, A. and McCluskey, P. (2025) Epidemiological Spectrum of Infectious Uveitis in the Asia-Pacific. TJO , 15, 157-181. https://doi.org/10.4103/tjo.tjo-d-25-00052
Aaby, M., Lalitha, P., Prajna, N.V., et al . (2022) Comparing Microbiologic Tests for Pathogen Detection in Infectious Keratitis Using Latent Class Analysis. Cornea .
Beutner, K. (2025) Looking Out for Atypical Cornea Infections. EyeWorld. https://www.eyeworld.org/2025/looking-out-for-atypical-cornea-infections/
Tilahun, M., Gedefie, A., Sharew, B., Debash, H. and Shibabaw, A. (2025) Prevalence of Bacterial Eye Infections and Multidrug Resistance Patterns among Eye Infection Suspected Patients in Ethiopia: A Systematic Review and Meta-Analysis. BMC Infectious Diseases , 25, Article No. 705. https://doi.org/10.1186/s12879-025-11095-y
Brown, L., Leck, A.K., Gichangi, M., Burton, M.J. and Denning, D.W. (2021) The Global Incidence and Diagnosis of Fungal Keratitis. The Lancet Infectious Disea ses , 21, e49-e57. https://doi.org/10.1016/s1473-3099(20)30448-5
Singh, R.B., Singh Parmar, U.P., Woreta, F., Srikumaran, D., Sharma, N. and Jhanji, V. (2026) Global Burden, Risk Factors, Causative Organisms and Antibiotic Susceptibility Patterns in Bacterial Keratitis. The Ocular Surface , 39, 49-57. https://doi.org/10.1016/j.jtos.2025.12.003
Stapleton, F. (2023) The Epidemiology of Infectious Keratitis. The Ocular Surfac e , 28, 351-363. https://doi.org/10.1016/j.jtos.2021.08.007
Maqbool, S., Shan, H., Daud, S., Navied, U. and Mirza, H. (2024) Acute Conjunctivitis through a Public Health Lens: A Review. BioMedica , 40, 153-158. https://doi.org/10.24911/biomedica/5-1165
Somerville, T.F., Mdala, S., Zungu, T., Gandiwa, M., Herbert, R., Everett, D., e t al . (2024) Microbial Keratitis in Southern Malawi: A Microbiological Pilot Study. BMJ Open Ophthalmology , 9, e001682. https://doi.org/10.1136/bmjophth-2024-001682
André, C., Lebreton, F., Van Tyne, D., Cadorette, J., Boody, R., Gilmore, M.S., et al . (2023) Microbiology of Eye Infections at the Massachusetts Eye and Ear: An 8-Year Retrospective Review Combined with Genomic Epidemiology. American Journal of Ophthalmology , 255, 43-56. https://doi.org/10.1016/j.ajo.2023.06.016
Asbell, P.A. and DeCory, H.H. (2018) Antibiotic Resistance among Bacterial Conjunctival Pathogens Collected in the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) Surveillance Study. PLOS ONE , 13, e0205814. https://doi.org/10.1371/journal.pone.0205814
Obaid, N., Saeed, A., Abbas, S., Perveen, S. and Younas, H. (2025) Resistance Trend in Bacteria Isolated from Corneal Ulcers: A Retrospective Analysis from Pakistan. PLOS ONE , 20, e0325157. https://doi.org/10.1371/journal.pone.0325157
Keay, L.J., Gower, E.W., Iovieno, A., Oechsler, R.A., Alfonso, E.C., Matoba, A., et al . (2011) Clinical and Microbiological Characteristics of Fungal Keratitis in the United States, 2001-2007: A Multicenter Study. Ophthalmology , 118, 920-926. https://doi.org/10.1016/j.ophtha.2010.09.011
Tiecco, G., Laurenda, D., Mulè, A., Arsuffi, S., Storti, S., Migliorati, M., et al . (2022) Gram-Negative Endogenous Endophthalmitis: A Systematic Review. Microorgani sms , 11, Article No. 80. https://doi.org/10.3390/microorganisms11010080
Akinyemi, K.O., Abegunrin, R.O., Iwalokun, B.A., Fakorede, C.O., Makarewicz, O., Neubauer, H., et al . (2021) The Emergence of Klebsiella pneumoniae with Reduced Susceptibility against Third Generation Cephalosporins and Carbapenems in Lagos Hospitals, Nigeria. Antibiotics , 10, Article No. 142. https://doi.org/10.3390/antibiotics10020142
Azzam, A., Khaled, H., Salem, A., Sayed, M., Mohieldein, A., Elsayed, M.S., et al . (2026) Proportion and Antibiogram of Methicillin-Resistant Staphylococcus aureus (MRSA) in Africa: A Systematic Review and Meta-Analysis. Antimicrobial Resistance & I nfection Control , 15, Article No. 13. https://doi.org/10.1186/s13756-025-01687-3
Fenta, M.D., Bitew, A.B., Demisse, B.W., Abey, S.L., Mengistu, B.A., Kinde, M.Z., et al . (2025) Systematic Review and Meta-Analysis of Staphylococcus aureus at the Human-Animal-Environment Interface in Eastern Africa: Prevalence, Virulence Genes, and Antimicrobial Resistance Profile. One Health , 21, Article ID: 101229. https://doi.org/10.1016/j.onehlt.2025.101229
Kindiki, S.K., Nyongesa, P.K., Mogoi, N.N. and Kiprono, S. (2025) The Role of Pseudomona s aeruginosa in Surgical Site Infections in Sub-Saharan Africa. Science Mundi , 5, 8-22. https://doi.org/10.51867/scimundi.5.1.2
Ather, M. and Conrady, C.D. (2025) Emerging Ocular Pathogen Resistance and Clinically Used Solutions: A Problem That Is More than Meets the Eye. Pharmaceuticals , 19, Article No. 31. https://doi.org/10.3390/ph19010031
Zomorodi, A.R., Mohammadi, M., Farshi, Z.G., Parvizi Mashhadi, M.H., Benam, S.P. and Motamedifar, M. (2025) Prevalence and Antimicrobial Susceptibility Pattern of Coagulase-Negative Staphylococci Isolated from Ocular Infections: A Systematic Review and Meta-Analysis. The Ocular Surface , 37, 227-235. https://doi.org/10.1016/j.jtos.2025.03.006
Serban, D., Popa Cherecheanu, A., Dascalu, A.M., Socea, B., Vancea, G., Stana, D., et al . (2021) Hypervirulent Klebsiella pneumoniae Endogenous Endophthalmitis—A Global Emerging Disease. Life , 11, Article No. 676. https://doi.org/10.3390/life11070676