Reported prevalence of carbapenem-resistant Klebsiella pneumoniae in African clinical studies with bloodstream infections as a predefined subgroup: a systematic review and meta-analysis

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a critical global antimicrobial resistance threat, yet continental-level synthesis of its epidemiology in Africa remains limited. Reported prevalence varies markedly across African settings, raising concern that pooled estimates may obscure substantial heterogeneity driven by outbreak amplification, methodological diversity, and uneven surveillance capacity. We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines to estimate CRKP prevalence in Africa while evaluating between-study heterogeneity, methodological influences, and bloodstream infection (BSI)–specific burden. Electronic databases were searched from 2010 to 2026. The review protocol was prospectively registered in PROSPERO (CRD420261390170). Studies reporting species-specific CRKP prevalence from African clinical settings were included. Random-effects meta-analysis using Freeman–Tukey transformation with Hartung–Knapp adjustment was performed, with additional binomial–normal (logit) modelling to address extreme proportions (0% and 100%). Sensitivity analyses excluded studies reporting complete resistance. Thirty-one studies (2011–2023) were included. CRKP prevalence estimates varied markedly across studies, ranging from 0% to 100%, with extreme between-study heterogeneity (I² = 99.6%) and a wide prediction interval indicating substantial variability across African clinical settings. CRKP prevalence varied markedly across studies, ranging from 0% to 100%, with extreme heterogeneity (I² = 99.6%) and a wide prediction interval (~ 6%–98%). Because this heterogeneity indicated that a single pooled estimate was unlikely to represent a typical African setting, sensitivity analyses were prioritized. After excluding studies reporting complete resistance (100%), the pooled prevalence was 29.6% (95% CI: 14.2%–47.4%), whereas inclusion of all studies yielded a pooled prevalence of 68.4% (95% CI: 53.2%–81.7%). The substantial difference between estimates demonstrates strong influence from outbreak-driven and resistance-enriched datasets. The principal finding of this study is the profound epidemiological heterogeneity of CRKP across African settings rather than a single representative continental prevalence.