Fungal pathogens cause a wide range of infections in humans, from superficial to disfiguring, allergic syndromes, and life-threatening invasive infections, affecting over a billion individuals globally. With an estimated 1.5 million deaths annually attributable to them, fungal pathogens are a major cause of mortality in humans, especially people with underlying immunosuppression. The continuous increase in the population of individuals at risk of fungal infections in sub-Saharan Africa, such as HIV patients, tuberculosis patients, intensive care patients, patients with haematological malignancies, transplant (haematopoietic stem cell and organ) recipients and the growing global threat of multidrug-resistant fungal strains, raise the need for an appreciation of the region’s perspective on antifungal usage and resistance. In addition, the unavailability of recently introduced novel antifungal drugs in sub-Saharan Africa further calls for regular evaluation of resistance to antifungal agents in these settings. This is critical for ensuring appropriate and optimal use of the limited available arsenal to minimise antifungal resistance. This review, therefore, elaborates on the multifaceted nature of fungal resistance to the available antifungal drugs on the market and further provides insights into the prevalence of fungal infections and the use of antifungal agents in sub-Saharan Africa.

Streptococcus pneumoniae serotype 1 is one of the most prevalent serotypes commonly associated with invasive pneumococcal disease cases and outbreaks worldwide. Several sequence types of this serotype have been identified globally, including those exhibiting both high virulence potential and antimicrobial resistance profiles. This systematic review presents the global distribution of clones of pneumococcal serotype 1, describing their circulating patterns in various regions in the world. A database search was conducted in Google Scholar, PubMed, Scopus, ScienceDirect, and Web of Science using keywords related to Streptococcus pneumoniae serotype 1. The inclusion criteria entailed peer-reviewed studies published in English describing the utilization of at least one molecular genotyping tool to identify S. pneumoniae serotype 1 clones based on their sequence types. Data extracted were managed and analyzed using Microsoft Excel 365 (Version 2108). Forty-three studies were finally included in the systematic review. A total of 103 MLST serotype 1 sequence types were identified in 48 countries. These clones were widely reported to be associated with invasive pneumococcal diseases. Globally, ST217 and ST306 clonal complexes (CC217 and CC306) were the predominant lineages of serotype 1 sequence types, exhibiting distinct continental distribution patterns. CC217, characterized by ST217, ST303, ST612, ST618, and ST3081, was predominant in Africa and Asia. ST306 clonal complex, which is grouped into ST306, ST304, and ST227 were mostly found in Europe, Oceania, North America, and some countries in South America. ST615 was predominant in Chile, Peru, and Argentina. The hypervirulence nature of serotype 1, coupled with its complex genetic diversity, poses a significant public health threat. Our findings emphasize the need for enhanced surveillance and targeted interventions to mitigate the spread of these hypervirulent clones, ultimately informing evidence-based strategies for disease prevention and control.

The diversity of pneumococcal serotypes poses significant challenges for both vaccination and treatment. Clinical management of pneumococcal infections is further complicated by the fact that individual serotypes exhibit distinct antimicrobial resistance patterns. This study aims to comprehensively estimate the antimicrobial resistance rates of pneumococcal serotypes. A comprehensive search was conducted in PubMed, Scopus, Web of Science, and ScienceDirect. A random-effect meta-analysis was used to pool the number of isolates resistant to a particular antimicrobial per total number of isolates tested for each pneumococcal serotype. Ninety studies were included in the analysis. The study identified 66 pneumococcal serotypes, with vaccine serotypes such as 19A, 19F, 23F, 6B, 14, 6A, 3, and 9V being the most frequently reported. Non-vaccine serotypes like 15A, 6C, 23A, 23B, 15B, and 35B were also prevalent. Most serotypes were associated with pneumococcal diseases. Serotypes exhibited varying and high resistance to cefuroxime, co-trimoxazole, tetracycline, macrolides, and clindamycin. The highest multidrug resistance was observed in serotypes 23F (63.34%, 95% CI [25.77; 94.31]), 15C (61.04%, 95% CI [0.74; 100.00]), 23A (57.28%, 95% CI [27.60; 84.58]), 19F (55.95%, 95% CI [30.26; 80.22]), 19A (54.07%, 95% CI [32.60; 74.90]), 15B (47.10%, 95% CI [9.66; 86.41]), 24F (45.77%, 95% CI [3.79; 91.31]), 15A (44.28%, 95% CI [29.58; 59.26]), and 6B (43.79%, 95% CI [28.48; 59.12]). This study highlights significant antimicrobial resistance among both vaccine (19A, 19F, 23F, 14, 6A, and 6B) and non-vaccine types (15A, 6C, 23A, 20, 15C, and 35B). Our findings emphasize the need for effective surveillance and targeted interventions to fight these resistant pneumococcal serotypes.

Background/Objectives: Antimicrobial resistance (AMR) is increasingly rising due to antimicrobial overuse and misuse. In sickle cell disease (SCD) care, frequent antibiotic use drives the rapid emergence of AMR, threatening treatment options and patient lives. This systematic review synthesizes data on AMR with regard to SCD patients for the first time. Methods: A comprehensive database search for articles published in English was conducted in PubMed, Scopus, ScienceDirect, and Web of Science, with no restriction set for the year of publication. The DerSimonian–Laird method was applied to derive the pooled prevalence, while the Mantel–Haenszel method was used to calculate the pooled odds ratio. Results: A total of 18 eligible studies covering 3220 SCD patients published between 1996 and 2024 were included in this review. The common bacterial pathogens reported in the included studies were Streptococcus pneumoniae (10 studies), Staphylococcus aureus (10 studies), and Escherichia coli (4 studies). For S. aureus, the pooled resistance was highest for penicillins (ampicillin = 100%; penicillin = 93.64%; and amoxicillin = 77.82%) followed by cefuroxime (51.23%). The pooled prevalence of methicillin-resistant S. aureus (MRSA) was 19.30%. SCD patients had 2.89 and 2.47 times higher odds of being colonized or infected with penicillin-resistant and erythromycin-resistant S. aureus strains, respectively. For S. pneumoniae, resistance prevalence was highest for co-trimoxazole (81.1%), followed by penicillin (47.08%). The pooled prevalence of multidrug-resistant (MDR) S. pneumoniae isolates was 32.12%. The majority of the studies included (n = 14, 77.8%) were of moderate quality according to the modified STROBE checklist. Conclusions: This review reveals a high prevalence of AMR with regard to SCD patients. SCD patients have an increased risk of resistance to penicillin and co-trimoxazole across several bacterial pathogens. The limited geographical distribution of the included studies underscores the urgent need for expanded AMR research on the subject, especially in regions with high SCD burden.

Background: Non‐typeable Streptococcus pneumoniae (NT‐Sp) strains lack detectable capsules and are often missed by traditional serotyping. While associated primarily with asymptomatic carriage, NT‐Sp has emerged as a key player in antimicrobial resistance (AMR) gene dissemination and serotype replacement in the post‐vaccine era. This systematic review and meta‐analysis synthesize global evidence on NT‐Sp carriage, its prevalence, antimicrobial resistance patterns, and genetic diversity. Methods: A systematic search of PubMed, Scopus, Web of Science, Google Scholar, and ScienceDirect was conducted up to May 2025. Eligible studies reporting NT‐Sp carriage, molecular typing, or AMR profiles were included. Data extraction and quality assessment followed PRISMA guidelines. A meta‐analysis was performed to estimate pooled prevalence of NT‐Sp carriage and resistance, with subgroup and meta‐regression analyses exploring heterogeneity. Methodological quality was assessed using the Newcastle–Ottawa Scale adapted for cross‐sectional studies. Only open‐access and free full‐text articles were included, which may have introduced selection bias. Results: Forty studies from 23 countries were included. The pooled NT‐Sp carriage prevalence was 4.64% (95% CI: 2.78%–6.92%), with substantial heterogeneity ( I ² = 97.1%, 95% CI: 96.6%–97.5%). Subgroup analyses revealed geographic variation, with Oceania showing the highest prevalence (7.24%, 95% CI: 1.39%–17.04%) and North America the lowest (0.44%, 95% CI: 0.05%–1.11%). Age‐stratified analysis showed that studies, including all ages had the highest estimate (29.88%, 95% CI: 0.00%–100.00%), while children had a pooled prevalence of 4.05% (95% CI: 0.00%–15.80%). Vaccination era did not significantly influence NT‐Sp carriage ( p = 0.312). Resistance was highest for co‐trimoxazole (67.21%, 95% CI: 49.92%–82.73%), penicillin (44.57%, 95% CI: 24.45%–65.50%), and erythromycin (39.85%, 95% CI: 19.58%–61.77%). Meta‐regression identified the “all ages” participant category as a significant predictor of lower NT‐Sp prevalence ( p = 0.034). Molecular tools revealed substantial genomic diversity, with dominant clonal complexes varying by region. Conclusion: NT‐Sp is a globally distributed and genetically diverse pneumococcal subset with considerable AMR potential. Its persistence post‐PCV introduction and resistance gene carriage highlights the need for improved detection, molecular surveillance, and consideration in next‐generation vaccine development. Specifically, clinical laboratories in high‐prevalence settings should adopt molecular methods (e.g., PCR or WGS) to detect NT‐Sp in carriage surveillance; empirical antibiotic guidelines for pediatric respiratory infections should consider NT‐Sp resistance patterns, particularly the high prevalence of co‐trimoxazole resistance (67%) and next‐generation PCV trials should include NT‐Sp carriage as an exploratory endpoint. Integrating NT‐Sp into global pneumococcal control strategies is essential.