Abstract:
Background: Antimicrobial resistance (AMR) is an escalating public health threat in Ethiopia, with high resistance among priority bacterial pathogens that compromise empirical treatment and increase morbidity and mortality. Continuous AMR surveillance is essential to guide treatment and inform stewardship interventions. We analysed five years of AMR surveillance data to assess the magnitude, temporal trends, and emerging resistance patterns among priority pathogens in Ethiopia.
Methods: We conducted a secondary analysis of antimicrobial susceptibility testing (AST) data routinely collected by the Ethiopian Public Health Institute (EPHI) National Reference Laboratory (NRL) from January 2020 to December 2024. The analysis focused on Ethiopia’s national AMR priority pathogens for surveillance: Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, and Streptococcus pneumoniae. Descriptive statistics summarised the specimen and demographic characteristics. Resistance prevalence was reported with 95% Confidence Intervals (CI). Analyses were conducted in R (version 4.4.2).
Results: A total of 1,417 isolates were analysed, primarily from urine (33.4%) and blood (32.0%). Most isolates were from children aged 0–5 years (33.7%) and adults aged 19–45 years (31.0%). E.coli (25.8%) and K.pneumoniae (11.1%) were the most frequent isolates. Gram-negative organisms showed high resistance to commonly used antibiotics; E. coli demonstrated high resistance to ampicillin (88.6%; 95% CI: 83.4–92.6) and ciprofloxacin (75.7%; 95% CI: 70.7–80.3). K.pneumoniae resistance to co-trimoxazole showed a notable decline from 100% in 2020 (95% CI: 78.2–100.0) to 57.1% by 2024 (95% CI: 28.9–82.3). Carbapenem resistance was substantial, reaching 39.5% in K.pneumoniae (95% CI: 30.9–48.7) and 69.2% in A.baumannii (95% CI: 38.6–90.9). The prevalence of methicillin-resistant S. aureus (MRSA) was 26.5% (95% CI: 18.2–36.1). The overall multi-drug resistance (MDR) rate was 56.1%, with the highest burden in A. baumannii (85.7%).
Conclusions: These findings indicate a high burden of AMR, particularly among Gram-negative pathogens, severely limiting empirical treatment options. The high magnitude of carbapenem resistance underscores an urgent need to strengthen antimicrobial stewardship and expand surveillance for last-line antibiotics to preserve treatment efficacy in Ethiopia.
Keywords: Antimicrobial Resistance; Ethiopia; Priority pathogens; Public Health Surveillance
Biography:
Munachimso Dim is an Africa Epidemic Service (AES) Fellow with the Africa Centres for Disease Control and Prevention, currently based at the Ethiopian Public Health Institute in Ethiopia, where she supports antimicrobial resistance surveillance and broader health system strengthening efforts. She is a trained epidemiologist with a Master’s degree in Epidemiology and Biostatistics and over six years of experience spanning infectious disease surveillance, outbreak response, and public health programme implementation. Her professional interests lie in applied infectious disease epidemiology and antimicrobial resistance containment, with a strong commitment to improving health security and strengthening evidence-informed public health action across Africa.
