Meta-analysis of antimicrobial resistance prevalence in Tanzanian hospital pathogens

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PloS one Published April 22, 2026 Medically reviewed April 28, 2026 Study authors: Kafaiya Charles Basil, Mshiu Johnson, Bishoge Obadia, Mcharo Jonathan, Malekia Sia, Mremi Irene, Lut… PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Note high resistance to penicillin and ceftriaxone in Tanzania; support stewardship and surveillance.

This systematic review and meta-analysis evaluates the prevalence of antimicrobial resistance among clinically relevant pathogens in Tanzania, drawing on 28 studies identified from Google Scholar, PubMed, and Science Direct. The included studies were predominantly conducted in hospital settings, accounting for 92.9% of the total evidence base. The authors quantified inconsistency and heterogeneity between studies using the I2 index, highlighting variability in the data sources.

Specific resistance patterns were detailed across multiple drug-pathogen combinations. Penicillin resistance was found to be high in Klebsiella pneumoniae [0.83-0.99], Acinetobacter baumannii [0.67-0.99], and Escherichia coli [0.81-0.95]. Erythromycin resistance in Campylobacter spp. was the most prevalent, with an effect size of 0.85 [0.80-0.89]. Ciprofloxacin resistance in Acinetobacter baumannii was the highest at 0.54 [0.33-0.73], while amikacin resistance in Proteus spp. reached 0.86 [0.35-0.99].

Carbapenem resistance remained low for meropenem in Escherichia coli [0.01-0.10] and Klebsiella spp. [0.03-0.15], and for imipenem against Escherichia coli and Klebsiella pneumoniae [0.02-0.14]. Conversely, ceftriaxone resistance was particularly high in Acinetobacter baumannii [0.70-0.98] and Pseudomonas aeruginosa [0.74-0.92]. Pooled resistance across ESKAPE-E pathogens was widespread at 0.11 [0.06-0.19], and clindamycin resistance against Escherichia coli and Klebsiella pneumoniae was 0.06 [0.02-0.14].

The authors do not report adverse events or tolerability data. They recommend supporting surveillance, infection control, and stewardship efforts, re-evaluating empirical treatment protocols, and strengthening antimicrobial stewardship systems. Clinicians should interpret these findings as prevalence estimates from observational studies and avoid overstatement regarding causality.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJan 2026

PMID42013121

View Original Abstract ↓

Antimicrobial resistance (AMR) threatens global health, and understanding resistance patterns aids in effective treatment and promotes responsible antimicrobial use. Despite the urgency of resistant pathogens, systematic reviews focusing specifically on Tanzania are limited, and while several studies report resistance patterns for individual pathogens, a consolidated analysis of overall prevalence is needed to inform policymaking and public health interventions. Therefore, this review and meta-analysis assessed the prevalence of antimicrobial resistance among clinically relevant pathogens in Tanzania, providing a comprehensive overview to support surveillance, infection control, and stewardship efforts. A total of 1865 studies identified from Google Scholar (1600), PubMed (13), and Science Direct (252) underwent screening and full article review. Finally, 28 studies were included. A subgroup analysis was performed to evaluate the resistance patterns within antibiotic classes for specific pathogens. Descriptive statistics were used to describe the characteristics of the studies, while the prevalence of antimicrobial resistance was estimated through Meta-analysis. Inconsistency and heterogeneity between studies were quantified by the I2 index. Among the included studies, most isolates (25.0%) were obtained from urine samples. Of these studies, 75% were cross-sectional studies and 92.9% were conducted in hospital settings. The analysis revealed high resistance to penicillin, particularly amoxicillin-clavulanic and ampicillin, with Klebsiella pneumoniae (0.96 [0.83-0.99]), Acinetobacter baumannii (0.94 [0.67-0.99]) and Escherichia coli (0.90 [0.81-0.95]). Similarly, erythromycin resistance was most prevalent in Campylobacter spp. (0.85 [0.80-0.89]). Ciprofloxacin resistance was highest in Acinetobacter baumannii (0.54 [0.33-0.73]), whereas amikacin resistance was highest in Proteus spp. (0.86 [0.35-0.99]). Ceftriaxone resistance was particularly high in Acinetobacter baumannii (0.91 [0.70-0.98]) and Pseudomonas aeruginosa (0.85 [0.74-0.92]). Meropenem resistance was lowest among Escherichia coli (0.04 [0.01-0.10]) and Klebsiella spp. (0.07 [0.03-0.15]), while the pooled resistance across ESKAPE-E pathogens was (0.11[0.06-0.19]). Imipenem and clindamycin each had an overall pooled resistance of (0.06[0.02-0.14]) against both Escherichia coli and Klebsiella pneumoniae. The findings highlight widespread resistance among bacterial pathogens, ESKAPE-E, particularly in the Access and Watch groups of antibiotics. The variability in resistance patterns underscores the need for the Ministry of Health to re-evaluate empirical treatment protocols (STG/NEMLIT) to ensure effective treatment regimens, strengthen antimicrobial stewardship, enhance surveillance systems, and promote rational antibiotic use.