Temporal trends in ESKAPE pathogen distribution and AMR patterns observed in 3,778 isolates from Rwanda
This retrospective laboratory-based surveillance study examined temporal trends in the distribution and antimicrobial resistance (AMR) patterns of ESKAPE pathogens among 3,778 culture-positive clinical specimens processed at the University Teaching Hospital of Kigali (CHUK) in Rwanda. The observation period covered five years, from 2020 through 2024. The primary outcome assessed changes in pathogen prevalence and resistance rates over time, while secondary outcomes included phenotypic resistance patterns and trends by antibiotic category.
Klebsiella pneumoniae was the most prevalent pathogen, accounting for 43.8% of isolates, followed by Staphylococcus aureus at 26.4% and Acinetobacter baumannii at 15.1%. The overall AMR rate across all pathogens was 56.5%. Specific high-resistance organisms included Enterococcus spp. at 74.6%, A. baumannii at 69.9%, and Enterobacter spp. at 64.4%. Notably, Extended-spectrum β-lactamase-producing Enterobacterales were identified in 32.9% of cases, Methicillin-resistant Staphylococcus aureus in 31.1%, Carbapenem-resistant Enterobacterales in 15.6%, and Vancomycin-resistant Enterococci in 5%.
Resistance to access antibiotics increased from 54.7% in 2020 to 83.3% in 2024. Resistance to watch antibiotics rose from 42.5% in 2020 to 57.2% in 2024. Resistance to Reserve antibiotics remained comparatively lower. Adverse events, serious adverse events, discontinuations, and tolerability were not reported. Funding or conflicts of interest were not reported. The study did not report p-values or confidence intervals for these estimates.
Key limitations include the single-center design and lack of reported safety data. The study does not establish causality. These findings underscore an urgent need to strengthen antimicrobial stewardship, infection prevention, and control measures in this setting. Clinicians should interpret these trends as descriptive data from a specific hospital cohort rather than generalizable population-level statistics.
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