Review Article

A review of antimicrobial resistance in East Africa

Lucas Ampaire, Abraham Muhindo, Patrick Orikiriza, Juliet Mwanga-Amumpaire, Lisa Bebell, Yap Boum
African Journal of Laboratory Medicine | Vol 5, No 1 | a432 | DOI: https://doi.org/10.4102/ajlm.v5i1.432 | © 2016 Lucas Ampaire, Abraham Muhindo, Patrick Orikiriza, Juliet Mwanga-Amumpaire, Lisa Bebell, Yap Boum | This work is licensed under CC Attribution 4.0
Submitted: 06 March 2016 | Published: 15 September 2016

About the author(s)

Lucas Ampaire, Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, Mbarara, Uganda
Abraham Muhindo, Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, Mbarara, Uganda
Patrick Orikiriza, Epicentre Mbarara Research Centre, Mbarara, Uganda and Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
Juliet Mwanga-Amumpaire, Epicentre Mbarara Research Centre, Mbarara, Uganda
Lisa Bebell, Massachusetts General Hospital, Boston, Massachusetts, United States
Yap Boum, Epicentre Mbarara Research Centre, Mbarara, Uganda

Abstract

Background and objectives: Knowledge of local and regional antimicrobial resistance (AMR) is important for clinical decision making. However, surveillance capacity for AMR is lacking throughout East Africa, and current AMR data are sparse. We sought to address this gap by summarising all available high-quality data on AMR in the East Africa region.

Method: We searched the PubMed database and African Journals Online archives in April and May 2015 using the search term ‘antimicrobial resistance AND sub-Saharan Africa’ to find articles published from 2005 onwards. Only full-text articles in English were included.

Results: We included 12 published articles in our analysis. Most articles were on bloodstream infections, hospital-based and cross-sectional in design; a majority described either community- or hospital-acquired infections. High levels of AMR to commonly-used antibiotics were reported, including 50% – 100% resistance to ampicillin and cotrimoxazole infections, emerging resistance to gentamicin (20% – 47%) and relatively high levels of resistance to ceftriaxone (46% – 69%) among Gram-negative infections. Much of the resistance was reported to be in Klebsiella species and Escherichia coli. Among Gram-positive infections, extensive resistance was reported to ampicillin (100%), gentamicin and ceftriaxone (50% – 100%), with methicillin-resistant Staphylococcus aureus prevalence ranging from 2.6% – 4.0%.

Conclusion: Overall, bacterial resistance was reported among commonly-used antibiotics (ampicillin, gentamicin and ceftriaxone), raising concern that these antibiotics may no longer be useful for treating moderate or severe bacterial infections in East Africa. Thus, empirical treatment of bacterial infections needs to be reconsidered and guided by local assessment of AMR. Improvements in the limited amount of quality data and lack of harmonisation in assessing the burden of AMR are also needed.


Keywords

Antimicrobial resistance; East Africa

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Birhanu Meresa Bishaw, Gobezie T Tegegne, Alemseged Beyene Berha
Infection and Drug Resistance  vol: Volume 14  first page: 3477  year: 2021  
doi: 10.2147/IDR.S329996

58. Medical students’ knowledge, attitudes, and motivation towards antimicrobial resistance efforts in Eastern Uganda
Jonathan Babuya, Daniel Waruingi, Douglas Mungujakisa, Osmas Ahimbisibwe, Victoria Ruth Kako, Faith Aporu, Emmanuel Mugume, Julian Nyamupachitu, Kenedy Kiyimba, Yoshito Nishimura
PLOS ONE  vol: 20  issue: 2  first page: e0314250  year: 2025  
doi: 10.1371/journal.pone.0314250

59. A Cross-Sectional Survey of the Knowledge, Attitudes, and Practices of Antimicrobial Users and Providers in an Area of High-Density Livestock-Human Population in Western Kenya
Steven A. Kemp, Gina L. Pinchbeck, Eric M. Fèvre, Nicola J. Williams
Frontiers in Veterinary Science  vol: 8  year: 2021  
doi: 10.3389/fvets.2021.727365

60. Antibiogram signatures of Vibrio species recovered from surface waters in South Western districts of Uganda: Implications for environmental pollution and infection control
Hope Onohuean, Anthony I. Okoh, Uchechukwu U. Nwodo
Science of The Total Environment  vol: 807  first page: 150706  year: 2022  
doi: 10.1016/j.scitotenv.2021.150706

61. Antibiotic Practices, Perceptions and Self-Medication Among Patients at a National Referral Hospital in Uganda
Irene Nabaweesi, Ronald Olum, Arthur Sekite, Willy Suubi, Prossy Nakiwunga, Aron Machali, Richard Kiyumba, Peter Kalyango, Allen Natamba, Yokosofati Igumba, Martin Kyeyune, Harriet Mpairwe, Eric Katagirya
Infection and Drug Resistance  vol: Volume 14  first page: 2155  year: 2021  
doi: 10.2147/IDR.S303075

62. Optical maps of plasmids as a proxy for clonal spread of MDR bacteria: a case study of an outbreak in a rural Ethiopian hospital
Yii-Lih Lin, Tsegaye Sewunet, Sriram KK, Christian G Giske, Fredrik Westerlund
Journal of Antimicrobial Chemotherapy  vol: 75  issue: 10  first page: 2804  year: 2020  
doi: 10.1093/jac/dkaa258

63. Antimicrobial Resistance of Escherichia coli Isolates from Livestock and the Environment in Extensive Smallholder Livestock Production Systems in Ethiopia
Biruk Alemu Gemeda, Barbara Wieland, Gezahegn Alemayehu, Theodore J. D. Knight-Jones, Hiwot Desta Wodajo, Misgana Tefera, Adem Kumbe, Abebe Olani, Shubisa Abera, Kebede Amenu
Antibiotics  vol: 12  issue: 5  first page: 941  year: 2023  
doi: 10.3390/antibiotics12050941

64. Antimicrobial-resistant foodborne pathogens in the Middle East: a systematic review
Abdullah F. Alsayeqh, Amany Hassan Attia Baz, Wageh Sobhy Darwish
Environmental Science and Pollution Research  vol: 28  issue: 48  first page: 68111  year: 2021  
doi: 10.1007/s11356-021-17070-9

65. Antibiotic overuse, poor antimicrobial stewardship, and low specificity of syndromic case management in a cross section of men with urethral discharge syndrome in Kampala, Uganda
Matthew M. Hamill, Annet Onzia, Rosalind M. Parkes-Ratanshi, Peter Kyambadde, Emmanuel Mande, Vivian Nakate, Johan H. Melendez, Ethan Gough, Yukari C. Manabe, Caroline Watts
PLOS ONE  vol: 19  issue: 3  first page: e0290574  year: 2024  
doi: 10.1371/journal.pone.0290574

66. Drug resistance and extended-spectrum β-lactamase (ESBLs) - producing Enterobacteriaceae, Acinetobacter and Pseudomonas species from the views of one-health approach in Ethiopia: a systematic review and meta-analysis
Mengistu Abayneh, Ahmed Zeynudin, Rahel Tamrat, Mulualem Tadesse, Abraham Tamirat
One Health Outlook  vol: 5  issue: 1  year: 2023  
doi: 10.1186/s42522-023-00088-z

67. Magnitude of non-prescribed antibiotic dispensing in Ethiopia: a multicentre simulated client study with a focus on non-urban towns
Sewunet Admasu Belachew, Lisa Hall, Linda A Selvey
Journal of Antimicrobial Chemotherapy  vol: 77  issue: 12  first page: 3462  year: 2022  
doi: 10.1093/jac/dkac341

68. Antibiotic consumption and utilization at a large tertiary care level hospital in Uganda: A point prevalence survey
Mark Kizito, Darius Owachi, Falisy Lule, Laura Jung, Vivian Bazanye, Ibrahim Mugerwa, Susan Nabadda, Charles Kabugo, Mabel Kamweli Aworh
PLOS ONE  vol: 20  issue: 1  first page: e0313587  year: 2025  
doi: 10.1371/journal.pone.0313587