Prevalence of antimicrobial resistance in Tanzania: A systematic review and meta-analysis
Clinical Snapshot
PICO Framework
| P — Population | Patients with bacterial infections in Tanzania from whom clinical isolates were obtained |
| I — Intervention | Antimicrobial susceptibility testing of bacterial pathogens |
| C — Comparator | Not applicable (prevalence study) |
| O — Outcomes | Prevalence of antimicrobial resistance across different bacterial pathogens and antibiotic classes |
Bottom Line
This Tanzanian systematic review reveals alarmingly high antimicrobial resistance rates, particularly to penicillins and third-generation cephalosporins among ESKAPE-E pathogens. Key findings include >90% penicillin resistance in K. pneumoniae, A. baumannii, and E. coli, with concerning ceftriaxone resistance (>85%) in A. baumannii and P. aeruginosa. Encouragingly, carbapenem resistance remains relatively low (<10% for most pathogens). However, the study's methodological limitations—including restricted database searching, unclear quality assessment, and apparent high heterogeneity—limit confidence in precise estimates. The predominance of hospital-based, cross-sectional studies may overestimate community resistance rates. Despite these limitations, the findings strongly support the authors' recommendations for urgent revision of empirical treatment guidelines, enhanced antimicrobial stewardship, and strengthened surveillance systems in Tanzania. Clinicians should exercise particular caution with penicillin and cephalosporin empirical therapy, while carbapenems appear to retain efficacy for severe infections.
Key Findings
P Value: Not reported
Effect Size: High resistance to penicillins: K. pneumoniae 96% (83-99%), A. baumannii 94% (67-99%), E. coli 90% (81-95%)
Primary Outcome: Prevalence of antimicrobial resistance across bacterial pathogens in Tanzania
Nnt Or Sensitivity: Meropenem resistance lowest: E. coli 4% (1-10%), Klebsiella spp. 7% (3-15%)
Confidence Interval: Varied by pathogen-antibiotic combination, generally wide intervals suggesting heterogeneity
Clinical Application
Highly feasible as data reflects current resistance patterns in Tanzanian healthcare facilities Limited direct applicability to Australia due to different resistance patterns, healthcare systems, and antibiotic availability. However, methodology could inform similar surveillance efforts and highlights importance of local resistance data for empirical therapy decisions Patients with bacterial infections in hospital settings across Tanzania, with particular relevance to urinary tract infections (25% of isolates from urine)
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.
References
- 1.Kafaiya, C. B., Mshiu, J., Bishoge, O., Mcharo, J., Malekia, S., Mremi, I., Lutambi, A. M., Kilima, M., Mayige, M., & Aboud, S. (2026). Prevalence of antimicrobial resistance in Tanzania: A systematic review and meta-analysis. PLoS One. https://doi.org/10.1371/journal.pone.0346433
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