Published in PLOS One on 2026-04-21, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Charles Basil Kafaiya, Johnson Mshiu, Obadia Bishoge, Jonathan Mcharo, Sia Malekia, Irene Mremi, Angelina M. Lutambi, Mwanaada Kilima, Mary Mayige, Said Aboud
Source: PLOS One • DOI 10.1371/journal.pone.0346433
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
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.
Introduction
Antimicrobial resistance occurs when pathogens resist exposure to antibiotics that are intended to kill or slow their growth [1,2]. It has become one of the leading public health threats of the 21st century, posing significant dangers to global health, economic stability, and the effectiveness of healthcare systems [3]. Globally, bacterial Antimicrobial Resistance(AMR) was estimated to be responsible for approximately 1.27 million deaths and associated with about 4.95 million deaths in 2019, making it comparable to major infectious diseases such as HIV/AIDS and Malaria in terms of mortality burden [4]. The World Health Organization (WHO) has recognised antimicrobial resistance as a serious public health concern that can result in prolonged hospital admissions, greater medical expenses and increased mortality rates [5]. The AWaRe framework guides rational antibiotic prescribing, promotes the use of first-line Access antibiotics when appropriate, restricts the use of Watch antibiotics due to their higher resistance potential, and reserves last-resort Reserve antibiotics for treatment of multidrug-resistant infections, thereby playing a critical role in slowing the emergence and spread of antimicrobial resistance [6]. Furthermore, in 2017, the WHO identified ESKAPE pathogens: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species as major global health threats due to their rising antibiotic resistance and potential to cause serious infections in humans [2]. This has made standard treatments less effective as bacterial pathogens change, making it more difficult to treat once-treatable infections. This phenomenon is particularly pronounced in low- and middle-income countries, where inappropriate antibiotic abuse is widespread, infectious disease burdens are high, and healthcare resources are limited [3,7].
Reading this evidence
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This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Charles Basil Kafaiya, Johnson Mshiu, Obadia Bishoge, Jonathan Mcharo, Sia Malekia, Irene Mremi, Angelina M. Lutambi, Mwanaada Kilima, Mary Mayige, Said Aboud. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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