ArticleBMC infectious diseases2025
Trends and patterns of antimicrobial resistance among common pathogens isolated from adult bloodstream and urinary tract infections in public health facilities in Malawi, 2020-2024.
Article in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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5 citing papers in PubMed.
- Temporal genomic dynamics of sequence type 39Microbial genomics · 2026Article
- Community engagement strategies for antimicrobial resistance control and interventions.BMJ public health · 2026Review
- Molecular Characterization of Staphylococcus aureus and Coagulase-Negative Staphylococci Isolates at a Rural Hospital in Southern Malawi.BioMed research international · 2026Article
- The epidemiology of ceftriaxone and cotrimoxazole-resistant Escherichia coli from humans, poultry, and their environment in central Malawi: A cross-sectional study.PLOS global public health · 2026Article
- Drug Resistance Patterns and Pathogen Distribution in Patients with Urinary Tract Infection in Suzhou, China: A Five-Year Retrospective Study (2020-2024).Infection and drug resistance · 2026Article
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Abstract
introductionBacterial bloodstream and urinary tract infections present a huge health burden especially in low-resource settings, which is worsened by the escalating burden of antimicrobial resistance (AMR). However, surveillance data on antimicrobial susceptibility profiles of pathogens remains scarce in Malawi. Therefore, this study aimed at establishing trends and patterns of AMR among common pathogens causing adult bloodstream and urinary tract infections in Malawi.
methodsThis was a secondary analysis of records from bacterial culture and susceptibility testing results of routinely collected adult blood and urinary tract samples from seven facilities in Malawi between January 2020 and August 2024. Antimicrobial susceptibility testing (AST) was performed using the disk diffusion method and interpreted according to EUCAST guidelines. The outcome of interest was the AST results of the bacterial isolates. Data were analyzed using SPSS version 28.
resultsOut of the 2787 isolates collected, 80.6% (n = 2246) were from urine samples and 19.4% (n = 541) were from blood samples. 74.1% (n = 2066) of the isolates were Gram-negative organisms. Escherichia coli (37.6%, n = 1048) and Klebsiella pneumoniae (8.3%, n = 232) were the most frequent isolates. A total of 16,696 ASTs were performed on the isolates, with 54.3% (n = 9,068) showing resistance to the antibiotics tested. Among Gram-positive organisms, there was increasing resistance to co-trimoxazole (71.4-83.3%), vancomycin (20.0-31.0%), with consistently high resistance rates to ciprofloxacin, erythromycin and gentamicin. Gram-negative organisms showed trends of increasing resistance to ceftriaxone (63.0-72.4%), co-trimoxazole (72.7-89.7%), and piperacillin and tazobactam (0.0-35.8%), with a notable significant increase in resistance to ciprofloxacin (66.7-81.0%, p = 0.001). There was an increasing trend of Enterobacteriaceae resistance to third-generation cephalosporins (58.9-71.5%). Overall, pathogens with the highest resistance include Citrobacter freundii (62.1%, n = 755/1216), Staphylococcus sp. (62.0%, n = 163/263) and K. pneumoniae (57.1%, n = 941/1648). Among the commonly isolated pathogens, E. coli, K. pneumoniae and Enterobacter spp. showed highest resistance to multiple antibiotics.
conclusionThe study revealed high resistance levels among pathogens that cause BSIs and UTIs in public hospitals in Malawi. Most pathogens demonstrated high resistance against multiple antibiotic classes. The high AMR trends and patterns pose a significant risk to healthcare provision, calling for enhancing surveillance and upscaling efforts to address the challenge.
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