ArticleBMC infectious diseases2026
Bacterial pathogens and antimicrobial resistance patterns in infections associated with stillbirths and under-five deaths in Ethiopia: a post-mortem surveillance study.
Article in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundBacterial infections remain major contributors to stillbirth, neonatal, and under-five mortality, particularly in low-resource settings where antimicrobial resistance (AMR) increasingly threatens the management of severe infections. Despite the growing burden of AMR in Ethiopia, data on bacterial pathogens and resistance patterns contributing to child mortality remain limited. This study aimed to characterize bacterial pathogens and antimicrobial resistance patterns among isolates obtained from stillbirths and under-five deaths in Ethiopia.
methodsWe analyzed microbiological data from two post-mortem surveillance studies conducted in Ethiopia: the Child Health and Mortality Prevention Surveillance (CHAMPS) and the Study of Illness in Preterm (SIP). CHAMPS investigated the causes of death in 416 stillbirths and children under five years of age between 2019 and 2022, while SIP examined 1,109 preterm neonatal deaths from five hospitals between 2016 and 2018. In both studies, bacterial pathogens were identified through culture of blood and cerebrospinal fluid samples-collected post-mortem in CHAMPS and ante-mortem in SIP. A total of 535 bacterial isolates were identified (302 from CHAMPS and 233 from SIP), of which 371 underwent antimicrobial susceptibility testing. Descriptive statistics were performed using Stata 16/MP 16.1 to summarize bacterial pathogen distribution and patterns of antimicrobial resistance.
resultsAmong the 302 isolates identified from stillbirths and under-five deaths in the CHAMPS study, Klebsiella pneumoniae accounted for 44.0% of isolates, followed by vaccine-preventable pathogens (Streptococcus pneumoniae, H. influenzae and Neisseria meningitidis) and Escherichia coli with 15.5% and 12.9%, respectively. In the SIP study, Klebsiella pneumoniae was also the predominant pathogen (29.2%) in preterm neonatal deaths followed by Staphylococcus aureus (17.6%). Group B Streptococcus comprised 2.1% of all isolates. Klebsiella pneumoniae exhibited high levels of resistance (≥ 75%) to commonly used antimicrobials, while lower resistance levels were observed for Amikacin and Ciprofloxacin. Among 110K. pneumoniae isolates tested, 83.6% were susceptible to Amikacin and 67.8% to Ciprofloxacin.
conclusionKlebsiella pneumonia is the predominant bacterial pathogen identified among stillbirths and under-five deaths in Ethiopian healthcare settings, with high levels of resistance to commonly used first-line antimicrobials. These findings highlight the need to strengthen infection prevention measures, AMR surveillance, and revision of empirical treatment protocols and antimicrobial stewardship to improve management of severe pediatric bacterial infections.
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