Seven-year surveillance of antimicrobial resistance in respiratory pathogens at a Ugandan referral hospital: Emerging trends and stewardship priorities.

BACKGROUND

Respiratory tract infections remain a leading cause of global morbidity and mortality. Their management is increasingly complicated by the emergence and spread of antimicrobial resistance (AMR), particularly in resource-limited settings such as Uganda.

OBJECTIVES

To describe the prevalence, distribution and AMR patterns of bacterial pathogens isolated from respiratory tract specimens collected at Mbarara Regional Referral Hospital (MRRH), Uganda, between 2018 and 2024.

METHODS

We conducted a retrospective analysis of 583 bacterial isolates from respiratory specimens collected at MRRH between 2018 and 2024. Data extracted from the WHONET system were analysed using Python to assess pathogen distribution, resistance patterns and multidrug resistance (MDR).

RESULTS

Streptococcus pneumoniae (48.9%) and Klebsiella pneumoniae (32.9%) were the most frequently isolated organisms. Over time, S. pneumoniae prevalence declined, while K. pneumoniae and Pseudomonas aeruginosa became more prominent. High resistance was observed to tetracyclines, macrolides, sulphonamides and beta-lactams. MDR was detected in 74.7% of S. pneumoniae and 77.1% of Klebsiella species.

CONCLUSION

The rising prevalence of MDR among respiratory pathogens, particularly K. pneumoniae and P. aeruginosa, signals an urgent need to revise treatment guidelines and strengthen local stewardship, diagnostic capacity and AMR surveillance systems.

STUDY SYNOPSIS: What the study adds. This study investigated the clinical and microbial characteristics of respiratory tract infections (RTIs) in patients at a tertiary hospital in Uganda between 2018 and 2024. Key findings were a high prevalence of multidrug-resistant organisms, particularly Klebsiella pneumoniae and Pseudomonas aeruginosa.Implications of the findings. The results underscore the need for routine microbial surveillance and antibiotic stewardship to guide empirical therapy and curb antimicrobial resistance, especially in RTIs.