High Burden of Multidrug-Resistant Bacteria in Eastern Democratic Republic of the Congo: A Retrospective Hospital-Based Study.

BACKGROUND

Antimicrobial resistance (AMR) is a major global public health threat, disproportionately affecting low- and middle-income countries, particularly in sub-Saharan Africa where microbiological surveillance remains limited.

OBJECTIVE

To describe the bacterial ecology, antibiotic resistance profiles, and major resistance phenotypes among clinical isolates collected at the Bukavu Provincial General Referral Hospital in 2024.

METHODS

A retrospective study was conducted on 1801 non-duplicate bacterial isolates recovered from routine clinical specimens. Bacterial identification was performed using conventional microbiological methods, and antimicrobial susceptibility testing was interpreted according to EUCAST 2024 recommendations. Resistance profiles were analyzed by bacterial group, antibiotic class, and major resistance phenotypes.

RESULTS

Enterobacterales predominated (80.4%, n=1448), followed by Gram-positive cocci (11.4%, n=205) and non-fermenting Gram-negative bacilli (7.9%, n=142). Escherichia coli was the most frequently isolated species (37.2%, n=670). High resistance rates were observed for amoxicillin-clavulanic acid (95.6%), ampicillin (86.0%), ceftazidime (82.0%), and ceftriaxone (62.0%). Carbapenem resistance remained comparatively lower, with resistance rates of 14.4% for imipenem and 13.1% for meropenem. Among Enterobacterales tested for at least one third-generation cephalosporin, 80.0% (986/1,233) showed an ESBL-compatible phenotype. Multidrug resistance was observed in more than 70% of isolates.

CONCLUSION

This study demonstrates a high burden of antimicrobial resistance in a tertiary hospital in eastern Democratic Republic of Congo, characterized by widespread resistance to commonly used antibiotics and a high frequency of ESBL-compatible Enterobacterales. Strengthening microbiological surveillance, antimicrobial stewardship, and infection prevention strategies is urgently needed in this setting.