A five-year retrospective analysis of antimicrobial resistance patterns in clinical bacterial isolates from the Jazeera University Laboratory in Mogadishu, Somalia.

INTRODUCTION: Antimicrobial resistance (AMR) is a critical global health threat, particularly in resource-constrained settings like Somalia, where fragile healthcare systems amplify the challenge. This study aimed to evaluate AMR patterns in clinical bacterial isolates over a five-year period at Jazeera University Laboratory Department in Mogadishu, Somalia, to identify prevalent resistant pathogens and assess resistance trends for commonly prescribed antibiotics. METHODS: A retrospective analysis examined 785 bacterial samples from clinical specimens (e.g., urine, blood, wound swabs) collected between January 2019 and December 2024. Isolates which included Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, or Enterobacter spp., underwent susceptibility testing for Ampicillin (AMP), Amoxicillin/Clavulanate (AMC), Ceftriaxone (CRO), Ciprofloxacin (CIP), Gentamicin (GENTA), Nitrofurantoin (NIT), and Methicillin (METH) using disk diffusion method per CLSI guidelines. Data on age, sex, specimen source, isolation year, and resistance profiles were analyzed using SPSS, with chi-square tests to assess associations and temporal trends (p < 0.05 indicating significance). RESULTS: Escherichia coli (38.7%), Staphylococcus aureus (34.9%), and Klebsiella pneumoniae (22.9%) were the prevalent pathogens, primarily from urine cultures (47.1%). High resistance was observed for Ampicillin (AMP) in Escherichia coli (96.7%, p = 0.001), Klebsiella pneumoniae (93.9%, p = 0.074), and Staphylococcus aureus (90.1%, p = 0.008), and for Amoxicillin/Clavulanate (AMC) in Escherichia coli (78.9%, p = 0.001), Klebsiella pneumoniae (57.8%, p = 0.002), and Staphylococcus aureus (57.3%, p = 0.001). Ceftriaxone (CRO) resistance was high in Escherichia coli (61.8%, p = 0.001) and low in Staphylococcus aureus (16.8%, p = 0.001). Ciprofloxacin (CIP) resistance was moderately high in Escherichia coli (46.7%, p = 0.001) and lower in Staphylococcus aureus (22.3%, p = 0.001). Gentamicin (GENTA) and Nitrofurantoin (NIT) showed an overall lower resistance, particularly in Escherichia coli (16.8%, p = 0.001; 8.2%, p = 0.001) and Staphylococcus aureus (17.9%, p = 0.001; 7.3%, p = 0.001). Staphylococcus aureus exhibited significant methicillin resistance (40.5%, p = 0.001). CONCLUSION: Widespread AMR, particularly to AMP, AMC, CRO, and CIP, the need for targeted antimicrobial stewardship, enhanced surveillance, and robust infection prevention strategies in Somalia’s resource-limited healthcare system to address the growing AMR crisis.