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High Antimicrobial Resistance in ESKAPE Pathogens at a Rwandan Tertiary Hospital
Charles Muhinda1,2, Gad Murenzi3, Leena Al-Hassan4
1Department of Clinical Laboratory, Rwanda Military Referral and Teaching Hospital, Kigali P.O. Box 3377, Rwanda.
Abstract:
Antimicrobial resistance (AMR) is a global health threat, increasing morbidity, mortality, and healthcare costs. Multi-drug resistant ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter cloacae) cause most hospital-acquired infections. Local data on their resistance profiles remain limited in low-income settings. This study assessed the prevalence and resistance patterns of ESKAPE pathogens isolated from clinical specimens at Rwanda Military Referral and Teaching Hospital. A descriptive cross-sectional study was conducted from June 2022 to January 2023. ESKAPE isolates were identified and tested for antimicrobial susceptibility using the BD Phoenix M50 System. Data on sample type, ward, and demographics were analyzed. Of 744 bacterial findings, 207 (30%) were ESKAPE isolates. After excluding duplicates and non-recovered isolates, 156 were identified as ESKAPE. K. pneumoniae was most common (41%), followed by S. aureus (27%), A. baumannii (13%), P. aeruginosa (11%), and E. cloacae (8%); no E. faecium was detected. Among Gram-negatives, 63% were resistant to third-generation cephalosporins and 32% to carbapenems, with A. baumannii showing highest resistance (85% and 75%). Methicillin-Resistance in Staphylococcus aureus (MRSA) was 7%. This first hospital-based study in Rwanda shows high cephalosporin and carbapenem resistance, highlighting the need to strengthen diagnostics and stewardship.
Insights
Antimicrobial resistance is a major threat. This study found high rates of resistance to common antibiotics among ESKAPE pathogens in Rwanda, emphasizing the need for better diagnostics and antibiotic stewardship.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Global Health Security
Background:
- Antimicrobial resistance (AMR) poses a significant global health challenge, leading to increased illness, death, and healthcare expenses.
- ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter cloacae) are key drivers of hospital-acquired infections.
- Limited data exists on AMR profiles of these critical pathogens in low-income regions.
Purpose of the Study:
- To determine the prevalence and antimicrobial resistance patterns of ESKAPE pathogens.
- To analyze resistance trends in clinical isolates from Rwanda Military Referral and Teaching Hospital.
- To provide local data for informing public health strategies against AMR.
Main Methods:
- A descriptive cross-sectional study was conducted from June 2022 to January 2023.
- ESKAPE isolates were identified from clinical specimens using the BD Phoenix M50 System.
- Antimicrobial susceptibility testing was performed, and data on sample type, ward, and demographics were analyzed.
Main Results:
- Of 744 bacterial findings, 156 unique ESKAPE isolates were identified.
- Klebsiella pneumoniae (41%) and Staphylococcus aureus (27%) were the most prevalent.
- High resistance rates were observed: 63% of Gram-negatives resistant to third-generation cephalosporins, 32% to carbapenems. Acinetobacter baumannii showed 85% cephalosporin and 75% carbapenem resistance. Methicillin-resistant Staphylococcus aureus (MRSA) prevalence was 7%.
Conclusions:
- This study represents the first hospital-based assessment of ESKAPE pathogens in Rwanda.
- High levels of resistance to third-generation cephalosporins and carbapenems were detected.
- Urgent strengthening of diagnostic capabilities and antimicrobial stewardship programs is recommended.
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