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Bacterial pathogens and antimicrobial resistance patterns in infections associated with stillbirths and under-five

Fentabil Getnet1,2, Dadi Marami3, Shikur Mohammed4

  • 1National Data Management and Analytics Center for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia. b.infen4ever@gmail.com.

BMC Infectious Diseases
|July 7, 2026
PubMed
Abstract

Insights

Klebsiella pneumoniae is the leading cause of bacterial infections in stillbirths and children under five in Ethiopia, showing high antimicrobial resistance (AMR). This highlights the urgent need for improved infection control and AMR surveillance to combat child mortality.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Public Health

Background:

  • Bacterial infections contribute significantly to stillbirth, neonatal, and under-five mortality, especially in low-resource settings.
  • Antimicrobial resistance (AMR) poses a growing threat to managing severe infections in children.
  • Limited data exists on bacterial pathogens and AMR patterns causing child mortality in Ethiopia.

Purpose of the Study:

  • To characterize bacterial pathogens causing stillbirths and under-five deaths in Ethiopia.
  • To determine antimicrobial resistance patterns of these bacterial isolates.
  • To inform strategies for combating pediatric bacterial infections and AMR in the region.

Main Methods:

  • Analysis of microbiological data from the Child Health and Mortality Prevention Surveillance (CHAMPS) and Study of Illness in Preterm (SIP) surveillance studies in Ethiopia.
  • Identification of bacterial pathogens from blood and cerebrospinal fluid samples using culture.
  • Antimicrobial susceptibility testing performed on 371 bacterial isolates.

Main Results:

  • Klebsiella pneumoniae was the predominant pathogen in both studies (44.0% in CHAMPS, 29.2% in SIP).
  • Vaccine-preventable pathogens (Streptococcus pneumoniae, H. influenzae, Neisseria meningitidis) and Escherichia coli were also significant contributors.
  • Klebsiella pneumoniae exhibited high resistance (≥75%) to common antimicrobials, with lower resistance to Amikacin (83.6% susceptible) and Ciprofloxacin (67.8% susceptible).

Conclusions:

  • Klebsiella pneumoniae is the primary bacterial pathogen linked to stillbirths and under-five deaths in Ethiopian healthcare settings.
  • High resistance to first-line antimicrobials necessitates strengthening infection prevention, AMR surveillance, and treatment protocols.
  • Improved antimicrobial stewardship is crucial for managing severe pediatric bacterial infections in Ethiopia.
Keywords:
Antimicrobial resistanceBacterial pathogensChild mortalityEthiopiaPost-mortem surveillanceSepsis

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