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Updated: Oct 19, 2026
Application of the Intelligent High-Throughput Antimicrobial Sensitivity Testing/Phage Screening System and Lar Index of Antimicrobial Resistance
Published on: July 21, 2023
Standardized antimicrobial resistance surveillance in Somaliland: A hospital-based baseline evaluation using CLSI M39
Nouh Botan1, Abdisamad Sh O Ali1, Hamse A Warsame1
1Hargeisa Group Hospital, Hargeisa, Somaliland, Federal Republic of Somalia.
Background:
Antimicrobial resistance (AMR) surveillance remains limited across the Horn of Africa because of constrained laboratory infrastructure and fragmented microbiological reporting systems. This study established the first hospital-based cumulative antibiogram in Somaliland using Clinical and Laboratory Standards Institute (CLSI) M39-A4 methodology and WHONET software to provide a baseline surveillance model for resource-limited healthcare settings.
Methods:
A retrospective surveillance study was conducted using microbiology records collected over a completed 12-month period (January-December 2025) at a tertiary referral hospital in Somaliland. Duplicate isolates were removed according to CLSI M39-A4 recommendations by including only the first isolate per patient per species. Intermediate susceptibility results were categorized as resistant. Subgroup comparisons by specimen source were evaluated using Fisher's exact test.
Results:
From an initial dataset of 286 positive cultures generating 1,787 individual susceptibility records, 277 unique bacterial isolates were analyzed. Escherichia coli was the predominant pathogen (50.9%, n = 141), followed by Staphylococcus aureus (33.6%, n = 93). For E. coli, nitrofurantoin demonstrated the highest susceptibility rate (78.5%), followed by gentamicin (60.4%). Reduced phenotypic susceptibility to meropenem was observed among tested Gram-negative isolates, with 30.5% classified as susceptible. Wound/pus E. coli isolates demonstrated lower meropenem susceptibility than urinary isolates (13.3% vs. 35.4%), although subgroup differences did not reach statistical significance (p = 0.128).
Conclusion:
This study establishes the first standardized cumulative antibiogram generated in Somaliland using CLSI M39-A4 and WHONET methodology. The findings demonstrate substantial resistance to multiple commonly used antimicrobial agents and highlight the need to strengthen antimicrobial stewardship, microbiological diagnostics, and structured AMR surveillance systems in resource-limited healthcare settings.
