Seven-year surveillance of antimicrobial resistance in respiratory pathogens at a Ugandan referral hospital: Emerging trends and stewardship priorities

Abstract

Background. Respiratory tract infections remain a leading cause of global morbidity and mortality. Their management is increasingly complicated by the emergence and spread of antimicrobial resistance (AMR), particularly in resource-limited settings such as Uganda. Objectives. To describe the prevalence, distribution and AMR patterns of bacterial pathogens isolated from respiratory tract specimens collected at Mbarara Regional Referral Hospital (MRRH), Uganda, between 2018 and 2024. Methods. We conducted a retrospective analysis of 583 bacterial isolates from respiratory specimens collected at MRRH between 2018 and 2024. Data extracted from the WHONET system were analysed using Python to assess pathogen distribution, resistance patterns and multidrug resistance (MDR). Results. Streptococcus pneumoniae (48.9%) and Klebsiella pneumoniae (32.9%) were the most frequently isolated organisms. Over time, S. pneumoniae prevalence declined, while K. pneumoniae and Pseudomonas aeruginosa became more prominent. High resistance was observed to tetracyclines, macrolides, sulphonamides and beta-lactams. MDR was detected in 74.7% of S. pneumoniae and 77.1% of Klebsiella species. Conclusion. The rising prevalence of MDR among respiratory pathogens, particularly K. pneumoniae and P. aeruginosa, signals an urgent need to revise treatment guidelines and strengthen local stewardship, diagnostic capacity and AMR surveillance systems.