{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T23:44:36Z","timestamp":1792194276290,"version":"4.4.0"},"reference-count":78,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>\n                    Antimicrobial resistance (AMR) threatens global health, and understanding resistance patterns aids in effective treatment and promotes responsible antimicrobial use. Despite the urgency of resistant pathogens, systematic reviews focusing specifically on Tanzania are limited, and while several studies report resistance patterns for individual pathogens, a consolidated analysis of overall prevalence is needed to inform policymaking and public health interventions. Therefore, this review and meta-analysis assessed the prevalence of antimicrobial resistance among clinically relevant pathogens in Tanzania, providing a comprehensive overview to support surveillance, infection control, and stewardship efforts. A total of 1865 studies identified from Google Scholar (1600), PubMed (13), and Science Direct (252) underwent screening and full article review. Finally, 28 studies were included. A subgroup analysis was performed to evaluate the resistance patterns within antibiotic classes for specific pathogens. Descriptive statistics were used to describe the characteristics of the studies, while the prevalence of antimicrobial resistance was estimated through Meta-analysis. Inconsistency and heterogeneity between studies were quantified by the I\n                    <jats:sup>2<\/jats:sup>\n                    index. Among the included studies, most isolates (25.0%) were obtained from urine samples. Of these studies, 75% were cross-sectional studies and 92.9% were conducted in hospital settings. The analysis revealed high resistance to penicillin, particularly amoxicillin-clavulanic and ampicillin, with\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    (0.96 [0.83\u20130.99]),\n                    <jats:italic>Acinetobacter baumannii<\/jats:italic>\n                    (0.94 [0.67\u20130.99]) and Escherichia coli (0.90 [0.81\u20130.95]). Similarly, erythromycin resistance was most prevalent in\n                    <jats:italic>Campylobacter spp.<\/jats:italic>\n                    (0.85 [0.80\u20130.89]). Ciprofloxacin resistance was highest in\n                    <jats:italic>Acinetobacter baumannii<\/jats:italic>\n                    (0.54 [0.33\u20130.73]), whereas amikacin resistance was highest in\n                    <jats:italic>Proteus spp.<\/jats:italic>\n                    (0.86 [0.35\u20130.99]). Ceftriaxone resistance was particularly high in\n                    <jats:italic>Acinetobacter baumannii<\/jats:italic>\n                    (0.91 [0.70\u20130.98]) and\n                    <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                    (0.85 [0.74\u20130.92]). Meropenem resistance was lowest among\n                    <jats:italic>Escherichia coli<\/jats:italic>\n                    (0.04 [0.01\u20130.10]) and\n                    <jats:italic>Klebsiella spp.<\/jats:italic>\n                    (0.07 [0.03\u20130.15]), while the pooled resistance across ESKAPE-E pathogens was (0.11[0.06\u20130.19]). Imipenem and clindamycin each had an overall pooled resistance of (0.06[0.02\u20130.14]) against both\n                    <jats:italic>Escherichia coli<\/jats:italic>\n                    and\n                    <jats:italic>Klebsiella pneumoniae.<\/jats:italic>\n                    The findings highlight widespread resistance among bacterial pathogens, ESKAPE-E, particularly in the\n                    <jats:italic>Access<\/jats:italic>\n                    and\n                    <jats:italic>Watch<\/jats:italic>\n                    groups of antibiotics. The variability in resistance patterns underscores the need for the Ministry of Health to re-evaluate empirical treatment protocols (STG\/NEMLIT) to ensure effective treatment regimens, strengthen antimicrobial stewardship, enhance surveillance systems, and promote rational antibiotic use.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0346433","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T17:39:38Z","timestamp":1776793178000},"page":"e0346433","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Prevalence of antimicrobial resistance in Tanzania: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5596-5010","authenticated-orcid":true,"given":"Charles Basil","family":"Kafaiya","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johnson","family":"Mshiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Obadia","family":"Bishoge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Mcharo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sia","family":"Malekia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Mremi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9755-6280","authenticated-orcid":true,"given":"Angelina M.","family":"Lutambi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mwanaada","family":"Kilima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Mayige","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Said","family":"Aboud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"pone.0346433.ref001","year":"2024"},{"issue":"10","key":"pone.0346433.ref002","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.3390\/pathogens10101310","article-title":"Bacterial Antibiotic Resistance: The Most Critical Pathogens","volume":"10","author":"G Mancuso","year":"2021","journal-title":"Pathogens"},{"issue":"10325","key":"pone.0346433.ref003","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"Antimicrobial Resistance Collaborators","year":"2022","journal-title":"Lancet"},{"issue":"10459","key":"pone.0346433.ref004","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/S0140-6736(24)01867-1","article-title":"Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050","volume":"404","author":"GBD 2021 Antimicrobial Resistance Collaborators","year":"2024","journal-title":"Lancet"},{"key":"pone.0346433.ref005","year":"2023"},{"issue":"1","key":"pone.0346433.ref006","doi-asserted-by":"crossref","DOI":"10.1017\/ash.2023.164","article-title":"World Health Organization AWaRe framework for antibiotic stewardship: Where are we now and where do we need to go? 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