{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T06:48:06Z","timestamp":1767682086496,"version":"3.48.0"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Multidrug-resistant (MDR) bacterial infections pose a serious global health threat, particularly in low-resource settings where empirical antimicrobial use is common, while associated with poor outcomes and increased resistance. This study evaluated the prevalence, resistance profiles, clinical impact, and treatment options for MDR bacterial infections at the University Teaching Hospital of Kigali, Rwanda.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective descriptive-analytical study reviewed patient records and microbiology logbooks for culture-confirmed MDR infections from 1\n                      <jats:sup>st<\/jats:sup>\n                      January to 31\n                      <jats:sup>st<\/jats:sup>\n                      December 2023. Data were analyzed using SPSS, with significance set at\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Out of 1,676 positive cultures, 368 (22%) were MDR cases, mostly from surgical patients (30.4%). Urine samples yielded the majority of MDR isolates (52.2%), with\n                      <jats:italic>Escherichia coli<\/jats:italic>\n                      as the most common (45.4%), particularly in urine (71.3%). MDR isolates showed high resistance rates to ampicillin, doxycycline (100%), third-generation cephalosporins (98%), amoxicillin-clavulanic acid (96%), clindamycin (88%), and ciprofloxacin (74%). Resistance was lowest against amikacin (6%), vancomycin (14%), imipenem (24%), and polymyxin B (26%). The mean hospital stay was 8.6\u202fdays, and the mortality rate was 22% among patients with MDR bacterial infection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MDR bacterial infections were prevalent with longer hospital stays and poor outcomes. Despite high resistance to common antibiotics, amikacin, vancomycin, imipenem, and polymyxin B were effective treatment options. Continuous surveillance, antimicrobial stewardship, and treatment guideline development are crucial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>The global rise in antimicrobial resistance is a major public health threat requiring local surveillance for targeted interventions and guideline creation. This study at the University Teaching Hospital of Kigali found a 21.9% prevalence of MDR infections, reflecting global trends. Strengthening infection prevention and control and antimicrobial stewardship programs is needed to break transmission chains and optimize antimicrobial use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1701316","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T06:44:41Z","timestamp":1767681881000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Multidrug-resistant bacterial infections and their clinical impact at the University Teaching Hospital of Kigali in Rwanda: a retrospective descriptive-analytical study"],"prefix":"10.3389","volume":"13","author":[{"given":"Jean Bosco","family":"Munyemana","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadine","family":"Nyishimente","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Rutare","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aline","family":"Nishimwe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yves","family":"Kundwa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Manirakiza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Th\u00e9oneste","family":"Nkubana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angelique","family":"Dusabe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francois Xavier","family":"Ndayambaje","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","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","year":"2024","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","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","year":"2022","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1186\/s12879-017-2713-1","article-title":"Antimicrobial resistance in Africa: a systematic review","volume":"17","author":"Tadesse","year":"2017","journal-title":"BMC Infect Dis"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"dlae019","DOI":"10.1093\/jacamr\/dlae019","article-title":"Predominance of multidrug-resistant bacteria causing urinary tract infections among symptomatic patients in East Africa: a call for action","volume":"6","author":"Maldonado-Barragan","year":"2024","journal-title":"JAC Antimicrob Resist"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"7380740","DOI":"10.1155\/2020\/7380740","article-title":"Molecular detection of carbapenemase-encoding genes in multidrug-resistant Acinetobacter baumannii clinical isolates in South Africa","volume":"2020","author":"Anane","year":"2020","journal-title":"Int J Microbiol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"22069","DOI":"10.1038\/s41598-022-26547-7","article-title":"Bacterial infections epidemiology and factors associated with multidrug resistance in the northern region of Ghana","volume":"12","author":"Gnimatin","year":"2022","journal-title":"Sci Rep"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1122059","DOI":"10.3389\/fcimb.2023.1122059","article-title":"Prevalence, multiple antibiotic resistance and virulence profile of methicillin-resistant Staphylococcus aureus (MRSA) in retail poultry meat from Edo, Nigeria","volume":"13","author":"Igbinosa","year":"2023","journal-title":"Front Cell Infect Microbiol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"e0265118","DOI":"10.1371\/journal.pone.0265118","article-title":"High prevalence of Panton-valentine leukocidin positive, multidrug resistant, methicillin-resistant Staphylococcus aureus strains circulating among clinical setups in Adamawa and far north regions of Cameroon","volume":"17","author":"Mohamadou","year":"2022","journal-title":"PLoS One"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1186\/s12941-023-00636-5","article-title":"Multidrug-resistant gram-negative bacterial infections and associated factors in a Kenyan intensive care unit: a cross-sectional study","volume":"22","author":"Maina","year":"2023","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"89","DOI":"10.21010\/ajid.v10i2.3","article-title":"High prevalence of multi-drug resistant Klebsiella Pneumoniae in a tertiary teaching Hospital in Western Kenya","volume":"10","author":"Apondi","year":"2016","journal-title":"Afr J Infect Dis"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"5419874","DOI":"10.1155\/2022\/5419874","article-title":"Multidrug-resistant Bacteria: their mechanism of action and prophylaxis","volume":"2022","author":"Bharadwaj","year":"2022","journal-title":"Biomed Res Int"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1080\/14787210.2021.1945922","article-title":"Proposed amendments regarding the definitions of multidrug-resistant and extensively drug-resistant bacteria","volume":"20","author":"Rafailidis","year":"2022","journal-title":"Expert Rev Anti-Infect Ther"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1478789","DOI":"10.3389\/fmicb.2024.1478789","article-title":"Navigating collateral sensitivity: insights into the mechanisms and applications of antibiotic resistance trade-offs","volume":"15","author":"Mahmud","year":"2024","journal-title":"Front Microbiol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1946","DOI":"10.3390\/healthcare11131946","article-title":"Antimicrobial resistance: a growing serious threat for global public health","volume":"11","author":"Salam","year":"2023","journal-title":"Healthcare"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"e141","DOI":"10.1017\/S0950268821001254","article-title":"Risk factors for antibiotic resistance development in healthcare settings in China: a systematic review","volume":"149","author":"Chen","year":"2021","journal-title":"Epidemiol Infect"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1089\/mdr.2015.0220","article-title":"Multidrug-resistant gram-negative bacterial infections in the hospital setting: overview, implications for clinical practice, and emerging treatment options","volume":"22","author":"Cerceo","year":"2016","journal-title":"Microb Drug Resist"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"2519","DOI":"10.4102\/ajlm.v13i1.2519","article-title":"ESKAPE pathogen incidence and antibiotic resistance in patients with bloodstream infections at a referral hospital in Limpopo, South Africa, 2014-2019: a cross-sectional study","volume":"13","author":"Mthombeni","year":"2024","journal-title":"Afr J Lab Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1080\/22221751.2022.2030196","article-title":"Antibiotic resistance in hospital-acquired ESKAPE-E infections in low- and lower-middle-income countries: a systematic review and meta-analysis","volume":"11","author":"Ayobami","year":"2022","journal-title":"Emerg Microbes Infect"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"S17","DOI":"10.1093\/cid\/ciaa1581","article-title":"National estimates of healthcare costs associated with multidrug-resistant bacterial infections among hospitalized patients in the United States","volume":"72","author":"Nelson","year":"2021","journal-title":"Clin Infect Dis"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1070","DOI":"10.1093\/cid\/ciab696","article-title":"Mortality, length of stay, and healthcare costs associated with multidrug-resistant bacterial infections among elderly hospitalized patients in the United States","volume":"74","author":"Nelson","year":"2022","journal-title":"Clin Infect Dis"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1499","DOI":"10.2147\/IDR.S386311","article-title":"Tracking epidemiological characteristics and risk factors of multi-drug resistant Bacteria in intensive care units","volume":"16","author":"Wu","year":"2023","journal-title":"Infect Drug Resist"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"e0221121","DOI":"10.1371\/journal.pone.0221121","article-title":"Widespread antimicrobial resistance among bacterial infections in a Rwandan referral hospital","volume":"14","author":"Sutherland","year":"2019","journal-title":"PLoS One"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"865","DOI":"10.4269\/ajtmh.14-0607","article-title":"High prevalence of antimicrobial resistance among common bacterial isolates in a tertiary healthcare facility in Rwanda","volume":"92","author":"Ntirenganya","year":"2015","journal-title":"Am J Trop Med Hyg"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"565","DOI":"10.4269\/ajtmh.23-0605","article-title":"Prevalence of extended-Spectrum Beta-lactamase-producing Enterobacteriaceae and associated clinical implications at the university teaching Hospital of Kigali in Rwanda","volume":"111","author":"Kayinamura","year":"2024","journal-title":"Am J Trop Med Hyg"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"ofaa065","DOI":"10.1093\/ofid\/ofaa065","article-title":"Antibiotic treatment failure and associated outcomes among adult patients with community-acquired pneumonia in the outpatient setting: a real-world US insurance claims database study","volume":"7","author":"Tillotson","year":"2020","journal-title":"Open Forum Infect Dis"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e0162323","DOI":"10.1128\/jcm.01623-23","article-title":"Overview of changes in the clinical and laboratory standards institute performance standards for antimicrobial susceptibility testing: M100 32nd and 33rd editions","volume":"63","author":"Schuetz","year":"2025","journal-title":"J Clin Microbiol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin Microbiol Infect"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1136\/ebnurs-2022-103540","article-title":"Antimicrobial Resistance Collaborators 2022. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","author":"Ranjbar","year":"2023","journal-title":"Evid Based Nurs"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"100719","DOI":"10.1016\/j.aohep.2022.100719","article-title":"Characteristics of bacterial infections and prevalence of multidrug-resistant bacteria in hospitalized patients with liver cirrhosis in Germany","volume":"27","author":"Kremer","year":"2022","journal-title":"Ann Hepatol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1795","DOI":"10.12998\/wjcc.v10.i6.1795","article-title":"Multidrug-resistant organisms in intensive care units and logistic analysis of risk factors","volume":"10","author":"Han","year":"2022","journal-title":"World J Clin Cases"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"2874","DOI":"10.12998\/wjcc.v11.i13.2874","article-title":"Burden of severe infections due to carbapenem-resistant pathogens in intensive care unit","volume":"11","author":"Pace","year":"2023","journal-title":"World J Clin Cases"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e12208","DOI":"10.7759\/cureus.12208","article-title":"High prevalence of antibiotic-resistant gram-negative Bacteria causing surgical site infection in a tertiary Care Hospital of Northeast India","volume":"12","author":"Deka","year":"2020","journal-title":"Cureus"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/s13037-019-0190-8","article-title":"Incidence, root causes, and outcomes of surgical site infections in a tertiary care hospital in Rwanda: a prospective observational cohort study","volume":"13","author":"Mukagendaneza","year":"2019","journal-title":"Patient Saf Surg"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"41","DOI":"10.5604\/01.3001.0012.7253","article-title":"Surgical site infections - review of current knowledge, methods of prevention","volume":"91","author":"Kolasinski","year":"2018","journal-title":"Pol Przegl Chir"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.3390\/antibiotics12081255","article-title":"Preventing multidrug-resistant bacterial transmission in the intensive care unit with a comprehensive approach: a policymaking manual","volume":"12","author":"Schinas","year":"2023","journal-title":"Antibiotics (Basel)"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"3949","DOI":"10.2147\/IDR.S376622","article-title":"Multi-drug resistance profile, prevalence of extended-Spectrum Beta-lactamase and Carbapenemase-producing gram negative Bacilli among admitted patients after surgery with suspected of surgical site nosocomial infection north East Ethiopia","volume":"15","author":"Tilahun","year":"2022","journal-title":"Infect Drug Resist"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1186\/s12941-020-00398-4","article-title":"Antimicrobial resistance in hospitalized surgical patients: a silently emerging public health concern in Benin","volume":"19","author":"Yehouenou","year":"2020","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1186\/s12879-020-05272-4","article-title":"High fecal carriage of extended Beta lactamase producing Enterobacteriaceae among adult patients admitted in referral hospitals in Dar es Salaam, Tanzania","volume":"20","author":"Kibwana","year":"2020","journal-title":"BMC Infect Dis"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"923","DOI":"10.4269\/ajtmh.2011.11-0057","article-title":"Decreased susceptibility to commonly used antimicrobial agents in bacterial pathogens isolated from urinary tract infections in Rwanda: need for new antimicrobial guidelines","volume":"84","author":"Muvunyi","year":"2011","journal-title":"Am J Trop Med Hyg"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1186\/s12879-024-09086-6","article-title":"Trends and predictors of antimicrobial resistance among patients with urinary tract infections at a tertiary hospital facility in Alexandria, Egypt: a retrospective record-based classification and regression tree analysis","volume":"24","author":"Shaker","year":"2024","journal-title":"BMC Infect Dis"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1186\/s13756-018-0408-z","article-title":"Prevalence of methicillin resistant Staphylococcus aureus, multidrug resistant and extended spectrum beta-lactamase producing gram negative bacilli causing wound infections at a tertiary care hospital of Nepal","volume":"7","author":"Upreti","year":"2018","journal-title":"Antimicrob Resist Infect Control"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"13024","DOI":"10.1038\/s41598-021-91332-x","article-title":"Impact of antibiotic usage on extended-spectrum beta-lactamase producing Escherichia coli prevalence","volume":"11","author":"Kim","year":"2021","journal-title":"Sci Rep"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"176","DOI":"10.1016\/S0140-6736(15)00473-0","article-title":"Understanding the mechanisms and drivers of antimicrobial resistance","volume":"387","author":"Holmes","year":"2016","journal-title":"Lancet"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"3589","DOI":"10.2147\/IDR.S342753","article-title":"Antimicrobial resistance rates and surveillance in sub-Saharan Africa: where are we now?","volume":"15","author":"Kariuki","year":"2022","journal-title":"Infect Drug Resist"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"100691","DOI":"10.1016\/j.onehlt.2024.100691","article-title":"The importance of \"one health approach\" to the AMR study and surveillance in Angola and other African countries","volume":"18","author":"da Costa","year":"2024","journal-title":"One Health"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"4713","DOI":"10.2147\/IDR.S290835","article-title":"Antimicrobial stewardship: fighting antimicrobial resistance and protecting global public health","volume":"13","author":"Majumder","year":"2020","journal-title":"Infect Drug Resist"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"e026072","DOI":"10.1136\/bmjopen-2018-026072","article-title":"Impact of antimicrobial stewardship managed by clinical pharmacists on antibiotic use and drug resistance in a Chinese hospital, 2010-2016: a retrospective observational study","volume":"9","author":"Wang","year":"2019","journal-title":"BMJ Open"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1701316\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T06:44:49Z","timestamp":1767681889000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1701316\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,6]]},"references-count":47,"alternative-id":["10.3389\/fpubh.2025.1701316"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1701316","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,6]]},"article-number":"1701316"}}