{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:12:34Z","timestamp":1788415954234,"version":"build-2803163510"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"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. Antibiot."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multidrug-resistant Enterobacteriaceae (MDRE) represent a critical threat in intensive care units, particularly in low- and middle-income countries, where surveillance data remain scarce. This study characterized the epidemiology and predictors of multidrug resistance among Enterobacteriaceae isolates in a Somali tertiary hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective descriptive study analyzed 758 unique Enterobacteriaceae isolates from culture-positive specimens between January 2019 and December 2024, using disk diffusion for eight agents; For colistin, broth microdilution (CLSI M07) was applied to isolates screening non-susceptible on disk diffusion, and genera with intrinsic polymyxin resistance (\n                      <jats:italic>Proteus<\/jats:italic>\n                      ,\n                      <jats:italic>Serratia<\/jats:italic>\n                      ,\n                      <jats:italic>Morganella<\/jats:italic>\n                      ) were excluded from the colistin denominator. Multidrug resistance (MDR) was defined as nonsusceptibility to \u22653 antimicrobial classes. Bivariate associations and multivariable logistic regression identified the independent predictors of MDR.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall prevalence of multidrug resistance was 37.9%. Klebsiella spp. demonstrated the highest MDR prevalence (54.9%), while Escherichia coli had lower odds of resistance (aOR, 0.27; 95% CI 0.19\u20130.38). Sputum specimens harbored the highest proportion of MDR isolates (44.9%), followed by blood (35.8%) and urine (19.0%). The prevalence of MDR remained relatively stable at 24\u201325% in 2019\u20132020, subsequently declined to 15% in 2021, and then escalated dramatically. Colistin retained the greatest\n                      <jats:italic>in vitro<\/jats:italic>\n                      activity: acquired resistance was documented in 1.2% (9\/735 tested) of isolates from genera without intrinsic polymyxin resistance, all of them multidrug-resistant (9\/283, 3.2%, versus 0\/452 of non-MDR isolates; p = 0.001). A further 21\/758 isolates (2.8%) belonged to genera intrinsically resistant to colistin. Because confirmatory broth microdilution was applied only to isolates screening non-susceptible, the colistin figure is a conservative lower-bound estimate. Tigecycline was tested in only 20.4% of isolates, among which resistance was 17.4%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Multidrug-resistant Enterobacteriaceae are escalating alarmingly in Somali ICUs, with ciprofloxacin resistance of 95.4% among tested MDR isolates, which severely constrains empiric therapeutic options. The urgent implementation of antimicrobial stewardship programs, restricted-use protocols for carbapenems and colistins, and strengthened infection prevention measures are essential. National engagement with the WHO GLASS surveillance is critical.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/frabi.2026.1889216","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:14:53Z","timestamp":1788412493000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Epidemiology and predictors of multidrug-resistant Enterobacteriaceae in intensive care units of a tertiary hospital in Somalia: a five-year retrospective study (2019\u20132024)"],"prefix":"10.3389","volume":"5","author":[{"given":"Omar Sidow","family":"Zubair","sequence":"first","affiliation":[{"name":"Department of Tropical Infectious Disease School of Postgraduate and Research, Banadir University","place":["Mogadishu, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuf Hared","family":"Abdi","sequence":"additional","affiliation":[{"name":"Center for Health Research and Innovation, Somali National University","place":["Mogadishu, Somalia"]},{"name":"Mogadishu Institute of Health","place":["Mogadishu, Somalia"]},{"name":"Department of Public Health, Faculty of Medicine and Health Sciences, Hormuud University","place":["Mogadishu, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tigad Abdisad","family":"Ali","sequence":"additional","affiliation":[{"name":"Department of Infection Prevention and Control, Mogadishu-Somalia-Turkey Recep Tayyip Erdo\u011fan Training and Research Hospital","place":["Mogadishu, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zakaria Ibrahim","family":"Issack","sequence":"additional","affiliation":[{"name":"SomHerd Solutions","place":["Mogadishu, Somalia"]},{"name":"Pastoral and Agro-Pastoral Research Organization (PARO)","place":["Mogadishu, Somalia"]},{"name":"One Health Unit, Department of Health Emergencies, Ministry of Health and Human Services, Federal Government of Somalia","place":["Mogadishu, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdirahman Abdirizak","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Centre for One Health, Somali National University","place":["Mogadishu, Somalia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/S42522-023-00088-Z","article-title":"Drug resistance and extended-spectrum \u03b2-lactamase (ESBLs) - producing Enterobacteriaceae, Acinetobacter and Pseudomonas species from the views of one-health approach in Ethiopia: a systematic review and meta-analysis","volume":"5","author":"Abayneh","year":"2023","journal-title":"One Health Outlook"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3390\/ANTIBIOTICS11111630","article-title":"Efficacy and safety of colistin versus tigecycline for multi-drug-resistant and extensively drug-resistant Gram-negative pathogens\u2014a meta-analysis","volume":"11","author":"Abushanab","year":"2022","journal-title":"Antibiotics"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.2174\/0113892010406135250828050228","article-title":"Understanding antimicrobial resistance: From mechanisms to public health implications","volume":"26","author":"Adhikary","year":"2025","journal-title":"Curr. 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