{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T15:11:41Z","timestamp":1780499501316,"version":"3.54.1"},"reference-count":96,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,3]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Antimicrobials are extensively used in patients admitted to intensive care units (ICUs). As a result, the ICU has become a hot spot for multidrug-resistant (MDR) and carbapenemase-producing (CP) Gram-negative bacteria (GNB) infection in hospitals.\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    ,\n                    <jats:italic>Escherichia coli<\/jats:italic>\n                    ,\n                    <jats:italic>Pseudomonas aeruginosa<\/jats:italic>\n                    , and\n                    <jats:italic>Acinetobacter baumannii<\/jats:italic>\n                    are critical priority GNB causing serious infections in ICUs. Therefore, this study aimed to assess the prevalence, antibiotic resistance profile, and associated factors of critical GNB among ICU patients in Amhara National Regional State, Ethiopia. A hospital-based cross-sectional study was conducted. Based on patients\u2019 clinical findings, different clinical samples were aseptically collected. Bacterial identification was done using biochemical tests, and antibiotic susceptibility was determined by the Kirby\u2013Bauer disk diffusion method. Modified and simplified carbapenem inactivation methods were used for meropenem-resistant isolates to phenotypically detect carbapenemase production. Six hundred clinical specimens were collected, most of which were blood (94.8%) followed by urine (2.7%), discharge (2.0%), and tracheal aspirates (0.5%). Of these specimens, 148 (24.7%) were culture positive. Overall prevalence rates of MDR (resistance to one or more agents in three or more antibiotic classes) and CP critical GNB were 79.7% and 9.5%, respectively, with 76.3\u2013100% resistance to commonly prescribed antibiotics. Empirical treatment with antibiotics was significantly associated with MDR critical GNB infection (adjusted odds ratio: 6.57, CI: 2.19\u201319.82). In conclusion, the majority of the isolates showed a higher resistance rate to commonly prescribed antibiotics. These findings urgently call for strengthened antimicrobial stewardship and enhanced infection prevention and control practices in these settings.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.25-0650","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T17:11:15Z","timestamp":1775581875000},"page":"1046-1052","source":"Crossref","is-referenced-by-count":0,"title":["Multidrug-Resistant and Carbapenemase-Producing Gram-Negative Bacteria among Intensive Care Unit Patients in Amhara National Regional State, Ethiopia"],"prefix":"10.4269","volume":"114","author":[{"given":"Mizan","family":"Kindu","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology, University of Gondar, Gondar, Ethiopia;"},{"name":"Department of Medical Laboratory Science, School of Medicine, Madda Walabu University, Bale Goba, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feleke","family":"Moges","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, University of Gondar, Gondar, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Getahun","family":"Negash","sequence":"additional","affiliation":[{"name":"Department of Medical Laboratory Science, School of Medicine, Madda Walabu University, Bale Goba, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zemene","family":"Tigabu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, University of Gondar, Gondar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baye","family":"Gelaw","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, University of Gondar, Gondar, Ethiopia;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Antimicrob Resist Infect Control","first-page":"67","article-title":"High burden of antimicrobial resistance among gram negative bacteria causing healthcare associated infections in a critical care unit of Nepal","volume":"6","author":"Parajuli","year":"2017"},{"key":"b2","series-title":"Lancet Infect Dis","first-page":"318","article-title":"Discovery, research, and development of new antibiotics: The WHO priority list of antibiotic-resistant bacteria and tuberculosis","volume":"18","author":"Tacconelli","year":"2018"},{"key":"b3","series-title":"J Intensive Care Med","first-page":"25","article-title":"Antimicrobial resistance in the intensive care unit: A focus on Gram-negative bacterial infections","volume":"32","author":"MacVane","year":"2017"},{"key":"b4","series-title":"Front Med (Lausanne)","first-page":"74","article-title":"Treatment of infections due to MDR Gram-negative bacteria","volume":"6","author":"Bassetti","year":"2019"},{"key":"b5","series-title":"Front Cell Infect Microbiol","first-page":"1109418","article-title":"Carbapenem-resistant Gram-negative bacterial infection in intensive care unit patients: Antibiotic resistance analysis and predictive model development","volume":"13","author":"Liao","year":"2023"},{"key":"b6","series-title":"Med Sci","first-page":"1","article-title":"Carbapenem resistance: A review","volume":"6","author":"Codjoe","year":"2017"},{"key":"b7","series-title":"Clin Infect Dis","first-page":"1290","article-title":"Carbapenemase-producing organisms: A global scourge","volume":"66","author":"Bonomo","year":"2018"},{"key":"b8","series-title":"J Clin Microbiol","first-page":"1575","article-title":"Travel-related carbapenemase-producing Gram-negative bacteria in Alberta, Canada: The first 3 years","volume":"52","author":"Peirano","year":"2014"},{"key":"b9","series-title":"Antibiotics","first-page":"186","article-title":"The current burden of carbapenemases: Review of significant properties and dissemination among Gram-negative bacteria","volume":"9","author":"Hammoudi Halat","year":"2020"},{"key":"b10","series-title":"One Health","first-page":"100527","article-title":"Situational analysis of antimicrobial resistance, laboratory capacities, surveillance systems and containment activities in Ethiopia: A new and One Health approach","volume":"16","author":"Beyene","year":"2023"},{"key":"b11","series-title":"Infect Drug Resist","first-page":"391","article-title":"Extended-spectrum \u03b2-lactamase and carbapenemase producing Gram-negative bacilli infections among patients in intensive care units of felegehiwot referral hospital: A prospective cross-sectional study","volume":"14","author":"Alebel","year":"2021"},{"key":"b12","series-title":"District Laboratory Practice in Tropical Countries","author":"Chesbrough","year":"2006"},{"key":"b13","series-title":"Performance Standards for Antimicrobial Susceptibility Testing","year":"2026"},{"key":"b14","series-title":"Clin Microbiol Infect","first-page":"268","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"},{"key":"b15","series-title":"Front Microbiol","first-page":"2391","article-title":"The simplified carbapenem inactivation method (sCIM) for simple and accurate detection of carbapenemase-producing Gram-negative bacilli","volume":"9","author":"Jing","year":"2018"},{"key":"b16","series-title":"PLoS One","first-page":"e0222911","article-title":"Multidrug-resistant profile and prevalence of extended spectrum \u03b2-lactamase and carbapenemase production in fermentative Gram-negative bacilli recovered from patients and specimens referred to National Reference Laboratory, Addis Ababa, Ethiopia","volume":"14","author":"Beyene","year":"2019"},{"key":"b17","series-title":"Medicina","first-page":"588","article-title":"High prevalence of antimicrobial resistance among Gram-negative isolated bacilli in intensive care units at a tertiary-care hospital in Yucat\u00e1n Mexico","volume":"55","author":"Uc-Cach\u00f3n","year":"2019"},{"key":"b18","series-title":"Pakistan J Sci Ind Res B Biol Sci","first-page":"232","article-title":"Correlation between Gram negative bacterial colonization, environmental contamination and the development of infections at intensive care unit: Colonization and environmental contamination in intensive care unit","volume":"67","author":"Gergawy","year":"2024"},{"key":"b19","series-title":"Mol Biol Rep","first-page":"5565","article-title":"Nosocomial infections and antimicrobial susceptibility patterns among patients admitted to intensive care unit of Imam Khomeini hospital in Ilam, Iran","volume":"50","author":"Hashemian","year":"2023"},{"key":"b20","series-title":"Ann Clin Microbiol Antimicrob","first-page":"85","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"},{"key":"b21","series-title":"Infect Drug Resist","first-page":"1367","article-title":"Prevalence and molecular characterization of extended spectrum \u03b2-lactamase and carbapenemase-producing Enterobacteriaceae isolates from bloodstream infection suspected patients in Addis Ababa, Ethiopia","volume":"15","author":"Seman","year":"2022"},{"key":"b22","series-title":"PLoS One","first-page":"e0215177","article-title":"High prevalence of extended-spectrum beta-lactamase-producing Gram-negative pathogens from patients attending Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Amhara region","volume":"14","author":"Moges","year":"2019"},{"key":"b23","series-title":"Int J Infect Dis","first-page":"201","article-title":"Laboratory-confirmed bloodstream infections in two large neonatal units in sub-Saharan Africa","volume":"103","author":"Gezmu","year":"2021"},{"key":"b24","series-title":"Front Antibiot","first-page":"1155005","article-title":"A spectrum of non-spore-forming fermentative and non-fermentative Gram-negative bacteria: Multi-drug resistance, extended-spectrum beta-lactamase, and carbapenemase production","volume":"2","author":"Desalegn","year":"2023"},{"key":"b25","series-title":"BioMed Res Int","first-page":"5727638","article-title":"Emergence of high prevalence of extended-spectrum beta-lactamase and carbapenemase-producing Enterobacteriaceae species among patients in northwestern Ethiopia region","volume":"2022","author":"Tadesse","year":"2022"},{"key":"b26","series-title":"Nat Microbiol","first-page":"512","article-title":"Characterization of 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largest teaching hospital at the northwest of Iran","volume":"52","author":"Hamishehkar","year":"2016"},{"key":"b30","series-title":"Ann Clin Microbiol Antimicrob","first-page":"16","article-title":"Multidrug resistance and extended-spectrum beta-lactamase producing Gram-negative bacteria from three Referral Hospitals of Amhara region, Ethiopia","volume":"20","author":"Moges","year":"2021"},{"key":"b31","series-title":"Infect Drug Resist","first-page":"369","article-title":"Phenotypic detection of carbapenem-resistant Gram-negative bacilli from a clinical specimen in Sidama, Ethiopia: A cross-sectional study","volume":"14","author":"Alemayehu","year":"2021"},{"key":"b32","series-title":"Sci Rep","first-page":"2071","article-title":"Bacteriological spectrum, extended-spectrum \u03b2-lactamase production and antimicrobial resistance pattern among patients with bloodstream infection in Addis Ababa","volume":"13","author":"Bitew","year":"2023"},{"key":"b33","series-title":"PLoS One","first-page":"e0256556","article-title":"Phenotypic characterization of carbapenem non-susceptible Gram-negative bacilli isolated from clinical specimens","volume":"16","author":"Abdeta","year":"2021"},{"key":"b34","series-title":"PLoS One","first-page":"e0279887","article-title":"Magnitude and antimicrobial susceptibility profiles of Gram-negative bacterial isolates among patients suspected of urinary tract infections in Arba Minch General Hospital, southern Ethiopia","volume":"17","author":"Mitiku","year":"2022"},{"key":"b35","series-title":"Ann Clin Microbiol Antimicrob","first-page":"48","article-title":"A high prevalence of multi-drug resistant Gram-negative bacilli in a Nepali tertiary care hospital and associated widespread distribution of extended-spectrum beta-lactamase (ESBL) and carbapenemase-encoding genes","volume":"19","author":"Manandhar","year":"2020"},{"key":"b36","series-title":"PLoS One","first-page":"e0287453","article-title":"High burden of ESBL and carbapenemase-producing Gram-negative bacteria in bloodstream infection patients at a tertiary care hospital in Addis Ababa, Ethiopia","volume":"18","author":"Beshah","year":"2023"},{"key":"b37","series-title":"Int J Microbiol","first-page":"3183076","article-title":"Prevalence of extended-spectrum beta-lactamases-producing microorganisms in patients admitted at KRRH, Southwestern Uganda","volume":"2017","author":"Andrew","year":"2017"},{"key":"b38","series-title":"F1000Res","first-page":"1656","article-title":"Phenotypic and genotypic detection of carbapenemase enzymes producing Gram-negative bacilli isolated from patients in Khartoum State","volume":"6","author":"Dahab","year":"2017"},{"key":"b39","series-title":"Infect Drug Resist","first-page":"27","article-title":"Extended-spectrum beta-lactamase-and carbapenemase-producing Enterobacteriaceae among Ethiopian children","volume":"10","author":"Legese","year":"2017"},{"key":"b40","series-title":"PLoS One","first-page":"e0241984","article-title":"Extended-spectrum beta-lactamase and AmpC beta-lactamases producing Gram negative bacilli isolated from clinical specimens at International Clinical Laboratories, Addis Ababa, Ethiopia","volume":"15","author":"Tekele","year":"2020"},{"key":"b41","series-title":"Biomed Res Int","first-page":"9999638","article-title":"Multidrug-resistant and carbapenemase-producing Enterobacteriaceae in Addis Ababa, Ethiopia","volume":"2021","author":"Tekele","year":"2021"},{"key":"b42","series-title":"FEMS Microbiol Rev","first-page":"252","article-title":"Klebsiella pneumoniae: A major worldwide source and shuttle for antibiotic resistance","volume":"41","author":"Navon-Venezia","year":"2017"},{"key":"b43","series-title":"Curr Opin Microbiol","first-page":"131","article-title":"Klebsiella pneumoniae as a key trafficker of drug resistance genes from environmental to clinically important bacteria","volume":"45","author":"Wyres","year":"2018"},{"key":"b44","series-title":"Cureus","first-page":"e7260","article-title":"Resistance patterns and phenotypic detection of \u03b2-lactamase enzymes among Enterobacteriaceae isolates from referral hospitals in Khartoum State, Sudan","volume":"12","author":"Dirar","year":"2020"},{"key":"b45","series-title":"PLoS One","first-page":"e0267657","article-title":"Detection of blaKPC and blaNDM carbapenemase genes among Klebsiella pneumoniae isolates in Addis Ababa, Ethiopia: Dominance of blaNDM","volume":"17","author":"Awoke","year":"2022"},{"key":"b46","series-title":"Antimicrob Resist Infect Control","first-page":"48","article-title":"Epidemiological, clinical, and microbiological characteristics of carbapenemase-producing Enterobacteriaceae bloodstream infection in the Republic of Korea","volume":"8","author":"Park","year":"2019"},{"key":"b47","series-title":"PLoS One","first-page":"e0154092","article-title":"Characterization and clinical impact of bloodstream infection caused by carbapenemase-producing Enterobacteriaceae in seven Latin American countries","volume":"11","author":"Villegas","year":"2016"},{"key":"b48","article-title":"Ethiopian Essential Medicines List.","year":"2020"},{"key":"b1","series-title":"Antimicrob Resist Infect Control","first-page":"67","article-title":"High burden of antimicrobial resistance among gram negative bacteria causing healthcare associated infections in a critical care unit of Nepal","volume":"6","author":"Parajuli","year":"2017"},{"key":"b2","series-title":"Lancet Infect Dis","first-page":"318","article-title":"Discovery, research, and development of new antibiotics: The WHO priority list of antibiotic-resistant bacteria and tuberculosis","volume":"18","author":"Tacconelli","year":"2018"},{"key":"b3","series-title":"J Intensive Care Med","first-page":"25","article-title":"Antimicrobial resistance in the intensive care unit: A focus on Gram-negative bacterial infections","volume":"32","author":"MacVane","year":"2017"},{"key":"b4","series-title":"Front Med (Lausanne)","first-page":"74","article-title":"Treatment of infections due to MDR Gram-negative bacteria","volume":"6","author":"Bassetti","year":"2019"},{"key":"b5","series-title":"Front Cell Infect Microbiol","first-page":"1109418","article-title":"Carbapenem-resistant Gram-negative bacterial infection in intensive care unit patients: Antibiotic resistance analysis and predictive model development","volume":"13","author":"Liao","year":"2023"},{"key":"b6","series-title":"Med Sci","first-page":"1","article-title":"Carbapenem resistance: A review","volume":"6","author":"Codjoe","year":"2017"},{"key":"b7","series-title":"Clin Infect Dis","first-page":"1290","article-title":"Carbapenemase-producing organisms: A global scourge","volume":"66","author":"Bonomo","year":"2018"},{"key":"b8","series-title":"J Clin Microbiol","first-page":"1575","article-title":"Travel-related carbapenemase-producing Gram-negative bacteria in Alberta, Canada: The first 3 years","volume":"52","author":"Peirano","year":"2014"},{"key":"b9","series-title":"Antibiotics","first-page":"186","article-title":"The current burden of carbapenemases: Review of significant properties and dissemination among Gram-negative bacteria","volume":"9","author":"Hammoudi Halat","year":"2020"},{"key":"b10","series-title":"One Health","first-page":"100527","article-title":"Situational analysis of antimicrobial resistance, laboratory capacities, surveillance systems and containment activities in Ethiopia: A new and One Health approach","volume":"16","author":"Beyene","year":"2023"},{"key":"b11","series-title":"Infect Drug Resist","first-page":"391","article-title":"Extended-spectrum \u03b2-lactamase and carbapenemase producing Gram-negative bacilli infections among patients in intensive care units of felegehiwot referral hospital: A prospective cross-sectional study","volume":"14","author":"Alebel","year":"2021"},{"key":"b12","series-title":"District Laboratory Practice in Tropical Countries","author":"Chesbrough","year":"2006"},{"key":"b13","series-title":"Performance Standards for Antimicrobial Susceptibility Testing","year":"2026"},{"key":"b14","series-title":"Clin Microbiol Infect","first-page":"268","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"},{"key":"b15","series-title":"Front Microbiol","first-page":"2391","article-title":"The simplified carbapenem inactivation method (sCIM) for simple and accurate detection of carbapenemase-producing Gram-negative bacilli","volume":"9","author":"Jing","year":"2018"},{"key":"b16","series-title":"PLoS One","first-page":"e0222911","article-title":"Multidrug-resistant profile and prevalence of extended spectrum \u03b2-lactamase and carbapenemase production in fermentative Gram-negative bacilli recovered from patients and specimens referred to National Reference Laboratory, Addis Ababa, Ethiopia","volume":"14","author":"Beyene","year":"2019"},{"key":"b17","series-title":"Medicina","first-page":"588","article-title":"High prevalence of antimicrobial resistance among Gram-negative isolated bacilli in intensive care units at a tertiary-care hospital in Yucat\u00e1n Mexico","volume":"55","author":"Uc-Cach\u00f3n","year":"2019"},{"key":"b18","series-title":"Pakistan J Sci Ind Res B Biol Sci","first-page":"232","article-title":"Correlation between Gram negative bacterial colonization, environmental contamination and the development of infections at intensive care unit: Colonization and environmental contamination in intensive care unit","volume":"67","author":"Gergawy","year":"2024"},{"key":"b19","series-title":"Mol Biol Rep","first-page":"5565","article-title":"Nosocomial infections and antimicrobial susceptibility patterns among patients admitted to intensive care unit of Imam Khomeini hospital in Ilam, Iran","volume":"50","author":"Hashemian","year":"2023"},{"key":"b20","series-title":"Ann Clin Microbiol Antimicrob","first-page":"85","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"},{"key":"b21","series-title":"Infect Drug Resist","first-page":"1367","article-title":"Prevalence and molecular characterization of extended spectrum \u03b2-lactamase and carbapenemase-producing Enterobacteriaceae isolates from bloodstream infection suspected patients in Addis Ababa, Ethiopia","volume":"15","author":"Seman","year":"2022"},{"key":"b22","series-title":"PLoS One","first-page":"e0215177","article-title":"High prevalence of extended-spectrum beta-lactamase-producing Gram-negative pathogens from patients attending Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Amhara region","volume":"14","author":"Moges","year":"2019"},{"key":"b23","series-title":"Int J Infect Dis","first-page":"201","article-title":"Laboratory-confirmed bloodstream infections in two large neonatal units in sub-Saharan Africa","volume":"103","author":"Gezmu","year":"2021"},{"key":"b24","series-title":"Front Antibiot","first-page":"1155005","article-title":"A spectrum of non-spore-forming fermentative and non-fermentative Gram-negative bacteria: Multi-drug resistance, extended-spectrum beta-lactamase, and carbapenemase production","volume":"2","author":"Desalegn","year":"2023"},{"key":"b25","series-title":"BioMed Res Int","first-page":"5727638","article-title":"Emergence of high prevalence of extended-spectrum beta-lactamase and carbapenemase-producing Enterobacteriaceae species among patients in northwestern Ethiopia region","volume":"2022","author":"Tadesse","year":"2022"},{"key":"b26","series-title":"Nat Microbiol","first-page":"512","article-title":"Characterization of antimicrobial-resistant Gram-negative bacteria that cause neonatal sepsis in seven low-and middle-income countries","volume":"6","author":"Sands","year":"2021"},{"key":"b27","series-title":"Can J Infect Dis Med Microbiol","first-page":"6054694","article-title":"Phenotypic characterization and antibiotic resistance patterns of extended-spectrum \u03b2-lactamase-and AmpC \u03b2-lactamase-producing Gram-negative bacteria in a referral hospital, Saudi Arabia","volume":"2019","author":"Ibrahim","year":"2019"},{"key":"b28","series-title":"Diagn Microbiol Infect Dis","first-page":"115557","article-title":"Antimicrobial susceptibility of Gram-negative bacteria from intensive care unit and non-intensive care unit patients from United States hospitals (2018\u20132020)","volume":"102","author":"Sader","year":"2022"},{"key":"b29","series-title":"Braz J Pharm Sci","first-page":"403","article-title":"Antimicrobial susceptibility patterns among bacteria isolated from intensive care units of the largest teaching hospital at the northwest of Iran","volume":"52","author":"Hamishehkar","year":"2016"},{"key":"b30","series-title":"Ann Clin Microbiol Antimicrob","first-page":"16","article-title":"Multidrug resistance and extended-spectrum beta-lactamase producing Gram-negative bacteria from three Referral Hospitals of Amhara region, Ethiopia","volume":"20","author":"Moges","year":"2021"},{"key":"b31","series-title":"Infect Drug Resist","first-page":"369","article-title":"Phenotypic detection of carbapenem-resistant Gram-negative bacilli from a clinical specimen in Sidama, Ethiopia: A cross-sectional study","volume":"14","author":"Alemayehu","year":"2021"},{"key":"b32","series-title":"Sci Rep","first-page":"2071","article-title":"Bacteriological spectrum, extended-spectrum \u03b2-lactamase production and antimicrobial resistance pattern among patients with bloodstream infection in Addis Ababa","volume":"13","author":"Bitew","year":"2023"},{"key":"b33","series-title":"PLoS One","first-page":"e0256556","article-title":"Phenotypic characterization of carbapenem non-susceptible Gram-negative bacilli isolated from clinical specimens","volume":"16","author":"Abdeta","year":"2021"},{"key":"b34","series-title":"PLoS One","first-page":"e0279887","article-title":"Magnitude and antimicrobial susceptibility profiles of Gram-negative bacterial isolates among patients suspected of urinary tract infections in Arba Minch General Hospital, southern Ethiopia","volume":"17","author":"Mitiku","year":"2022"},{"key":"b35","series-title":"Ann Clin Microbiol Antimicrob","first-page":"48","article-title":"A high prevalence of multi-drug resistant Gram-negative bacilli in a Nepali tertiary care hospital and associated widespread distribution of extended-spectrum beta-lactamase (ESBL) and carbapenemase-encoding genes","volume":"19","author":"Manandhar","year":"2020"},{"key":"b36","series-title":"PLoS One","first-page":"e0287453","article-title":"High burden of ESBL and carbapenemase-producing Gram-negative bacteria in bloodstream infection patients at a tertiary care hospital in Addis Ababa, Ethiopia","volume":"18","author":"Beshah","year":"2023"},{"key":"b37","series-title":"Int J Microbiol","first-page":"3183076","article-title":"Prevalence of extended-spectrum beta-lactamases-producing microorganisms in patients admitted at KRRH, Southwestern Uganda","volume":"2017","author":"Andrew","year":"2017"},{"key":"b38","series-title":"F1000Res","first-page":"1656","article-title":"Phenotypic and genotypic detection of carbapenemase enzymes producing Gram-negative bacilli isolated from patients in Khartoum State","volume":"6","author":"Dahab","year":"2017"},{"key":"b39","series-title":"Infect Drug Resist","first-page":"27","article-title":"Extended-spectrum beta-lactamase-and carbapenemase-producing Enterobacteriaceae among Ethiopian children","volume":"10","author":"Legese","year":"2017"},{"key":"b40","series-title":"PLoS One","first-page":"e0241984","article-title":"Extended-spectrum beta-lactamase and AmpC beta-lactamases producing Gram negative bacilli isolated from clinical specimens at International Clinical Laboratories, Addis Ababa, Ethiopia","volume":"15","author":"Tekele","year":"2020"},{"key":"b41","series-title":"Biomed Res Int","first-page":"9999638","article-title":"Multidrug-resistant and carbapenemase-producing Enterobacteriaceae in Addis Ababa, Ethiopia","volume":"2021","author":"Tekele","year":"2021"},{"key":"b42","series-title":"FEMS Microbiol Rev","first-page":"252","article-title":"Klebsiella pneumoniae: A major worldwide source and shuttle for antibiotic resistance","volume":"41","author":"Navon-Venezia","year":"2017"},{"key":"b43","series-title":"Curr Opin Microbiol","first-page":"131","article-title":"Klebsiella pneumoniae as a key 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Korea","volume":"8","author":"Park","year":"2019"},{"key":"b47","series-title":"PLoS One","first-page":"e0154092","article-title":"Characterization and clinical impact of bloodstream infection caused by carbapenemase-producing Enterobacteriaceae in seven Latin American countries","volume":"11","author":"Villegas","year":"2016"},{"key":"b48","article-title":"Ethiopian Essential Medicines List.","year":"2020"}],"container-title":["The American Journal of Tropical Medicine and 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