Peer Review Report For: Impact of antibiotics on the genomic expression of Pseudomonas aeruginosa in the East African community: a systematic review [version 1; peer review: 1 not approved]

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Introduction Antimicrobial resistance (AMR) is a major global health concern, with the greatest burden observed in lower-middle-income countries. Monitoring AMR through a One Health approach is essential to understand the link between clinical, animal, and environmental sources and to develop targeted interventions. Objectives This systematic review aimed to assess the impact of antibiotics on gene expression in Pseudomonas spp. within the East African Community (EAC). Methodology A thorough literature search across Web of Science, Scopus, and PubMed yielded 284 articles, of which 11 met the inclusion criteria after screening. The selected studies came from five EAC countries. Findings showed a high prevalence of AMR in Pseudomonas aeruginosa , with over 90% resistance to most antibiotics, except Amikacin, which remained effective likely due to limited usage. Results and discussion Common resistance genes identified included carbapenemases such as blaNDM-1 and blaVIM. The disc diffusion method was the most commonly used technique (50%).Multidrug-resistant clones like ST244 and ST357 were frequently reported. Environmental isolates had lower resistance rates (54%) compared to clinical strains (73%), suggesting differing selection pressures. Most studies originated from Kenya and Uganda (each 30%), reflecting differences in research capacity and healthcare infrastructure across the region. Conclusion These results underscore the urgent need for expanded AMR surveillance, stronger antimicrobial stewardship, and further research to inform public health responses in East Africa.