A national surveillance study on five-year trends in AMR of E. coli from urine samples in Ethiopia

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INTRODUCTION: Antimicrobial resistance has become a global public health threat putting the health of millions in danger. Therefore, it is imperative to monitor the trends of resistant bacterial pathogens to better inform public health policies aiming at containing the spread of antimicrobial resistance. OBJECTIVE: This study aimed to assess the prevalence and trends of E. coli resistance from 2020 to 2024 among patients suspected of urinary tract infection in Ethiopia. METHODS: For this study, five years data (2020–2024) from 16 laboratory-based AMR surveillance system sentinel sites were captured by WHONET software and analyzed using R programming language. The data included 4696 E. coli isolates from urine specimens. Descriptive statistics were used to assess the prevalence of antimicrobial resistance and its distribution. Correspondence analysis was used to demonstrate the antimicrobial resistance profile by visualizing the E. coli resistance levels to antibiotics. Furthermore, the Cochran Armitage trend test was employed to test the null hypothesis of no linear trend in antimicrobial resistance against the alternative of a linear trend. RESULTS: The majority of patients (n = 2353, 58%) with isolates (n = 2711, 57.7%) were females and 1703 (42%) of patients with 1985 (42.3%) isolates were males. Among 16 sentinel sites, Tikur Anbessa Specialized Hospital and St. Paul’s Hospital contributed the highest numbers of E. coli isolates. Ampicillin, Cefazolin, Cefotaxime, Cefuroxime, and Trimethoprim/Sulfamethoxazole were among a high burden of E. coli resistance rates exceeding 70%, whereas Imipenem, Meropenem, Nitrofurantoin, Amikacin, and Gentamicin exhibited E. coli resistance rates below 30% across 2020 to 2024. CONCLUSION: The study findings revealed that a high burden and increasing trends of antimicrobial resistance among E.coli isolates from urine samples. These results highlight a critical need to strengthen the national AMR surveillance systems and antimicrobial stewardship programs to help control the growing antimicrobial resistance in the country.

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