Epidemiology and predictors of multidrug-resistant Enterobacteriaceae in intensive care units of a tertiary hospital in Somalia: a five-year retrospective study (2019-2024)
Abstract
Background: 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.
Methods: 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 (Proteus, Serratia, Morganella) were excluded from the colistin denominator. Multidrug resistance (MDR) was defined as nonsusceptibility to ≥3 antimicrobial classes. Bivariate associations and multivariable logistic regression identified the independent predictors of MDR.
Results: 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 0.19-0.38). 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 24-25% in 2019-2020, subsequently declined to 15% in 2021, and then escalated dramatically. Colistin retained the greatest in…
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