High Prevalence of ESBL-Producing Enterobacteriaceae and Antimicrobial Resistance Patterns in a Tertiary Care Hospital in Mogadishu, Somalia: A Retrospective Cross-Sectional Study.

Abstract

Background: Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae are a major global public health threat because of resistance to third-generation cephalosporins and frequent multidrug resistance. Data from Somalia remain limited. This study determined the prevalence of ESBL production, antimicrobial resistance patterns, and associated clinical and demographic factors.

Methods: A retrospective cross-sectional study was conducted on 369 non-duplicate clinical Enterobacteriaceae isolates collected from inpatient and outpatient departments of a tertiary care hospital in Mogadishu, Somalia, between April and December 2025. ESBL production was detected using the combination disc test according to Clinical Laboratory Standards Institute (CLSI) guidelines. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method and E-test. Multidrug resistance (MDR) was defined as resistance to at least one agent in three or more antimicrobial classes. Associations were assessed using Pearson's chi-square test.

Results: Overall, 71.27% (263/369) of isolates were ESBL producers and 48.78% (180/369) were MDR. Escherichia coli (59.35%) was the predominant isolate, followed by Klebsiella spp. (30.62%) and Enterobacter spp. (5.15%). High resistance (>68%) to third- and fourth-generation cephalosporins was observed across major species. Meropenem resistance was highest in Enterobacter spp. (63.16%). Hospital department was significantly associated with ESBL production (p = 0.003) and MDR (p = 0.004), with the highest burden in the intensive care unit. Gender was associated with ESBL production (p = 0.034), while organism type was associated with MDR (p = 0.044).

Conclusion: The high prevalence of ESBL-producing and multidrug-resistant Enterobacteriaceae, particularly in intensive care settings, highlights the need for strengthened antimicrobial stewardship, enhanced infection prevention and control, and continuous antimicrobial resistance surveillance.