“We often say that the main challenge in addressing antibiotic resistance in Africa is the lack of data. This study shows that the issue is not only limited to missing data, but also to the very high resistance levels that are now becoming visible,” says Gilbert Osena, one of the authors and a PhD student at the University of Gothenburg. He is also affiliated with the Centre for Antibiotic Resistance Research (CARe) in Gothenburg and the One Health Trust in Washington, DC.
Worrying levels in common infections
The study reveals high resistance in common bacteria such as Klebsiella pneumoniae and E.coli, especially to third-generation cephalosporins, which is often the last available treatment option.
“It is worrying to see such high resistance in bacteria responsible for the most common infections. For patients who already have limited access to antibiotics, this can mean having no effective treatment left,” Gilbert Osena explains.
The findings also show that older, male inpatients are particularly affected. According to GIlbert Osena, this reflects how chronic conditions, repeated hospital stays, and delayed care interact with antibiotic use and hospital-acquired infections.
Beyond mapping resistance, the study introduces a Drug Resistance Index (DRI), which links resistance levels with antibiotic use. This gives countries a new way to evaluate the impact of their national strategies.
“Clinicians can use these results to make better treatment decisions, while policymakers get evidence to strengthen infection control and update their national action plans. Countries like Kenya and Nigeria have already done so, based on our findings,” says Gilbert Osena.
Four urgent priorities
To reduce resistance in the African context, Gilbert Osena highlights four priorities: preventing infections through clean water and sanitation, ensuring that correct antibiotics are prescribed and of good quality, strengthening infection prevention in hospitals, and investing in laboratories and data systems. Alongside these, raising awareness among clinicians and the public is essential to understand the full scale of the problem.
“Without urgent action such as smarter antibiotic use and better surveillance, we risk losing the effectiveness of our most important antibiotics. Inaction is not an option,” Gilbert Osena concludes.
The study is published in PLOS Medicine and is based on one of the largest collections of clinical laboratory data on antibiotic resistance in Africa to date.
