Emergence of extensively and pan-drug resistance in clinical bacterial isolates: A systematic scoping review from Ethiopian public health perspective

Abstract

INTRODUCTION: The growing challenge of antimicrobial resistance in Ethiopia and itsprogression towards XDR and PDR has become a critical public health concern. Therefore, thisreview determined the current state of emerging XDR and PDR bacteria, including pre-XDR and XDR-TB, their contributing factors, advancements, and future perspectives against drug-resistant bacteria, as well as their implications for public health and insights for future research. METHODOLOGY: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search of all available literature was conducted using PubMed/Medline, Scopus, EMBASE, Google Scholar, Hinari, Web of Science, ScienceDirect, Cochrane Library, and African Journals Online databases.This study included original articles published in English that reported XDR and PDR bacteria, Pre-XDR-TB, and XDR-TBb without limit on the study period and publication year. Descriptive statistics were used to summarize the findings. RESULTS: Twenty-five studies published between 2010 and 2025 were included in this review. Among 5620 bacterial isolates identified,1289 were XDR (22.9%), with the prevalence ranging from 5.7% to 43.2%. A total of 440 bacterial isolates were PDR (9.1%), with its prevalence in individual studies ranged from 0.8% to 19.1%. The most common XDR bacteria identified were Klebsiella species; 26.7% (2.8%-84.6%), followed by E. coli; 26.4%(14.6%-35.7%), Acinetobacter species; 24.9%(10.1%-58.3%), and P. aeruginosa; 18.7% (2.8%-44.4%). The most frequently identified PDR bacteria were Acinetobacter species; 17.3% (7.9%-50.0%), followed by Klebsiella species; 13.7%(2.7%-25.8%), E. coli; 10.2%(2.4%-22.6%), and P. aeruginosa; 5.7%(4.3%-33.3%). Additionally, from 1419 MDR-TB and 160 TB confirmed cases, Pre-XDR-TB was 3.4% (2.4%-5.7%) and XDR-TB was 1.5%(0.6%-10.0%). These isolates were identified from different clinical specimens, which represents a significant concern in community and hospital settings. CONCLUSION: The emergence of XDR and PDR represents a major threat to Ethiopian public health, resulting in increased morbidity, mortality, prolonged hospitalizations, high healthcare costs, and challenged treatment options. Urgent national surveillance and genomic detection of resistance mechanisms are needed to better track the spread of drug-resistant bacteria, promote antimicrobial stewardship, and enhance drug and vaccine trials.