# Antimicrobial resistance of bacteria isolated in a resource-limited region: the experience of the North Kivu Provincial Reference Laboratory in the Democratic Republic of the Congo

## TL;DR

This study examines antimicrobial resistance patterns in bacteria from a resource-limited region in the Democratic Republic of the Congo, highlighting the urgent need for improved surveillance and treatment strategies.

## Contribution

The study provides a detailed analysis of AMR in clinically significant bacteria in Goma, DRC, using the WHO AWaRe framework.

## Key findings

- Escherichia coli was the most prevalent isolate, with resistance exceeding 60% to ampicillin, amoxicillin/clavulanate, and ciprofloxacin.
- Klebsiella pneumoniae showed high resistance to multiple antibiotics including cefuroxime, cefotaxime, and colistin.

## Abstract

Antimicrobial resistance (AMR) is a growing global threat with disproportionate impact in resource-limited settings. We characterized clinically significant bacteria in Goma, Democratic Republic of the Congo (DRC), and their susceptibility using the WHO AWaRe framework.

We conducted a cross-sectional study (September 2019–March 2022) of routine clinical specimens (blood cultures, urine, vaginal, perineal swabs and pus). Specimens were cultured on standard nonselective (chocolate agar with polyvitamin supplement, fresh blood agar, tryptican broth) and selective media (MacConkey and Chapman agar); isolates were identified locally and referred to the Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB) for confirmation and antimicrobial susceptibility testing (AST).

Overall, 341 isolates underwent AST. Escherichia coli was most prevalent (~27%), followed by Klebsiella pneumoniae and Enterococcus faecalis. Enterobacterales exhibited high non-susceptibility to first- and second-line AWaRe Access agents. In E. coli, resistance exceeded 60% to ampicillin, amoxicillin/clavulanate, and ciprofloxacin. K. pneumoniae showed uniform resistance to ampicillin and high resistance to cefuroxime, cefotaxime, gentamicin, and colistin. These patterns constrain the effectiveness of commonly used empiric regimens.

AMR is a major public-health problem in Goma. Strengthening laboratory capacity and establishing continuous surveillance are urgent priorities. Recommended actions include participation in WHONET/GLASS program and antibiotic stewardship. In the interim, empiric strategies should favor nitrofurantoin for uncomplicated cystitis, judicious aminoglycoside use where appropriate, early culture, and prompt de-escalation, reserving carbapenems for severe ESBL-risk presentations.