The Mapping Antimicrobial Resistance and Antimicrobial Use Partnership (MAAP) Country Reports for Zambia found a drug resistance index (DRI) of 60.9% implying low antibiotic effectiveness. High AMR rates were reported for penicillins, tetracyclines, folate pathway inhibitors, quinolones, and cephalosporins due to their high consumption and use.

In 2019, it was estimated that approximately 1.27 million deaths were attributed to bacterial AMR of which 255,000 were from the sub-Saharan African region where Zambia belongs.

A further 4.95 million deaths were associated with antimicrobial-resistant infections.

An exploratory cross-sectional study was conducted from September to December 2023 using the WHO Periodic National and Healthcare Facility Assessment Tool to evaluate AMS activities in eight public hospitals across five Zambian provinces.

Overall AMS score across core elements was 56%.

Additionally, 62.5% (6/8) of the hospitals scored below 60% in AMS program implementation.

Main challenges identified included reporting AMS feedback (average score: 46%), Functionality of Drugs and Therapeutics Committees (DTCs) (average score: 49%), AMS actions (average score: 50%), Education and training (average score: 54%), Leadership commitment to AMS (average score: 56%), none of the hospitals had a dedicated budget for AMS programs, and more than 50% of the hospitals lacked antibiograms and AMS-trained staff.

AMS implementation in these hospitals was low, especially in facilities where DTCs were non-functional. Urgent actions are needed to address these challenges and establish sustainable multidisciplinary AMS programs.

A cross-sectional study in December 2023 used the WHO Point Prevalence Survey (PPS) and AWaRe classification to assess antibiotic use among 1296 inpatients across 16 Zambian hospitals.

Findings revealed a 70% overall antibiotic prevalence, with 52% receiving Watch group antibiotics—mainly ceftriaxone—and 48% receiving Access group antibiotics.

Compliance with local guidelines was 53%, highlighting a high use of Watch antibiotics beyond recommended levels.

This underscores the need for stronger antimicrobial stewardship programs to encourage rational antibiotic use in Zambian hospitals.

A cross-sectional study conducted from October to December 2023 surveyed 64 healthcare workers (HCWs) using a semi-structured questionnaire.

Of the participants, 59.4% were female, 60.9% were aged 25 - 34 years, with 37.5% being nurses, 18.7% pharmacists, 17.2% medical doctors, and one microbiologist.

The study found that 75% of HCWs had good knowledge, 84% were highly aware, and 84% demonstrated good practices concerning AMU, AMR, and AMS.

Additionally, 90.6% reported having a multidisciplinary AMS team at their hospitals and implementing the WHO AWaRe classification of antibiotics.

Overall, the study highlighted good knowledge, high awareness, and strong practices related to AMU, AMR, and AMS among HCWs in Zambia involved in AMS activities.

This study found a high prevalence of antibiotic resistant E. coli and Enterococcus species isolated from pregnant women and children under five years in Zambia.

Most prescribed antibiotics at the primary healthcare facilities belonged to the Access group of the WHO Access, Watch and Reserve (AWaRe) classification.

All the primary healthcare facilities adhered to the WHO AWaRe framework of ≥60% prescribed antibiotics belonging to the Access group.

However, resistance was highest in the Access group of antibiotics. E. coli resistance to ampicillin ranged from 71% to 77% and to co-trimoxazole from 74% to 80%, while enterococcal resistance to tetracycline was 59% - 64%.

MDR was highest in E. coli (75%) isolates, while XDR was highest in enterococcal isolates (97%). The identified AMR genes in E. coli included blaCTX-M, sul2 and qnrA, while those of enterococci included erm(B), erm(C) and erm(A).

The study concluded that resistance was highest in the prescribed WHO Access group of antibiotics.

Therefore, these findings highlight the need to use local susceptibility data to formulate country-specific treatment guidelines in line with WHO AWaRe classification and enforce regulations that prohibit easy access to antibiotics.

Of the 335 participants in a multicenter cross-sectional study, 56.7% had good knowledge about antibiotics, but 77.3% exhibited low adherence to prescribed usage.

Additionally, 54.6% believed that antibiotics were effective against viral infections, while 43.9% accurately understood the concept of AMR.

Formal employment was significantly associated with better knowledge of antibiotics. Meanwhile, being divorced and possessing good knowledge were linked to higher adherence rates.

In terms of antibiotic use, 50.0% of respondents had used antibiotics in the past year, and 58.2% had taken them for a common cold. Furthermore, 74% reported purchasing antibiotics without a prescription.

Out of 241 patient records reviewed, 77% were female. Among these patients, 44% were newly diagnosed with TB, 29% experienced a relapse, 10% were treated after treatment failure, and 8.3% were treated after loss to follow-up.

The study revealed that 65% of M. tuberculosis isolates were susceptible to both rifampicin and isoniazid, while 35% were resistant to either rifampicin or isoniazid, and 21.2% were MDR.

Treatment after failure and treatment after loss to follow-up were significantly associated with MDR-TB.

Unknown HIV status was significantly linked to isoniazid mono-resistance.

The study aimed to evaluate the quality of antiretroviral, antimalarial, and antituberculosis medicines provided in Zambia’s public health sector.

A total of 198 samples were analyzed: 86 (43.43%) were antiretrovirals, 54 (27.27%) antimalarials, and 58 (29.29%) antituberculosis medicines.

The majority of the samples (86.36%) originated from Asia, followed by Africa (9.60%) and Europe (4.04%).

All the sampled medicines met their respective quality standards, including tests for appearance, identification, assay, uniformity of mass, weight variation, disintegration, dissolution, pH, and specific gravity, resulting in a 100% compliance rate.

A cross-sectional study conducted from May to August 2020 surveyed 369 Mtendere residents using a structured questionnaire.

Of the participants, 50.9% were male, and 62.1% were aged between 18 and 29 years. The study revealed poor knowledge, attitudes, and practices (KAP) regarding AMU and AMR, with only 38% demonstrating good knowledge, 58% having positive attitudes, and 52% showing good practices.

While 66.7% had heard of antibiotics, only 33.6% were aware of AMR, and 23% knew about antimicrobial-resistant infections.

Additionally, 48.2% were unaware that AMR is a public health issue. The prevalence of self-medication with antibiotics was 47.2%.

The study concluded that Mtendere residents had poor KAP towards AMU and AMR.

This cross-sectional study, conducted between August and December 2023, evaluated the AMR testing capacity of eight hospitals in Zambia using the Laboratory Assessment of Antibiotic Resistance Testing Capacity (LAARC) tool.

None of the hospitals had full AMR surveillance capacity, with performance ranging from moderate (63%) to low (38%).

Major barriers included the lack of an electronic laboratory information system (63%) and the absence of locally generated antibiograms (75%).

The lowest performing areas were quality control for antimicrobial susceptibility testing (14%), pathogen identification (20%), and media preparation (44%).

The strongest areas were specimen processing (79%), data management (78%), specimen collection and transport (71%), and safety (70%).

While most hospitals had general operating procedures, they lacked specimen-specific protocols.

This multi-facility cross-sectional study, conducted from February to April 2024, assessed the antibiotic resistance testing capacity of laboratories in Zambia using the LAARC tool.

The results revealed an overall low capacity for AMR surveillance, with an average score of 39%. The highest laboratory score was 47%, and the lowest was 25%.

Only one hospital had full capacity (100%) to utilize a laboratory information system (LIS), while three hospitals demonstrated satisfactory data management capabilities with scores of 83%, 85%, and 95%.

Additionally, only one hospital had full capacity for specimen processing, and one met the safety standards for a microbiology laboratory (89%).

This cross-sectional study, conducted between December 2022 and January 2023, involved 2038 participants, of whom 53.4% were female and 51.5% had at least a secondary education.

Antibiotic use was found to be extremely high at 99.2%, but only 40.9% of this use was appropriate. Hospitals were the source of 79.1% of antibiotics, while 20.9% were taken from leftover supplies or obtained without prescriptions.

Factors associated with appropriate antibiotic use included being female, aged 35 and above, having a secondary or tertiary education, a monthly expenditure of at least $195 USD, understanding that antibiotics are not painkillers, and confidence in hospital care effectiveness.

A year-long cross-sectional study was conducted at two major tertiary hospitals in Zambia to screen patients with current or past hospital contact for nosocomial infections (Nis), specifically focusing on Pseudomonas aeruginosa.

A total of 841 patients were screened, and 116 (13.7%) were diagnosed with P. aeruginosa Nis. The patients’ ages ranged from 15 to 98 years, with a mean age of 51.

The most common infections were catheter-associated urinary tract infections (57%), followed by pressure sores (38.7%).

P. aeruginosa showed the highest susceptibility to amikacin, but there was a high prevalence of MDR (73.6%), particularly linked to the presence of the carbapenem-hydrolyzing β-lactamase gene blaOXA-51 and surgical care.

The study highlighted a significant prevalence of MDR P. aeruginosa in hospitals in Lusaka and Ndola, Zambia, indicating the need for enhanced infection control and AMS.

This cross-sectional study, conducted between February 2023 and June 2023, analyzed 450 samples using the VITEK^® 2 Compact system for E. coli identification and antimicrobial susceptibility testing.

Among the 450 samples, 66.7% (n = 300) were clinical, and 33.3% (n = 150) were environmental. Overall, 47.8% (n = 215) tested positive for E. coli, with 37.8% of positive results from clinical samples and 10% from environmental samples.

Of the 215 E. coli isolates, 66.5% were identified as MDR, and 42.8% ESBL producers. The isolates showed high resistance to ampicillin (81.4%), sulfamethoxazole/trimethoprim (70.7%), ciprofloxacin (67.9%), levofloxacin (64.6%), ceftriaxone (62.3%), and cefuroxime (62%).

However, E. coli isolates were highly susceptible to amikacin (100%), imipenem (99.5%), nitrofurantoin (89.3%), ceftolozane/tazobactam (82%), and gentamicin (72.1%).

This study reveals a significant resistance of E. coli to several commonly used antibiotics in humans.

A cross-sectional study was conducted at a tertiary hospital in Lusaka, Zambia, to assess preoperative (preop) and postoperative (postop) carriage and antimicrobial susceptibility patterns of rectal ESBL-producing E. coli (ESBL-Ec) in elective surgery patients.

120 participants were recruited, with 75 followed up at least 72 hours after surgery.

Of 195 rectal swabs, 177 (90.8%) were positive for E. coli; 53 (29.9%) were ESBL-Ec, with a significantly higher proportion in postop (47.9%) compared to preop (17.3%) participants.

Postop ESBL-Ec isolates showed higher resistance compared to preop for cefotaxime: 100% vs 88.9%, ampicillin: 100% vs 94.4%, ciprofloxacin: 88.3% vs 83.3%, amoxicillin/clavulanic acid: 80% vs 66.7%, and cefepime: 80% vs 77.8%.

MDR ESBL-Ec strains were more frequent in postop (91.4%) than preop (88.9%).

The study revealed a significantly higher rate of antimicrobial-resistant rectal E. coli in postop participants compared to preop.

A cross-sectional study of 58 ESBL-producing E. coli strains from hospital inpatients, outpatients, and non-hospital environments.

Genotypic analyses were performed using the Illumina NextSeq 2000 sequencing platform.

Phylogroup B2 was the most common among the isolates. Resistant MLST sequence types identified included ST131, ST167, ST156, and ST69.

ESBL genes detected: blaTEM-1B, blaCTX-M, blaOXA-1, blaNDM-5, blaCMY

ST131 and ST410 were the most common strains.

ST131 had a high prevalence of blaCTX-M-15 and resistance to fluoroquinolones.

Both clinical and environmental isolates carried blaNDM-5 (3.4%), with clinical isolates showing a higher risk of carbapenemase resistance genes.

BlaCTX-M and blaTEM variants, especially blaCTX-M-15, were frequent in ST131.

The study highlights the public health risks posed by blaCTX-M-15 and blaNDM-5-carrying E. coli strains.

Strengthening AMS programs and continuous surveillance of AMR in clinical and environmental settings are essential to control the spread of resistant pathogens.

This study was conducted to isolate pathogens that cause blood stream infections and reported that 88 Gram-negative bacteria were isolated including 76% Enterobacterales, 14% Acinetobacter baumannii and 8% P. aeruginosa.

Resistance to third and fourth-generation cephalosporins was 75% and 32%, respectively. Further, the study found a high prevalence (68%) of inappropriate empirical treatment, carbapenem resistance (7%), MDR (83%) and ESBL-producers (76%).

In comparison to E. coli as a causative agent of BSI, the odds of death were significantly higher among patients infected with Acinetobacter baumannii (OR = 3.8).

The odds of death were also higher in patients that received third-generation cephalosporins as empiric treatment than in those that received fourth-generation cephalosporins or other (none cephalosporin) treatment options.

The study concluded that a structured surveillance, yearly antibiogram updates, improved infection prevention and control measures, and a well-functioning AMS program, are of utmost importance in improving appropriate antimicrobial treatment selection and favourable patient outcomes.

This study focused on characterizing 63 drug-resistant M. tuberculosis strains collected from the University Teaching Hospital between 2018 and 2019, using targeted gene sequencing.

Of these, 50 strains were conveniently selected for whole genome sequencing. The results showed that 60 strains had resistance mutations associated with MDR, one was poly-resistant, and two were rifampicin-resistant.

Among the MDR strains, 7% (4/60) exhibited mutations linked to pre-XDR-TB. Additionally, mutations associated with resistance to ethionamide, para-aminosalicylic acid, and streptomycin were found in four, one, and nine strains, respectively.

All 50 strains belonged to lineage 4, with the predominant sub-lineage being 4.3.4.2.1, which accounted for 38% of the strains.

Notably, three out of the four pre-XDR strains were part of this sub-lineage. When comparing the clustering of strains based on single nucleotide polymorphism differences, sub-lineage 4.3.4.2.1 was less clustered compared to sub-lineages L4.9.1 and L4.3.4.1.

This cross-sectional study, conducted from April 2022 to August 2022, analyzed 980 samples collected from both clinical and environmental settings.

Of the total samples, 51% were from environmental sources. Overall, 64.5% of the samples tested positive for E. coli, with 52.5% of these isolates originating from clinical sources.

Additionally, 31.8% of the E. coli isolates were identified as ESBL producers, with 70.1% of these being clinical isolates.

Among the 632 isolates, 48.3% were classified as MDR. Clinical isolates showed high resistance to ampicillin (83.4%), sulfamethoxazole/trimethoprim (73.8%), and ciprofloxacin (65.7%).

In contrast, all environmental isolates were resistant to sulfamethoxazole/trimethoprim (100%), and a portion also showed resistance to levofloxacin (30.6%). The study identified key factors driving MDR in the isolates, including pus samples, male sex, and water samples.

A cross-sectional study was conducted by swabbing trolley and basket handles, and standard microbiological methods were used to identify bacteria. Of the 200 samples collected, 28% were culture-positive.

The predominant isolates were S. aureus (17.3%), Pseudomonas species (4.5%), E. coli (2%), Corynebacterium species (2%), Staphylococcus species (1.5%), and Enterobacter aerogenes (0.5%). S. aureus exhibited the highest resistance to azithromycin (17%), followed by ciprofloxacin (2.8%), nitrofurantoin (2.8%), and chloramphenicol (2.8%).

E. coli showed 100% resistance to amoxicillin, cloxacillin, and ampicillin, 75% resistance to ciprofloxacin, and 25% resistance to azithromycin, but was susceptible to nitrofurantoin.

Other bacteria, including Staphylococcus species, Corynebacterium species, Enterobacter aerogenes, and Pseudomonas species, showed no resistance to any tested panel of antibiotics.

Overall, the prevalence of resistance to one or more anti-TB drugs was 23.5%. Among the patients, 9.8% had MDR-TB, with 1.2% being new cases and 25.5% having a history of previous TB treatment.

Isoniazid (INH) resistance was the most common among mono-resistant TB strains, occurring in 9.8% of cases.

Two cases of XDR-TB (6.5%, 2/31) and one case of pre-XDR-TB (3.2%, 1/31) were identified among the MDR-TB patients.

Notably, patients with a history of previous TB treatment were 40 times more likely (OR: 40.3, 95% CI: 11.1% - 146.5%) to have drug-resistant TB compared to those with no prior treatment history.

This study reveals a high rate of MDR-TB and has also identified cases of both pre-XDR and XDR-TB, highlighting the significant challenge of drug-resistant TB in this population.

This cross-sectional, laboratory-based study included 101 participants with pus swab specimens collected from burn wounds and 50 environmental swabs from strategic locations.

The median age of participants with burn wound fungal infections was 3 years, with a median burn surface area of 18% TBSA. The study group comprised 3 males and 6 females.

Fungal organisms isolated included Candida albicans from 8 (7.9%) participants and 2 (4%) of the environmental swabs. Additionally, 1 (1%) Candida spp. was found in pus swabs.

Among the 11 Candida isolates, 4 (36.4%) were susceptible to fluconazole, while 7 (63.6%) were resistant.

The presence of Candida albicans and other Candida species in both burn wound patients and hospital environments indicates fungal contamination.

A cross-sectional anonymous survey was conducted among students from six accredited medical schools in Zambia using a self-administered Qualtrics questionnaire.

A total of 180 student responses were analyzed. Fifty-six percent rated their education on antibiotic use as useful or very useful.

While 91% believed antibiotics are overused, and 88% recognized antibiotic resistance as a problem in Zambia, only 47% felt adequately trained on antibiotic prescribing, and 43% were confident in selecting the correct antibiotic for infections.

Worryingly, only 2% felt prepared to interpret antibiograms, and few students were trained in key prescribing practices, such as de-escalation to narrow-spectrum antibiotics (3%), transitioning from IV to oral antibiotics (6%), or understanding dosing and duration (12%). Additionally, 47% thought hand hygiene was unimportant.

The survey highlighted that while Zambian medical students possess good knowledge about antibiotics and resistance, they lack sufficient training and confidence in key antimicrobial prescribing practices.

A study measured antibiotic usage in clinics at three intervals over 16 months (April 2021, March 2022, and August 2022) through chart reviews to assess compliance with national prescribing guidelines.

A total of 340 consultations were reviewed across the three audits (240, 50, and 50 consultations).

Overprescription of antibiotics decreased from a ratio of 3.59:1 (212 prescribed vs. 59 indicated) to 3:1 (33 prescribed vs. 11 indicated), and finally to 2.78:1 (25 prescribed vs. 9 indicated).

The correct choice of antibiotics fluctuated, with rates of 25.9% (14/59), 9% (1/11), and 33% (3/9) across the three audits.

Antibiotic overuse declined steadily after mentoring and educational interventions. However, incorrect antibiotic selection was primarily due to limited medication availability.

This hospital-based cross-sectional study collected rectal swabs 565 and 455 diarrhoeic and healthy children, respectively, from which 1020 E. coli were cultured and subjected to antibiotic susceptibility testing.

The study found that 96.9% of E. coli isolates were resistant to at least one antimicrobial agent tested.

Further, 700 isolates were MDR, 136 were possibly XDR and nine were PDR.

Furthermore, 40% of the isolates were imipenem-resistant, mostly from healthy children.

This study revealed AMR was prevalent in children and emphasised the need for a community-specific-risk-based approach to implementing mitigating measures to curb the problem.

This study examined the prevalence and characteristics, both phenotypic and genotypic, of S. aureus from pigs and workers at farms and abattoirs in Lusaka Province, Zambia.

A total of 492 nasal swabs from pigs, along with 53 hand and 53 nasal swabs from human workers, were collected across selected districts.

The overall prevalence of S. aureus was 33.1%, with 37.8% in pigs and 11.8% in humans.

The isolates exhibited resistance to several antibiotics, with resistance rates ranging from 18% to 98%, though all were susceptible to vancomycin.

Typical livestock-associated S. aureus (LA-SA) spa types were identified. The detection of plasmid-mediated resistance genes, such as tetM (12.8%), along with other resistance determinants and immune evasion cluster genes, raises significant public health concerns.

Continuous surveillance of S. aureus using a “One Health” approach is essential to monitor infections and the spread of AMR.

A prospective cross-sectional study was conducted from 2019 to 2020 involving 630 patients with urethral or vaginal discharge due to STIs.

A study of 630 patients with a median age of 29 years (IQR 19 - 39) found that 46% (290/630) were male. Among females, the median age was 26 years.

N. gonorrhoeae was isolated in 19.4% (122/630) of patients, with 72.9% of these cases (89/122) being male, predominantly in the 25 - 34 age group.

High resistance was observed to penicillin (85.2%), tetracycline (68.9%), and ciprofloxacin (59.8%), while reduced susceptibility was noted for cefixime (1.6%), spectinomycin (4.9%), and azithromycin (4.9%).

All isolates were susceptible to ceftriaxone. Risk factors for AMR included douching in females (AOR 6.69), female gender (AOR 7.64), HIV positivity (AOR 26.59), unprotected sex (AOR 5.48), sex trading (AOR 4.19), and over-the-counter ciprofloxacin use (AOR 3.44).

Out of 765 specimens processed, only 500 (65.4%) met the inclusion criteria. Among these, 291 (58.2%) were from female patients, with the majority belonging to the 17 - 39 years age group (253, 50.6%) and the 40 - 80 years group (145, 29%).

The specimens were primarily blood (331, 66.2%), urine (165, 33%), and sputum (4, 0.8%).

The most frequently identified bacterial isolate was S. aureus (142, 28.4%), followed by E. coli (91, 18.2%), Enterobacter agglomerans (76, 15.2%), and K. pneumoniae (43, 8.6%).

The AMR pattern revealed high resistance rates to ampicillin (93%), oxacillin (88%), penicillin (85.6%), co-trimoxazole (81.5%), erythromycin (71.9%), nalidixic acid (68%), and ceftazidime (60%).

In contrast, the most effective antibiotics were imipenem (14.5% resistance) and piperacillin/tazobactam (16.7% resistance). Screening for MRSA using cefoxitin showed a 23.7% (9/38) resistance rate.

This cross-sectional study surveyed 172 randomly selected participants using a structured questionnaire. Of the total participants, 55.2% (n = 95) were male, and the majority (64%) were aged between 21 and 25 years (n = 110).

Most pharmacy students demonstrated good knowledge (90% average score, n = 155) and a positive attitude (84% average score, n = 145) regarding AMU and AMR, but their practices were suboptimal (64% average score, n = 110).

Despite high knowledge and attitude scores, self-medication with antibiotics was prevalent in 41% (n = 70) of participants.

The suboptimal practice score raises concerns, highlighting the need for urgent improvements in the undergraduate pharmacy curriculum, particularly regarding AMU, AMR, and AMS programs.

A cross-sectional study conducted between February and April 2022 assessed the knowledge, attitudes, and practices of 178 community pharmacy professionals regarding poultry antibiotic dispensing, usage, and bacterial AMR in Lusaka, Zambia.

The most commonly dispensed antibiotic was oxytetracycline, a Watch antibiotic, often given without prescriptions.

Good knowledge of antibiotic use (ABU) and AMR was significantly associated with more than one year of work experience (p = 0.016), while good practices were linked to being male (p = 0.039) and having over one year of experience (p = 0.011).

The study found moderate levels of knowledge and practices, along with positive attitudes among pharmacy professionals regarding poultry ABU and AMR.

However, the high rate of dispensing antibiotics without prescriptions highlights the need for stricter antimicrobial stewardship and surveillance programs in poultry production to combat AMR in Zambia.

This study aimed to explore the genetic diversity and transmission patterns of MDR M. tuberculosis strains in Lusaka, Zambia.

Eighty-five MDR MTB samples collected between 2013 and 2017 from the University Teaching Hospital were analyzed.

Techniques used included drug-resistance gene sequencing, spoligotyping, 24-loci mycobacterial interspersed repetitive units-variable number of tandem repeats (MIRU-VNTR), and multiplex PCR for RD-Rio sub-lineage identification.

The study identified the following clades: LAM (48%), CAS (29%), T (14%), X (6%), and Harlem (2%). The dominant clonal complexes were SIT21/CAS1-Kili and SIT20/LAM1.

Combining spoligotyping with 24-loci MIRU-VNTR identified 47 distinct genotypic patterns, with a clustering rate of 63%. Additionally, 95% of LAM strains belonged to the RD-Rio sub-lineage.

The high clustering rate indicates that recent transmission rather than independent MDR acquisition is a major factor in the spread of MDR-TB.

This spread is primarily due to the clonal expansion of SIT21/CAS1-Kili and SIT20/LAM1 strains.

Genotyping combined with conventional epidemiological methods could enhance TB control programs by providing insights to curb MDR-TB transmission effectively.

A descriptive cross-sectional study involving 263 participants was conducted using a structured questionnaire.

Of the 263 participants, 225 (85.6%) were nurses and 38 (14.4%) were pharmacy personnel.

Pharmacy personnel had significantly better knowledge of the transmission of resistant bacteria (P = 0.001) and the role of antibiotics in livestock in contributing to AMR (P = 0.01) compared to nurses.

They also exhibited more positive attitudes towards AMR as a public health issue (P = 0.001) and the impact of antibiotics in livestock (P = 0.001).

Additionally, a higher proportion of pharmacy personnel participated in awareness campaigns (P = 0.029), continued professional development (P = 0.001), and courses on antibiotics and AMR (P = 0.028).

Overall, pharmacy personnel demonstrated superior knowledge and attitudes regarding AMR and were more engaged in related professional activities compared to nurses.

This retrospective cross-sectional study analyzed 388 patient medical files from five primary healthcare hospitals in Zambia (Chawama, Matero, Chilenje, Kanyama, and Chipata) between September and November 2021.

Of the patients, 52.3% were male. Antibiotic use was significantly high at 82.5%, far surpassing the WHO’s recommended threshold of 30%.

The most prescribed antibiotic was ceftriaxone (20.3%), a Watch group antibiotic, followed by metronidazole (17.8%) and sulfamethoxazole/trimethoprim (16.3%), both from the Access group.

Alarmingly, 41.9% of prescriptions did not follow standard treatment guidelines, highlighting excessive antibiotic use and poor guideline adherence in these healthcare facilities.

A 2020 retrospective study at two Lusaka hospitals reviewed 838 women who delivered via C-section, with 55% aged 21 - 25, 56.3% from low-cost areas, and 57% undergoing emergency procedures.

The prevalence of surgical site infections (SSIs) was 6%, with key predictors including education level, type of C-section, post-C-section oral antibiotics, and IV antibiotic duration.

Nearly all women (99.8%) received antibiotics, primarily a benzylpenicillin, gentamicin, and metronidazole combination, followed by ceftriaxone.

This highlights the common use of triple therapy and third-generation cephalosporins in managing infection risks post-C-section.

This cross-sectional study focused on S. aureus and Enterococcus species isolated from skin, soft tissue, and bloodstream infections.

Out of 59 S. aureus isolates, 37 were from skin and soft tissue infections, while 22 were from blood cultures.

Among these, 26 isolates (44.1%) were identified as Methicillin-resistant S. aureus (MRSA).

Additionally, 39 Enterococcus isolates were obtained from blood cultures. Vancomycin resistance was not detected in any of the S. aureus or Enterococcus isolates tested.

However, 12.5% of S. aureus and 14.3% of Enterococcus showed intermediate susceptibility to vancomycin. S. aureus exhibited high resistance to penicillin (93.2%), erythromycin (52.5%), and tetracycline (50.8%).

Enterococcus showed resistance to penicillin (83%) and tetracycline (84.6%).

The absence of vancomycin resistance among S. aureus and Enterococcus isolates indicates that vancomycin remains an effective treatment option for invasive infections caused by these organisms.

In this study (n = 203), the prevalence of urinary tract infections (UTIs) was found to be 60% (95% CI: 53.3% - 66.7%). The most commonly isolated bacteria were E. coli (59%) and Klebsiella species (21%).

AMR was detected in 53% of the cases. The highest resistance rates were against nalidixic acid (88.3%), ampicillin (77.8%), and norfloxacin (58.5%), while chloramphenicol exhibited the lowest resistance rate (20%).

No significant predictors of AMR were identified among the pregnant women in this study.

The findings highlight a high burden of AMR, which is closely linked to the elevated prevalence of UTIs in this population.

Out of 232 samples with available drug susceptibility testing (DST) results, 211 (90.9%) were identified as drug-resistant TB, while 21 (9%) were drug-susceptible.

Among these, 53% (124/232) were cases of MDR-TB, and 32.3% (75/232) were confirmed as having rifampicin mono-resistance. Only 1.7% (4/232) of the MDR-TB patients were classified as pre-extensively drug-resistant tuberculosis (pre-XDR TB).

The Copperbelt province had the highest proportion of MDR-TB cases at 56%, followed by Luapula at 48% and North-Western at 30%.

The proportion of MDR-TB was 41.7% (88/211) in previously treated patients and 12.7% (27/211) in new patients.

There has been a slight increase in the incidence of MDR-TB over the four years under review, with the highest rates observed in the Copperbelt Province.

We recommend strengthening routine laboratory surveillance and enhancing the management of MDR-TB cases in the region to address this growing challenge.

This study determined the AMR patterns of bacterial pathogens from urine, blood and wound infections and their distribution by age, sex and location, and found MDR in almost all bacterial pathogens in blood urine and wound swabs.

In urine and females odds ratio (OR) = 0.864, p = 0.023, OR = 0.909, p = 0.013 urine and neonates were susceptible to antibiotics OR = 0.859, p = 0.003, OR = 0.741, p < 0.001.

Ampicillin resistance was above 90% for E. coli isolates in blood, urine and wound swabs.

A cross-sectional study of 304 healthcare professionals at tertiary hospitals in Lusaka, Zambia, found that overall knowledge about AMR was 60.4%. Knowledge of pharmacogenetics (PGx) was lower, at 38%.

Structural Equation Modeling (SEM) showed that a higher AMR knowledge score was linked to a positive attitude toward combating AMR (p < 0.001).

Pharmacists had the highest AMR knowledge scores, while nurses scored lower. Only 31.5% of respondents believed that poor access to local antibiogram data contributed to AMR, while 56.5% felt that poor adherence to prescribed antimicrobials was a major factor.

Pharmacists also had the most positive attitudes toward AMR, while nurses had the least. The study concluded that suboptimal knowledge of AMR and PGx among healthcare professionals in Zambia could hinder the adoption of precision medicine approaches to combat AMR.

This retrospective study analyzed samples from the University Teaching Hospital in Lusaka, Zambia, to assess carbapenem resistance and antimicrobial susceptibility in Pseudomonas aeruginosa and Acinetobacter species, collected between March 2018 and June 2019.

Among 384 samples, 84 P. aeruginosa and 11 Acinetobacter species were isolated. P. aeruginosa showed high susceptibility to imipenem (94%), piperacillin-tazobactam (95.2%), and amikacin (91%), but lower for ciprofloxacin (69%) and gentamicin (63.1%).

Acinetobacter had high susceptibility to amikacin (90.9%) and imipenem (82.9%), but very low susceptibility to gentamicin (9.1%) and cefotaxime (9.1%).

Carbapenem resistance was low, with 6% of P. aeruginosa and 18.2% of Acinetobacter isolates being resistant, and carbapenemase production confirmed in all resistant P. aeruginosa cases.

These results indicate that imipenem remains an effective treatment for invasive infections.

Enhanced AMR surveillance, AMS, and IPC measures are recommended to reduce hospital-acquired infections and improve patient outcomes.

The study aimed to isolate and analyze the AMR patterns of pathogenic E. coli from chickens in Chisamba and Lusaka districts.

A total of 417 samples were collected and processed microbiologically, with E. coli isolated from 333 samples (79.9%.

The majority of isolates came from cloacal swabs (313; 75.1%; 95% CI: 70.2% - 78.5%), followed by 18 isolates from litter in poultry houses (4.3%), and one each from eggs and environmental swabs (0.2%).

Of the 333 E. coli isolates, 62 (18.6%) were identified as pathogenic.

The bacteria showed 100% resistance to tetracycline and 92% resistance to cephalexin, while 77% were susceptible to gentamicin.

MDR was observed in 4.8% of pathogenic isolates, which were resistant to all six antibiotics tested, and 17.7% were resistant to five antibiotics.

The presence of antimicrobial-resistant pathogenic E. coli suggests prior exposure to these antibiotics.

This resistance poses a significant public health threat, as it complicates treatment options. There is an urgent need to enhance education on biosecurity and good hygiene practices to address this issue.

A total of 58 AMR genes were identified, including four blaCTX-M alleles: blaCTX-M-14, blaCTX-M-15, blaCTX-M-27, and blaCTX-M-55.

Hierarchical clustering suggested clonal dissemination of the blaCTX-M genes among the isolates. Out of the 45 strains carrying blaCTX-M genes, seven had these genes integrated into their chromosomes.

In particular, one E. cloacae and three E. coli strains had chromosomal blaCTX-M-15 genes located within large insertions exceeding 10 kilobases.

These insertions, flanked by the ISEcp1 element, were highly similar to previously reported plasmids and carried multiple AMR genes corresponding to the observed AMR.

The study highlights the role of the ISEcp1 element in transferring AMR genes from plasmids to bacterial chromosomes, facilitating the stable integration and spread of MDR clones within Enterobacteriaceae.

This study emphasizes the need for monitoring such genetic changes, as they can lead to the persistent and widespread dissemination of antibiotic-resistant bacteria.

A retrospective cross-sectional among bacteria that causes bacteremia found that K. pneumoniae was the most commonly isolated bacteria.

This study further found that K. pneumoniae, E. coli, Pantoea agglomerans, and Enterococcus species have developed high resistance levels against ampicillin, cefotaxime, ciprofloxacin, gentamicin and trimethoprim/sulfamethoxazole but a very low resistance levels against imipenem and amikacin.

Vibrio cholerae isolates from patients during the 2009 and 2010 outbreaks were found to be 100% resistant to nalidixic acid and cotrimoxazole, yet fully sensitive to ampicillin and azithromycin.

Notably, reduced sensitivity to tetracycline was observed in both years, with 67% of the 2009 isolates and 64% of the 2010 isolates showing intermediate resistance.

During the 2016 outbreak, 98% (51/52) of the isolates were resistant to nalidixic acid, but the majority were highly sensitive to cotrimoxazole (90%), tetracycline (98%), and azithromycin (98%).

However, reduced sensitivity to ciprofloxacin was noted in 6% (3/52) of the isolates, with 83% (43/52) showing intermediate resistance.

In profiling AMR patterns, it was evident that AMR was present in all outbreak isolates, though MDR was rare.

None of the isolates from 2009 (0/6) or 2010 (0/25) were MDR, while only one isolate from the 2016 outbreak (1.9%, 1/52) exhibited an MDR pattern, resistant to tetracycline, trimethoprim-sulfamethoxazole, ampicillin, and azithromycin.

A cross-sectional study at the University of Zambia Ridgeway Campus surveyed 260 randomly selected undergraduate medical students using a structured questionnaire.

The results showed that 87.3% (227/260) had good knowledge of antibiotic use and resistance, 96.9% (252/260) had positive attitudes, and 75% (195/260) demonstrated good practices regarding AMR.

A significant relationship was found between the year of study and knowledge levels (χ² = 16.333, p= 0.003) and practices (χ² = 10.926, p= 0.027), but no significant link was observed between year of study and attitudes (χ² = 4.061, p= 0.398).

Out of 273 participants receiving ART, 99 experienced viral load (VL) failure. Among these, 77 underwent successful HIV drug resistance (HIVDR) testing. Of the 77 tested, 75% (58 individuals) had at least one drug-resistant mutation, with 83% (48 of 58) needing a change in their medication regimen.

The prevalence of resistance mutations among these 58 patients was as follows: 81% to nucleoside reverse transcriptase inhibitors (NRTIs), 65.5% to non-nucleoside reverse transcriptase inhibitors (NNRTIs), and 1.7% to protease inhibitors (PIs).

The most common NRTI-associated mutation was M184V, found in 81% of cases, which confers resistance to lamivudine (3TC) and emtricitabine (FTC).

This was followed by K65R, present in 34.5% of cases, which affects resistance to tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide fumarate (TAF).

Thymidine analogue mutations (TAMs), primarily associated with resistance to zidovudine (AZT), stavudine (d4T), and other NRTIs, were observed in 32.8% of patients.

Common TAMs included K70RTQNE (32.8%), K219QE (22.4%), D67N (17.2%), and T215IT (15.5%).

For NNRTIs, the most frequent mutation was K103N (65.5%), which impairs efficacy of efavirenz (EFV) and nevirapine (NVP).

Additionally, mutations such as V106A, Y188C, and Y181C, each present in 36.2% of cases, were noted, affecting resistance to etravirine.

In this study, drug resistance mutations (DRMs) were detected in 45% (44/97) of the samples, with these samples showing resistance to at least two antiretrovirals.

The prevalence of non-nucleoside reverse transcriptase inhibitor resistance was significantly higher than that of other antiretroviral classes.

DRMs were detected disproportionately in infants (67%; 33/49) compared to mothers (23%; 11/48); however, the extent of resistance was similar when present.

The disparity in drug resistance profiles was further highlighted in pairwise comparisons of resistance profiles between mother-infant pairs.

This cross-sectional study, conducted from April to July 2019, reviewed 357 medical files of in-patients and outpatients aged 1 month to 18 years. The majority of files (64.4%) were for pediatric patients aged 1 month to 5 years.

The study found an overall antibiotic prescribing rate of 78.7%. Of the patients, 33.3% needed antibiotics and were receiving treatment, while 12.9% received antibiotics despite not needing them.

Respiratory system diseases were the most common (41.2%). Penicillins were the most frequently prescribed antibiotics (54.8%), followed by cephalosporins (31.3%).

Significant associations were found between age, white blood cell count, and the system of illness with antibiotic use.

The study highlighted a high frequency of antibiotic use among pediatric patients, exceeding the World Health Organization’s prescribing indicators.

The study aimed to evaluate the carriage rate, antimicrobial susceptibility, and spa typing of S. aureus among healthcare workers at a major tertiary hospital in Lusaka, Zambia.

Conducted between May and July 2017 at the University Teaching Hospital, this cross-sectional study involved collecting nasal and hand swabs from 140 healthcare workers, including nurses, doctors, and laboratory scientists.

The overall carriage rate of S. aureus among healthcare workers was 17.1%, with 13.6% being nasal carriers and 8.6% hand carriers.

Carriage rates were highest among doctors (17.9%), followed by nurses (17.5%) and laboratory scientists (11.1%).

MRSA was detected in 25.8% of the isolates, with these strains showing resistance to more than four antibiotics.

Spa typing revealed that 25.8% of the isolates were positive for the spa gene, with identified types including t015 (42.8%) and t069 (14.3%), while 42.8% of the spa types remained unknown.

The study’s findings indicate a significant carriage rate of S. aureus and a notable presence of MRSA among healthcare workers, underscoring the importance of regular screening and decolonization efforts to mitigate the spread of this pathogen in healthcare environments.

This study retrospectively analyzed 693 laboratory specimens from Ndola Teaching Hospital to assess the prevalence of bacterial pathogens and their antibiotic resistance patterns.

The majority of the specimens (65.9%) were from inpatient departments, and nearly half (49.1%) were from female patients.

The most common types of samples were urine (58.6%), followed by blood (12.7%) and wound swabs (8.5%).

The primary bacteria identified included coliforms (29.3%), S. aureus (15.4%), coagulase-negative staphylococci (CoNS, 13.4%), and E. coli (13%).

The analysis revealed significant AMR, with the highest rates observed for co-trimoxazole (91.7%), nalidixic acid (75.2%), norfloxacin (69.0%), ceftazidime (55.7%), nitrofurantoin (46.6%), chloramphenicol (43%), and ciprofloxacin (8.6%).

The study also found that patient location within the hospital and gender significantly influenced resistance patterns.

Coliforms showed varying resistance to nitrofurantoin based on patient location, while gender influenced resistance in Enterobacter and Proteus species to certain antibiotics.

The study highlights the need to consider patient-specific factors, such as location and gender, when selecting antibiotics for treatment, as these can significantly impact bacterial resistance.

This descriptive cross-sectional study, conducted between November 2018 and February 2019, surveyed 46 randomly selected hospital pharmacists.

Of the participants, 52% were male, and 48% were female. Most were aged 26 - 30 years, with ages ranging from 23 to 47 years (mean age: 32.11, SD: 6.533).

A majority (61%) were married, and 52% had worked for 1 - 5 years. The results revealed that the pharmacists had adequate knowledge, positive attitudes, and good practices regarding AMR.

Statistical tests showed no significant associations between knowledge and attitude (p = 0.693), knowledge and practices (p = 0.409), or attitude and practices (p = 0.226).

Overall, pharmacists at the University Teaching Hospital in Lusaka demonstrated strong knowledge, attitudes, and practices towards AMR.

This study analyzed 32 clinical isolates of S. aureus collected from a major referral hospital in Lusaka, Zambia, between June 2009 and December 2012.

The analysis involved Staphylococcal cassette chromosome mec (SCCmec) typing, Staphylococcus protein A gene typing (spa), and detection of the Panton-Valentine Leucocidin (pvl) genes.

The study identified three SCCmec types among the isolates: SCCmec type IV (65.6%), SCCmec type III (21.9%), and SCCmec type I (3.1%).

Additionally, 9.4% of the isolates were untypable. Five different spa types were detected, including a novel type, with spa type t064 being the most prevalent (40.6%).

Other spa types identified were t2104 (31.3%), t355 (3.1%), and t1257 (21.9%).

The pvl genes were present in 3 out of the 32 isolates.

The study revealed a diverse population of MRSA strains in Lusaka.

A study conducted at a secondary care hospital in Zambia found that 14% of inpatients and 18% of outpatients carried S. aureus, with no cases of MRSA detected.

Among inpatients, 90% carried at least one strain of Enterobacteriaceae, primarily E. coli and K. pneumoniae that were resistant to gentamicin, ciprofloxacin, and/or ceftriaxone, compared to 48% of outpatients.

Gentamicin resistance was most common among inpatients (78%), while ciprofloxacin resistance was more prevalent among outpatients (38%).

All ceftriaxone-resistant Enterobacteriaceae were ESBL-positive, with a significantly higher presence in inpatients (52%) than outpatients (12%).

The study demonstrated the feasibility of performing basic microbiological procedures in a low-income hospital setting, generating essential data on antimicrobial susceptibility.

The high prevalence of drug-resistant Enterobacteriaceae among both inpatients and outpatients is concerning.

The findings underscore the importance of local surveillance data to develop antimicrobial therapy guidelines, guide individual patient treatment, and support the implementation of infection control measures in hospitals.

This cross-sectional study investigated rifampicin resistance in Mycobacterium tuberculosis patients at Livingstone Central Hospital in 2015, utilizing GeneXpert technology.

Participants’ ages ranged from 8 months to 73 years, with a median age of 34. Of those with complete gender data, 66% were male and 34% were female.

The study found a high prevalence of TB co-infection with HIV at 98.3% (p < 0.001).

Rifampicin resistance was identified in 5.9% of the cases, with no statistically significant difference in resistance rates between males and females (p = 0.721).

In this cross-sectional study, samples were collected from healthcare workers’ hands, touch surfaces, and disinfectant buckets across delivery rooms, post-natal and pediatric wards, operating theatres, post-op wards, and outpatient departments.

A total of 132 swabs led to the isolation of 275 bacteria, with 65 successfully identified, including Acinetobacter, Enterobacter, Klebsiella, Pseudomonas, Staphylococcus, and Streptococcus species.

Drug resistance testing revealed high resistance levels, particularly among Pseudomonas spp., with 70%, 90%, and 60% resistance to cephalosporins, amoxicillin, and carbenicillin, respectively.

Staphylococcus spp. showed resistance to penicillin (86%), ampicillin (76%), azithromycin (57%), and cephalosporins (95%), with 19% resistant to vancomycin.

The study highlights high drug resistance levels among pathogens in Zambian healthcare facilities, reflecting the prolonged empiric use of antibiotics.

A study was conducted to identify fungi in immunocompromised patients and found that Candida albicans were the predominant species (66.7%), followed by C. lusitaniae (12.2%), C. glabrata (6.7%), C. tropicalis (5.6%), C. parapsilosis (3.3%), C. quilliermondii (3.3%), C. pelliculosa (1.1%) and C. keyr (1.1%).

Majority of the Candida species were highly resistant to fluconazole and amphotericin B, but were highly sensitive to caspofungin and flucytosine.

C. albicans was resistant to fluconazole (18.3%,) with an MIC90 of 256 μg/ml and amphotericin B (10%) with MIC90 of 1.5 μg/ml.

C. glabrata was the most resistant species against amphotericin B (66.6%) with an MIC90 of 2 μg/ml. C. albicans and most of the non-albicans species were MDR.

This shows that fungal infections and resistance are prevalent among immunocompromised patients with pulmonary fungal infections in Zambia.

Samples collected from children with suppurative otitis media at Arthur Davidson Children’s Hospital revealed the isolation of Staphylococcus species (36%), Proteus vulgaris (35%), Pseudomonas species (15%), Streptococcus species (7%), E. coli species (3%), Enterobacter species (2%), and Serratia marcescens species (2%).

Antimicrobial sensitivity testing indicated that ciprofloxacin was the most effective against the majority of these isolates.

A study assessing the non-prescription sale and dispensing of antibiotics was conducted in 73 randomly selected community retail pharmacies using a structured interviewer-administered questionnaire with simulated case scenarios.

The majority (97%) of pharmacists reported frequent client requests for non-prescribed antibiotics. Most respondents asked about client symptoms (94%), provided dosing advice (96%), and suggested alternative antibiotics (97%).

However, all pharmacies (100%) dispensed antibiotics without prescriptions.

The most commonly dispensed antibiotics were amoxicillin (52%), cotrimoxazole (25%), and metronidazole (23%).

The sale of non-prescribed antibiotics was significantly linked to the professional qualifications of the pharmacists in four out of five simulated cases.

Semi-structured interviews were conducted with two groups: 1) traders, which included a random selection of both males and females, and 2) consumers, also randomly selected males and females.

Following the interviews, we collected flies found on fish in markets located in Mongu and Lusaka districts of Zambia.

A total of 418 fly samples were analyzed in the laboratory. Salmonella spp. and enteropathogenic E. coli were isolated from houseflies.

Further laboratory screening revealed that 17.2% (72/418) of the samples contained ESBL-producing E. coli.

This cross-sectional, descriptive, retrospective study analyzed prescription encounters at the adult and pediatric outpatient departments of the University Teaching Hospital (UTH) in 2015.

A total of 1486 drug encounters were reviewed, with an average of 2.5 drugs prescribed per patient (ranging from 1 to 7 drugs).

The antibiotic prescribing rate was 53.7%, while injections were prescribed in 11.8% of encounters.

Generic prescribing was noted in 56.1% of cases, and 98.1% of drugs were from the Zambia Essential Medicines List (ZEML).

The average consultation time was 9.5 minutes, with a dispensing time of 1.3 minutes.

About 78.9% of patients demonstrated correct knowledge of their dosing schedule.

However, none of the consultation rooms had Standard Treatment Guidelines (STGs) or access to reference literature or the internet.

This prospective cross-sectional study was conducted from October 2013 to May 2014 at the University Teaching Hospital (UTH) in Lusaka.

A total of 107 white coats worn by healthcare workers at UTH were sampled to assess bacteriological contamination.

Of the 107 white coats screened, 94 (72.8%) were found to be contaminated with bacteria.

Contamination levels did not differ significantly between white coats worn for more than 60 minutes (47.8%) and those worn for 30 - 60 minutes (46.7%) (p = 0.612).

Antibiotic sensitivity tests revealed that the bacterial isolates were resistant to several of the antibiotics tested.

Notably, isolates of S. aureus and K. pneumoniae showed the highest levels of resistance.

The genomic analysis of MDR Salmonella enterica serovar Typhi from a significant outbreak in Zambia (2010-2012) provided new insights.

The outbreak affected 2040 patients with a 0.5% fatality rate, and 83% of isolates were MDR.

These MDR isolates were identified as MLST ST1 and a new variant of the H58B haplotype.

A chromosomally translocated region with seven resistance genes—catA1, blaTEM-1, dfrA7, sul1, sul2, strA, and strB—was found in most isolates, along with fragments of the IncQ1 plasmid replicon, class 1 integron, and mer operon.

Whole-genome sequencing of 33 isolates showed 415 SNPs and 35 deletions, indicating a distinct clonal group from other H58 genomes in Central Africa and India.

The small number of SNPs suggests short-term transmission during the outbreak. Phylogenetic analysis and deletions point to a single MDR clone as the main cause of the outbreak, though other S. Typhi lineages, including sensitive ones, were also present.

This study challenges the view that the H58B haplotype with the MDR IncHI1 plasmid is the primary cause of typhoid in Asia and sub-Saharan Africa.

It suggests that a new H58B variant with chromosomally translocated MDR regions is emerging in Zambia, potentially altering the understanding of MDR typhoid and indicating that such variants may be more widespread than previously recognized.

Over an 11-year period, a total of 2038 drug susceptibility tests (DSTs) were conducted, representing 2.6% of all retreatment cases reported (2038 out of 78,639).

During this time, 446 cases of MDR-TB were diagnosed. Of these, 56.3% were male (251/446) and 41.7% were female (186/446), with only one case in a child.

Poly-drug resistance was observed in 18.9% of drug-resistant TB (DR-TB) cases (172/911) and 8.8% of DSTs. Additionally, 8.8% of DR-TB cases exhibited rifampicin mono- or poly-resistance without MDR-TB.

No cases of extensively drug-resistant TB (XDR-TB) were reported.

Data on DR-TB and HIV co-infection were not available. Only 65 MDR-TB patients were notified and started on second-line treatment per WHO guidelines.

The study reviewed TB notification records and program reports from 1990 to 2010, revealing two distinct trends: an increase in TB cases until 2004, followed by a moderate decline from 2004 to 2010.

Treatment outcomes improved over time. However, data on pediatric TB, TB in prisoners, and TB in pregnant women were limited due to poor diagnostics. There was also no data on drug-resistant TB due to the lack of drug sensitivity testing. The rise in TB cases from 1990 to 2000 was closely linked to the HIV/AIDS epidemic.

The slight decline in cases between 2004 and 2010 was attributed to better TB care, sustained DOTS implementation, and improved diagnostics.

To enhance TB control, newer diagnostic technologies and drug-resistance testing should be integrated into national TB programs, and TB-HIV services should be aligned for better outcomes.

In this study, samples were collected from breast abscesses in both HIV-positive and HIV-negative women.

S. aureus was identified as the primary causative agent in 91.8% of the isolates. Among the S. aureus isolates, 69.3% (70 out of 101) were susceptible to oxacillin.

However, in HIV-positive patients, 86.0% (43 out of 50) of the specimens were resistant to trimethoprim/sulphamethoxazole.

In an urban setting in Zambia with a long-standing DOTS program, the prevalence of tuberculosis (TB) drug resistance among pulmonary TB patients was assessed.

Among 156 new cases, 7.7% showed any drug resistance, with 4.5% exhibiting monoresistance to isoniazid and 1.3% to rifampicin.

Of 31 retreatment cases, 16.1% had drug resistance, with monoresistance to isoniazid and rifampicin at 3.3% each and one case of multidrug resistance (both isoniazid and rifampicin).

No resistance was found to kanamycin or ofloxacin. While these results may not represent the entire country, they indicate low levels of drug resistance in a community with effective DOTS implementation.

Resource-limited countries could potentially reduce TB drug resistance by adopting community-based strategies that ensure treatment completion.

Among 260 infants followed over 3096 patient-months, pneumococci were detected in 360 out of 1394 samples (25.8%).

HIV-exposed infants were more frequently colonized than HIV-unexposed infants. Co-trimoxazole prophylaxis reduced colonization by approximately 7%, but it increased the risk of colonization with co-trimoxazole-resistant pneumococci within six weeks of starting prophylaxis.

The prophylaxis led to a small but statistically significant increase in nasopharyngeal colonization with pneumococci that were not susceptible to clindamycin, but it did not increase the risk of non-susceptibility to penicillin, erythromycin, tetracycline, or chloramphenicol.

Co-trimoxazole prophylaxis did not alter the prevalence of pneumococcal serotypes targeted by the 7-valent conjugate pneumococcal vaccine.

This pilot study investigated resistance to chloroquine (CQ) and sulfadoxine-pyrimethamine (SP) in Falciparum malaria in rural Zambia.

The combined prevalence of CQ resistance, including both R-II and R-III categories, was 58%, with a higher rate of 60% observed in children under five years old.

This level of resistance aligns with previously reported figures from Zambia.

In contrast, SP resistance (R-II and R-III) was significantly higher at 26%, compared to earlier reports of 3% to 17%.

The study found a strong correlation between prior CQ use and resistance levels, as indicated by the Dill-Glazko test, but did not find evidence of prior SP use to explain the high levels of SP resistance.

This cross-sectional study aimed to identify the bacterial pathogens in diseased chickens in Lusaka and to detect the presence of extended-spectrum beta-lactamase (ESBL)-encoding genes.

A total of 215 samples were collected from 91 diseased chickens at three post-mortem facilities and screened for Gram-negative bacteria.

Among these, 103 samples tested positive for various clinically significant Enterobacteriaceae including Enterobacter (41.7%, 43/103), E. coli (19.4%, 20/103), Salmonella species (9.7%, 10/103), and Shigella species (7.8%, 8/103).

Other bacteria isolated included Yersinia, Morganella, Proteus, and Klebsiella, accounting for 21.4%.

The study revealed that E. coli, Enterobacter, and Shigella exhibited high resistance to tetracycline, ampicillin, amoxicillin, and trimethoprim-sulfamethoxazole.

Conversely, Salmonella showed complete susceptibility to all tested antibiotics.

The observed resistance patterns corresponded with antimicrobial usage data obtained from a major wholesale and retail company.

Furthermore, 42.9% (6/14) of E. coli isolates tested positive for the blaCTX-M gene, while 57.1% (8/14) of Enterobacter isolates carried the blaTEM gene. Notably, 66.7% (4/6) of the blaCTX-M-positive E. coli strains were also positive for blaTEM.

Sanger sequencing revealed that 83.3% (5/6) of the blaCTX-M-positive isolates harbored the bla_CTX-M-15 allele.

The cross-sectional survey indicated that medium- and small-scale poultry farmers were more likely to use antimicrobials compared to commercial farmers. However, they issued fewer prescriptions.

Susceptibility testing revealed the highest resistance to ampicillin (86.5%, 128/148) and tetracycline (74.3%, 101/136).

MDR was also notably high, found in 93.3% (28/30) of isolates. Whole-genome sequencing (WGS) of 26.7% (8/30) of isolates with a CTX Minimum Inhibitory Concentration (MIC) ≥ 4 µg/mL identified ESBL-encoding genes, including blaCTX-M-14, blaCTX-M-55, and blaTEM.

WGS further revealed resistance genes for quinolones, aminoglycosides, phenicols, tetracycline, macrolides, and folate-pathway antagonists.

The survey results underscored a higher level of antimicrobial use and lower prescription frequency among medium- and small-scale poultry farmers compared to their commercial counterparts.

This cross-sectional study was conducted from August 2023 to October 2023 among 200 veterinary medicine dispensers in the Lusaka District of Zambia using a simulated farmer or mystery shopper approach.

Out of the 200 medicine outlets investigated, 23 (11.5%) were agro-veterinary shops, while 177 (88.5%) were community pharmacies.

A total of 165 community pharmacies and agro-veterinary shops provided veterinary services in the Lusaka District and sold medicines without prescription giving a 100% non-prescription sale.

Of the 178 medicines dispensed for prophylaxis, 88.5% were antibiotics, while 13.5% were vitamins.

The most dispensed antibiotic drug for prophylaxis in broiler chickens was oxytetracycline (30.34%), amoxicillin (17.98%) and gentamicin/doxycycline (10.67%).

This cross-sectional study found a high prevalence of antibiotic resistant E. coli isolated from laying hens.

Of the 365 samples, E. coli was isolated from 92.9% (n = 339).

The AMR was detected in 96.5% (n = 327) of the isolates, of which 64.6% (n = 219) were MDR.

E. coli was highly resistant to tetracycline (54.6%) and ampicillin (54%) but showed low resistance to meropenem (0.9%), ceftazidime (6.2%) and chloramphenicol (8.8%).

This cross-sectional study was conducted using 418 pooled raw cow milk samples and analysed using standard culture methods to isolate E. coli.

The prevalence of E. coli was found to be 51.2% (214/418) of which 21% (45/214) were MDR.

A high resistance was observed towards ampicillin (107/214, 50%), tetracycline (86/214, 40.1%), trimethoprim/sulfamethoxazole (61/214, 28.5%), and amoxicillin/clavulanic acid (50/214, 23.4%).

A low resistance was observed towards CTX (32/214, 15%) and imipenem (27/214, 12.6%). The blaCTX-M and blaTEM genes were detected in CTX-resistant isolates.

The study concluded that MDR E. coli that harbour blaCTX-M and blaTEM genes in raw cow’s milk demonstrate serious public health risks for consumers.

This was a cross-sectional study that was conducted in four districts of Lusaka Province in Zambia to determine the AMR patterns, ESBL production of E. coli isolated from stool samples of broiler poultry farm workers, and to assess poultry farmers’ awareness of AMR.

Sixty-six human stool samples were collected and processed for E. coli isolation, performed AST, and screened for ESBL production.

Further, 80 farmers were assessed for their level of awareness on AMR. A total of 58 single E. coli isolates were isolated and demonstrated high resistance to tetracycline (87.9%), trimethoprim/sulfamethoxazole (48.3%), and ampicillin (46.8%); nalidixic acid (19.0%), ciprofloxacin (12.1%), cefotaxime (8.6%) and chloramphenicol (5.2%).

The prevalence of AMR E. coli was 67.2% and 29.3% were found to be MDR. Two (3.4%) isolates were identified to be ESBL producers, harboring the CTX-M gene.

The study concluded that broiler farmers were aware and knowledgeable of AMR, although their knowledge about its impact on human health was low.

This study demonstrated the presence of resistant and ESBL-producing E. coli among poultry farm workers indicated a potential transmission of AMR between humans and poultry and vice-versa.

A cross-sectional study found a high prevalence (99.4%) of antibiotic-resistant Enterococcus species isolated from laying hens.

A total of 308 (83%) single Enterococcus species isolates were obtained and showed resistance to tetracycline (80.5%), erythromycin (53.6%), quinupristin/dalfopristin (53.2%), ampicillin (36.72%), vancomycin (32.8%), linezolid (30.2%), ciprofloxacin (11.0%), nitrofurantoin (6.5%) and chloramphenicol (3.9%).

The prevalence of enterococci resistant to at least one antibiotic was 99.4% (n = 306), of which 86% (n = 265) were MDR.

This study assessed the awareness of AMR and associated factors among layer poultry farmers in Zambia. A cross-sectional study was conducted among 77 participants from September 2020 to April 2021.

Overall awareness of AMR among the farmers was 47% (n = 36). The usage of antibiotics in layer poultry production was high at 86% (n = 66).

Most antibiotics were accessed from agrovets (31%, n = 24) and pharmacies (21%, n = 16) without prescriptions.

Commercial farmers were more likely to be aware of AMR compared to medium-scale farmers, as were farmers who used prescriptions to access antibiotics compared to those who did not, and farmers who did not treat market-ready birds with antibiotics compared to those who did.

The awareness of AMR among some layer farmers was low.

Therefore, policies that promote the rational use of antibiotics need to be implemented together with heightened surveillance activities aimed at curbing AMR.

This cross-sectional study investigated the presence of Listeria species in chickens from abattoirs and assessed their AMR profiles.

A total of 150 broiler carcass swabs were collected, including cloacal (n = 60), exterior surface (n = 60), and environmental (n = 30) samples.

Listeria species were identified using biochemical tests and PCR, while antibiotic resistance was tested via disc diffusion and Etest methods.

Listeria species were isolated in 15% (23/150) of the samples, with 2% from environmental swabs and 13% from carcass swabs.

The species distribution included L. monocytogenes (74%), L. welshimeri (22%), and L. innocua (4%).

Most isolates came from exterior carcass swabs (61%), followed by cloacal swabs (26%), and environmental swabs (3%).

L. monocytogenes showed the highest resistance to clindamycin (61%), tetracycline (30%), and erythromycin (13%).

The relatively high isolation of L. monocytogenes and its AMR profile indicates a potential public health risk, highlighting concerns about food safety for consumers.

A cross-sectional study was conducted on a 10,000-acre game ranch near Lusaka, Zambia, to assess the prevalence and AMR profiles of E. coli and other enterobacteria in wildlife and livestock cohabiting in the area.

The study involved purposive sampling of 84 fecal samples from animals with similar behaviors and grazing habits, resulting in 66 bacterial isolates.

These included E. coli (72.7%), E. fergusonii (1.5%), Shigella sonnei (22.7%), Sh. flexneri (1.5%), and an unidentified Enterobacteriaceae bacterium (1.5%).

The study found that 89.6% of E. coli and 73.3% of Shigella isolates exhibited resistance or intermediate sensitivity to at least one antimicrobial agent.

Among E. coli isolates, the highest resistance rates were to ampicillin (27%), ceftazidime (14.3%), cefotaxime (9.5%), and kanamycin (9.5%).

MDR was observed in 18.8% of E. coli and 13.3% of Shigella isolates, including those from both wild and domesticated animals.

This study analysed 384 poultry fecal samples using microbiological and molecular methods. S. Typhimurium was detected at 17.7% in commercial poultry farms in Copperbelt province, of which 12.8% were found harboring the CTX-M-type ESBL genes.

S. Typhimurium isolates showed 88.2% resistance to at least one antimicrobial compound. All the isolates showed 100% resistance to tetracycline, followed by ampicillin and amoxicillin at 91.2%.

These isolates also showed 58.8% resistance to cefotaxime and 54.4% to ceftazidime.

Detection of CTX-M ESBL-producing S. Typhimurium suggests the contamination of the chicken food chain at the farm level and calls for public health protection measures.

A cross-sectional study was conducted across seven districts in Zambia to assess the resistance profiles of Salmonella spp. and E. coli isolated from broiler chickens at farms, abattoirs, and open markets.

A total of 470 samples, including litter, cloacal swabs, and carcass swabs, were collected. In total, 4 Salmonella spp. and 280 E. coli isolates were identified.

Among the Salmonella spp., one showed resistance to ampicillin (25%), amoxicillin/clavulanic acid (25%), and cefotaxime (25%).

E. coli demonstrated the highest resistance to tetracycline (81.4%) and was 100% susceptible to imipenem.

The antibiotic susceptibility profile indicated that 75.7% (237/280) of the E. coli isolates were MDR.

The highest MDR profile was found in 8.2% (23/280) of the isolates, with resistance observed in 6 out of the 9 antibiotic classes tested. Additionally, 11.4% (32/280) of the isolates exhibited XDR.

This study aimed to determine the AMR profiles of E. coli and Salmonella species isolated from retail broiler chicken carcasses purchased from open markets and supermarkets in Zambia.

A total of 189 E. coli and five Salmonella isolates were identified.

The E. coli isolates showed high resistance to tetracycline (79.4%), ampicillin (51.9%), and trimethoprim/sulfamethoxazole (49.7%).

Additionally, two of the five Salmonella isolates were resistant to at least one antibiotic.

This study highlights the presence of AMR in E. coli and Salmonella on retail broiler chicken carcasses from both open markets and supermarkets, posing a public health risk.

This study compared whole genome sequences of E. coli isolates from dairy cattle (n = 224) and patients at a local hospital (n = 73) to identify acquired AMR genes.

Additionally, the researchers analyzed publicly available genomes of 317 human E. coli isolates from across Africa.

The study identified antibiotic resistance genes and phylogroups from de novo assemblies and used SNP-based phylogenetic analyses to visualize the distribution of resistance genes between the two hosts.

The findings revealed greater diversity of acquired AMR genes in human E. coli isolates compared to those from bovines, particularly for genes conferring resistance to ESBL, quinolones, macrolides, and fosfomycin, which were only found in human isolates.

Notably, E. coli isolates from Zambian and other African human sources were significantly more likely to carry multiple AMR genes compared to those from Zambian dairy cattle.

The median number of resistance genes in the Zambian cattle cohort was 0 (interquartile range: 0 - 1), while in the Zambian human and wider African cohorts, the medians were 6 (interquartile ranges: 4 - 9 and 0 - 8, respectively).

The lower frequency and diversity of AMR genes in dairy cattle isolates align with the relatively limited antibiotic use documented in the region, especially among smallholder farmers.

Of the 384 poultry samples collected and analyzed, 20.1%, were ESBL-producing E. coli.

Additionally, 85.7% of ESBL-producing E. coli isolates conferred resistance to beta-lactam and other antibiotics.

These findings demonstrate that ESBL-producing E. coli isolates are also found in poultry and may be transmitted to human consumers.

An E. coli isolate was obtained from 98.67% (371/376) of the sampled animals and tested for resistance against six classes of antibiotics.

The estimated prevalence of resistance across different farming systems was: tetracycline (10.61%), ampicillin (6.02%), sulfamethoxazole/trimethoprim (4.49%), cefpodoxime (1.91%), gentamicin (0.89%), and ciprofloxacin (0%).

Univariate analyses identified certain diseases, exotic breeds, location, farm size, and specific management practices as risk factors for antibiotic resistance.

Multivariate analyses further revealed an association with lumpy skin disease and suggested a protective effect for older animals (>25 months).

The study investigated the prevalence and diversity of Staphylococcus aureus in Zambia’s dairy value chain, focusing on raw milk from traditional and smallholder farms.

S. aureus contamination was found in 33% to 46% of raw milk samples, varying by province. It was also detected in milk collection centers, informal traders, traditional market sellers, processors, and on swabs from milk buckets, as well as nasal and hand swabs of milkers.

No S. aureus was found in industrially processed (heat-treated) milk or dairy products. Although MRSA was not detected, 10% of isolates carried the lukS-PV gene, which is associated with the virulence factor Pantone-Valentine leucocidin (PVL) and severe human diseases.

Molecular typing revealed 44 spa types, including 13 novel types, and 12 new multi-locus sequence types (MLSTs), some of which were linked to the bovine-associated clonal lineage CC97.

The dominant spa types varied by province, though some were common across all regions. Whole-genome sequencing (WGS) and core genome multi-locus sequence typing (cgMLST) indicated transmission of S. aureus strains along the dairy value chain, with potential persistence over time.

Genetic similarities were observed between isolates from milkers and those from raw milk or milk buckets.

The study underscores the widespread contamination of raw milk with S. aureus in Zambia’s dairy sector and calls for continued monitoring to mitigate public health risks.

High burden of diseases in Zambia prompting the use of antimicrobials

Poor infection prevention and control practices in healthcare facilities in Zambia

The presence of bacteria with significant AMR on supermarket trolley and basket handles in Zambia

Lack of effective surveillance and monitoring systems, and limited access to quality healthcare and diagnostic services

High practice of self-medication in Zambia

Access to antibiotics without prescriptions. The reasons behind the dispensing of antibiotics without a prescription in community pharmacies needs to be explored in future studies.

Lack of laboratory capacity to conduct bacteriology and AMR testing

Lack of awareness and knowledge of AMR among university students

Poor knowledge, attitudes, and practices concerning AMU and AMR among community members

Inadequate regulatory systems regarding access to antimicrobials and antimicrobial use

Non-adherence to recommended treatment guidelines in healthcare facilities

Lack of knowledge on AMS among physicians and pharmacists

Limited diagnostic capacity of laboratories to conduct microbiological tests and AMR surveillance contributing to poor diagnostic stewardship

Limited finances and laboratory consumables required for effective surveillance of AMR

One of the major challenges in Zambia is the acceptance, integration, and institutionalization of the One Health approach across all relevant sectors.

A significant issue is the absence of a unifying policy, framework, and governance structure that is independent of any single ministry.

Currently, the Zambia National Public Health Institute (ZNPHI) is still perceived as being under the Ministry of Health, creating operational difficulties.

To address this, there is a need for a fully independent One Health platform under the Vice President’s office.

Another challenge is the practical implementation of the One Health approach, as observed during recent anthrax outbreaks. In districts with a good understanding of One Health, teams were quickly formed to implement cross-sectoral interventions.

However, operationalization faced practical challenges, particularly in the early stages of coordination.

The anthrax and COVID-19 outbreaks highlighted the necessity of having a well-established One Health workforce, making capacity building across all sectors crucial to ensure the necessary skills and knowledge are in place.

Financing for One Health initiatives in Zambia is a consistent challenge.

Resource mobilization to support One Health interventions needs better organization, and there is a lack of sustainable financing mechanisms to ensure the long-term success of these interventions.

There is a need to develop educational programs to raise awareness and understanding of the One Health concept among implementers and policymakers.

This includes creating short, targeted courses and training programs to build the capacity of all One Health actors.

This will enhance disease surveillance and combating of AMR across the One Health sectors

There is an urgent coordinated need for acceptance, integration, institutionalization, and operationalization of the One Health approach across all relevant sectors to promote diseases surveillance and combating AMR

Strengthening surveillance and monitoring systems for early detection and identification of disease-causing pathogens and AMR trends

Instigating AMS programs to optimize antimicrobial use in healthcare facilities, universities, colleges, schools, communities, veterinary practice, aquaculture, and agriculture

Enhancing infection prevention and control practices in healthcare facilities and communities

Increasing access to diagnostic services and improved laboratory capacity to conduct microbiological tests and AMR surveillance

Promoting public awareness and education on AMU, AMR, and AMS

Promote research and surveillance to support evidence-based decision-making to address AMR

Improving funding required to combat AMR in the One Health approach to address AMR

Strengthening local and international collaborations in instigating strategies to combat AMR

Community engagement in AMS programs

Strengthening University and College curricular on AMR and AMS

Providing CPD education for healthcare workers concerning AMU, AMR, IPC, and AMS

Frequent monitoring of antimicrobial prescribing and use in healthcare facilities