Antibiotic Resistance Surveillance in Tanzania Finds Gaps Between Data and Care

Tanzania has built a national framework for tracking antimicrobial resistance, with roughly ten sentinel healthcare facilities feeding microbiological data from across the country’s geographic zones, yet a new scoping review finds that the resistance information these systems generate is still not reaching the doctors who prescribe antibiotics. The review, published in Discover Public Health, mapped antimicrobial resistance surveillance evidence from Tanzania published between January 2017 and December 2025 and concluded that while the surveillance foundation is real and growing, laboratory capacity, reporting completeness, and the clinical use of surveillance outputs remain highly variable across facilities.

They searched PubMed, PubMed Central, African Journals Online, Google Scholar, grey literature sources, and Tanzanian government repositories, with the final search completed on 15 December 2025. From 1,050 records initially identified, the team screened 760 titles and abstracts, assessed 150 full-text reports, and ultimately included 32 studies and policy documents in the synthesis. Because the evidence was so heterogeneous, spanning surveillance reports, observational studies, point-prevalence surveys, stewardship assessments, and policy documents, the authors did not attempt quantitative pooling or meta-analysis, instead synthesizing the findings narratively.

The headline numbers are sobering. Escherichia coli, one of the most common causes of urinary and bloodstream infections, showed reported resistance to ampicillin reaching as high as 95.8 percent, ceftriaxone resistance of approximately 60 percent, and ciprofloxacin resistance of approximately 69 percent in individual studies and surveillance datasets. Klebsiella pneumoniae fared little better, with reported ceftriaxone resistance of approximately 73 percent and extended-spectrum beta-lactamase, or ESBL, production estimates of around 40 percent. Across the included evidence, reported ESBL production among Enterobacterales ranged from roughly 31 percent to 54 percent, with the higher estimates generally coming from tertiary-care hospital isolates rather than broader surveillance datasets. Carbapenem resistance, by contrast, remained uncommon in the available reports, generally below 5 percent, although the review notes that higher levels have occasionally been described among selected hospital-associated Klebsiella and Acinetobacter isolates.

The temporal picture is equally concerning. In national surveillance datasets with comparable reporting periods, ceftriaxone resistance among E. coli rose from 38.7 percent in 2017 to 57.5 percent in 2023, while resistance among K. pneumoniae climbed from 62 percent to 73.5 percent over the same window. A comparative surveillance study of urinary tract infection pathogens in Mwanza found a statistically significant increase in ESBL-producing Enterobacterales, from 38.7 percent during the implementation period of Tanzania’s first National Action Plan on Antimicrobial Resistance to 56.9 percent afterward, a difference the study reported with a p-value of 0.0307. Ciprofloxacin resistance in the same Mwanza study rose from 32.0 percent to 45.8 percent, with a p-value of 0.0481. These are measured associations from specific surveillance datasets rather than pooled national estimates, and the review’s authors caution that differences in laboratory methods, specimen types, and reporting completeness across facilities may have influenced the observed patterns.

Resistance was not evenly distributed across the health system. Studies from tertiary and referral hospitals reported higher ESBL prevalence, up to 54 percent, while some rural facilities reported estimates of approximately 23 to 27 percent. Multidrug-resistant organisms, defined as isolates non-susceptible to at least one agent in three or more antimicrobial categories, were reported in hospital-based studies with prevalence ranging from 40 to 57 percent, predominantly involving E. coli and K. pneumoniae from urinary tract and bloodstream infections. Methicillin-resistant Staphylococcus aureus, or MRSA, was reported at a prevalence of approximately 29 percent among skin and soft tissue infection isolates, with differences noted between healthcare-associated and community-associated isolates. The review explicitly states that these MDR and MRSA figures represent findings from individual studies and surveillance reports rather than pooled national prevalence estimates.

Perhaps the most striking finding of the review is not about bacteria at all but about the gap between data generation and clinical action. Despite Tanzania’s established surveillance structures, the review reports that only 30 to 40 percent of hospitals consistently implement antimicrobial stewardship activities, and resistance data are not routinely incorporated into empirical prescribing. Facility-specific antibiograms, the local resistance summaries that clinicians are supposed to consult when choosing an initial antibiotic, are of limited availability. A point-prevalence survey at Tanga Regional Referral Hospital, cited in the review, demonstrated high antibiotic utilization among hospitalized patients while microbiological results informed only a minority of prescriptions. The barriers identified include fragmented information systems, limited clinician capacity to interpret antibiograms, inadequate laboratory-clinical integration, and weak stewardship infrastructure.

Tanzania’s surveillance system is aligned with the World Health Organization Global Antimicrobial Resistance and Use Surveillance System and guided by the National Action Plan on AMR 2023-2028. The sentinel facilities contribute routine microbiological data from clinical specimens including urine, blood, wound, and respiratory samples. However, the review found that laboratory capacity varies considerably, with some tertiary hospitals using automated identification and susceptibility testing platforms while others rely on conventional methods, and with differences reported in quality assurance systems, data completeness, and reporting capacity. The available evidence itself originated mainly from sentinel hospitals, tertiary referral facilities, and selected clinical studies, meaning the reported resistance patterns primarily reflect monitored healthcare settings rather than population-level national estimates.

The authors argue that the way forward runs through digital integration and stewardship. They suggest that connecting laboratory information systems, electronic medical records, antimicrobial consumption databases, and national surveillance platforms could improve timely access to resistance intelligence and strengthen surveillance-informed prescribing, though successful implementation would require interoperable systems, reliable laboratory services, effective governance, and integration into routine clinical workflows. Evidence from African healthcare settings cited in the review indicates that stewardship interventions combining prescribing guidelines, audit and feedback, clinician education, pharmacy engagement, and microbiological support can improve antimicrobial use. For Tanzania specifically, the authors propose strengthening collaboration between microbiology laboratories, clinicians, pharmacists, and health information systems, together with wider use of facility-specific antibiograms and digital decision-support tools.

The review has limitations the authors themselves acknowledge. The included studies were heterogeneous in design, populations, laboratory methods, and resistance definitions, which precluded quantitative synthesis. Most evidence came from tertiary and referral hospitals, limiting generalizability to district and community settings. Different studies used different editions of the Clinical and Laboratory Standards Institute interpretive criteria, or did not specify which version they applied, and the review made no attempt to retrospectively reclassify results under a single standard. Limited molecular surveillance data also restricted assessment of resistance mechanisms and transmission dynamics. ESBL estimates were based on phenotypic and, in some cases, molecular detection methods reported by the individual studies, and where confirmatory testing was unavailable, resistance to third-generation cephalosporins was treated only as a presumptive indicator rather than confirmed ESBL positivity.

What the review ultimately documents is a country that has done the hard structural work of building a surveillance system, national coordination, sentinel laboratory networks, and a national action plan, while still struggling with the last mile of translating resistance data into prescribing decisions at the bedside. The authors conclude that strengthening these surveillance-to-action pathways is essential to improve evidence-informed antibiotic use and to support implementation of the National Action Plan on AMR 2023-2028.

Subject of Research: Antimicrobial resistance surveillance and its use in guiding antibiotic therapy and stewardship in Tanzania

Article Title: A scoping review of antimicrobial resistance surveillance and its use in guiding empirical therapy and antimicrobial stewardship in Tanzania

Article References: Kamori, D., Mahiti, M., Majigo, M. V., Kibwana, U. O., Nkinda, L., Mbelele, P., Msafiri, F., Masoud, S. S., Kimera, Z. I., Mugusi, S., Niccodem, E., & Matee, M. I. (2026). A scoping review of antimicrobial resistance surveillance and its use in guiding empirical therapy and antimicrobial stewardship in Tanzania. Discover Public Health, 23(1), Article 1717. https://doi.org/10.1186/s12982-026-03119-y

Image Credits: AI Generated

DOI: 10.1186/s12982-026-03119-y

Keywords: antimicrobial resistance, Tanzania, scoping review, surveillance, antimicrobial stewardship, ESBL, MRSA, E. coli, Klebsiella pneumoniae, antibiograms, empirical therapy, public health