Cancer patients in Rwanda face frequent multidrug-resistant bacterial infections

Multidrug resistance was common among bacterial infections in cancer patients treated at a tertiary referral hospital in Kigali, Rwanda, according to a retrospective records study covering 2019–2024. Researchers analyzed 297 culture-confirmed infection episodes in 286 patients and found that 138 of 214 bacterial isolates classifiable under the study’s resistance definitions, or 64.5%, were resistant to antibiotics in at least three classes. The estimate was 59.5% when the denominator included the 232 isolates covered by the multidrug-resistance criteria, corresponding to a 95% confidence interval of 53.1–65.6%.

The study, conducted at King Faisal Hospital, focused on routine clinical microbiology records rather than prospectively following patients. Urinary tract infections were the predominant reason for culture-confirmed infection, accounting for 172 of 297 episodes, or 57.9%. Escherichia coli was the most frequently identified organism, appearing in 101 episodes, followed by Klebsiella species in 32 and Enterococcus species in 25. Members of the ESKAPEE group of pathogens accounted for 201 episodes, or 67.7%. Resistance patterns also limited the activity of commonly used empirical agents: ceftriaxone resistance was detected in 65 of 87 E. coli isolates, or 74.7%, and in 20 of 29 Klebsiella isolates, or 69.0%. Among 13 Acinetobacter isolates for which carbapenem results could be assessed, eight, or 61.5%, were carbapenem resistant.

Modified Poisson regression found that multidrug-resistance prevalence did not differ significantly by infection type when bloodstream infections and skin and soft-tissue infections were each compared with urinary tract infections. The adjusted prevalence ratio was 0.94 for bloodstream infection, with a 95% confidence interval of 0.67–1.31, and 0.98 for skin and soft-tissue infection, with an interval of 0.72–1.34. Multidrug resistance was less prevalent among gram-positive isolates than among the comparison group, with an adjusted prevalence ratio of 0.42 and a 95% confidence interval of 0.21–0.85; the authors attributed this pattern to Enterococcus species. The observational design, incomplete routine susceptibility panels and restriction to a single tertiary hospital limit how broadly the findings can be applied.

The analysis also examined empirical antibiotic regimens recorded in the electronic medical record for 105 episodes, including 100 involving inpatients. These records were assessed against the World Health Organization AWaRe framework and Rwanda’s 2022 Standard Treatment Guidelines. Adherence to the national guideline was particularly low for urinary tract infections: only one of 43 eligible regimens, or 2.3%, matched the recommended treatment. Ceftriaxone was the most frequently documented empirical agent, but the laboratory findings indicated limited in vitro activity against the organisms most commonly recovered. Outpatient empirical prescribing was rarely documented, preventing its evaluation and limiting assessment of prescribing practices outside the inpatient setting.

The findings indicate a need to examine whether oncology-specific empirical protocols based on local susceptibility data could improve infection management in Rwanda, but the researchers said such protocols should be evaluated prospectively and include clinical outcomes. They also called for AWaRe-aligned stewardship, stronger documentation of antibiotic prescribing, particularly for outpatients, and better linkage of cancer-ward data with national antimicrobial-resistance surveillance. The study does not establish that a particular antibiotic regimen improves patient outcomes, nor does it demonstrate that the recorded prescribing practices caused resistance. Instead, it documents a local mismatch between empirical treatment, national recommendations and the susceptibility patterns observed in a vulnerable hospital population.

Subject of Research: Antimicrobial resistance and empirical antibiotic prescribing in cancer patients with culture-confirmed infections in Rwanda

Article Title: Antimicrobial resistance and documented empirical antibiotic prescribing among cancer patients with culture-confirmed infections at a tertiary referral hospital in Rwanda, 2019–2024

Article References: Asuman, B. N., Dukundane, D., Kreuger, M. J., Ganal, S., Stete, K., Grundmann, H., & Eichel, V. M. (2026). Antimicrobial resistance and documented empirical antibiotic prescribing among cancer patients with culture-confirmed infections at a tertiary referral hospital in Rwanda, 2019–2024. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14689-2

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14689-2

Keywords: antimicrobial resistance, cancer patients, Rwanda, antibiotic prescribing, multidrug resistance, Escherichia coli, ceftriaxone, urinary tract infections, hospital surveillance, antibiotic stewardship, Antimicrobial, resistance