Assessing phenotypic resistance of HAI and their association with patient outcomes in Ghana, Kenya, Malawi and Uganda

Globally, antimicrobial resistance(AMR) is a public health threat responsible for an estimated 1.27 million deaths annually and is associated with nearly 5 million deaths. Drug-resistant healthcare associated infections(HAI) are a growing threat and have been reported to compromise both patient safety and health system performance particularly in sub-Saharan Africa where diagnostic services, surveillance capacity and infection prevention and control remain limited. This multi-site study in Ghana, Kenya, Malawi and Uganda aims to generate critical evidence on the phenotypic resistance patterns of HAI pathogens and their association with patient outcomes including mortality, length of hospital stay, treatment failure and healthcare costs. Recent studies have demonstrated that drug-resistant HAIs are associated with worse clinical outcomes, prolonged hospitalization, increased healthcare expenditure and higher mortality compared to most community acquired infection. The study seeks to estimate antimicrobial resistance rates in healthcare-associated infections (HAIs) and assess their impact on patient outcomes, including duration of hospitalization, treatment response and mortality among hospitalized patients. Our findings will inform patient management by providing clinicians with locally relevant resistance data to guide empiric and targeted antimicrobial therapy. Timely access to resistance profiles can reduce inappropriate antibiotic use, improve treatment success and decrease the risk of adverse outcomes. Furthermore, understanding the relationship between resistance patterns and patient outcomes will help identify high-risk pathogens and patient groups requiring enhanced clinical management. From a public health perspective, the study will contribute valuable surveillance data on AMR. The multi-country evidence generated will support national AMR action plans, infection prevention and control strategies and regional policy development. By strengthening laboratory surveillance, data-driven decision-making and stewardship capacity this research will enhance health system resilience and support more effective responses to the growing burden of AMR and HAIs across Africa.