Antimicrobial resistance in Burundi: a silent crisis

Antimicrobial resistance (AMR) represents a critical global health challenge that undermines the effectiveness of treatment for infectious diseases, with profound implications for patient outcomes and public health. This review focuses on AMR in Burundi, a country facing significant hurdles due to its unique socioeconomic and healthcare context. Globally, the World Health Organization estimates around 700 000 deaths annually due to resistant infections. In Africa, including Burundi, up to 70% of bacterial infections are resistant to at least one commonly used antibiotic. In Burundi, rising resistance rates in pathogens such as Escherichia coli and Staphylococcus aureus reflect a broader crisis exacerbated by limited resources, inadequate healthcare infrastructure, and high infectious disease burdens. Contributing factors include inappropriate antibiotic use, such as self-medication and inadequate dosing, alongside systemic issues like weak antimicrobial stewardship and gaps in surveillance. This review critically evaluates the current state of antimicrobial use and resistance in Burundi, identifies underlying drivers of AMR, and proposes evidence-based strategies for addressing the issue. Through a comprehensive analysis of existing literature, national policies, and international guidelines, the review seeks to offer a subtle understanding of the AMR landscape in Burundi. It explores patterns of antimicrobial consumption, resistance prevalence, and contributing factors, as well as the economic and societal impacts of AMR. The findings aim to inform a holistic and interdisciplinary response to mitigate the effects of AMR and improve public health outcomes in Burundi.