Emerging Antibiotic Resistance in Vibrio cholerae: A Study of Cholera Prevalence and Resistance Patterns in Zambia's Copperbelt Province

Introduction Cholera is a severe diarrheal disease caused by the bacterium Vibrio cholerae , typically spread through contaminated water. Cholera remains a significant public health challenge in Zambia, particularly in the Copperbelt Province, where antibiotic-resistant Vibrio cholerae strains are increasingly threatening treatment efficacy. This study aimed to determine the prevalence of cholera and the antibiotic resistance patterns of Vibrio cholerae isolates at three tertiary hospitals in the region. Methods A retrospective cross-sectional study was conducted across three major referral hospitals in the Copperbelt Province (Arthur Davison Children's Hospital, Kitwe Teaching Hospital, and Ndola Teaching Hospital) during the cholera outbreak from January to April 2024. Clinical samples from suspected cholera cases were analysed, and antimicrobial susceptibility testing followed Clinical Laboratory Standards Institute guidelines and the European Committee on Antimicrobial Susceptibility Testing methodology for Vibrio cholerae. To isolate Vibrio cholerae , alkaline peptone water and thiosulfate-citrate-bile salt-sucrose agar were utilized. The isolates were identified based on colony morphology, Gram staining, biochemical testing, and serotyping. Antimicrobial susceptibility testing was conducted by determining the minimum inhibitory concentration using the agar dilution method. Descriptive statistics were employed to assess the prevalence of Vibrio cholerae , and chi-square tests were applied with p-values of < 0.05 indicating statistical significance. Results Of the 892 suspected cases, 334 (37.4%) were confirmed as V. cholerae through culture. The highest number of V. cholerae confirmed cases was recorded at Ndola Teaching Hospital (24.8%), followed by Kitwe Teaching Hospital (9.9%), while Arthur Davison Children’s Hospital (2.8%) reported the lowest. High antimicrobial resistance was observed to ampicillin (98.6%), co-trimoxazole (96.8%) and imipenem (91.5%). In contrast, erythromycin (100%), ceftriaxone (96%) and gentamicin (85.7%) remained highly effective. The most common multidrug-resistant V. cholerae profile showed resistance to four or more antibiotics (14.6%). This was followed by resistance to the combination of ampicillin, ceftazidime, and co-trimoxazole (4.1%) and ampicillin, co-trimoxazole, and imipenem (2%). Conclusion The high prevalence of antibiotic-resistant V. cholerae in the Copperbelt Province highlights the urgent need for enhanced antimicrobial stewardship and surveillance programs to guide cholera treatment. The sustained efficacy of erythromycin and ceftriaxone suggests their potential as first-line treatments, but ongoing resistance monitoring is crucial.