The surveillance of antibiotic resistance in clinical isolates to inform antimicrobial stewardship in Tanzania: a systematic review and meta-analysis

Background Antimicrobial resistance (AMR), particularly antibiotic resistance (AR), is a major global public health concern, with the impact being especially severe in low-resource settings. In Tanzania, the availability of national-level data on AR has remained limited, particularly following COVID-19 pandemic. To address this gap, this study synthesized recent evidence on AR patterns among clinical bacterial isolates from Tanzanian patients to inform antimicrobial stewardship (AMS) and guide national policymaking. Methods This systematic review and meta-analysis were conducted following PRISMA 2020 guidelines and registered in PROSPERO (CRD420251043755). PubMed, Scopus, and Embase were searched for studies published from inception to May 2025. Eligible studies reported antibiotic susceptibility testing (AST) results from clinical specimens collected in Tanzania between 2021 and 2025. Pooled resistance proportions with 95% confidence intervals (CI), heterogeneity ( I ²), and p-values were calculated using a random-effects model. All statistics were conducted using R software. Results Twelve studies were included; 11 qualified for meta-analysis. Staphylococcus epidermidis (43.37%) and Escherichia coli (38.23%) were the most frequently isolated pathogens. Streptococcus agalactiae had the highest resistance rates among gram-positive bacteria 69% (95% CI: 38–89%, I ²  = 96.9%, p-value = < 0.0001) and Klebsiella pneumoniae among gram-negatives 57% (95% CI: 42–71%, I ²  = 74.1%, p-value = < 0.0001). Penicillin showed the highest pooled resistance at 91% (95% CI: 78% − 97%, I² = 76.5%; p = 0.0052). The lowest resistance was observed for vancomycin (3%; 95% CI: 0–20%; I² = 0%; p = 0.9071), nitrofurantoin (6%; 95% CI: 3–11%; I² = 1.8%; p = < 0.0001), and meropenem (5%; 95% CI: 2–12%; I² = 52.3%; p = 0.0094). Neonates exhibited high resistance to ampicillin (83%; 95% CI: 47–97%; I² = 91%; p = < 0.0001) and gentamicin (53%; 95% CI: 44–62%; I² = 19.8%; p = 0.2889). Conclusion This study demonstrates a high burden of antibiotic resistance in Tanzania, with resistance proportions exceeding 50% in nearly 40% of the antibiotics analysed. The widespread resistance in community-acquired pathogens and first-line treatments, especially among neonates, reflects a critical threat to clinical effectiveness. These findings highlight the urgent need for localized surveillance and data-driven AMS initiatives.