BACKGROUND:
Antimicrobial resistance (AMR) poses a serious threat to public health, especially in low-resource settings where surveillance infrastructure is limited. In 2024, Mwanza District Hospital in south-west Malawi initiated an internal AMR surveillance program without external financial or technical support. This abstract shares the hospital’s experience in establishing and sustaining the program over its first year.

METHODS:
From April 2024 to March 2025, the hospital laboratory implemented culture and antimicrobial susceptibility testing (AST) for all indicated clinical specimens. Testing was conducted according to EUCAST standards, with data captured using Microsoft Excel software. An internal AMR/AMS committee was formed to oversee data review, stewardship interventions, and staff capacity building. All laboratory and clinical staff received internal orientation on sample collection, processing, and rational antibiotic use.

RESULTS:
A total of 99 samples were cultured, with 36 (36.3%) yielding significant bacterial growth. The predominant isolates were Pseudomonas aeruginosa (8%), Staphylococcus aureus (28%), Citrobacter freundii (11%), and Escherichia coli (14%). Resistance to first-line antibiotics was alarmingly high: Ampicillin (58%) and Sulfonamide-trimethoprim (58%). However, susceptibility remained relatively high for Amikacin (100%). Morning handover meetings enhanced clinician engagement and improved prescription practices. Despite the lack of external support, data completeness and quality were maintained at over 85%.

CONCLUSIONS:
The Mwanza District Hospital experience shows that district-level AMR surveillance is achievable with local leadership, internal resource mobilisation, and teamwork. The generated data informed local treatment guidelines, strengthened stewardship, and demonstrated a scalable model for other Malawian districts.