Microbial Etiology and Antimicrobial Resistance in Pneumonia Among Hospitalized Patients in Kazakhstan: A Systematic Review and Single‐Arm Meta‐Analysis of Prevalence Data

ABSTRACT Background and Aims Pneumonia is an inflammatory condition of the lower respiratory tract, commonly caused by infection and associated with substantial morbidity and healthcare utilization. The burden of pneumonia on healthcare is exacerbated by limited data on pathogenic causes and associated antimicrobial resistance (AMR). Here, we conducted a literature review and synthesized data on the microbial causes and AMR in hospitalized pneumonia patients from Kazakhstan. Methods We searched PubMed, Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trials, eLIBRARY, and CyberLeninka for observational studies of hospitalized pneumonia patients reporting microbiologically confirmed pathogen and antimicrobial resistance data from Kazakhstan. Exclusion criteria were unclear pneumonia definitions or absence of pathogen‐specific AMR data. We assessed study quality using the Joanna Briggs Institute checklist and extracted data on microbial prevalence and resistance rates by pathogen‐antibiotic combinations. We synthesized microbial etiology and AMR patterns and performed random‐effects meta‐analysis of prevalence data. Results Nine studies represented 1534 isolates from 1474 inpatients (2008–2022). The most prevalent pathogens were Streptococcus pneumoniae (17.8%), Streptococcus spp. (17.3%), Haemophilus influenzae (12.6%), and Klebsiella pneumoniae (10.7%). Hospital‐acquired pathogens comprised 48% of isolates. Acinetobacter baumannii had the highest resistance, exceeding 70% across major antibiotic classes. Escherichia coli had high resistance to β‐lactams (> 66%) and fluoroquinolones (63%). Pseudomonas aeruginosa had 60% fluoroquinolone and 27% carbapenem resistance. Fluoroquinolone resistance was widespread across multiple pathogens. K. pneumoniae had relatively lower resistance rates. Pathogen distribution varied by clinical setting and patient population. Conclusion Data on the etiologic causes and AMR in pneumonia are sparse in Kazakhstan and methodologically heterogeneous. Hospital‐acquired pneumonia pathogens were highly prevalent and associated with high AMR rates. These findings underscore the need for improved pathogen surveillance and antimicrobial stewardship in Kazakhstan to address the high burden of antibiotic‐resistant and hospital‐acquired pneumonia.