The occurrence of resistance to last-resort antibiotics was evaluated among isolates recovered from hospitalized children in a remote African archipelago, São Tomé and Príncipe, where there is limited access to those antibiotics. Fifty patients were screened for colonization by carbapenem-, pan-aminoglycoside-, or polymyxin-resistant A total of 36 isolates (including 30 and 4) were recovered from 23 patients, including 26 isolates harboring the carbapenemase gene, a single isolate harboring the 16S rRNA methylase gene encoding pan-resistance to aminoglycosides, and 8 isolates coharboring both genes. A single isolate possessed the plasmid-borne colistin resistance gene A high clonal relationship was found for OXA-181-producing (4 clones), and conversely, three of the four OXA-181-producing isolates were clonally unrelated. This study overall showed a high prevalence of resistance to last-resort antibiotics in this country, where no epidemiological data were previously available.