Antimicrobial resistance in the Pacific Island countries and territories

Abstract

Antimicrobial resistance (AMR) is a critical global health threat with a disproportionate impact on low-income and middle-income countries (LMICs) due to their higher burden of infections, reduced laboratory surveillance infrastructure and fewer regulations governing antimicrobial use among humans or animals. While there have been increasing descriptions of AMR within many LMICs in WHO’s Western Pacific and South East Asian regions, there remains a paucity of data from Pacific Island countries and territories (PICTs). The PICTs represent 22 predominantly middle-income countries and territories with a combined population of 12 million people and 20 official languages, spread over hundreds of separate islands spanning an area corresponding to more than 15% of the earth’s surface. Our paper outlines the present state of the evidence regarding AMR in PICTs—discussing the present estimates of AMR and their accompanying limitations, important drivers of AMR, as well as outlining key priorities and potential solutions for tackling AMR in this region. Significant areas for action include developing National Action Plans, strengthening laboratory surveillance systems and educational activities targeted at both healthcare workers and the wider community. Ensuring adequate funding for AMR activities in PICTs is challenging given competing health and environmental priorities, in this context global or regional funding initiatives such as the Fleming Fund can play a key role.

Gram-negative neonatal sepsis in low- and lower-middle-income countries and WHO empirical antibiotic recommendations: A systematic review and meta-analysis

“…Yet there are no published data available from many countries in this region to help us understand the infectious aetiology of neonatal sepsis. Recent reviews from Pacific Island countries and territories confirm the presence of MDR organisms in the region [ 112 ], but the capacity for structured AMR surveillance and reporting is limited, which leads to challenges in interpretation of the findings [ 113 ]. It has been previously noted that systematic reviews aiming to include evidence from LMICs face challenges in accessing non-English literature and require searches of less well-known regional databases, particularly for grey literature [ 114 ].…”

Antimicrobial resistance management in Pacific Island countries: Current status, challenges, and strategic solutions

“…This could cause an annual shortfall of $US3.4 trillion by 2030 [9]. Ordinarily, AMR is discussed as a threat to human health; it is, however, a complex problem associated with livestock and environmental health [39]. AMR emerged because of the bacterial exposure to antibiotics in medicine, crop production, households, and farms.…”

Strategies Used for Implementing and Promoting Adherence to Antibiotic Guidelines in Low- and Lower-Middle-Income Countries: A Systematic Review

“…Guided by the World Health Organization (WHO), LLMICs have been developing NAPs, but progress on implementation has been slow. LLMICs are hindered by insufficient resources, weaker health systems, limited access to reliable antibiotic susceptibility testing and guidance on appropriate antibiotic use and, lack awareness of AMR [ 3 , 4 ]. Thus, whilst the need to develop NAPs to preserve the effectiveness of antibiotics is paramount, it is challenging in LLMICs.…”

“…An ASP is defined as an organisation-wide strategy to promote appropriate use of antimicrobials through the implementation of evidence-based interventions [ 5 ]. Guidelines and standards underpin ASPs and LLMICs are developing and implementing clinical guidelines (CGs), albeit slowly [ 4 , 6 ]. Clinical guidelines are defined as “statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options” [ 7 ].…”