Attributable mortality and excess length of stay associated with third-generation cephalosporin-resistant Enterobacterales bloodstream infections: a prospective cohort study in Suva, Fiji

Molecular and clinical epidemiology of carbapenem resistant Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacterales in Fiji: a multicentre prospective observational study

“…78 Despite this, we identified a troubling trend in the management of CROs across Fiji's major hospitals. 16 , 18 , 19 Specifically, we discovered continued inappropriate use of meropenem, a finding consistent with what we observed at the CWMH in 2019. 16 Furthermore, few patients were treated with colistin.…”

“…Patients with AMR infections have higher case fatality ratio than those infected with susucpetible organims. 1 , 18 Fiji's 30-day case fatality ratio for those with CR Ab infection (26.7%) was higher than China (16.7%) 101 but lower than USA (32.2%). 102 As for CR Pa , it (18.9%) was higher than combined data from Australia and Singapore (11%), and China (7%), 77 but lower than South and Central America (27%).…”

“…While previous reports have offered valuable insights into AMR, shedding light on issues such as the high prevalence of AMR, unrecognised nosocomial outbreaks, and the high case fatality ratios associated with AMR in Fiji, they have primarily focused on CWMH. 16 , 17 , 18 , 19 , 20 This single facility focus has prevented assessment of the movement of strains between facilities in the country's wider healthcare landscape. To address this, we undertook a molecular epidemiologic and phylogenetic study of CR Ab , CR Pa , CR Ec , and CR Kp strains collected from the three major hospitals in Fiji, and CR Ab strains isolated from Fiji patients admitted to New Zealand hospitals.…”

Antimicrobial susceptibility of bacterial isolates from clinical specimens in four Pacific Island countries, 2017–2021

“…One recent study from Fiji reported that CTX-M-15 and OXA-1 were the most frequently identified resistance genes among E. coli and K. pneumoniae , however this was based on a subset of 61 isolates. 29 We note with concern that for many PICTs, susceptibility to the oral agents amoxicillin + clavulanate and sulfamethoxazole + trimethoprim was close to 50%, with implications for local antibiotic guidelines especially for management of abdominal and urinary infections in the community. Finally, meropenem-resistance among E. coli and K. pneumoniae appeared to be very infrequent: despite a selective testing strategy (that can inflate the reported proportion of resistance), most PICTs had susceptibility at or close to 100%.…”

“…These are comparable to results among bloodstream isolates in Australia (87% among E. coli , and 91% among K. pneumoniae ) 22 and hospitalised patients in the United States (87% among all Enterobacterales), 28 however much higher than the 60% susceptibility recently reported among 162 consecutive Enterobacterales bloodstream isolates in Fiji. 29 Ceftriaxone resistance among Enterobacterales is often mediated by ESBL production, and such organisms have been labelled a ‘Critical’ Priority Pathogen for AMR research by the WHO. 11 Unfortunately, our understanding of the primary mechanisms of ceftriaxone resistance in PICTs is limited by a paucity of sequencing data.…”