Challenges Facing PICUs in Low- and Middle-Income Countries in the Treatment of Emerging Multidrug-Resistant Organisms: a Review and Perspective from a South African PICU

Abstract

Purpose of Review Antimicrobial resistance continues to increase throughout the world, with the impact on critically ill children in low- and middle-income paediatric intensive care units largely unknown. Recent Findings There has been a global shift indicating a predominance of Gram-negative bacilli among multidrug-resistant isolates. A 4-year review (2019 to 2022) found a progressive and substantial increase in the incidence of carbapenem-resistant Klebsiella pneumoniae (29% to 51%) alongside high levels of carbapenem-resistant Acinetobacter baumannii (93%) within the paediatric intensive care unit at the Chris Hani Baragwanath Academic Hospital in South Africa. The pharmacological treatment of these infections relies heavily on the continued use of carbapenems, often in combination with colistin. Summary The burden of antimicrobial resistance is disproportionately borne, particularly within sub-Saharan Africa and South Asia. The resource-constrained South African public healthcare system, already significantly burdened by both HIV and TB, continues to face several challenges in combating the growth in antimicrobial resistance. Limited access, largely driven by prohibitive costs, to sophisticated laboratory techniques and newer pharmacological agents, leaves the implementation of effective infection prevention and control and antimicrobial stewardship programmes as the most pragmatic options to address the problem.

Hospital Wastes as Potential Sources for Multi-Drug-Resistant ESBL-Producing Bacteria at a Tertiary Hospital in Ethiopia

“…The resistance spectrum of identified bacterial strains, as well as the detected resistanceencoding genes, was found to be similar to those observed in clinical samples from the same area [17]. This highlights the potential risk of transmission and the challenges in treating patients who acquire infections caused by these MDR bacteria transmitted through the hospital environment [17,34,35]. Of particular concern is the presence of the acquired blaNDM gene in this study, which encodes the New Delhi metallo-beta-lactamase and confers resistance to many beta-lactam antibiotics, including carbapenems, the last-resort antibiotics used to treat severe MDR bacterial infections [36].…”