Implementation of a standardised and quality-assured enhanced gonococcal antimicrobial surveillance programme in accordance with WHO protocols in Kampala, Uganda

Kakooza, Francis; Musinguzi, Patrick; Workneh, Meklit; Walwema, Richard; Kyambadde, Peter; Mande, Emmanuel; Lubega, Christopher; Nakasi, Jhamira M; Kiggundu, Reuben; Hamill, Matthew M; Bagaya, Bernard S.; Lamorde, Mohammed; Unemo, Magnus; Manabe, Yukari C.

doi:10.1136/sextrans-2020-054581

Cited by 20 publications

(19 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Overall, 12 (19%) countries in five WHO regions reported more than 90% resistance to ciprofloxacin: Bhutan, Cambodia, Ecuador, India, South Korea, Madagascar, Pakistan, Peru, Saudi Arabia, Thailand, Tunisia, and Uganda. 13 4).…”

Section: Resistance (%)mentioning

confidence: 99%

“…No isolates with decreased susceptibility or resistance to cefixime were detected in Côte d'Ivoire, Kenya, or South Africa; however, less than 5% of isolates with decreased susceptibility or resistance were reported in Uganda (0•3% [1/340]; figure 2). 13 In 2018, five (24%) of 21 countries in the WHO Eastern Mediterranean region reported data on ceftriaxone for For El Salvador and Tunisia, data are from 2017 (no data reported in 2018). Due to the low number of isolates in several countries (appendix pp 1-3), interpretations of antimicrobial resistance levels in these countries should be done with great caution.…”

Section: Resistance (%)mentioning

confidence: 99%

“…Côte d'Ivoire, Madagascar, Uganda, 13 or South Africa (figure 3). Notably, less than 5% resistance was reported in Côte d'Ivoire in 2016 (2•0%).…”

Section: Resistance (%)mentioning

confidence: 99%

See 2 more Smart Citations

WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017–18: a retrospective observational study

Unemo

Lahra

Escher³

et al. 2021

The Lancet Microbe

Self Cite

176

138

View full text Add to dashboard Cite

Background Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major health concerns globally. Increased global surveillance of gonococcal AMR is essential. We aimed to describe the 2017-18 data from WHO's global gonococcal AMR surveillance, and to discuss priorities essential for the effective management and control of gonorrhoea. MethodsWe did a retrospective observational study of the AMR data of gonococcal isolates reported to WHO by 73 countries in 2017-18. WHO recommends that each country collects at least 100 gonococcal isolates per year, and that quantitative methods to determine the minimum inhibitory concentration of antimicrobials, interpreted by internationally standardised resistance breakpoints, are used. FindingsIn 2017-18, 73 countries provided AMR data for one or more drug. Decreased susceptibility or resistance to ceftriaxone was reported by 21 (31%) of 68 reporting countries and to cefixime by 24 (47%) of 51 reporting countries. Resistance to azithromycin was reported by 51 (84%) of 61 reporting countries and to ciprofloxacin by all 70 (100%) reporting countries. The annual proportion of decreased susceptibility or resistance across countries was 0-21% to ceftriaxone and 0-22% to cefixime, and that of resistance was 0-60% to azithromycin and 0-100% to ciprofloxacin. The number of countries reporting gonococcal AMR and resistant isolates, and the number of examined isolates, have increased since 2015-16. Surveillance remains scarce in central America and the Caribbean and eastern Europe, and in the WHO African, Eastern Mediterranean, and South-East Asian regions.Interpretation In many countries, ciprofloxacin resistance was exceedingly high, azithromycin resistance was increasing, and decreased susceptibility or resistance to ceftriaxone and cefixime continued to emerge. WHO's global surveillance of gonococcal AMR needs to expand internationally to provide imperative data for national and international management guidelines and public health policies. Improved prevention, early diagnosis, treatment of index patients and partners, enhanced surveillance (eg, infection, AMR, treatment failures, and antimicrobial use or misuse), and increased knowledge on antimicrobial selection, stewardship, and pharmacokinetics or pharmacodynamics are essential. The development of rapid, accurate, and affordable point-of-care gonococcal diagnostic tests, new antimicrobials, and gonococcal vaccines is imperative.

show abstract

Section: Resistance (%)mentioning

confidence: 99%

Section: Resistance (%)mentioning

confidence: 99%

See 1 more Smart Citation

WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017–18: a retrospective observational study

Unemo

Lahra

Escher³

et al. 2021

The Lancet Microbe

Self Cite

176

138

View full text Add to dashboard Cite

show abstract

“…Data pertaining to AMR in M. genitalium from Africa are beginning to emerge but have been largely limited to South Africa, where low levels (0 to 1.1%) of azithromycin resistance have been reported ( 22 – 24 ). Considering the high levels of antimicrobial-resistant gonorrhea in Uganda ( 25 , 26 ), understanding the epidemiology and AMR profile of M. genitalium infections is critical to help shape treatment guidelines, which have not been defined for M. genitalium infections in Uganda ( 27 ).…”

Section: Introductionmentioning

confidence: 99%

Retrospective Analysis of Ugandan Men with Urethritis Reveals Mycoplasma genitalium and Associated Macrolide Resistance

et al. 2022

Self Cite

View full text Add to dashboard Cite

Mycoplasma genitalium is a common sexually transmitted infection associated with urethritis in men. Little is known about M. genitalium infection in men with urethritis in Uganda. We report that 12% of participants in this study were positive for M. genitalium and that resistance to azithromycin, a macrolide antibiotic, is present. Furthermore, we show that either self-collected penile-meatal swabs or urine can be used for detection of M. genitalium .

show abstract

“…Notably, through an ongoing sentinel surveillance program, microbiology capacity has been enhanced in selected RRHs that contribute significantly toward bacterial ID and antimicrobial susceptibility testing (AST) in Uganda [9]. In addition, Uganda is among the few African countries that have adopted and established a quality-assured World Health Organization (WHO) Enhanced Gonococcal Antimicrobial Surveillance Program and reported data locally and globally [10,11].…”

Section: Introductionmentioning

confidence: 99%

Implementation of the World Health Organization Global Antimicrobial Resistance Surveillance System in Uganda, 2015-2020: Mixed-Methods Study Using National Surveillance Data

Nabadda¹,

Kakooza²,

Kiggundu³

et al. 2021

JMIR Public Health Surveill

Self Cite

View full text Add to dashboard Cite

Background Antimicrobial resistance (AMR) is an emerging public health crisis in Uganda. The World Health Organization (WHO) Global Action Plan recommends that countries should develop and implement National Action Plans for AMR. We describe the establishment of the national AMR program in Uganda and present the early microbial sensitivity results from the program. Objective The aim of this study is to describe a national surveillance program that was developed to perform the systematic and continuous collection, analysis, and interpretation of AMR data. Methods A systematic qualitative description of the process and progress made in the establishment of the national AMR program is provided, detailing the progress made from 2015 to 2020. This is followed by a report of the findings of the isolates that were collected from AMR surveillance sites. Identification and antimicrobial susceptibility testing (AST) of the bacterial isolates were performed using standard methods at both the surveillance sites and the reference laboratory. Results Remarkable progress has been achieved in the establishment of the national AMR program, which is guided by the WHO Global Laboratory AMR Surveillance System (GLASS) in Uganda. A functional national coordinating center for AMR has been established with a supporting designated reference laboratory. WHONET software for AMR data management has been installed in the surveillance sites and laboratory staff trained on data quality assurance. Uganda has progressively submitted data to the WHO GLASS reporting system. Of the 19,216 isolates from WHO GLASS priority specimens collected from October 2015 to June 2020, 22.95% (n=4411) had community-acquired infections, 9.46% (n=1818) had hospital-acquired infections, and 68.57% (n=12,987) had infections of unknown origin. The highest proportion of the specimens was blood (12,398/19,216, 64.52%), followed by urine (5278/19,216, 27.47%) and stool (1266/19,216, 6.59%), whereas the lowest proportion was urogenital swabs (274/19,216, 1.4%). The mean age was 19.1 (SD 19.8 years), whereas the median age was 13 years (IQR 28). Approximately 49.13% (9440/19,216) of the participants were female and 50.51% (9706/19,216) were male. Participants with community-acquired infections were older (mean age 28, SD 18.6 years; median age 26, IQR 20.5 years) than those with hospital-acquired infections (mean age 17.3, SD 20.9 years; median age 8, IQR 26 years). All gram-negative (Escherichia coli, Klebsiella pneumoniae, and Neisseria gonorrhoeae) and gram-positive (Staphylococcus aureus and Enterococcus sp) bacteria with AST showed resistance to each of the tested antibiotics. Conclusions Uganda is the first African country to implement a structured national AMR surveillance program in alignment with the WHO GLASS. The reported AST data indicate very high resistance to the recommended and prescribed antibiotics for treatment of infections. More effort is required regarding quality assurance of laboratory testing methodologies to ensure optimal adherence to WHO GLASS–recommended pathogen-antimicrobial combinations. The current AMR data will inform the development of treatment algorithms and clinical guidelines.

show abstract

Implementation of a standardised and quality-assured enhanced gonococcal antimicrobial surveillance programme in accordance with WHO protocols in Kampala, Uganda

Cited by 20 publications

References 17 publications

WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017–18: a retrospective observational study

WHO global antimicrobial resistance surveillance for Neisseria gonorrhoeae 2017–18: a retrospective observational study

Retrospective Analysis of Ugandan Men with Urethritis Reveals Mycoplasma genitalium and Associated Macrolide Resistance

Implementation of the World Health Organization Global Antimicrobial Resistance Surveillance System in Uganda, 2015-2020: Mixed-Methods Study Using National Surveillance Data

Contact Info

Product

Resources

About