Surveillance strategies using routine microbiology for antimicrobial resistance in low- and middle-income countries

Lim, Cherry; Ashley, Elizabeth A.; Hamers, Raph L; Turner, Paul; Kesteman, Thomas; Akech, Samuel; Corso, Alejandra; Mayxay, Mayfong; Okeke, Iruka N.; Limmathurotsakul, Direk; Doorn, H. Rogier van

doi:10.1016/j.cmi.2021.05.037

Cited by 32 publications

(28 citation statements)

References 67 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Culture underuse may be due to lack of laboratory capacity, cost-prohibitive bacterial culture testing and thresholds of national health insurance coverage, absence of clear culture guidelines, as well as long turnaround time and/or lack of trust in the results. 19 The study has some limitations. First, the reliance on routinely collected culture specimens may have caused overrepresentation of drug-resistant infections, given that a culture may have been preferentially performed on more severe, non-responding and antibiotic-treated patients.…”

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

“…First, the reliance on routinely collected culture specimens may have caused overrepresentation of drug-resistant infections, given that a culture may have been preferentially performed on more severe, non-responding and antibiotic-treated patients. 19 Second, the use of routine data may have caused variations in, for instance, clinical diagnosis, antibiotic indications, and quality and interpretation of culture results. Lastly, the limited hospital sample precludes generalizing the findings to other hospitals or the country.…”

Section: Discussionmentioning

confidence: 99%

“…[53]); 44.6% (33/74) of skin and soft tissue (SST) infection patients (wound 25.7% [19], blood 14.9% [11], pus 13.5% [10]); 51.1% of urinary tract infection (UTI) patients (urine 44.4% [20] and blood 33.3% [15]); and 54.8% (17/31) of sepsis patients (blood 51.6% [16]) (Figure S2).…”

Section: Use and Reporting Of Bacterial Culturesmentioning

confidence: 99%

See 3 more Smart Citations

Bacterial culture use, etiology and antibiotic susceptibility of common bacterial infections in Indonesian hospitals in 2019

Brabander

Nelwan

Limato

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Objectives: To describe the use of bacterial cultures, and the etiology and antibiotic susceptibility of common high-priority bacteria isolated from hospitalized patients in Jakarta, Indonesia. Methods: We conducted a hospital-wide cross-sectional study of all inpatients receiving systemic antibiotic treatment (WHO ATC J01) in six hospitals in 2019, capturing routine data on antibiotic treatment and cultures. We reported bug-drug combinations for Escherichia coli and the ESKAPE group of bacteria. Results: 562 patients (52% women, median age 46 years) had 587 diagnoses, with pneumonia (258, 44%) most common. One or more culture specimens were taken in 38% (215/562) overall, a sputum culture in 25% (64/258) of pneumonia patients; and a blood culture in 52% (16/31) of sepsis patients. 50% of positive blood culture results were reported after ≥4 days. From 670 culture specimens, 279 bacteria were isolated, 214 (77%) were Gram-negative, including Klebsiella pneumoniae (70, 25%), Pseudomonas aeruginosa (36, 13%), and E. coli (21, 11%). Resistance included third-generation cephalosporin-resistant K. pneumoniae (77%), E. coli (65%) and Enterobacter spp (81%); carbapenem-resistant K. pneumoniae (26%), P. aeruginosa (24%), E. coli (33%), Acinetobacter spp (57%), and Enterobacter spp (60%); and meticillin-resistant S. aureus (71%). Vancomycin-resistant S. aureus (0%) and Enterococcus faecalis (12%) were uncommon. Multi-drug resistance was 30% for K. pneumoniae, 29% for P. aeruginosa, 49% for E. coli, 42% for Acinetobacter spp, and 71% for S. aureus. Conclusions: In Indonesian hospitals, bacterial cultures were underused and antibiotic resistance is at alarming levels. Enhanced context-specific infection prevention, diagnostic and antibiotic stewardship interventions are urgently needed.

show abstract

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Use and Reporting Of Bacterial Culturesmentioning

confidence: 99%

See 2 more Smart Citations

Bacterial culture use, etiology and antibiotic susceptibility of common bacterial infections in Indonesian hospitals in 2019

Brabander

Nelwan

Limato

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…AMR surveillance in LMIC is primarily conducted passively, with data obtained from clinical samples [ 17 , 18 ]. However, the use of clinical samples alone for AMR surveillance may misrepresent AMR community carriage rates, due to the underutilisation of diagnostic microbiology services in many LMICs and the fact that bacterial culture is often not performed until after the initial treatment has failed [ 17 , 19 ]. Community transmission is a known risk factor for AMR spread in Southeast Asia [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Gastrointestinal Carriage of Antimicrobial Resistance in School-Aged Children in Three Municipalities of Timor-Leste

Oakley¹,

Conceicao³

et al. 2022

Antibiotics

View full text Add to dashboard Cite

Invasive bacterial infections are a leading cause of death in children, primarily in low- and middle-income countries (LMIC). Links between carriage of antimicrobial-resistant organisms and more resistant infections have been established; however, little has been reported regarding community carriage of antibiotic-resistant organisms such as extended-spectrum β-lactamase (ESBL)-producing Enterobacterales in LMIC. The aim of this study was to determine colonic carriage of ESBL-producing fluoroquinolone- and aminoglycoside-resistant Enterobacterales in healthy children in three municipalities of Timor-Leste. In November 2020, 621 stool samples were collected from school-aged children and underwent screening for the presence of Enterobacterales species and antimicrobial resistance (AMR). Ciprofloxacin-resistant Gram-negative organisms were cultured from 16.5% (95% CI 6.2–26.9), and gentamicin resistance was identified in 6.8% (95% CI 2.8–10.7). Compared to the prevalence of ciprofloxacin resistance in Dili (36.1%), there was significantly lower prevalence in the rural municipalities of Ermera (12.9%; AOR 0.38, 95% CI 0.24–0.60, p < 0.001) and Manufahi (4.5%; AOR 0.07, 95% CI 0.01–0.51, p = 0.009). The overall cluster-adjusted prevalence of ESBL-producing bacteria was 8.3%, with no significant differences between municipalities. This study demonstrates high rates of carriage of AMR among school-aged children in Timor-Leste, with higher rates observed in Dili compared to rural municipalities. Empiric antibiotic guidelines should include recommendations for treating community-acquired infections that account for the possibility of antimicrobial resistance.

show abstract

Implementing the severe community-acquired pneumonia guidelines in low- and middle-income countries

Salluh,

Kawano-Dourado

2023

Intensive Care Med

View full text Add to dashboard Cite

Surveillance strategies using routine microbiology for antimicrobial resistance in low- and middle-income countries

Abstract: Surveillance strategies using routine microbiology for antimicrobial resistance in low and middle-income countries, Clinical Microbiology and Infection,

Cited by 32 publications

References 67 publications

Bacterial culture use, etiology and antibiotic susceptibility of common bacterial infections in Indonesian hospitals in 2019

Bacterial culture use, etiology and antibiotic susceptibility of common bacterial infections in Indonesian hospitals in 2019

Gastrointestinal Carriage of Antimicrobial Resistance in School-Aged Children in Three Municipalities of Timor-Leste

Implementing the severe community-acquired pneumonia guidelines in low- and middle-income countries

Contact Info

Product

Resources

About