Antimicrobial Resistance in Uganda and the Urgent Need for Standardized Reporting and a National Surveillance Program
Year: 2015
Type: article
Study design: Observational Study
Abstract: Background. Antimicrobial resistance (AMR) has become an increasing concern worldwide. Despite the high burden of infectious diseases in sub-Saharan Africa, there is a paucity of data on local AMR patterns due to lack of surveillance, routine culture, and susceptibility testing, as well as widespread empiric antimicrobial therapy. Our aim was to determine the prevalent AMR patterns among culture isolates at Mulago National Referral Hospital and the Makerere Microbiology Laboratory. Methods. Positive blood culture isolates from children and adults from microbiology laboratories at Makerere University (n = 346) and Mulago Hospital (n = 117) were summarized into an antibiogram from June 2013 to October 2014. Antibiotic susceptibility testing of positive cultures was performed according to CLSI guidelines. Isolates were categorized as “sensitive,” “intermediate,” and “resistant” based on disc diffusion diameter cut-off points. Results. A total of 463 positive blood cultures were isolated from 215 children and 219 adults. Many of the samples from Makerere were from research studies rather than routine testing. Sex distribution was relatively equal (males 56%). The most common pathogens isolated were coagulase-negative Staphylococcus (n = 108), Staphylococcus aureus (n = 128), Echerichia coli (n = 47), and Klebsiella pneumonia (n = 36), and other Enterobacteriae (n = 17). Of S. aureus, 38% were methicillin-resistant. E. coli was susceptible to ceftriaxone 33%, ciprofloxacin 39%, chloramphenicol 56%, piperacillin/tazobactam 80%, and imipenem 81%. Klebsiella pneumoniae was susceptible to ceftriaxone 15%, ciprofloxacin 23%, piperacillin/tazobactam 64%, and imipenem 80%. Susceptibility testing was not always performed. Conclusion. Significant proportions of AMR exist in bacterial isolates identified in Kampala, Uganda and are consistent over time when compared to data from 2011 to 2012. Cost of testing, supply shortage, inability to confirm certain species (e.g. Acinetobacter) as pathogenic or contamination, and differentiation of community versus hospital-acquired infections remain significant challenges. Systematic surveillance, microbiology laboratory strengthening, and standardized reporting in resource-limited settings will inform policy guidelines for the rationale use of antimicrobials in SSA. Disclosures. All authors: No reported disclosures.
Source: Open Forum Infectious Diseases
Language: English
Subfield: Applied Microbiology and Biotechnology
Field: Immunology and Microbiology
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2276831367