DOI: 10.25934/pr00009035
title: Data Challenge: Long term trends in antimicrobial susceptibility to therapeutic options for carbapenem-resistant A. baumannii, K. pneumoniae and P. aeruginosa in Africa

description: Antimicrobial resistance (AMR) is a global challenge. In Africa, it is further aggravated by limited financial resources, indiscriminate antimicrobial use, patchy AMR surveillance systems, poor regulatory systems and failing infrastructure for clean water, sanitation and hygiene, coupled with the massive burden of communicable diseases. The consequences are patent; recent findings showed African regions ranking highest globally in AMR-associated deaths. Robust AMR surveillance systems and effective antimicrobial stewardship programmes are needed urgently to inform antimicrobial choices and improve patient outcomes.

The World Health Organization’s global priority pathogen list identified carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae as critical priorities for development of effective antimicrobials. These pathogens are commonly implicated in hospital-acquired infections (HAI). Multidrug-resistance (MDR) is frequent among these and resistance to the newer generation beta-lactam/beta-lactamase inhibitor (BL/BLI) combinations, such as ceftazidime-avibactam, meropenem-vaborbactam, ceftolozane-tazobactam, aztreonam-avibactam and ampicillin-sulbactam, is emerging. 

Antimicrobial access in Africa is inconsistent, with most regions constrained by financial, logistical or administrative factors. Given the aforementioned challenges in healthcare provision and the predominance of Gram negative pathogens in HAI in Africa, it is imperative that hospitalised patients can access appropriate therapy equitably. The newer generation BL/BLIs are largely inaccessible at present, with alternative agents such as cefepime, colistin, tigecycline, meropenem, imipenem, amikacin and gentamicin being relied upon. Knowledge of resistance patterns (including for those agents not yet in use in Africa) will direct appropriate use of these agents to optimise patient outcomes while preserving their future activity, and serve as a catalyst for access advocacy.

This study aims to describe long-term resistance trends, phenotypically and genotypically where available,      in A. baumannii, P. aeruginosa and K.  pneumoniae isolates from Africa for the following antimicrobials used to treat MDR Gram negative infections: ceftazidime-avibactam, meropenem-vaborbactam, ceftolozane-tazobactam, ampicillin-sulbactam, aztreonam-avibactam, cefepime, colistin, tigecycline, meropenem, imipenem, amikacin and gentamicin.

This data will be contextualised by country-specific information on antimicrobial access (using data from Y. Ramsamy’s collaborators). A subgroup analysis will be performed for selected specimen types in each country/region to facilitate pragmatic use of this data in guiding empirical therapy recommendations.

The findings of this study may be compared with similar data from developed settings in future studies to delineate differences between regions, to highlight inequalities in access or laboratory capability and to draw attention to the need for globally applicable solutions in the era of escalating AMR.