Abstract
Several studies have investigated antimicrobial resistance in low- and middle-income countries, but to date little attention has been paid to the Pacific Islands Countries and Territories (PICTs). This study aims to review the literature on antibiotic resistance (ABR) in healthcare settings in PICTs to inform further research and future policy development for the region. Following the PRISMA-ScR checklist health databases and grey literature sources were searched. Three reviewers independently screened the literature for inclusion, data was extracted using a charting tool and the results were described and synthesised. Sixty-five studies about ABR in PICTs were identified and these are primarily about New Caledonia, Fiji and Papua New Guinea. Ten PICTs contributed the remaining 21 studies and nine PICTs were not represented. The predominant gram-positive pathogen reported was community-acquired methicillin resistant S. aureus and the rates of resistance ranged widely (>50% to <20%). Resistance reported in gram-negative pathogens was mainly associated with healthcare-associated infections (HCAIs). Extended spectrum beta-lactamase (ESBL) producing K. pneumoniae isolates were reported in New Caledonia (3.4%) and Fiji (22%) and carbapenem resistant A. baumannii (CR-ab) isolates in the French Territories (24.8%). ABR is a problem in the PICTs, but the epidemiology requires further characterisation. Action on strengthening surveillance in PICTs needs to be prioritised so strategies to contain ABR can be fully realised.
Highlights
The prevention and treatment of infectious diseases is increasingly being challenged by the growing spread of antimicrobial resistance (AMR) [1]
The Pacific Islands Countries and Territories (PICTs) included in this scoping study are the 22 low- and middle-income country members of the Secretariat of the Pacific Community: Cook Islands, Federated States of Micronesia (FSM), Fiji, French Polynesia, Guam, Kiribati, Marshall Islands, Nauru, New Caledonia, Niue, Northern Mariana Islands, Palau, Pitcairn Islands, Papua New Guinea (PNG), Samoa, American
Kiribati, Marshall Islands, Micronesia, PNG, Samoa, Solomon Islands and Tonga were all mentioned in the eight studies which included multiple PICTs
Summary
The prevention and treatment of infectious diseases is increasingly being challenged by the growing spread of antimicrobial resistance (AMR) [1]. If AMR is not contained, experts estimate the excess mortality rate will rise to 10 million deaths per year by 2050 [3], with nearly half of these occurring in the Asia Pacific region [4]. In 2015, WHO WPRO undertook a situational review of surveillance and health systems response to AMR in the region [7]. Their findings indicated wide variation amongst countries with respect to AMR, including the capacity to participate in regional surveillance networks; regulations around the purchase and use of antimicrobial agents; support provided by health systems in the containment of AMR; and in their understanding and awareness of AMR [6,7]
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