Abstract
BackgroundTo combat antimicrobial resistance, the World Health Organization developed a global priority pathogen list of antibiotic-resistant bacteria for prioritisation of research and development of new, effective antibiotics.ObjectiveThis study describes a five-year resistance trend analysis of the ESKAPE pathogens: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp., from Kwazulu-Natal, South Africa.MethodsThis retrospective study used National Health Laboratory Services data on 64 502 ESKAPE organisms isolated between 2011 and 2015. Susceptibility trends were ascertained from minimum inhibitory concentrations and interpreted using Clinical and Laboratory Standards Institute guidelines.ResultsS. aureus was most frequently isolated (n = 24, 495, 38%), followed by K. pneumoniae (n = 14, 282, 22%). Decreasing rates of methicillin-resistant S. aureus (28% to 18%, p < 0.001) and increasing rates of extended spectrum beta-lactamase producing K. pneumoniae (54% to 65% p < 0.001) were observed. Carbapenem resistance among K. pneumoniae and Enterobacter spp. was less than 6% during 2011–2014, but increased from 4% in 2014 to 16% in 2015 (p < 0.001) among K. pneumoniae. P. aeruginosa increased (p = 0.002), but resistance to anti-pseudomonal antimicrobials decreased from 2013 to 2015. High rates of multi-drug resistance were observed in A. baumanni (> 70%).ConclusionThis study describes the magnitude of antimicrobial resistance in KwaZulu-Natal and provides a South African perspective on antimicrobial resistance in the global priority pathogen list, signalling the need for initiation or enhancement of antimicrobial stewardship and infection control measures locally.
Highlights
The burden of multi-drug resistant (MDR) bacteria has increased substantially worldwide[1] and infections caused by these organisms continue to pose a great challenge to public health systems and populations at large
A request was made to the World Health Organization (WHO) by member states in 2017 to develop a global priority pathogen list (PPL) of antibiotic-resistant bacteria to help in prioritising the research and development of new and effective antibiotic treatments.[3]
This study provides the largest data set of the ESKAPE pathogens gathered from adults and children who presented to the largest public service hospitals in KwaZulu-Natal, South Africa, over a five-year period
Summary
The burden of multi-drug resistant (MDR) bacteria has increased substantially worldwide[1] and infections caused by these organisms continue to pose a great challenge to public health systems and populations at large. There is no formal framework for collaboration among surveillance programmes in the region.[1] A request was made to the World Health Organization (WHO) by member states in 2017 to develop a global priority pathogen list (PPL) of antibiotic-resistant bacteria to help in prioritising the research and development of new and effective antibiotic treatments.[3] Due to the high prevalence of multidrug resistance among ESKAPE bacteria, defined by the Infectious Diseases Society of America as Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp., these pathogens feature prominently in the global PPL of antibiotic-resistant bacteria and are the focus of this article. The World Health Organization developed a global priority pathogen list of antibiotic-resistant bacteria for prioritisation of research and development of new, effective antibiotics
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