Abstract
BackgroundIn 2018 Pakistan initiated its national antimicrobial resistance (AMR) surveillance aligned with Global Antimicrobial Surveillance System (GLASS). To complement this surveillance, we conducted a situational analysis of AMR rates among GLASS organisms in the country. Data from published studies and from antibiograms was compared and role of antibiograms as potential contributors to national AMR surveillance explored.MethodsAMR rates for GLASS specified pathogen/antimicrobials combination from Pakistan were reviewed. Data sources included published studies (2006–2018) providing AMR rates from Pakistan (n = 54) as well as antibiograms (2011–2018) available on the Pakistan Antimicrobial Resistance Network (PARN) website. Resistance rates were categorized as follows: Very low: 0–10%, Low: 11–30%, Moderate: 30–50% and High: > 50%.ResultsPublished data from hospital and community/laboratory-based studies report resistance rates of > 50% and 30–50% respectively to 3rd generation cephalosporins, fluoroquinolones and cotrimoxazole amongst Klebsiella pneumoniae and Escherichia coli. Carbapenem resistance rates amongst these organisms remained below 30%. High (> 50%) resistance was reported in Acinetobacter species to aminoglycosides and carbapenems among hospitalized patients. The evolution of ceftriaxone resistant Salmonella Typhi and Shigella species is reported. The data showed > 50% to fluoroquinolones amongst Neisseria gonorrhoeae and the spread of methicillin resistant Staphylococcus aureus (< 30%; 2008) to (> 50%; 2010) in hospital settings. Resistance reported in published studies aligned well with antibiogram data. The latter also captured a clear picture of evolution of resistance over the study period.ConclusionBoth published studies as well antibiograms suggest high rates of AMR in Pakistan. Antibiogram data demonstrating steady increase in AMR highlight its potential role towards supplementing national AMR surveillance efforts particularly in settings where reach of national surveillance may be limited.
Highlights
In 2018 Pakistan initiated its national antimicrobial resistance (AMR) surveillance aligned with Global Antimicrobial Surveillance System (GLASS)
Review of published literature Literature search was performed for studies reporting antimicrobial susceptibility rates of GLASS specified microorganisms (GLASS) [13]: Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, Salmonella Typhi, Shigella species, Neisseria gonorrhoeae, Staphylococcus aureus and Streptococcus pneumoniae from Pakistan
Based on our findings we propose similar initiatives at a national level offering a central platform for sharing antibiograms, allowing comparison of susceptibility rates at sub-national levels to create opportunities for information sharing, monitoring of AMR, and focused control efforts
Summary
In 2018 Pakistan initiated its national antimicrobial resistance (AMR) surveillance aligned with Global Antimicrobial Surveillance System (GLASS). To complement this surveillance, we conducted a situational analysis of AMR rates among GLASS organisms in the country. Antimicrobial resistance (AMR) recognized as a natural evolutionary process is facilitated by the genomic plasticity of microorganisms [1]. In recent times, this process has been greatly accelerated by the increased exposure of microorganisms to antimicrobial agents. Following the Global Action Plan to tackle antimicrobial resistance at the 68th World Health Assembly, 2015, Global Antimicrobial Surveillance System (GLASS) was established [13] to collate antimicrobial resistance data at a global level
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
