Antimicrobial Resistance in the Caribbean

Abstract

ABSTRACT Objectives Antimicrobial resistance is a global problem. The extent of this problem in the Caribbean sub-region is not well characterised. Most reports are from a few countries within the Caribbean sub-region. The aim was to develop and refine an antimicrobial resistance surveillance system at the Caribbean Public Health Agency (CARPHA) for member states. The objectives were to: 1. establish and test a surveillance system for antimicrobial resistance (AMR) starting with key bacterial isolates such as Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Enterococcus spp. and Streptococcus pneumoniae from key specimens such as blood, in line with the Global Antimicrobial Resistance and Use Surveillance System (GLASS), 2. to expand this surveillance to other organisms and specimens, 3. to share data with CARPHA member states (CMS) for quality improvement. Methods Isolates were submitted by hospitals from 13 (50%) CMS. The CMS laboratories sent clinically relevant isolates of five key species: Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, Streptococcus pneumoniae and Enterococcus faecium. The isolates were mainly from urine, blood, and wound samples. Phenotypes and antimicrobial susceptibilities were determined using the VITEK 2 Compact (VITEK) system. The VITEK identification and susceptibilities were emailed back to the laboratories. Results The laboratory received 1013 isolates from April 2017 through July 2018. Most of the bacteria received were Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus. Three hundred and sixteen isolates were identified as S. aureus from 323 Staphylococcus spp. and 38% of the S. aureus isolates received were Methicillin Resistant Staphylococcus aureus (MRSA). Two hundred and seventy-eight isolates of E. coli were tested and identified; 11% were extended spectrum beta-lactamase (ESBL) producers. Two hundred and eighty-three isolates of K. pneumoniae were identified from 291 Klebsiella spp.; 30% were ESBL producers. The samples were received from multiple specimen types. Three carbapenem resistant isolates of K. pneumoniae, confirmed on subculture and repeat testing, were obtained from 3 CMS, widely distributed in the Caribbean region. Conclusions Antimicrobial resistance within the Caribbean is widespread. There is need for continued antimicrobial stewardship and infection control efforts. Surveillance should be started with Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus, from blood specimens. Key Words: antibiotic, antimicrobial, resistance, Caribbean, Staphylococcus, Klebsiella, Escherichia, Yeast