Abstract
Introduction: Antimicrobial resistance is a global public health concern, but the problems are context specific, with each county or setting facing differing challenges. In Africa, third-generation cephalosporin resistant Enterobacterales (3GCR-E) are of particular concern, given the widespread reliance on ceftriaxone for treatment of severe infection in this setting. In Malawi, despite the rising prevalence of 3GCR-E, the health impact of these infections has not been described. This study is designed to estimate attributable mortality, morbidity and economic cost of 3GC-R bloodstream infection (BSI) in a large, urban hospital. Methods: This study will investigate the burden of antimicrobial resistance by recruiting a a prospective longitudinal cohort of patients who have bloodstream infection with 3GCR-E, at Queen Elizabeth Central Hospital, Blantyre, Malawi. Patients whose blood culture is positive for either 3GC-S or 3GC-R Enterobacterales will be enrolled and provide clinical and healthcare economic data. Patients will be followed throughout their hospital stay and to 6-months post discharge. Mortality, direct and indirect costs and other health outcomes will be compared between patients with 3GC-R and comparable 3GC-sensitive BSI. Based on our observation that some patients with clinical suspicion of sepsis and 3GC-R BSI are surviving without an effective antibiotic, we review each patient prospectively and classify what role the isolated bacteria is playing in the patient's clinical presentation. These classifications will then be incorporated into our analysis. Ethics and dissemination: The study protocol has been approved by the Malawi College of Medicine Research Ethics Committee and by the Liverpool School of Tropical Medicine Research Ethics committee. Written informed consent will be obtained from study participants or their parents/guardians. Results will be submitted to international peer-reviewed journals, presented at international conferences and shared with participating communities and collaborators.
Highlights
Antimicrobial resistance is a global public health concern, but the problems are context specific, with each county or setting facing differing challenges
Inclusion criteria Blood culture is positive for non-Salmonella Enterobacterales or Acinetobacter Patient is an inpatient at Queen Elizabeth Central Hospital (QECH) or can be contacted for admission or assessment Exclusion criteria Blood culture is positive for Salmonella enterica Patient is unable to provide informed consent and there is no representative to provide informed consent Patient speaks neither English or Chichewa
This study is designed to investigate the attributable morbidity, mortality and economic cost of third-generation cephalosporin resistant bloodstream infections in Malawi, a country which has the largest bacteraemia and Antimicrobial resistance (AMR) surveillance dataset from sSA, but in which the health burden of AMR infections is currently unknown
Summary
Antimicrobial resistance is a global public health concern, but the problems are context specific, with each county or setting facing differing challenges. The greatest burden of DRIs, is expected to occur in low and middle-income countries, where alternative antibiotics are frequently unavailable or prohibitively expensive, and the morbidity and mortality from these infections is predicted to be high[2]. Third-generation cephalosporin resistant Enterobacterales (3GCR-E), have been identified by the World Health Organization (WHO) as critical priority pathogens on which national AMR programmes should focus their surveillance and reporting[2]. These pathogens are of particular importance in subSaharan African hospitals, where the third-generation cephalosporin, ceftriaxone, is frequently relied upon in the empirical treatment of sepsis[3,4,5]
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