背景:乌干达抗菌素耐药性(AMR)的持续监测涉及在国家和地区医院检测临床样本中的细菌分离株。尽管国家微生物学参考实验室(NMRL)分析了这些分离株的官方AMR监测数据,与公共卫生规划的整合有限。为了加强NMRL数据的利用,以更好地指导药物选择和公共卫生策略,以对抗抗生素耐药性,我们评估了乌干达常用抗生素的AMR趋势和空间分布。
方法:我们分析了从血液中分离的病原菌的数据,脑脊液,腹膜,和来自2018-2021年AMR监测数据的胸膜积液。我们计算了对常见抗菌类别耐药的分离株的比例。我们使用卡方检验趋势来评估研究期间AMR抗性的变化。
结果:在537个分离株中,有15个病原菌,478(89%)来自血液,34例(6.3%)来自胸腔积液,21(4%)来自脑脊液,4例(0.7%)来自腹膜液。最常见的病原体是金黄色葡萄球菌(20.1%),其次是沙门氏菌(18.8%)。四年来,磺胺类药物的耐药性总体变化为63-84%,氟喹诺酮类大环内酯类(46-76%),酚类(48-71%),青霉素(42-97%),β-内酰胺酶抑制剂(20-92%),氨基糖苷类(17-53%),头孢菌素(8.3-90%),碳青霉烯类(5.3-26%),和糖肽(0-20%)。在革兰氏阴性菌中,金黄色葡萄球菌对甲氧西林的耐药性有波动(60%-45%)(使用头孢西丁耐药性作为苯唑西林耐药性的替代品),对四环素的耐药性增加(29-78%p<0.001),环丙沙星(17-43%,p=0.004),头孢曲松(8-72%,p=0.003),亚胺培南(6-26%,p=0.004),和美罗培南(7-18%,p=0.03)。
结论:该研究强调了四年来抗生素耐药率的增加,在革兰氏阳性和革兰氏阴性生物体的不同类别的抗生素中观察到的耐药性显着增加。这增加了抗生素耐药性,特别是常用的抗生素,如头孢曲松和环丙沙星,坚持世界卫生组织的准入,观看,和储备(AWARE)类别更加关键。它还强调了通过适当使用药物来防范日益增长的抗生素耐药性威胁的重要性,尤其是那些标记为“观察”或“保留”的。\"
BACKGROUND: Continuous monitoring of antimicrobial resistance (AMR) in Uganda involves testing bacterial isolates from clinical samples at national and regional hospitals. Although the National Microbiology Reference Laboratory (NMRL) analyzes these isolates for official AMR surveillance data, there\'s limited integration into public health planning. To enhance the utilization of NMRL data to better inform drug selection and public health strategies in combating antibiotic resistance, we evaluated the trends and spatial distribution of AMR to common antibiotics used in Uganda.
METHODS: We analyzed data from pathogenic bacterial isolates from blood, cerebrospinal, peritoneal, and pleural fluid from AMR surveillance data for 2018-2021. We calculated the proportions of isolates that were resistant to common antimicrobial classes. We used the chi-square test for trends to evaluate changes in AMR resistance over the study period.
RESULTS: Out of 537 isolates with 15 pathogenic bacteria, 478 (89%) were from blood, 34 (6.3%) were from pleural fluid, 21 (4%) were from cerebrospinal fluid, and 4 (0.7%) were from peritoneal fluid. The most common pathogen was Staphylococcus aureus (20.1%), followed by Salmonella species (18.8%). The overall change in resistance over the four years was 63-84% for sulfonamides, fluoroquinolones macrolides (46-76%), phenicols (48-71%), penicillins (42-97%), β-lactamase inhibitors (20-92%), aminoglycosides (17-53%), cephalosporins (8.3-90%), carbapenems (5.3-26%), and glycopeptides (0-20%). There was a fluctuation in resistance of Staphylococcus aureus to methicillin (60%-45%) (using cefoxitin resistance as a surrogate for oxacillin resistance) Among gram-negative organisms, there were increases in resistance to tetracycline (29-78% p < 0.001), ciprofloxacin (17-43%, p = 0.004), ceftriaxone (8-72%, p = 0.003), imipenem (6-26%, p = 0.004), and meropenem (7-18%, p = 0.03).
CONCLUSIONS: The study highlights a concerning increase in antibiotic resistance rates over four years, with significant increase in resistance observed across different classes of antibiotics for both gram-positive and gram-negative organisms. This increased antibiotic resistance, particularly to commonly used antibiotics like ceftriaxone and ciprofloxacin, makes adhering to the WHO\'s Access, Watch, and Reserve (AWaRe) category even more critical. It also emphasizes how important it is to guard against the growing threat of antibiotic resistance by appropriately using medicines, especially those that are marked for \"Watch\" or \"Reserve.\"