Antimicrobial resistance in Africa: A retrospective analysis of data from 14 countries, 2016-2019.

IF 15.8 1区 医学 Q1 Medicine
PLoS Medicine Pub Date : 2025-06-24 eCollection Date: 2025-06-01 DOI:10.1371/journal.pmed.1004638
Gilbert Osena, Geetanjali Kapoor, Erta Kalanxhi, Timothée Ouassa, Edwin Shumba, Sehr Brar, Yewande Alimi, Manuel Moreira, Martin Matu, Abdourahmane Sow, Eili Klein, Pascale Ondoa, Ramanan Laxminarayan
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引用次数: 0

Abstract

Background: Antimicrobial resistance (AMR) is a major global health issue that exacerbates the burden of infectious diseases and healthcare costs. However, the scarcity of national-level AMR data in African countries hampers our understanding of its scale and contributing factors in the region. To gain insights into AMR prevalence in Africa, we collected and analyzed retrospective AMR data from 14 countries.

Methods and findings: We estimated bacterial AMR prevalence, defined as the proportion of resistant human isolates tested from antimicrobial susceptibility (AST) data collected retrospectively for 2016-2019 from 205 laboratories across 14 African countries. We generated 95% confidence intervals (CIs) for aggregated AMR estimates to account for data quality disparities across countries; the median data quality score was 73.1%, ranging from 56.4% to 80.8%. We assessed 819,584 culture records covering 9,266 pathogen-drug combinations, of which 187,832 (22.9%) were positive cultures with AST results. The most frequently cultured specimens were urine (32.0%) and purulent samples (28.1%), and the most frequently isolated pathogens were Escherichia coli (22.2%) and Staphylococcus aureus (15.0%). Aggregated AMR estimates did not change significantly across the years studied (p > 0.337); however, there were significant variations in AMR prevalence estimates in culture-positive samples across countries, regions, patient departments (inpatient/outpatient), and specimen sources (p < 0.05). Male sex (adjusted odds ratio [aOR] 1.15; 95% CI [1.09,1.21]; p < 0.0001), ages above 65 (aOR 1.28; 95% CI [1.16-1.41]; p < 0.0001), and inpatient department (aOR 1.24; 95% CI [1.13-1.35]; p < 0.0001) were associated with higher AMR prevalence among culture-positive samples. The lack of routine testing, as reflected in the low data volume from most contributing laboratories, and the absence of patient clinical information, represent significant limitations of this study.

Conclusion: Analysis of the largest retrospective AMR dataset in Africa indicates high variability in AMR prevalence across countries, coupled with differences in AMR testing capacities, data quality, and AMR estimates. Gaps in AST practices and inadequate digital infrastructures for data collection and reporting represent barriers to estimating the true AMR burden in the region. These barriers warrant large-scale investments to expand healthcare access and strengthen bacteriology laboratory capacities.

非洲抗菌素耐药性:2016-2019年14个国家数据回顾性分析
背景:抗菌素耐药性(AMR)是一个主要的全球卫生问题,它加剧了传染病的负担和医疗保健费用。然而,非洲国家缺乏国家级抗菌素耐药性数据,妨碍了我们了解该地区抗菌素耐药性的规模和影响因素。为了深入了解非洲的AMR流行情况,我们收集并分析了来自14个国家的回顾性AMR数据。方法和发现:我们估计了细菌AMR的患病率,定义为从14个非洲国家的205个实验室回顾性收集的2016-2019年抗菌药物敏感性(AST)数据中检测的耐药人类分离株的比例。我们为总AMR估计生成了95%置信区间(ci),以解释各国之间的数据质量差异;数据质量评分中位数为73.1%,范围为56.4% ~ 80.8%。我们评估了819,584份培养记录,涵盖9,266种病原体-药物组合,其中187,832份(22.9%)为AST阳性培养。最常见的培养标本为尿液(32.0%)和化脓标本(28.1%),最常见的分离病原菌为大肠杆菌(22.2%)和金黄色葡萄球菌(15.0%)。研究年份的总AMR估计值没有显著变化(p > 0.337);然而,不同国家、地区、患者科室(住院/门诊)和标本来源的培养阳性样本中AMR患病率估计值存在显著差异(p结论:对非洲最大的AMR回顾性数据集的分析表明,各国AMR患病率存在高度差异,同时AMR检测能力、数据质量和AMR估计值也存在差异。AST实践方面的差距以及用于数据收集和报告的数字基础设施不足,是估计该区域实际抗微生物药物耐药性负担的障碍。这些障碍需要进行大规模投资,以扩大获得医疗保健的机会并加强细菌学实验室的能力。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
PLoS Medicine
PLoS Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
17.60
自引率
0.60%
发文量
227
审稿时长
4-8 weeks
期刊介绍: PLOS Medicine is a prominent platform for discussing and researching global health challenges. The journal covers a wide range of topics, including biomedical, environmental, social, and political factors affecting health. It prioritizes articles that contribute to clinical practice, health policy, or a better understanding of pathophysiology, ultimately aiming to improve health outcomes across different settings. The journal is unwavering in its commitment to uphold the highest ethical standards in medical publishing. This includes actively managing and disclosing any conflicts of interest related to reporting, reviewing, and publishing. PLOS Medicine promotes transparency in the entire review and publication process. The journal also encourages data sharing and encourages the reuse of published work. Additionally, authors retain copyright for their work, and the publication is made accessible through Open Access with no restrictions on availability and dissemination. PLOS Medicine takes measures to avoid conflicts of interest associated with advertising drugs and medical devices or engaging in the exclusive sale of reprints.
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