Progress on implementation of the World Health Organization global antimicrobial resistance surveillance system recommendations on antimicrobial resistance surveillance in Africa: Findings of preliminary analysis of a scoping review

Introduction

Antimicrobial resistance (AMR) is a significant global health concern, especially impacting low- and middle-income countries. The World Health Organization (WHO) global antimicrobial resistance surveillance system (GLASS) was rolled out in 2016 to guide AMR surveillance systems. However, its implementation has not been fully evaluated. We conducted a scoping review of the current status of implementation of GLASS and present preliminary findings.

Methods

We developed a search strategy and retrieved articles conducted between January 2016 and November 2023 from four electronic databases (MEDLINE, SCOPUS, CINAHL, and Embase). We followed the Arksey and O'Malley's methodological framework for scoping reviews to guide analysis and reporting. We extracted data on priority samples, pathogens, pathogen-antibiotic combinations and assessed compliance to WHO GLASS recommendations on AST and AMR surveillance.

Results

7477 articles were identified, 6868 duplicates and irrelevant articles were removed at abstract screening, and 609 studies were included for the full-text review, of which 344 were considered for data extraction. Of the 344 studies, 38/344 (11%) were included in this analysis. Majority of studies were conducted in Eastern 50% (19/38), followed by Western 34% (13/38) and Northern 16% (6/38), Africa. 95% (36/38) of studies were conducted in hospital settings. Majority 92% (35/38) of the studies involved only one priority sample type (blood 46% (16/35); urine 32% (11/35) and stool 23% (8/35); while 8% (3/38) studies involved the collection of two priority sample types, specifically urine and blood. Of the 19 studies that focused on blood as a priority sample type, 8 (42%), 11 (58%), 13 (68%), 10 (53%), 1 (5%) and 5 (26%) recovered Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Salmonella species respectively. Shigella and Salmonella species were recovered from 6 (75%) and 7 (88%) of the 8 studies that focused on stool. Escherichia coli and Klebsiella pneumoniae were also recovered from 11 (79%) of the 14 studies that focused on urine. Compliance to GLASS priority pathogen-antibiotic combinations was 13% (1/8), 9% (1/11), 8% (1/13), 70% (7/10), and 60% (3/5) of the studies that recovered Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Salmonella species from blood respectively. 17% (1/6) and 29% (2/7) of the studies that recovered Salmonella and Shigella species from stool followed the GLASS priority pathogen-antibiotic combinations for AST. None of the studies on urine followed the GLASS-recommended pathogen-antibiotic combination.

Discussion

Africa has made progress in implementing the GLASS recommendations. However, adoption of GLASS recommendations including appropriate pathogen-antibiotic combinations for priority pathogens and samples, varied across countries. This limits a standardisation and comparability of data.

Conclusion

Gaps exist in AST for AMR surveillance with priority pathogen-antibiotic combinations not routinely tested in most surveillance programs. A full report from this study will be published by June 2024.