The epidemiology of antibiotic-resistant clinical pathogens in Uganda

Abstract

Background: Antibiotic resistance (ABR) is a global challenge, and its control depends on robust evidence primarily derived from surveillance systems. Methods: Here, we utilize a national surveillance dataset to demonstrate how such evidence can be systematically generated. In doing so, we characterize the ABR profiles of priority clinical pathogens and identify factors associations , as well as draw inferences on antibiotic usage in Uganda.
Results: Of the 12,262 samples collected between 2019 and 2021, 9033 with complete metadata were analyzed. ABR was steadily increasing at a rate of 0.5 per year, with a surge in 2021, with the highest and lowest levels to penicillin and carbapenems, detected in the northern (OR=2.26, P < 0.001) and the northeast (OR=0.28, P < 0.001) regions of Uganda respectively. ABR was commonly observed with Escherichia coli (OR=1.18, P < 0.001) and Klebsiella pneumoniae (OR=1.25, P < 0.001), among older and male patients, i.e. 61–70-year-olds (OR=1.88, P=0.005). Multi-drug resistance (MDR) and ABR were disproportionately higher among bloodstream infections compared to respiratory tract infections and urinary tract infections, often caused by Acinetobacter baumannii. Co-occurrence of ABR suggests that cephalosporins such as ceftriaxone are in high use all over Uganda.
Conclusions: ABR is indeed a silent pandemic, and our results suggest it is increasing at 0.5% per year, with a notable surge in 2021 likely due to COVID-19. Of concern, ABR and MDR are mainly associated with bloodstream and surgical wound infections, with a gender and age dimension. However, it is encouraging that carbapenem resistance remains relatively low. Such evidence is critical for contextualizing the implementation and evaluation of national action plans.

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DOI

https://doi.org/10.7189/jogh.14.04184

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https://www.research.ed.ac.uk/en/publications/1cfe7fe3-9884-444d-87dc-deb2fef19096