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Nabadda S, Kakooza F, Kiggundu R, Walwema R, Bazira J, Mayito J, Mugerwa I, Sekamatte M, Kambugu A, Lamorde M, Kajumbula H, Mwebasa H. Implementation of the World Health Organization Global Antimicrobial Resistance Surveillance System in Uganda, 2015-2020: Mixed-Methods Study Using National Surveillance Data. JMIR Public Health Surveill 2021; 7:e29954. [PMID: 34673531 PMCID: PMC8569544 DOI: 10.2196/29954] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 12/17/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is an emerging public health crisis in Uganda. The World Health Organization (WHO) Global Action Plan recommends that countries should develop and implement National Action Plans for AMR. We describe the establishment of the national AMR program in Uganda and present the early microbial sensitivity results from the program. Objective The aim of this study is to describe a national surveillance program that was developed to perform the systematic and continuous collection, analysis, and interpretation of AMR data. Methods A systematic qualitative description of the process and progress made in the establishment of the national AMR program is provided, detailing the progress made from 2015 to 2020. This is followed by a report of the findings of the isolates that were collected from AMR surveillance sites. Identification and antimicrobial susceptibility testing (AST) of the bacterial isolates were performed using standard methods at both the surveillance sites and the reference laboratory. Results Remarkable progress has been achieved in the establishment of the national AMR program, which is guided by the WHO Global Laboratory AMR Surveillance System (GLASS) in Uganda. A functional national coordinating center for AMR has been established with a supporting designated reference laboratory. WHONET software for AMR data management has been installed in the surveillance sites and laboratory staff trained on data quality assurance. Uganda has progressively submitted data to the WHO GLASS reporting system. Of the 19,216 isolates from WHO GLASS priority specimens collected from October 2015 to June 2020, 22.95% (n=4411) had community-acquired infections, 9.46% (n=1818) had hospital-acquired infections, and 68.57% (n=12,987) had infections of unknown origin. The highest proportion of the specimens was blood (12,398/19,216, 64.52%), followed by urine (5278/19,216, 27.47%) and stool (1266/19,216, 6.59%), whereas the lowest proportion was urogenital swabs (274/19,216, 1.4%). The mean age was 19.1 (SD 19.8 years), whereas the median age was 13 years (IQR 28). Approximately 49.13% (9440/19,216) of the participants were female and 50.51% (9706/19,216) were male. Participants with community-acquired infections were older (mean age 28, SD 18.6 years; median age 26, IQR 20.5 years) than those with hospital-acquired infections (mean age 17.3, SD 20.9 years; median age 8, IQR 26 years). All gram-negative (Escherichia coli, Klebsiella pneumoniae, and Neisseria gonorrhoeae) and gram-positive (Staphylococcus aureus and Enterococcus sp) bacteria with AST showed resistance to each of the tested antibiotics. Conclusions Uganda is the first African country to implement a structured national AMR surveillance program in alignment with the WHO GLASS. The reported AST data indicate very high resistance to the recommended and prescribed antibiotics for treatment of infections. More effort is required regarding quality assurance of laboratory testing methodologies to ensure optimal adherence to WHO GLASS–recommended pathogen-antimicrobial combinations. The current AMR data will inform the development of treatment algorithms and clinical guidelines.
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Affiliation(s)
- Susan Nabadda
- Laboratory and Diagnostics Services Department, Ministry of Health, Kampala, Uganda
| | - Francis Kakooza
- Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda.,Department of Immunology and Molecular Biology, Makerere University, Kampala, Uganda
| | - Reuben Kiggundu
- Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda.,United States Agency for International Development Medicines, Technologies, and Pharmaceutical Services Program, Management Sciences for Health, Kampala, Uganda
| | - Richard Walwema
- Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Joel Bazira
- Department of Medical Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jonathan Mayito
- Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Ibrahimm Mugerwa
- Laboratory and Diagnostics Services Department, Ministry of Health, Kampala, Uganda.,Antimicrobial Resistance Sub-Committee, National One Health Platform, Kampala, Uganda
| | - Musa Sekamatte
- Antimicrobial Resistance Sub-Committee, National One Health Platform, Kampala, Uganda
| | - Andrew Kambugu
- Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Mohammed Lamorde
- Global Health Security Department, Infectious Diseases Institute, Kampala, Uganda
| | - Henry Kajumbula
- Antimicrobial Resistance Sub-Committee, National One Health Platform, Kampala, Uganda.,Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | - Henry Mwebasa
- Laboratory and Diagnostics Services Department, Ministry of Health, Kampala, Uganda.,Antimicrobial Resistance Sub-Committee, National One Health Platform, Kampala, Uganda
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Acharya J, Zolfo M, Enbiale W, Kyaw KWY, Bhattachan M, Rijal N, Shrestha A, Shrestha B, Madhup SK, Raghubanshi BR, Kattel HP, Rajbhandari P, Bhandari P, Thakur S, Sharma S, Singh DR, Jha R. Quality Assessment of an Antimicrobial Resistance Surveillance System in a Province of Nepal. Trop Med Infect Dis 2021; 6:60. [PMID: 33922405 PMCID: PMC8167624 DOI: 10.3390/tropicalmed6020060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/28/2021] [Accepted: 04/08/2021] [Indexed: 11/17/2022] Open
Abstract
Antimicrobial resistance (AMR) is a global problem, and Nepal is no exception. Countries are expected to report annually to the World Health Organization on their AMR surveillance progress through a Global Antimicrobial Resistance Surveillance System, in which Nepal enrolled in 2017. We assessed the quality of AMR surveillance data during 2019-2020 at nine surveillance sites in Province 3 of Nepal for completeness, consistency, and timeliness and examined barriers for non-reporting sites. Here, we present the results of this cross-sectional descriptive study of secondary AMR data from five reporting sites and barriers identified through a structured questionnaire completed by representatives at the five reporting and four non-reporting sites. Among the 1584 records from the reporting sites assessed for consistency and completeness, 77-92% were consistent and 88-100% were complete, with inter-site variation. Data from two sites were received by the 15th day of the following month, whereas receipt was delayed by a mean of 175 days at three other sites. All four non-reporting sites lacked dedicated data personnel, and two lacked computers. The AMR surveillance data collection process needs improvement in completeness, consistency, and timeliness. Non-reporting sites need support to meet the specific requirements for data compilation and sharing.
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Affiliation(s)
- Jyoti Acharya
- National Public Health Laboratory, Kathmandu 44600, Nepal; (N.R.); (A.S.); (R.J.)
| | - Maria Zolfo
- Institute of Tropical Medicine, 2000 Antwerp, Belgium;
| | - Wendemagegn Enbiale
- Department of Dermatology and Venereology, BahirDar University, 1996 Bahir Dar, Ethiopia;
- Amsterdam UMC, Academic Medical Centre, Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&I), University of Amsterdam, 7057 Amsterdam, The Netherlands
| | - Khine Wut Yee Kyaw
- International Union against Tuberculosis and Lung Disease, Paris, France and International Union against Tuberculosis and Lung Disease, Mandalay 11061, Myanmar;
| | - Meika Bhattachan
- World Health Organization, Health Emergencies Unit, Kathmandu 44700, Nepal;
| | - Nisha Rijal
- National Public Health Laboratory, Kathmandu 44600, Nepal; (N.R.); (A.S.); (R.J.)
| | - Anjana Shrestha
- National Public Health Laboratory, Kathmandu 44600, Nepal; (N.R.); (A.S.); (R.J.)
| | | | | | | | | | - Piyush Rajbhandari
- Patan Hospital, Patan Academy of Health Sciences, Lalitpur 44700, Nepal;
| | | | - Subhash Thakur
- Paropakar Maternity and Women’s Hospital, Kathmandu 44600, Nepal;
| | - Saroj Sharma
- Kanti Children’s Hospital, Kathmandu 44600, Nepal;
| | - Dipendra Raman Singh
- Quality Standard and Regulation Division, Ministry of Health and Population, Kathmandu 44600, Nepal;
| | - Runa Jha
- National Public Health Laboratory, Kathmandu 44600, Nepal; (N.R.); (A.S.); (R.J.)
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Abstract
Surveillance of antibiotic resistance involves the collection of antibiotic susceptibility patterns undertaken by clinical microbiology laboratories on bacteria isolated from clinical specimens. Global surveillance programs have shown that antibiotic resistance is a major threat to the public at large and play a crucial role in the development of enhanced diagnostics as well as potential vaccines and novel antibiotics with activity against antimicrobial-resistant organisms. This review focuses primarily on examples of global surveillance systems. Local, national, and global integrated surveillance programs with sufficient data linkage between these schemes, accompanied by enhanced genomics and user-friendly bioinformatics systems, promise to overcome some of the stumbling blocks encountered in the understanding, emergence, and transmission of antimicrobial-resistant organisms.
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O'Brien TF, Stelling J. The world's microbiology laboratories can be a global microbial sensor network. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2015; 34 Suppl 1:9-15. [PMID: 24968031 DOI: 10.1590/s0120-41572014000500002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 11/22/2013] [Indexed: 02/02/2023]
Abstract
The microbes that infect us spread in global and local epidemics, and the resistance genes that block their treatment spread within and between them. All we can know about where they are to track and contain them comes from the only places that can see them, the world's microbiology laboratories, but most report each patient's microbe only to that patient's caregiver. Sensors, ranging from instruments to birdwatchers, are now being linked in electronic networks to monitor and interpret algorithmically in real-time ocean currents, atmospheric carbon, supply-chain inventory, bird migration, etc. To so link the world's microbiology laboratories as exquisite sensors in a truly lifesaving real-time network their data must be accessed and fully subtyped. Microbiology laboratories put individual reports into inaccessible paper or mutually incompatible electronic reporting systems, but those from more than 2,200 laboratories in more than 108 countries worldwide are now accessed and translated into compatible WHONET files. These increasingly web-based files could initiate a global microbial sensor network. Unused microbiology laboratory byproduct data, now from drug susceptibility and biochemical testing but increasingly from new technologies (genotyping, MALDI-TOF, etc.), can be reused to subtype microbes of each genus/species into sub-groupings that are discriminated and traced with greater sensitivity. Ongoing statistical delineation of subtypes from global sensor network data will improve detection of movement into any patient of a microbe or resistance gene from another patient, medical center or country. Growing data on clinical manifestations and global distributions of subtypes can automate comments for patient's reports, select microbes to genotype and alert responders.
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Affiliation(s)
- Thomas F O'Brien
- Department of Medicine, Brigham and Women´s Hospital and Harvard Medical School, Boston, MA, USA
| | - John Stelling
- Department of Medicine, Brigham and Women´s Hospital and Harvard Medical School, Boston, MA, USA
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