Antibiotic Resistance in Pacific Island Countries and Territories: A Systematic Scoping Review

Abstract

Several studies have investigated antimicrobial resistance in low- and middle-income countries, but to date little attention has been paid to the Pacific Islands Countries and Territories (PICTs). This study aims to review the literature on antibiotic resistance (ABR) in healthcare settings in PICTs to inform further research and future policy development for the region. Following the PRISMA-ScR checklist health databases and grey literature sources were searched. Three reviewers independently screened the literature for inclusion, data was extracted using a charting tool and the results were described and synthesised. Sixty-five studies about ABR in PICTs were identified and these are primarily about New Caledonia, Fiji and Papua New Guinea. Ten PICTs contributed the remaining 21 studies and nine PICTs were not represented. The predominant gram-positive pathogen reported was community-acquired methicillin resistant S. aureus and the rates of resistance ranged widely (>50% to <20%). Resistance reported in gram-negative pathogens was mainly associated with healthcare-associated infections (HCAIs). Extended spectrum beta-lactamase (ESBL) producing K. pneumoniae isolates were reported in New Caledonia (3.4%) and Fiji (22%) and carbapenem resistant A. baumannii (CR-ab) isolates in the French Territories (24.8%). ABR is a problem in the PICTs, but the epidemiology requires further characterisation. Action on strengthening surveillance in PICTs needs to be prioritised so strategies to contain ABR can be fully realised.

Bacteriology and Antimicrobial Resistance in Vanuatu: January 2017 to December 2019

“…To date, there has been no research about MRSA, either hospital-associated MRSA (HA-MRSA) or community-associated MRSA (CA-MRSA) in Vanuatu, and there is scarce data about HA-MRSA in other PICTs [9]. Given the strong relationships and frequent travel between PICTs, these high rates of MRSA in the region may present a significant risk of importation into Vanuatu (and Solomon Islands).…”

“…For these life-threatening infections, broad-spectrum therapies, such as the carbapenems, will likely be used more frequently. If resistance continues to emerge in the PICTs, these last line antibiotics which are more expensive, toxic and not readily available will be required [9].…”

“…Whilst no research has been conducted on AMR in Vanuatu so far, there have been a small number of studies in other PICTs [9]. Staphylococcus aureus was reported as being the predominant gram-positive pathogen in the region, mainly in association with community-acquired infection.…”

“…Staphylococcus aureus was reported as being the predominant gram-positive pathogen in the region, mainly in association with community-acquired infection. Methicillin-resistant S. aureus is >50% in Papua New Guinea and <20% in other PICTs [9]. Several gram-negative pathogens were reported in PICTs, including Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumonia, and Escherichia coli, to name a few.…”

“…Several gram-negative pathogens were reported in PICTs, including Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumonia, and Escherichia coli, to name a few. All were reported in association with HCAIs [9]. In other countries in WHO's Western Pacific Region (WPR), Australia [10][11][12][13], New Zealand [14][15][16][17], and China [18], AMR is clearly a problem.…”