Antibiotic resistance in Pakistan: a systematic review of past decade

Taj

2021

Preprint

Bacterial meningitis (BM) is lethal infectious disease that persists as substantial cause of morbidity and mortality. The antimicrobial drug resistances in BM pathogens possess a major threat in the community, while escalating challenges for clinicians. We for the first time elucidate incidence rate of BM and its drug resistance among the population of Quetta, Balochistan. A cross-sectional study was conducted (form January 2018 to March 2021) among meningitis patients admitted at Government Hospitals in Quetta. The cerebrospinal fluid (CSF) specimen was collected and processed for microbiological and cytological analysis. Bacterial isolates were identified and confirmed using phylogenetic analysis of 16S rRNA gene. We found 35.9% (321/894) confirmed cases of BM among the population of Quetta, Balochistan. The identified bacterial isolates comprised of Streptococcus pneumonia 14.7% (130/894), Staphylococcus aureus 6.9% (61/894), Neisseria meningitidis 5.7% (51/894). Haemophilus influenza 2.5% (22/894), Escherichia coli 4.5% (40/894), and Klebsiella pneumoniae 1.9% (17/894). A surge in male patients 20.8% (186/894) was identified as compare to female patients 15.1% (135/894). Extreme age groups such as Infants (age range: 1month- 1year) and adults (age range: 61years- 99years) with low immunity were critically affected with BM. Clinical parameters such as abnormal CSF appearance, pH, high WBCs in BM patients with endocarditis as underlying disease were significantly at elevated risk of fatal outcome. 16S rRNA gene phylogenetic analysis confirmed evolutionary similarity of isolated strains with prevailing pathogenic strains in Asia. Furthermore, age was identified as significant risk factors for clinical outcomes. Majority of the identified BM patients belonged to rural areas with limited healthcare facilities and paramedics’ staff. High fatality rate demonstrates increased antibiotic resistance among BM isolates, thereby stimulating its devastation among underdeveloped region. Timely detection and intensive treatment of BM may improve critical outcomes in patients

Section: Discussionmentioning

confidence: 95%

WITHDRAWN: Antimicrobial Resistance Pattern of Bacterial Meningitis Among Patients in Quetta, Pakistan

Taj

2021

Preprint

“…These resistant bacteria make even ordinary infections more difficult to treat and surgical procedure riskier to perform. Centuries of progress in improving health and economy is at stake due to antibiotic resistance [ 1 , 2 ]. If healthcare systems do not implement systematic interventions, by 2050, antibiotic resistance may inflict 10 million deaths per year around the globe and an economic loss of USD 100 trillion [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Antibiotic resistance is no longer only a problem of high-income countries, for instance, five Low- and Middle-Income Countries (LMICs) bear more than half (52%) of the burden of mortalities caused by neonatal sepsis associated with resistant strains of bacteria. In some cases, bacteria are resistant to up to 90% of antibiotics [ 1 , 2 ]. Over prescribing, limited surveillance or regulatory framework, and rampant poor practices of infection prevention and control incite a faster spread of resistant bacteria in LMIC.…”

Section: Introductionmentioning

confidence: 99%

“…Pakistan, a country in South Asia, belongs to the World Bank strata of LMICs with a population 216.5 million. In terms of healthcare infrastructure, Punjab is the most developed province that accommodates more than 65% of the population of Pakistan [ 1 , 12 ]. Healthcare is provided by a rapidly expanding network of private hospitals and heavily subsidized public hospitals where the latter fulfils the healthcare needs of the majority of the population [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Recent point prevalence surveys on antibiotic use in hospitals of Punjab also depict a gloomy situation where patients receive unnecessary antibiotics [ 15 , 16 ]. Furthermore, various studies have reported pervasive infections caused by multidrug resistant and extensively drug resistant bacteria [ 1 ]. Rampant inappropriate prescribing requires systematic interventions to change the physician’s attitude, and, in this context, ASPs can play a formidable role to optimize the antibiotic use in hospitals.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Adherence to the Core Elements of Hospital Antibiotic Stewardship Programs: A Survey of the Tertiary Care Hospitals in Punjab, Pakistan

et al. 2021

Background: To restrain antibiotic resistance, the Centers for Disease Control and Prevention (CDC), United States of America, urges all hospital settings to implement the Core Elements of Hospital Antibiotic Stewardship Programs (CEHASP). However, the concept of hospital-based antibiotic stewardship programs is relatively new in Low- and Middle-Income Countries. Aim: To appraise the adherence of the tertiary care hospitals to seven CEHASPs. Design and Setting: A cross-sectional study in the tertiary care hospitals in Punjab, Pakistan. Method: CEHASP assessment tool, (a checklist) was used to collect data from the eligible hospitals based on purposive sampling. The check list had 19 statements to cover seven CEHASPs: Hospital Leadership Commitment, Accountability, Pharmacy Expertise, Action (Implement Interventions to Improve Antibiotic Use), Tracking Antibiotic Use and Outcomes, Reporting Antibiotic Use and Outcomes, and Education. For each statement, a response of “YES”, “NO” or “Under Process” constituted a score of 2, 0 and 1, respectively, where the higher the scores the better the adherence. Categorical variables were described through descriptive statistics, while independent t-test computed group differences. Result: A total of 68 hospitals (n = 33 public, n = 35 private) participated with a response rate of 79.1%. No hospital demonstrated “Perfect” adherence. Roughly half private (48.6%) and more than half public (54.5%) sector hospitals were “Poor“ in adherence. Based on the mean score, there was no significant difference between the private and the public hospitals in terms of comparison of individual core elements. The two most neglected core elements emerged as top priority area were: Reporting Antibiotic Use and Outcomes and Tracking Antibiotic Use and Outcomes.Conclusion: The current response of Pakistan to implement hospital-based antibiotic stewardship programs is inadequate. This study points out significant gaps of practice both in public and private tertiary care hospitals. A majority of the core elements of antibiotic stewardship are either absent or ”Under Process”. The deficiency/priority areas mentioned require immediate attention of the concerned stakeholders in Pakistan.

The impact of antibiotic resistance on the rampant spread of infectious diseases in Pakistan: Insights from a narrative review

Mirha,

Ali,

Aamar

et al. 2024

Health Science Reports

Background and AimsAntibiotic resistance (ABR) is a global public health emergency which has seen an uptick in low‐ to middle‐income countries in recent times due to a plethora of aggravating factors and has led to a whole host of setting‐specific pathogens registering high rates of resistance, causing outbreaks with graver mortality and morbidity. This review analyzes available literature to determine the causes and effects of ABR and recommend solutions to the problem in a Pakistani setting.MethodsSources for this narrative review were identified via electronic databases using keyword search methods. The information was retrieved using databases such as PubMed and Science Direct. Additionally, websites such as CDC and World Health Organization were used to attain pertinent information. All the sources were selected as per their relevance and appropriateness toward the purpose of this review.ResultsThis review details the causes by dividing them into three primary strata, namely (1) under‐regulation, (2) over‐prescription and self‐medication, and (3) lack of medical stewardship. This is made much graver when the COVID‐19 pandemic and the subsequent erratic treatment response is considered, with the pandemic augmenting already high levels of consumption. These factors have led a cascade of effects including, but not limited to, a considerable increase in ABR in pathogens to first‐line drugsConclusionABR is a serious and growing issue which will result in undesirable personal, local, and national consequences if unchecked. Mitigation and reversal of this trend is necessary by developing existing programs and investing in novel therapies and pharmaceutical research and strengthening regulatory policies and mechanisms.