Limiting the Spread of Multidrug-Resistant Bacteria in Low-to-Middle-Income Countries: One Size Does Not Fit All

Abstract

The spread of multidrug-resistant organisms (MDRO) is associated with additional costs as well as higher morbidity and mortality rates. Risk factors related to the spread of MDRO can be classified into four categories: bacterial, host-related, organizational, and epidemiological. Faced with the severity of the MDRO predicament and its individual and collective consequences, many scientific societies have developed recommendations to help healthcare teams control the spread of MDROs. These international recommendations include a series of control measures based on surveillance cultures and the application of barrier measures, ranging from patients’ being isolated in single rooms, to the reinforcement of hand hygiene and implementation of additional contact precautions, to the cohorting of colonized patients in a dedicated unit with or without a dedicated staff. In addition, most policies include the application of an antimicrobial stewardship program. Applying international policies to control the spread of MDROs presents several challenges, particularly in low-to-middle-income countries (LMICs). Through a review of the literature, this work evaluates the real risks of dissemination linked to MDROs and proposes an alternative policy that caters to the means of LMICs. Indeed, sufficient evidence exists to support the theory that high compliance with hand hygiene and antimicrobial stewardship reduces the risk of MDRO transmission. LMICs would therefore be better off adopting such low-cost policies without necessarily having to implement costly isolation protocols or impose additional contact precautions.

Occurrence of Multidrug-Resistant Strains of Acinetobacter spp.: An Emerging Threat for Nosocomial-Borne Infection in Najran Region, KSA

“…Direct contact with infected people or indirect interaction via contaminated environments is the main way that A. baumannii spreads. Thus, it was generally assumed that A. baumannii transmission occurs due to interactions between patients, healthcare providers, and contaminated fomites in the hospital’s environment; A. baumannii was not considered an airborne droplet bacillus despite causing outbreaks of community-acquired pneumonia in some countries [ 23 , 24 ].…”

Bloodstream Infections: Comparison of Diagnostic Methods and Therapeutic Consequences between a Hospital in a Resource-Limited Setting and Two French Hospitals

“…Even though comprehensive data remain scarce, previous studies suggest that low-to-middle-income countries (LMICs) including Lebanon are likely to be most affected by the declining effectiveness of antibiotics. LMICs’ higher exposure is by dint of pre-existing developmental and economical challenges and likely deficiencies in the healthcare system [ 19 ]. In fact, certain countries in the Mediterranean region and Arabian Peninsula report a high prevalence of CPE [ 20 ].…”

Healthcare challenges in LMICs: addressing antibiotic resistance threats, a call for comprehensive global solutions: an editorial

“…Furthermore, resistance rates are made worse, and healthcare systems are severely constrained by the larger socioeconomic issues that are common in areas with limited resources 7 . The livelihoods and general well-being of the impacted communities are adversely affected by these problems, which have a knock-on effect.…”