The epidemiology of antibiotic-resistant clinical pathogens in Uganda

Abstract

ABSTRACTBackgroundAntibiotic resistance (ABR) is silent global pandemic. Our current global control strategies are informed by evidence primarily from surveillance strategies. Here, we use a national surveillance dataset to demonstrate how such evidence can be systematically generated, in so doing we characterize ABR profiles of priority clinical pathogens and identify potential drivers in addition to inferences on antibiotic usage in Uganda.Resultsof the 12,262 samples cultured between 2019-2021, 9,033 with complete metadata were analyzed, Female patients accounted for 57.8% of the patients who were between 1 to 104 years. The isolated bacteria (69%) were clustered into twelve clinical pathogens and eight syndromes. This includedEscherichia coli26%(n=1620),Klebsiella spp.11% (n=685),Acinetobacter spp. 4%(n=250),Citrobacter spp. 4% (n=250),Pseudomonas spp. 3% (n=187), andEnterobacter spp. 2% (n=124), as well asSalmonella spp. 1% (n=62). Among gram-positive bacteria,Staphylococcus aureus10% (n=623),Enterococcus spp. 8% (n=498), andStreptococcus spp. 2% (n=124) were predominant.Acinetobacter baumanniiwas predominantly multi drug resistant (MDR) and mostly recovered from septic wound infection (SWI).Pseudomonas aeruginosa,Escherichia coli,Klebsiella pneumoniae, andStaphylococcus aureuswere also linked to ABR SWIs & urinary tract infections (UTIs). Male patients were more likely to carry ABR pathogens OR=1.14, 95% CI [1.12-1.42], p<0.001), within specific age groups (51-60, OR=1.16, 95% CI [0.88-1.28], p=0.001). Seasonality also influences ABR associated to clinical syndromes, for example, the second quarter, OR=2.1, 95% CI [1.9-2.6], p<0.001), is associated with resistance to narrow spectrum antibiotics OR=1,64, 95% CI [1.39-1.94], p<0.001) targeting respiratory tract infections (RTIs). ABR associated bloodstream infections (BSIs) were significantly more common than UTIs and RTIs.ConclusionsABR across clinical pathogens was increasing at a rate of 2.8% per year, with an upsurge in 2021. SWIs account for the disproportionately high prevalence of ABR and MDR mostly caused byAcinetobacter spp. Staphylococcus aureusincluding MRSA is main driver of BSIs. Male patients are far more likely to carry ABR in their adult life. Encouragingly, carbapenem resistance remains relatively low in-line with the predicted antibiotic use. Such evidence is critical for effective implementation and evaluation AMR National action plans, therefore national public health institutes (NPHIs) ought to invest in building capacity for surveillance and data analysis to support informed decision-making.