Trends in Antimicrobial Resistance of Bacterial Pathogens in Harare, Zimbabwe, 2012-2017: A Secondary Data Analysis

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Background:
In 2017, World Health Organisation published a list 12 priority-bacteria, which require surveillance because they are resistant to antibiotics.Data from a private laboratory in Harare revealed increasing resistance rates to common antibiotics like ampicillin (73.9% in 2011 to 74.6% in 2015). The increasing resistance rates indicate that antimicrobial resistance (AMR) affects Zimbabwe. We determined the magnitude and trends of AMR to commonly used and last-resort antibiotics.
Methods:
We conducted a retrospective record review on data collected from a private microbiology laboratory, which is the largest in Zimbabwe with capacity to screen microorganisms to species level and has a constant supply of antibiotic discs compared to public laboratories. The outcome of interest was the antimicrobial susceptibility test result of the isolates. We used Microsoft Excel 2016 to plot trends from 2012 to 2017. Statistical significance was determined by simple linear regression using Epi InfoTM7.
Results:
We analyzed 23 432 isolates, of 12 medically important bacteria. Of the isolates, analyzed 43.4% were from urines, 36.7% from pus-swabs and 7% from blood specimens. The most common pathogen was E. coli (43.2%), followed by Staphylococcus aureus (15.8%) and the least common was Neisseria gonorrhoeae (0.2%). Resistance by all bacteria was highest to ampicillin followed by penicillin, both ranging between 70% and 100% over the 6 years. Increases in resistance to commonly used antibiotics were observed in amoxicillin-resistant Escherichia coli (R2=0.98; p<0.01), Streptococcus pneumoniae (R2=0.83; p<0.01) and 3rd generation cephalosporin-resistant E. coli(R2=0.89; p<0.01).Increasing resistance trends were also seen in last-line antibiotics i.e., fluoroquinolone- resistant Salmonellaspp, carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. However, a decreasing resistance trend was noted in methicillin-resistant S. aureus.
Conclusion
There is a high burden of drug resistance to common antibiotics, which include priority organisms in Harare, and an emergence of resistance to last-line antibiotics. We recommend development of robust nationwide surveillance for monitoring priority-organisms for identification and treatment before spread.

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