A review of antimicrobial resistance in East Africa.
A review of antimicrobial resistance in East Africa.
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DOI：
10.4102/ajlm.v5i1.432
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发表时间：
2016
影响因子：
1.1
通讯作者：
Boum Y
中科院分区：
文献类型：
--
作者：
Ampaire L;Muhindo A;Orikiriza P;Mwanga-Amumpaire J;Bebell L;Boum Y
了解当地和区域抗菌素耐药性 (AMR) 对于临床决策非常重要。然而，整个东非缺乏抗菌素耐药性监测能力，目前的抗菌素耐药性数据也很少。我们试图通过总结东非地区所有可用的抗菌素耐药性高质量数据来弥补这一差距。我们在 2015 年 4 月和 5 月使用搜索词“抗生素耐药性和撒哈拉以南非洲”搜索了 PubMed 数据库和非洲期刊在线档案，以查找 2005 年以来发表的文章。仅包含英文全文文章。我们的分析中纳入了 12 篇已发表的文章。大多数文章都是关于血流感染的，以医院为基础，采用横断面设计；大多数人描述的是社区或医院获得性感染。据报道，对常用抗生素的 AMR 水平较高，包括革兰氏阴性菌感染中对氨苄青霉素和复方新诺明感染的耐药性为 50% – 100%，对庆大霉素的新出现耐药性 (20% – 47%) 以及相对较高水平的头孢曲松耐药性 (46% – 69%)。据报道，大部分耐药性来自克雷伯菌属和大肠杆菌。在革兰氏阳性菌感染中，据报道对氨苄青霉素（100%）、庆大霉素和头孢曲松（50% - 100%）具有广泛耐药性，耐甲氧西林金黄色葡萄球菌的患病率在2.6% - 4.0%之间。总体而言，据报道常用抗生素（氨苄西林、庆大霉素和头孢曲松）存在细菌耐药性，这引起了人们的担忧，即这些抗生素可能不再可用于治疗东非的中度或重度细菌感染。因此，细菌感染的经验性治疗需要重新考虑，并以当地抗菌素耐药性评估为指导。还需要改进有限的质量数据以及评估抗菌素耐药性负担方面缺乏统一的情况。
Knowledge of local and regional antimicrobial resistance (AMR) is important for clinical decision making. However, surveillance capacity for AMR is lacking throughout East Africa, and current AMR data are sparse. We sought to address this gap by summarising all available high-quality data on AMR in the East Africa region. We searched the PubMed database and African Journals Online archives in April and May 2015 using the search term ‘antimicrobial resistance AND sub-Saharan Africa’ to find articles published from 2005 onwards. Only full-text articles in English were included. We included 12 published articles in our analysis. Most articles were on bloodstream infections, hospital-based and cross-sectional in design; a majority described either community- or hospital-acquired infections. High levels of AMR to commonly-used antibiotics were reported, including 50% – 100% resistance to ampicillin and cotrimoxazole infections, emerging resistance to gentamicin (20% – 47%) and relatively high levels of resistance to ceftriaxone (46% – 69%) among Gram-negative infections. Much of the resistance was reported to be in Klebsiella species and Escherichia coli. Among Gram-positive infections, extensive resistance was reported to ampicillin (100%), gentamicin and ceftriaxone (50% – 100%), with methicillin-resistant Staphylococcus aureus prevalence ranging from 2.6% – 4.0%. Overall, bacterial resistance was reported among commonly-used antibiotics (ampicillin, gentamicin and ceftriaxone), raising concern that these antibiotics may no longer be useful for treating moderate or severe bacterial infections in East Africa. Thus, empirical treatment of bacterial infections needs to be reconsidered and guided by local assessment of AMR. Improvements in the limited amount of quality data and lack of harmonisation in assessing the burden of AMR are also needed.