Increasing Antimicrobial Resistance in Surgical Wards at Mulago National Referral Hospital, Uganda, from 2014 to 2018—Cause for Concern?

Antimicrobial Resistance (AMR) and Healthcare Associated Infections (HAIs) are major global public health challenges in our time. This study provides a broader and updated overview of AMR trends in surgical wards of Mulago National Referral Hospital (MNRH) between 2014 and 2018. Laboratory data on the antimicrobial susceptibility profiles of bacterial isolates from 428 patient samples were available. The most common samples were as follows: tracheal aspirates (36.5%), pus swabs (28.0%), and blood (20.6%). Klebsiella (21.7%), Acinetobacter (17.5%), and Staphylococcus species (12.4%) were the most common isolates. The resistance patterns for different antimicrobials were: penicillins (40–100%), cephalosporins (30–100%), β-lactamase inhibitor combinations (70–100%), carbapenems (10–100%), polymyxin E (0–7%), aminoglycosides (50–100%), sulphonamides (80–100%), fluoroquinolones (40–70%), macrolides (40–100%), lincosamides (10–45%), phenicols (40–70%), nitrofurans (0–25%), and glycopeptide (0–20%). This study demonstrated a sustained increase in resistance among the most commonly used antibiotics in Uganda over the five-year study period. It implies ongoing hospital-based monitoring and surveillance of AMR patterns are needed to inform antibiotic prescribing, and to contribute to national and global AMR profiles. It also suggests continued emphasis on infection prevention and control practices (IPC), including antibiotic stewardship. Ultimately, laboratory capacity for timely bacteriological culture and sensitivity testing will provide a rational choice of antibiotics for HAI.

One Health Approach and Antimicrobial Resistance: From Global to Ethiopian Context

Recently, antimicrobial resistance is considered as a global health crisis. Some are thought that we are now in post-antibiotic era. Despite data gaps are largest; it creates particularly significant intimidation to low- and middle-income countries. Many factors are responsible for the development of resistance to antimicrobials by microorganisms. Weak regulations and usage inaccuracies are the major causes for the occurrence of antibiotic resistance. In the last three decades, greater than thirty new infectious diseases, most originated from animals, have been emerged. There is also rising of antimicrobial consumption across the world. The growth
of human populations and an increase in contact with wildlife contribute to the spread of resistance and making it a global health concern. Since there are many routes by which drug metabolites and resistant microbes can disseminate among humans, animals and the environment, One Health Approach is urgently required to address antimicrobial resistance in global, national and local level, including Ethiopia. Internationally, the worst threat comes from the emergence and rapid spread of multi-drug resistant Gramnegative bacteria. Once again, an intercontinental, interdisciplinary and multiple approaches should be taken to combat this problem among worldwide nations with special emphasis in developing countries encompassing Africa and Ethiopia.