Threat of antimicrobial resistance on the rise in low-, middle-income countries
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Key takeaways:
- Resistance to third-generation cephalosporins in E. coli and resistance to carbapenems in A. baumannii are on the rise.
- Notable increases were observed in Sub-Saharan Africa and South Asia between 2004 and 2021.
New estimates presented at ESCMID Global Congress show that antimicrobial resistance prevalence in WHO gram-negative priority pathogens may be “substantial” in countries lacking current data.
“The study was initiated by the need to better understand the scale of antimicrobial resistance (AMR), especially in regions which lack sufficient data, in order to prioritize AMR surveillance activities,” Sneha Kotian, a PhD fellow at the Amsterdam Institute for Global Health & Development at Amsterdam University Medical Center, told Healio. “We aimed to improve on our previously published work by using a more informed modeling approach.”
To generate better estimates of global AMR prevalence in priority gram-negative pathogens such as Escherichia coli, Klebsiella pneumonia, Pseudomonas aeruginosa and Acinetobacter baumannii, Kotian and colleagues compiled data on AMR resistance from between 2004 and 2021, sociodemographics and health care and environmental factors from various global databases.
With these data, the researchers then used a novel stacked ensemble modeling approach — a machine learning approach that combines multiple models, including a generalized additive model, gradient boosting machine and multiple regression models — to estimate AMR prevalence in countries lacking data.
Using the ensemble model, the researchers were able to successfully estimate AMR rates for nine pathogen-drug combinations in countries without data between 2004 and 2021, improving estimate coverage from 24% to 85%. According to the study, further analysis of the data showed “varying degrees of success” for different pathogen-antibiotic combinations in these areas.
Most concerning were estimates indicating that resistance to third-generation cephalosporins in E. coli and resistance to carbapenems in A. baumannii are both on the rise, with a notably sharp increase observed in Sub-Saharan Africa and South Asia between 2004 and 2021, the authors wrote.
This is particularly concerning, according to the authors, because resistance to the commonly used third-generation cephalosporins leaves limited options for treating patients with serious infections, whereas resistance to carbapenems in A. baumannii poses its own set of dangers because WHO has already identified A. baumannii as one of the top pathogens in critical need of new antibiotic therapies.
Kotian explained that these resistance trends confirm the need to invest in diagnostic and surveillance activities globally — particularly in low- and middle-income countries, where residents are likely to be disproportionately affected by factors such as inadequate water and sanitation infrastructure, along with limited health care resources and access to antibiotics.
“It is critical to increase diagnostic and surveillance capacity,” Kotian said. “Our work may help to make informed decisions about prioritizing surveillance activities to inform trends in AMR, empirical treatment guidelines, and antimicrobial stewardship activities.”
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Kotian S, et al. Deciphering global patterns of antimicrobial resistance in key Gram-negative pathogens using indirect predictors. Presented at: ESCMID Global Congress; April 27-30, 2024; Barcelona.
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