Antimicrobial susceptibility of bacterial isolates from community acquired infections in Sub-Saharan Africa and Asian low and middle income countries

Abstract

Objective: Antimicrobial resistance has arisen across the globe in both nosocomial and community settings as a consequence of widespread antibiotic consumption. Poor availability of laboratory diagnosis means that resistance frequently goes unrecognised and may only be detected as clinical treatment failure. In this review, we provide an overview of the reported susceptibility of common community acquired bacterial pathogens in Sub-Saharan Africa and Asia to the antibiotics that are most widely used in these areas.

Methods: We reviewed the literature for reports of the susceptibility of prevalent pathogens in the community in SSA and Asia to a range of commonly prescribed antibiotics. Inclusion criteria required that isolates were collected since 2004 and that they were obtained from either normally sterile sites or urine. The data were aggregated by region and by age group.

Results: Eighty-three studies were identified since 2004 which reported the antimicrobial susceptibilities of common bacterial pathogens. Different methods were used to assess in-vitro susceptibility in the different studies. The quality of testing (evidenced by resistance profiles) also varied considerably. For Streptococcus pneumoniae and Neisseria meningitidis most drugs maintained relatively high efficacy, apart from co-trimoxazole to which there were high levels of resistance in most of the pathogens surveyed.

Conclusions: Compared with the enormous infectious disease burden and widespread use of antibiotics there are relatively few reliable data on antimicrobial susceptibility from tropical Asia and Africa upon which to draw firm conclusions, although it is evident that many commonly used antibiotics face considerable resistance in prevalent bacterial pathogens. This is likely to exacerbate morbidity and mortality. Investment in improved antimicrobial susceptibility testing and surveillance systems is likely to be a highly cost-effective strategy and should be complemented by centralized and readily accessible information resources.

Figure 1

Proportion susceptible of S. pneumoniae by region (left) and age group (right). Macr – Macrolides; Ceph –third generation cephalosporins; Amp – aminopenicillins; Chlr – chloramphenicol; Ctrx – co-trimoxazole; Gent – gentamicin.

Figure 2

Proportion susceptible of S. aureus by region (left) and age group (right). Macr – macrolides; Ceph –third generation cephalosporins; Amp – aminopenicillins; Chlr – chloramphenicol; Ctrx – co-trimoxazole; Gent – gentamicin; Ox/Clox – oxacillin/cloxacillin.

Figure 3

Proportion susceptible of N. meningitidis by region (left) and age group (right). Macr – macrolides; Ceph –third generation cephalosporins; Amp – aminopenicillins; Chlr – chloramphenicol; Ctrx – co-trimoxazole; Gent – gentamicin.

Figure 4

Proportion susceptible of H. influenzae by region (left) and age group (right). Macr – macrolides; Ceph –third generation cephalosporins; Amp – aminopenicillins; Chlr – chloramphenicol; Ctrx – co-trimoxazole; Gent – gentamicin.

Figure 5

Proportion susceptible of Klebsiella spp. by region (left) and age group (right). Macr – macrolides; Ceph –third generation cephalosporins; Amp – aminopenicillins; Chlr – chloramphenicol; Ctrx – co-trimoxazole; Gent – gentamicin.

Figure 6

Proportion susceptible of E. coli by region (left) and age group (right). Macr – macrolides; Ceph –third generation cephalosporins; Amp – aminopenicillins; Chlr – chloramphenicol; Ctrx – co-trimoxazole; Gent – gentamicin.

Figure 7

Proportion susceptible S. typhi (left) and S. paratyphi (right) by region. Macr – macrolides; Ceph –third generation cephalosporins; Amp – aminopenicillins; Chlr – chloramphenicol; Ctrx – co-trimoxazole; Gent – gentamicin.

Figure 8

Proportion susceptible of non-typhoid salmonellae by region (left) and age group (right). Macr – macrolides; Ceph –third generation cephalosporins; Amp – aminopenicillins; Chlr – chloramphenicol; Ctrx – co trimoxazole.

Figure 9

Individual studies reporting the susceptibility of non-typhoid salmonellae to aminopenicillins. n– number of isolates in study.