Epidemiology of antibiotic consumption and resistance in Mauritius

Abstract

Introduction: This study aims at determining the pattern of antibiotic consumption and resistance in Mauritius, a tropical island in the Indian Ocean.

Methodology: Antibiotic consumption was measured in kilograms of purchased antibiotics and also in defined daily dose (DDD) in different health institutions from 2015 to 2017. Data on antibiotic resistance was collected at the Central Health Laboratory (CHL) at Victoria Hospital and at Jeetoo Hospital Laboratory, where antibiotic sensitivity testing is done for all public health institutions. For this study, Escherichia coli, Klebsiella species, Acinetobacter species, and Pseudomonas aeruginosa isolates from blood samples of patients from 2015 to 2023 were included. The resistance rate and prevalence of multi-drug-resistant (MDR) organisms were calculated.

Results: The amount of antibiotics (in kilograms) distributed to the human sector was between 11,000 to 13,000 kg, compared to only 700 to 1,500 kg in the animal sector. The DDD per 1,000 inhabitants per day was 20.9, 22.1, and 21.7 in 2015, 2016, and 2017, respectively, with a greater consumption of WATCH and RESERVE group antibiotics in the private sector. In public health institutions, health centers in the northern region had the highest DDD per 1,000 outpatients per day for beta-lactams penicillins and quinolones. Concerning antibiotic resistance, the proportion of MDR Acinetobacter baumannii and Pseudomonas aeruginosa has increased from 58% to 74% and from 33% to 45%, respectively, from 2015 to 2023. During the same period, the proportion of E. coli and K. pneumoniae isolates sensitive to ceftriaxone decreased from 55% to 39% and from 37% to 22%, respectively, while the proportion of E. coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa isolates sensitive to meropenem decreased from 98% to 94%, 83% to 53%, 45% to 28%, and 63% to 47%, respectively.

Conclusion: This study provides valuable insights on antibiotic consumption and resistance in the country and emphasizes the significance of adopting a One Health approach to combat antimicrobial resistance (AMR) effectively. These findings will aid policymakers in formulating targeted strategies to address the challenge of AMR and should be integrated into the National Action Plan on AMR in Mauritius.

Keywords: Mauritius; antibiotic consumption; antibiotic resistance; defined daily dose; epidemiology; human and animal sector; multi-drug resistant organisms; tropical island.

Figure 1

Proportion of antibiotics classified by the AWARE category in the public and private sectors in Mauritius from 2015 to 2017.

Figure 2

Average defined daily dose per 1,000 outpatients per day by class of antibiotics administered via oral route in primary health centers, regional hospitals, specialized hospitals, and district hospitals in Mauritius from 2015 to 2017.

Figure 3

Average defined daily dose per 1,000 admissions per day for antibiotics administered via parenteral route in regional hospitals, specialized hospitals, and district hospitals in Mauritius from 2015 to 2017.

Figure 4

Proportion of multi-drug-resistant E. coli, Klebsiella, Acinetobacter species, and Pseudomonas aeruginosa in different ward types in the hospitals of Mauritius from 2015 to 2017.