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Antibiotic-resistant bacterial sepsis in Papua New Guinea
1Goroka Hospital, Eastern Highlands Province, Papua New Guinea.
Insights
Antibiotic-resistant gram-negative bacteria cause child deaths in Papua New Guinea due to unregulated antibiotic use. Strategies must reduce antibiotic use and risk factors for resistant infections.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Public Health
Background:
- Antibiotic-resistant gram-negative bacteria, including Escherichia coli and Klebsiella, are a significant cause of child mortality in Papua New Guinea.
- High-level resistance to common antibiotics like amoxycillin and cotrimoxazole is prevalent.
- Widespread unregulated antibiotic use and a high burden of bacterial infections drive resistance.
Purpose of the Study:
- To identify the causes and risk factors of antibiotic-resistant bacterial infections in children in Papua New Guinea.
- To propose cost-effective strategies to combat these resistant pathogens.
Main Methods:
- Review of existing literature and data on antibiotic resistance patterns and child mortality in Papua New Guinea.
- Identification of risk factors associated with resistant enteric gram-negative infections.
- Analysis of current antibiotic use practices and healthcare system weaknesses.
Main Results:
- Key resistant pathogens include enteric gram-negative bacilli (Escherichia coli, Klebsiella, Enterobacter) and Haemophilus influenzae type b.
- Risk factors identified: village births, prolonged hospital stays, kwashiorkor, and prior broad-spectrum antibiotic use.
- Inappropriate antibiotic prescribing and lack of regulation contribute to the problem.
Conclusions:
- Combating antibiotic resistance requires reducing antibiotic use for trivial illnesses and preventing infections.
- Recommendations include stricter pharmacy regulation, health worker education, improved vaccination, enhanced maternal care, and village public health measures.
- Enhanced hospital surveillance, laboratory capacity, research collaboration, and a national coordinating committee are essential.
Abstract:
Infections due to antibiotic-resistant bacteria, especially gram-negative bacteria, are a common cause of child mortality in Papua New Guinea. Antibiotic-resistant bacteria include the enteric gram-negative bacilli, especially Escherichia coli, Klebsiella and Enterobacter, and Haemophilus influenzae type b, a major respiratory tract pathogen and cause of meningitis. Among these bacteria there is now high-level resistance to standard antibiotics, including chloramphenicol, amoxycillin and cotrimoxazole. Reasons behind the increase in antibiotic-resistant bacterial infections are the widespread unregulated use of antibiotics and the very large burden of bacterial infections. Risk factors for development of resistant enteric gram-negative infections include village births, prolonged hospital stay, kwashiorkor in adopted children and previous treatment with broad-spectrum antibiotics. Cost-effective strategies to combat these pathogens will need to be broad and must focus on reducing the use of antibiotics for trivial illnesses, reducing the need to use antibiotics and reducing the risk factors for resistant bacterial sepsis. There must be stricter regulation of commercial pharmacies, education of health workers on how to avoid inappropriate antibiotic prescribing, a focus on the prevention of pneumonia by immunization with new vaccines, improvements in the quality and uptake of formal maternal care services and public health measures within villages. In addition there is a need for better surveillance for antibiotic-resistant bacteria within hospitals; this will require substantial improvements in laboratory facilities and carefully planned research collaboration. A national committee should be established to advise on these matters and coordinate interventions.