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Bacterial Resistance in Surgical Infections in Low-Resource Settings
1Department of Surgery, University of Minnesota Minneapolis, Minnesota, USA.
Abstract:
There is an alarming increase in antimicrobial resistance (AMR) globally, complicating management of surgical infections, especially in low-resource settings. Of particular concern for surgeons are third generation cephalosporin-resistant and carbapenem-resistant Enterobacteriaceae. The published literature was searched to identify the scope and causative factors of emerging bacterial resistance in low- and middle-income countries (LMICs). Antimicrobial resistance impacts economics, human development, health equity, health security, and food production. Factors that contribute to AMR include use of antibiotic agents in livestock, antibiotic agents in wastewater and sewage, poor sanitation, and overprescribing or unregulated use of antibiotic agents. Because the factors influencing AMR globally are multi-factorial, solutions must be addressed at multiple levels. In LMICs, these can occur through national initiatives, at the facility level, or at the community level with coordination engaging government agencies, the private sector, civil service, and professional groups. There is a growing recognition of the need for national AMR prevention programs. Meanwhile, infection prevention and control programs and antimicrobial stewardship remain cornerstones of management at the facility level.
Insights
Antimicrobial resistance (AMR) is rising globally, especially in low-resource settings. Addressing AMR requires multi-level solutions, including national programs and facility-level infection control and stewardship.
Area of Science:
- Global health
- Infectious diseases
- Microbiology
Background:
- Antimicrobial resistance (AMR) poses a significant global threat, complicating the management of surgical infections.
- Third generation cephalosporin-resistant and carbapenem-resistant Enterobacteriaceae are of particular concern.
- AMR disproportionately affects low- and middle-income countries (LMICs).
Purpose of the Study:
- To identify the scope and causative factors of emerging bacterial resistance in LMICs.
- To review the multifaceted impacts of AMR on global development and health security.
- To explore multi-level solutions for combating AMR.
Main Methods:
- A comprehensive search of published literature was conducted.
- The review focused on identifying factors contributing to AMR in LMICs.
- Analysis of multi-factorial drivers and potential interventions was performed.
Main Results:
- Key contributors to AMR include antibiotic use in livestock, wastewater contamination, poor sanitation, and unregulated antibiotic prescribing.
- AMR has far-reaching impacts on economics, human development, health equity, and food production.
- Effective AMR control requires coordinated efforts at national, facility, and community levels.
Conclusions:
- National AMR prevention programs are increasingly recognized as essential.
- Infection prevention and control programs and antimicrobial stewardship are critical at the facility level.
- Addressing AMR necessitates a coordinated, multi-sectoral approach involving various stakeholders.
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