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Cross-sectional survey of resistant priority pathogen carriage in the hospital setting in Timor-Leste 2020-2021
Sarah A Lynar1,2,3, A Vieira4, A D K Draper4,5,6
1Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste. sarah.lynar@nt.gov.au.
Background:
Antimicrobial resistance (AMR) is a major global threat. The World Health Organization (WHO) has identified key organisms that carry the potential for both pathogenicity and AMR, leading to reduced treatment options and worsened outcomes, through the Global Antimicrobial Resistance and Use Surveillance System (GLASS). In Timor-Leste, surveillance is now possible due to significant gains in diagnostic capacity.
Methods:
In 2020-2021 a cross-sectional surveillance study was performed on inpatients and outpatients across all hospitals in Timor-Leste. Nose/axilla/groin swabs were selectively cultured for Staphylococcus aureus and methicillin-resistant S. aureus (MRSA); rectal/perianal swabs for extended spectrum beta-lactamase (ESBL) producing organisms and on MacConkey agar with ciprofloxacin and gentamicin discs. S. aureus, Escherichia coli and Klebsiella pneumoniae isolates were assessed for resistance; univariate and multivariable analyses assessed for associations.
Results:
516/517 had Gram-positive bacteria screening. S. aureus was detected in 93 (18.0%), 14 (15.1%) of which were MRSA, representing 2.7% MRSA carriage. 511/517 were screened for Gram-negative organisms; 108 (21.1%) cultured at least one ESBL-producing organism; ciprofloxacin resistance was found in 109 (21.3%) and gentamicin resistance in 77 (15.1%). Only one carbapenem-resistant organism (an Acinetobacter baumannii) was detected. Participants in Dili were more likely to be colonised with resistant Gram-negative bacteria (aOR 5.3 ESBL, aOR 3.5 ciprofloxacin resistance, aOR 2.7 gentamicin resistance). Being an inpatient was associated with gentamicin resistance (aOR 2.9); dog ownership was associated with ESBL carriage (aOR 1.9).
Conclusions:
ESBL, ciprofloxacin and gentamicin resistance carriage rates were high, particularly in Dili. MRSA carriage and carbapenem resistance were reassuringly low. Ongoing surveillance is essential to monitor AMR and inform guideline development.
Insights
Antimicrobial resistance is a global threat. High rates of ESBL, ciprofloxacin, and gentamicin resistance were found in Timor-Leste, while MRSA and carbapenem resistance were low, necessitating ongoing surveillance.
Area of Science:
- Microbiology
- Public Health
- Infectious Diseases
Background:
- Antimicrobial resistance (AMR) poses a significant global health challenge.
- The World Health Organization (WHO) identifies critical AMR pathogens through the Global Antimicrobial Resistance and Use Surveillance System (GLASS).
- Timor-Leste has enhanced its diagnostic capabilities, enabling AMR surveillance.
Purpose of the Study:
- To conduct a cross-sectional surveillance study of AMR in inpatients and outpatients in Timor-Leste.
- To determine the prevalence of key resistant organisms, including Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL) producing Gram-negative bacteria.
- To assess associations between resistance and demographic or environmental factors.
Main Methods:
- A cross-sectional study was conducted in 2020-2021 across all hospitals in Timor-Leste.
- Swabs were cultured for S. aureus (including MRSA) and ESBL-producing organisms.
- Isolates of S. aureus, Escherichia coli, and Klebsiella pneumoniae were tested for resistance to ciprofloxacin and gentamicin; univariate and multivariable analyses were performed.
Main Results:
- Prevalence of S. aureus was 18.0% (MRSA 2.7%).
- Prevalence of ESBL-producing organisms was 21.1%, with 21.3% ciprofloxacin resistance and 15.1% gentamicin resistance.
- Higher resistance rates for ESBL, ciprofloxacin, and gentamicin were observed in Dili; inpatient status was linked to gentamicin resistance; dog ownership to ESBL carriage.
Conclusions:
- Carriage rates of ESBL, ciprofloxacin, and gentamicin resistance were high, especially in Dili.
- Methicillin-resistant S. aureus (MRSA) carriage and carbapenem resistance were low.
- Continuous AMR surveillance is crucial for monitoring trends and guiding treatment guidelines.
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