The epidemiology of antibiotic-resistant clinical pathogens in Uganda

Ritah Namusoosa, Ibrahimm Mugerwa , Keneth Iceland Kasozi, Allan Muruta, Grace Najjuka, Winifred D. Atuhaire, Susan Nabadda, Henry Mwebesa, Charles Olaro, Isaac Ssewanyana, Aloysious Ssemaganda, Adrian Muwonge

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Antibiotic resistance (ABR) is a global challenge, and its control depends on robust evidence primarily derived from surveillance systems.

METHODS: We utilised a national surveillance data set to demonstrate how such evidence can be systematically generated. In doing so, we characterised the ABR profiles of priority clinical pathogens, identified associated factors, and drew inferences on antibiotic usage in Uganda.

RESULTS: Of the 12 262 samples collected between 2019-21, we analysed 9033 with complete metadata. ABR was steadily increasing at a rate of 0.5% per year, with a surge in 2021 and the highest and lowest levels of penicillin and carbapenems detected in the northern (odds ratio (OR) = 2.26; P < 0.001) and the northeast (OR = 0.28; P < 0.001) regions of Uganda respectively. ABR was commonly observed with Escherichia coli (OR = 1.18; P < 0.001) and Klebsiella pneumoniae (OR = 1.25; P < 0.001) among older and male patients (61-70 years old) (OR = 1.88; P = 0.005). Multi-drug resistance (MDR) and ABR were disproportionately higher among bloodstream infections than respiratory tract infections and urinary tract infections, often caused by Acinetobacter baumannii. Co-occurrence of ABR suggests that cephalosporins such as ceftriaxone are in high use all over Uganda.

CONCLUSIONS: ABR is indeed a silent pandemic, and our results suggest it is increasing at 0.5% per year, with a notable surge in 2021 likely due to coronavirus disease 2019 (COVID-19). Of concern, ABR and MDR are mainly associated with bloodstream and surgical wound infections, with a gender and age dimension. However, it is encouraging that carbapenem resistance remains relatively low. Such evidence is critical for contextualising the implementation and evaluation of national action plans.

Original languageEnglish
Article number04184
Pages (from-to)1-14
Number of pages14
JournalJournal of Global Health
Volume14
Early online date30 Aug 2024
DOIs
Publication statusPublished - 30 Aug 2024

Keywords / Materials (for Non-textual outputs)

  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents/pharmacology
  • Bacterial Infections/epidemiology
  • COVID-19/epidemiology
  • Child
  • Child, Preschool
  • Drug Resistance, Bacterial
  • Drug Resistance, Multiple, Bacterial
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Uganda/epidemiology
  • Young Adult

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