This study investigates diagnostic stewardship and antimicrobial resistance (AMR) profiles of bacterial isolates in Zambia from 2020 to 2024, providing crucial data on AMR trends. The research reveals a severe AMR situation in Zambia, particularly for commonly used antibiotics such as doxycycline, azithromycin, trimethoprim/sulfamethoxazole, ciprofloxacin, and rifampicin, with resistance rates ranging from 50% to 80%. Additionally, resistance alerts for vancomycin-resistant enterococci (VRE), linezolid-resistant, carbapenem-resistant, and potential ESBL-producing Enterobacteriaceae indicate the need for enhanced antimicrobial stewardship and continuous diagnostic monitoring.
Literature Overview
This article, 'Diagnostic Stewardship Trends and Antimicrobial Resistance Profiles of Bacteria Isolated in Zambia: A Five-Year Retrospective Study (2020–2024)', published in the journal Antibiotics, reviews and summarizes diagnostic stewardship and AMR trends of bacterial isolates from AMR surveillance sentinel sites in Zambia between 2020 and 2024. The paper highlights a significant increase in antimicrobial resistance, particularly in commonly used antibiotics, and underscores the importance of resistance alerts for VRE, linezolid, carbapenems, and potential ESBL-producing Enterobacteriaceae, suggesting the necessity for improved antimicrobial stewardship and ongoing diagnostic surveillance.
Background Knowledge
Antimicrobial resistance (AMR) is a global public health crisis, particularly severe in low- and middle-income countries (LMICs). Zambia, as one of the African nations, faces significant challenges from AMR. Despite implementing a national AMR action plan (NAP) since 2017, AMR remains widespread. The sentinel laboratories analyzed 184,788 bacterial isolates via the WHONET database, identifying Escherichia coli as the most common isolate, accounting for 25.9% of all isolates. Resistance trend analysis revealed no significant changes for most pathogens, though Shigella sp. showed a significant increase in azithromycin resistance (p=0.027). The study found resistance rates for doxycycline, azithromycin, clindamycin, trimethoprim/sulfamethoxazole, ciprofloxacin, and rifampicin ranging between 50% and 80%. Alarmingly, resistance rates for VRE, linezolid-resistant, and carbapenem-resistant bacteria were 65%, 72%, and 44%, respectively, while potential ESBL-producing Enterobacteriaceae showed resistance rates as high as 35%. These findings demonstrate that AMR in Zambia is worsening, necessitating enhanced antimicrobial stewardship and continuous diagnostic monitoring.
Research Methods and Experiments
This descriptive retrospective study analyzed routine laboratory data from seven designated AMR surveillance sentinel hospitals in Zambia, spanning from January 2020 to December 2024. The data included clinical specimen types and antimicrobial susceptibility testing results, analyzed through the WHONET database. The study also assessed resistance to various antibiotics, including those categorized under the WHO AWaRe classification. Furthermore, the research team analyzed key AMR alerts, such as vancomycin-resistant enterococci (VRE), linezolid resistance, carbapenem resistance, and potential ESBL-producing Enterobacteriaceae.
Key Conclusions and Perspectives
Research Significance and Prospects
This study represents the first large-scale analysis of AMR trends and diagnostic stewardship in Zambia, offering critical data on antimicrobial resistance. The findings are significant for shaping policy and public health interventions. Future efforts should focus on strengthening antimicrobial stewardship, optimizing prescription strategies, increasing the use of diagnostic tests, and promoting cross-sector collaboration to combat AMR challenges.
Conclusion
This study summarizes the diagnostic stewardship and AMR trends of bacterial isolates in Zambia from 2020 to 2024, highlighting the severity of AMR, particularly the high resistance rates to commonly used antibiotics. The research emphasizes the urgent need for enhanced antimicrobial stewardship and continuous surveillance to address the growing threat of AMR. Furthermore, the results indicate that while resistance to some antibiotics is declining, key resistance alerts—such as those for VRE, linezolid, and carbapenem-resistant bacteria—require focused attention. Future research should delve deeper into the molecular mechanisms of AMR and promote evidence-based interventions to curb the spread of resistance.
