A descriptive model featuring expansive clinical microbiology approaches and antimicrobial stewardship to control antimicrobial resistance in low- and middle-income countries
The upsurge and escalation of antimicrobial resistance (AMR) poses a major worry on the global scene. Effective antimicrobial stewardship (AMS) programs are critical to combat this challenge, and applied knowledge in clinical microbiology serves as the cornerstone for the successful implementation. Despite technological advances, many low- and middle-income countries (LMICs) still adopt traditional phenotypic techniques in clinical microbiology laboratories. An expansive implementation of clinical microbiology approaches can bridge this apparent gap. Good laboratory assessment, hospital epidemiology, and infection prevention and control, which are the sub-divisions of the expansive clinical microbiology approaches, can be deployed to implement AMS appropriately in LMICs. In this paper, we describe a model featuring a functional AMS equipped with expansive clinical microbiology approaches to control AMR in LMICs.
Australian Commission on Safety and Quality in Healthcare. (2018). Antimicrobial stewardship in Australian health care. In: Role of the Clinical Microbiology Service in Antimicrobial Stewardship. Sydney: Australian Commission on Safety and Quality in Healthcare.
Barbé, B., Yansouni, C.P., Affolabi, D., & Jacobs, J. (2017). Implementation of quality management for clinical bacteriology in low-resource settings. Clinical Microbiology and Infection, 23(7):426-433. https://doi.org/10.1016/j.cmi.2017.05.007
Baur, D., Gladstone, B.P., Burkert, F., Carrara, E., Foschi, F., Döbele, S., et al. (2017). Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: A systematic review and meta-analysis. The Lancet Infectious Diseases, 17(9):990-1001. https://doi.org/10.1016/S1473-3099(17)30325-0
Centre for Disease Control and Prevention (CDC). Core Elements of Antibiotic Stewardship: Antibiotic Use. Available from: https://www.cdc.gov/antibiotic-use/core-elements/index. html [Last accessed on 2023 Aug 03].
Dellit, T.H., Owens, R.C., McGowan, J.E., Gerding, D.N., Weinstein, R.A., Burke, J.P., et al. (2007). Infectious diseases society of America and the society for healthcare epidemiology of America. Guidelines for developing an institutional program to enhance antimicrobial stewardship. Clinical Infectious Diseases, 44(2):159-177. https://doi.org/10.1086/510393
Guder, W.G., Narayanan, S., Wisser, H., & Zawta, B. (2003). Samples: From the Patient to the Laboratory. The Impact of Preanalytical Variabled on the Quality of Laboratory Results. 3rd ed. United States: Wiley. https://doi.org/10.1002/9783527612505
Kohlmann, R., Bähr, T., & Gatermann, S.G. (2018). Species-specific mutation rates for ampCderepression in Enterobacterales with chromosomally encoded inducible AmpC β-lactamase. Journal of Antimicrobial Chemotherapy, 73(6):1530-1536. https://doi.org/10.1093/jac/dky084
Larocco, M.T., Franek, J., Leibach, E.K., Weissfeld, A.S., Kraft, C.S., Sautter, R.L., et al. (2015). Effectiveness of preanalytic practices on contamination and diagnostic accuracy of urine cultures: A laboratory medicine best practices systematic review and meta-analysis. Clinical Microbiology Reviews, 29(1):105-147. https://doi.org/10.1128/CMR.00030-15
MacDougall, C. (2011). Beyond susceptible and resistant, part I: Treatment of infections due to gram-negative organisms with inducible β-lactamases. The Journal of Pediatric Pharmacology and Therapeutics, 16(1):23-30.
Manning, M.L., Septimus, E.J., Ashley, E.S., Cosgrove, S.E., Fakih, M.G., Schweon, S.J., et al. (2018). Antimicrobial stewardship and infection prevention-leveraging the synergy: A position paper update. American Journal of Infection Control, 46(4):364-368. https://doi.org/10.1016/j.ajic.2018.01.001
Messacar, K., Parker, S.K., Todd, J.K., & Dominguez, S.R. (2017). Implementation of rapid molecular infectious disease diagnostics: The role of diagnostic and antimicrobial stewardship. Journal of Clinical Microbiology, 55(3):715-723. https://doi.org/10.1128/JCM.02264-16
Odih, E.E., Irek, E.O., Obadare, T.O., Oaikhena, A.O., Afolayan, A.O., Underwood, A., et al. (2022). Rectal colonization and nosocomial transmission of carbapenem-resistant Acinetobacter baumannii in an intensive care unit, Southwest Nigeria. Frontiers in Medicine (Lausanne), 9:846051. https://doi.org/10.3389/fmed.2022.846051
Oduyebo, O., Olayinka, A., Iregbu, K., Versporten, A., Goossens, H., Nwajiobi-Princewill, P., et al. (2017). A point prevalence survey of antimicrobial prescribing in four Nigerian tertiary hospitals. Annals of Tropical Pathology, 8(1):42. https://doi.org/10.4103/atp.atp_38_17
Saurav Patra, M.D., Mukherjee, B., & Das, A.K. (2013). Pre-analytical errors in the clinical laboratory and how to minimize them. International Journal of Bioassays, 2(3):551-553.
Standards for Microbiology Investigations (UK SMI)-GOV UK. Available from: https://www.gov.uk/government/ collections/standards-for-microbiology-investigations-smi [Last accessed on 2023 Aug 22].
Vera, P., & Luther, A.A. (2015). The Essential Role of Clinical Microbiology Laboratories in Antimicrobial Stewardship. Available from: https://www.aacc.org/cln/articles/2015/ august/stewardship [Last accessed on 2023 Aug 03].
WHONET Microbiology Laboratory Database Software. Available from: https://whonet.org [Last accessed on 2023 Aug 22].
World Health Organization (WHO). Laboratory Quality Stepwise Implementation tool. Available from: https://extranet.who. int/lqsi/content/quality-management [Last accessed on 2023 Dec 07].
World Health Organization Regional Office for Africa. Guide for the Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) in the African Region (with checklist). Available from: https://www.afro. who.int/publications/who-guide-stepwise-laboratory-improvement-process-towards-accreditation-slipta-african [Last accessed on 2023 Aug 23].
World Health Organization WHO. Global Action Plan on Antimicrobial Resistance. Available from: https://www.who. int/publications/i/item/9789241509763 [Last accessed on 2023 Dec 01].
Wu, H., Lutgring, J.D., McDonald, L.C., Webb, A., Fields, V., Blum, L., et al. (2023). Selective and cascade reporting of antimicrobial susceptibility testing results and its impact on antimicrobial resistance surveillance-national healthcare safety network, April 2020 to March 2021. Microbiology Spectrum, 11(2):e0164622. https://doi.org/10.1128/spectrum.01646-22
Yale School of Medicine. Antimicrobial Stewardship and hospital Epidemiology. In: Infectious diseases. Available from: https://medicine.yale.edu/intmed/infdis/research/hospital-epidemiology/[Last accessed 2023 Aug 23].