Infectious Disease

The examine identifies areas in want of monitoring

February 08, 2021

2 min read

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Oldenkamp does not report any relevant financial information. In the study you will find all relevant financial information from all other authors.

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The Middle East, Sub-Saharan Africa and the Pacific Islands should be prioritized for antibiotic resistance surveillance, researchers argued in a recent study that surveillance in these areas is either needed or could be improved.

“Clinical resistance to antibiotics is an increasing threat to global health. Structural monitoring of clinical resistance is essential to inform treatment and action to address this threat. ” Rik Oldenkamp, ​​PhD, said Healio, a postdoctoral fellow at the Amsterdam Institute for Global Health and Development and the Department of Global Health at the Medical Centers of the University of Amsterdam.

“However, it is very costly to set up and maintain surveillance, especially for low- and middle-income countries, and there are still large knowledge gaps in these countries,” said Oldenkamp. “At the same time, these countries are disproportionately affected by infectious diseases. For this reason, we have developed a data-driven method to estimate resistance levels around the world and use this to prioritize monitoring efforts. “

Oldenkamp and colleagues used models for nine pathogens that are resistant to 19 classes of antibiotics to investigate the statistical relationship between the prevalence of antibiotic resistance (AMR) and socio-economic characteristics. According to the study, the researchers combined prevalence data from ResistanceMap, a repository of AMR trends, with socio-economic profiles built from 5,595 World Bank indicators, and used cross-validated models to estimate clinical AMR prevalence and trends for countries with no data.

Overall, the study showed a high level of predictive accuracy for six out of nine pathogens. They found that the prediction accuracy for Pseudomonas aeruginosa (q2 = 0.58) and Staphylococcus aureus (q2 = 0.56) was lower and the prediction performance for Streptococcus pneumoniae was much lower (q2 = 0.27). Forecast errors were greatest for Enterobacter aerogenes / cloacae and Enterococcus faecium, as well as for Escherichia coli estimates, especially in Iran and Indonesia. E. aerogenes / cloacae and E. faecium are represented in ResistanceMap with a relatively small number of 13 and 46 countries, respectively.

The researchers said performance is lower in target countries with different characteristics, although clinical AMR prevalence is accurately predicted in similar countries.

According to Oldenkamp, ​​they were able to identify three regions of interest for prioritizing surveillance based on various data-driven criteria: Middle Eastern countries where resistance levels were highest, Sub-Saharan Africa where relative increases in resistance had been the highest over the past 20 years and various small island states such as the Pacific Islands that could benefit from improved coverage.

However, the researchers admitted that their models at the upper end of the spectrum “tend to overestimate the prevalence of resistance”. However, they said that AMR surveillance efforts should be prioritized in countries where AMR is expected to increase rapidly.

“We value clinical resistance at the individual country level. These estimates can support the formulation of (supra) national surveillance strategies and possibly national treatment guidelines, but local clinical conclusions are more difficult to draw, especially in large and very heterogeneous countries, ”said Oldenkamp. “I think that would require a more local approach, tailored to the specific local conditions.”

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