Antibiotic resistance

Antibiotic resistance refers to the mechanism whereby bacteria mutate thereby making antibiotics ineffective. Irrational use of antibiotics has created selection pressure on resistant bacteria that may be responsible for some serious invasive bacterial infections. These infections then require last-line antibiotics that are both costly and increase the risk of complications and even death.

Antibiotic resistance has become one of the greatest threats to global health. Resistant bacteria already cause more than 700,000 deaths globally every year and the annual toll would climb to 10 million deaths in the next 35 years.

There is scant information on antibiotic resistance in low-income countries and even more so in the regions and among the populations where Médecins Sans Frontières (MSF) works. This is principally due to the lack of laboratories. This means that antibiotic treatments are often prescribed on an empirical basis and this may not be effective if the infection is due to resistant bacteria.

Epicentre is working to provide better descriptions of severe bacterial infections and their antibiotic resistant to strengthen the rational use of antibiotics. This is a primary issue if we want to limit the spread of antibiotic resistance.

In order to better understand the scale and nature of the problem, Epicentre concentrates its efforts in describing the epidemiology of antibiotic resistance in the community and hospitals in low-income settings where MSF works.

For example, in sub-Saharan Africa invasive bacterial infections in children under the age of 5 that are acquired in the community or in hospitals (bacteremia and meningitis); and osteomyelitis in the war-wounded in the Middle East. We also investigated infection in patients suffering from serious burns in Haiti^1-7.

Comparisons between West Africa, East Africa and the Middle East indicate there is considerable variation in the types and proportions of antibiotic resistance. These complexities and local differences need to be understood and taken into account when adapting therapeutic protocols.

Epicentre has monitored the evolution of antibiotic resistance at its research centers in Niger and Uganda for many years, and this shows a worrying trend in multiresistance. Our 2008 study into septicemia in children in Niger, showed no enterobacterial  resistance to ceftriaxone¹, but results from our 2018 investigation show that 15% are resistant to this antibiotic now. Similarly, in Uganda, between 2009 and 2012, 2% of meningitis cases were resistant to ceftriaxone between 2009 and 2012, compared with 9% for bacteremia in 2015-16².

Epicentre’s carriage study in Niger in 2017 of intestinal multiresistant bacteria indicate high levels of antibiotic consumption in the general population. A total of 90% of the population (of all ages) carry multiresistant bacteria⁸.

The bacteriological investigations of all these studies in Niger and Uganda are done through the  bacteriology laboratories in our research centers in Niger and Uganda that provide important data in countries and regions with limited access to quality bacteriology laboratory.

Important collaborations with reference laboratories allow us to refine our research and to investigate in more detail the mechanisms of resistance, for example by molecular biology.

References

¹ Page A-L, de Rekeneire N, Sayadi S, Aberrane S, Janssens A-C, Rieux C, et al. Infections in children admitted with complicated severe acute malnutrition in Niger. PLoS One. 2013 Jan;8(7):e68699. 
² Page A-L, Boum Y, Kemigisha E, Salez N, Nanjebe D, Langendorf C, et al. Aetiology and outcomes of suspected infections of the central nervous system in Children in Mbarara, Uganda. Sci Rep. 2017;7(1). 
³ Teicher CL, Ronat J-B, Fakhri RM, Basel M, Labar AS, Herard P, et al. Antimicrobial drug-resistant bacteria isolated from Syrian war-injured patients, August 2011-March 2013. Emerg Infect Dis [Internet]. 2014 Nov [cited 2018 May 21];20(11):1949–51. 
⁴ Murphy RA, Nisenbaum L, Labar AS, Sheridan RL, Ronat J-B, Dilworth K, et al. Invasive Infection and Outcomes in a Humanitarian Surgical Burn Program in Haiti. World J Surg [Internet]. 2016 Jul 25 [cited 2018 May 21];40(7):1550–7. 
⁵ Bernabé KJ, Langendorf C, Ford N, Ronat J-B, Murphy RA. Antimicrobial resistance in West Africa: a systematic review and meta-analysis. Int J Antimicrob Agents. 2017 Nov;50(5):629–39. 
⁶ Isanaka S, Langendorf C, Berthé F, Gnegne S, Li N, Ousmane N, et al. Routine amoxicillin for uncomplicated severe acute malnutrition in children. N Engl J Med. 2016;374(5). 
⁷  Langendorf C, Le Hello S, Moumouni A, Gouali M, Mamaty A-A, Grais RF, et al. Enteric bacterial pathogens in children with diarrhea in niger: Diversity and antimicrobial resistance. PLoS One. 2015;10(3). 
⁸  Coldiron ME, Assao B, Page A-L, Hitchings MDT, Alcoba G, Ciglenecki I, et al. Single-dose oral ciprofloxacin prophylaxis as a response to a meningococcal meningitis epidemic in the African meningitis belt: A 3-arm, open-label, cluster-randomized trial. PLoS Med. 2018;15(6).