Described as the silent pandemic, antimicrobial resistance (AMR) was identified in 2017 as one of the World Health Organization (WHO)’s top 10 global healthcare threats.[1] It is estimated that AMR was associated with 4.95 million deaths in 2019, with a disproportionate burden in low- and middle-income countries (LMICs), especially in Africa, where AMR is estimated to be associated with 1.05 million deaths.[2,3] The highest burden is in respiratory followed by bloodstream infections.[3] Neonatal deaths associated with AMR exceeded older age groups in most African countries.[3] Six pathogens are associated with almost 1 million deaths: Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, Acinetobacter baumannii and Pseudomonas aeruginosa. K. pneumoniae is a more prevalent organism in LMICs compared with high-income countries (HICs), where E.coli contributes more significantly to AMR and associated deaths.[2] The rate at which AMR develops has been linked to overuse of antibiotics; however, there are several other contributory factors, especially in LMICs, including environmental contamination, healthcare transmission and suboptimal diagnostics.[4,5] While consumption of antibiotics in HICs is higher than in LMICs, there has been minimal increase over the last 5 years. This contrasts with LMICs, where consumption of antibiotics continues to rise.[2]

 

Authors

H Finlayson,Cert ID (Paeds), MBA ; V Chibabhai, MB BCh, FCPath Micro ; P Jeena, FCP (Paeds), PhD ; S Kolman, BPharm, MSc (Med) ; W Lowman, MMed (Micro), FC Path Micro ; T C Manzini, Cert ID, MMed (Int Med) ; T Nana, MB BCh, FCPath Micro ; J Nuttall, MB ChB, FCPaed ; A Parker, Cert ID, PhD ; P Skosana, MPharm, PhD ; V Ueckermann, PhD (Infect Dis), MMed (Int Med) ; A Wise, Cert MFM (SA), MSc

 

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