Challenges Facing PICUs in Low- and Middle-Income Countries in the Treatment of Emerging Multidrug-Resistant Organisms: a Review and Perspective from a South African PICU

• Published in: Current infectious disease reports Vol. 25; no. 11; pp. 233 - 242
• Main Authors: Saggers, Robin T., Mothibi, Lesego M., Irwin, Adam D., Naidoo, Kuban D.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-11-2023; Springer Nature B.V
• Subjects: Antimicrobial agents; Disease prevention; Drug resistance; Drug therapy; Hospitals; Infectious Diseases; Intensive care; Low income groups; Medicine; Medicine & Public Health; Multidrug resistant organisms; Pediatrics; Pneumonia; Public health; Section Editor; Sepsis in the ICU (J Lipman; Topical Collection on Sepsis in the ICU; South Africa; Antimicrobial stewardship; Antimicrobial resistance; Multidrug-resistant organisms; Colistin; HIV; Infection prevention and control
• ISSN: 1523-3847; 1534-3146
• DOI: 10.1007/s11908-023-00817-5

Purpose of Review
Antimicrobial resistance continues to increase throughout the world, with the impact on critically ill children in low- and middle-income paediatric intensive care units largely unknown.
Recent Findings
There has been a global shift indicating a predominance of Gram-negative bacilli among multidrug-resistant isolates. A 4-year review (2019 to 2022) found a progressive and substantial increase in the incidence of carbapenem-resistant
Klebsiella pneumoniae
(29% to 51%) alongside high levels of carbapenem-resistant
Acinetobacter baumannii
(93%) within the paediatric intensive care unit at the Chris Hani Baragwanath Academic Hospital in South Africa. The pharmacological treatment of these infections relies heavily on the continued use of carbapenems, often in combination with colistin.
Summary
The burden of antimicrobial resistance is disproportionately borne, particularly within sub-Saharan Africa and South Asia. The resource-constrained South African public healthcare system, already significantly burdened by both HIV and TB, continues to face several challenges in combating the growth in antimicrobial resistance. Limited access, largely driven by prohibitive costs, to sophisticated laboratory techniques and newer pharmacological agents, leaves the implementation of effective infection prevention and control and antimicrobial stewardship programmes as the most pragmatic options to address the problem.