Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi, 74800, Pakistan.
Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
BMC Infect Dis. 2021 Dec 7;21(1):1231. doi: 10.1186/s12879-021-06795-0.
In 2018 Pakistan initiated its national antimicrobial resistance (AMR) surveillance aligned with Global Antimicrobial Surveillance System (GLASS). To complement this surveillance, we conducted a situational analysis of AMR rates among GLASS organisms in the country. Data from published studies and from antibiograms was compared and role of antibiograms as potential contributors to national AMR surveillance explored.
AMR rates for GLASS specified pathogen/antimicrobials combination from Pakistan were reviewed. Data sources included published studies (2006-2018) providing AMR rates from Pakistan (n = 54) as well as antibiograms (2011-2018) available on the Pakistan Antimicrobial Resistance Network (PARN) website. Resistance rates were categorized as follows: Very low: 0-10%, Low: 11-30%, Moderate: 30-50% and High: > 50%.
Published data from hospital and community/laboratory-based studies report resistance rates of > 50% and 30-50% respectively to 3rd generation cephalosporins, fluoroquinolones and cotrimoxazole amongst Klebsiella pneumoniae and Escherichia coli. Carbapenem resistance rates amongst these organisms remained below 30%. High (> 50%) resistance was reported in Acinetobacter species to aminoglycosides and carbapenems among hospitalized patients. The evolution of ceftriaxone resistant Salmonella Typhi and Shigella species is reported. The data showed > 50% to fluoroquinolones amongst Neisseria gonorrhoeae and the spread of methicillin resistant Staphylococcus aureus (< 30%; 2008) to (> 50%; 2010) in hospital settings. Resistance reported in published studies aligned well with antibiogram data. The latter also captured a clear picture of evolution of resistance over the study period.
Both published studies as well antibiograms suggest high rates of AMR in Pakistan. Antibiogram data demonstrating steady increase in AMR highlight its potential role towards supplementing national AMR surveillance efforts particularly in settings where reach of national surveillance may be limited.
2018 年，巴基斯坦启动了与全球抗菌药物监测系统（GLASS）一致的国家抗菌药物耐药性（AMR）监测。为了补充这一监测，我们对该国 GLASS 生物体中的 AMR 率进行了情况分析。比较了来自已发表研究和抗生素耐药性监测数据的结果，并探讨了抗生素耐药性监测作为国家 AMR 监测的潜在贡献。
审查了巴基斯坦 GLASS 指定病原体/抗菌药物组合的 AMR 率。数据来源包括提供来自巴基斯坦的 AMR 率的已发表研究（2006-2018 年）（n=54）以及巴基斯坦抗菌药物耐药性网络（PARN）网站上的抗生素耐药性监测数据。耐药率分为以下几类：极低：0-10%、低：11-30%、中：30-50%和高：>50%。
来自医院和社区/实验室研究的已发表数据报告称，肺炎克雷伯菌和大肠埃希菌对第三代头孢菌素、氟喹诺酮类和复方磺胺甲恶唑的耐药率分别为>50%和 30-50%。这些生物体的碳青霉烯类耐药率仍低于 30%。住院患者的不动杆菌属对氨基糖苷类和碳青霉烯类的耐药率较高（>50%）。报告了耐头孢曲松的伤寒沙门氏菌和志贺氏菌的演变情况。数据显示，淋病奈瑟球菌对氟喹诺酮类的耐药率>50%，耐甲氧西林金黄色葡萄球菌（<30%；2008 年）在医院环境中（>50%；2010 年）的传播情况。已发表研究中的报告与抗生素耐药性监测数据一致。后者还清楚地反映了研究期间耐药性的演变情况。
已发表的研究和抗生素耐药性监测数据均表明，巴基斯坦的 AMR 率很高。抗生素耐药性监测数据表明 AMR 率稳步上升，这突出了其在补充国家 AMR 监测工作方面的潜在作用，特别是在国家监测可能有限的情况下。
