Getahun Strobel Aneley, Prasad Prinika, Lane Courtney R, Naidu Ravi, Autar Sanjeshni, Young-Sharma Tracey, Richards Matthew, Suka Ana, Cameron Donna, James Rodney, Prasad Ravendra, Buising Kirsty, Howden Benjamin P, Prasad Vinita
Department of Infectious Diseases, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
Ministry of Health and Medical Services, Colonial War Memorial Hospital, Suva, Fiji.
Lancet Reg Health West Pac. 2024 Mar 14;45:101036. doi: 10.1016/j.lanwpc.2024.101036. eCollection 2024 Apr.
There is a paucity of data on antimicrobial resistance in Fiji. The aim of this study was to determine the antimicrobial susceptibility profile of bacterial isolates from clinical samples at Colonial War Memorial Hospital in Fiji.
This retrospective study reviewed four-year of data from January 1, 2019, through December 31, 2022. Laboratory testing was carried out using locally approved protocols. Selective antimicrobial susceptibility testing was performed whereby only isolates resistant to first line antimicrobials were tested against second line antimicrobials. Only the first isolate of a given species per patient in a single year were included in the analysis. WHONET software and Microsoft Excel were used for analysis.
A total of 29,222 bacterial isolates were included, 62% (n = 18,084) were Gram-negative bacteria. was the most common (n = 5363), followed by (n = 4321). Extended spectrum beta lactamase (ESBL) production increased from 30% in 2019 to 43% in 2022 amongst , and 10%-23% . There were 733 carbapenem-resistant isolates identified from clinical samples, 61% (n = 445) were . , 15% (n = 110) and 14% (n = 101) . Amongst the isolates tested, susceptibility to meropenem declined from 99% (272/274) in 2019 to 79% (255/325) in 2022. The rate of methicillin resistance amongst was steady, remaining between 11% and 13%.
This study demonstrated a high rate of MDR amongst Gram-negative bacteria, especially ESBL producing and carbapenem-resistant . The emergence and rapid spread of carbapenemase producing in Fiji's largest hospital is of particular concern. There is an urgent need to allocate resources to improve existing capacity and to develop effective multimodal strategies to detect, manage and control the spread of MDR organisms.
This study was supported by the Medical Research Future Fund through the Australian government (grant number APP 1200970).
斐济关于抗菌药物耐药性的数据匮乏。本研究的目的是确定斐济殖民战争纪念医院临床样本中细菌分离株的抗菌药物敏感性概况。
这项回顾性研究回顾了2019年1月1日至2022年12月31日这四年的数据。实验室检测按照当地批准的方案进行。进行了选择性抗菌药物敏感性测试，即仅对耐一线抗菌药物的分离株进行二线抗菌药物测试。分析中仅纳入每位患者在同一年中某一特定菌种的首个分离株。使用WHONET软件和Microsoft Excel进行分析。
共纳入29222株细菌分离株，62%（n = 18084）为革兰氏阴性菌。大肠埃希菌最为常见（n = 5363），其次是肺炎克雷伯菌（n = 4321）。产超广谱β-内酰胺酶（ESBL）的大肠埃希菌比例从2019年的30%增至2022年的43%，肺炎克雷伯菌为10% - 23%。从临床样本中鉴定出733株耐碳青霉烯类分离株，61%（n = 445）为肺炎克雷伯菌，15%（n = 110）为大肠埃希菌，14%（n = 101）为鲍曼不动杆菌。在测试的金黄色葡萄球菌分离株中，对美罗培南的敏感性从2019年的99%（272/274）降至2022年的79%（255/325）。金黄色葡萄球菌中甲氧西林耐药率稳定，维持在11%至13%之间。
本研究表明革兰氏阴性菌中多重耐药率很高，尤其是产ESBL的大肠埃希菌和耐碳青霉烯类肺炎克雷伯菌。在斐济最大的医院中产碳青霉烯酶肺炎克雷伯菌的出现和迅速传播尤其令人担忧。迫切需要分配资源以提高现有能力，并制定有效的多模式策略来检测、管理和控制多重耐药菌的传播。
本研究由澳大利亚政府通过医学研究未来基金资助（拨款编号APP 1200970）。
