Epidemiology of antibiotic consumption and resistance in Mauritius

L. Veerapa-Mangroo, Harena Rasamoelina-Andriamanivo, M.I. Issack, Eric Cardinale
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Abstract

This study aims at determining the pattern of antibiotic consumption and resistance in Mauritius, a tropical island in the Indian Ocean.Antibiotic consumption was measured in kilograms of purchased antibiotics and also in defined daily dose (DDD) in different health institutions from 2015 to 2017. Data on antibiotic resistance was collected at the Central Health Laboratory (CHL) at Victoria Hospital and at Jeetoo Hospital Laboratory, where antibiotic sensitivity testing is done for all public health institutions. For this study, Escherichia coli, Klebsiella species, Acinetobacter species, and Pseudomonas aeruginosa isolates from blood samples of patients from 2015 to 2023 were included. The resistance rate and prevalence of multi-drug-resistant (MDR) organisms were calculated.The amount of antibiotics (in kilograms) distributed to the human sector was between 11,000 to 13,000 kg, compared to only 700 to 1,500 kg in the animal sector. The DDD per 1,000 inhabitants per day was 20.9, 22.1, and 21.7 in 2015, 2016, and 2017, respectively, with a greater consumption of WATCH and RESERVE group antibiotics in the private sector. In public health institutions, health centers in the northern region had the highest DDD per 1,000 outpatients per day for beta-lactams penicillins and quinolones. Concerning antibiotic resistance, the proportion of MDR Acinetobacter baumannii and Pseudomonas aeruginosa has increased from 58% to 74% and from 33% to 45%, respectively, from 2015 to 2023. During the same period, the proportion of E. coli and K. pneumoniae isolates sensitive to ceftriaxone decreased from 55% to 39% and from 37% to 22%, respectively, while the proportion of E. coli, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa isolates sensitive to meropenem decreased from 98% to 94%, 83% to 53%, 45% to 28%, and 63% to 47%, respectively.This study provides valuable insights on antibiotic consumption and resistance in the country and emphasizes the significance of adopting a One Health approach to combat antimicrobial resistance (AMR) effectively. These findings will aid policymakers in formulating targeted strategies to address the challenge of AMR and should be integrated into the National Action Plan on AMR in Mauritius.
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毛里求斯抗生素消费和耐药性流行病学
本研究旨在确定毛里求斯(印度洋上的一个热带岛屿)的抗生素消费和耐药性模式。2015 年至 2017 年期间,不同医疗机构的抗生素消费量以购买抗生素的公斤数和定义日剂量(DDD)为单位进行测量。抗生素耐药性数据由维多利亚医院的中央卫生实验室(CHL)和Jeetoo医院实验室收集,所有公共卫生机构均在该实验室进行抗生素敏感性检测。在这项研究中,大肠埃希菌、克雷伯氏菌、醋杆菌和铜绿假单胞菌被纳入了从2015年至2023年患者血液样本中分离出来的菌株。计算了耐药率和多重耐药菌(MDR)的流行率。分配给人类的抗生素数量(以公斤为单位)为 11,000 至 13,000 公斤,而分配给动物的抗生素数量仅为 700 至 1,500 公斤。2015 年、2016 年和 2017 年,每千名居民每天的 DDD 分别为 20.9、22.1 和 21.7,私营部门的 WATCH 和 RESERVE 类抗生素消费量更大。在公共卫生机构中,北部地区的卫生中心每天每千名门诊患者使用β-内酰胺类青霉素和喹诺酮类药物的DDD最高。关于抗生素耐药性,从 2015 年到 2023 年,MDR 鲍曼不动杆菌和铜绿假单胞菌的比例分别从 58% 增加到 74%,从 33% 增加到 45%。同期,对头孢曲松敏感的大肠埃希菌和肺炎克雷伯菌分离株的比例分别从 55% 降至 39%,从 37% 降至 22%,而对美罗培南敏感的大肠埃希菌、肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌分离株的比例分别从 98% 降至 94%,83% 降至 53%,45% 降至 28%,63% 降至 47%。这项研究提供了有关该国抗生素消费和耐药性的宝贵见解,并强调了采用 "一体健康 "方法有效抗击抗菌药耐药性(AMR)的重要性。这些研究结果将有助于决策者制定有针对性的战略,以应对抗菌药物耐药性的挑战,并应纳入毛里求斯抗菌药物耐药性国家行动计划。
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