The changing epidemiology of antimicrobial resistance in Fiji: a descriptive analysis of antimicrobial susceptibility and trends of endemic and emerging pathogens, 2019-2022

Aneley Getahun Strobel; Prinika Prasad; Courtney R Lane; Ravi Naidu; Sanjeshni Autar; Tracey Young-Sharma; Matthew Richards; Ana Suka; Donna Cameron; Rodney James; Ravendra Prasad; Kirsty Buising; Benjamin P Howden; Vinita Prasad

doi:10.1016/j.lanwpc.2024.101036

The changing epidemiology of antimicrobial resistance in Fiji: a descriptive analysis of antimicrobial susceptibility and trends of endemic and emerging pathogens, 2019-2022

Lancet Reg Health West Pac. 2024 Mar 14:45:101036. doi: 10.1016/j.lanwpc.2024.101036. eCollection 2024 Apr.

Authors

Affiliations

¹ Department of Infectious Diseases, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
² Ministry of Health and Medical Services, Colonial War Memorial Hospital, Suva, Fiji.
³ Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
⁴ Infection Prevention and Surveillance Service, The Royal Melbourne Hospital, Melbourne, Australia.
⁵ The Royal Melbourne Hospital, Melbourne, Australia.

Abstract

Background: 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.

Methods: 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.

Findings: A total of 29,222 bacterial isolates were included, 62% (n = 18,084) were Gram-negative bacteria. K. pneumoniae was the most common (n = 5363), followed by E. coli (n = 4321). Extended spectrum beta lactamase (ESBL) production increased from 30% in 2019 to 43% in 2022 amongst K. pneumoniae, and 10%-23% in E coli. There were 733 carbapenem-resistant isolates identified from clinical samples, 61% (n = 445) were A. baumannii, 15% (n = 110) E. coli and 14% (n = 101) P. aeruginosa. Amongst the E. coli isolates tested, susceptibility to meropenem declined from 99% (272/274) in 2019 to 79% (255/325) in 2022. The rate of methicillin resistance amongst Staphylococcus aureus was steady, remaining between 11% and 13%.

Interpretation: This study demonstrated a high rate of MDR amongst Gram-negative bacteria, especially ESBL producing K. pneumoniae and E. coli and carbapenem-resistant A. baumannii. The emergence and rapid spread of carbapenemase producing E. coli 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.

Funding: This study was supported by the Medical Research Future Fund through the Australian government (grant number APP 1200970).

Keywords: Antimicrobial resistance; Epidemiology; Fiji; Gram-negative organisms; Multidrug resistance.