Antimicrobial Resistance in Critical Care: A Scoping Review
CCCF ePoster library. Nazir A. Nov 8, 2018; 233404
Anisa Nazir
Anisa Nazir
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Abstract
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Introduction: Antimicrobial resistance (AMR) is an emerging global public health issue in both developed and developing countries. Nosocomial infections are particularly important in the intensive care unit where the most seriously ill patients are managed. Due to this, ICUs are at the focal point of hospitals where multi-drug resistance occurs and leads to high rates of morbidity and mortality.

 

Objectives:  We sought to understand antimicrobial resistance in ICUs in low resource settings and areas of high AMR rates. To identify gaps in AMR surveillance, catalogue AMR surveillance strategies, and evaluate potential environmental reservoirs. Countries with high AMR rates and low resource settings were analyzed and assessed for future comparison to resource-rich critical care settings.

 

Methods: An extensive literature search was conducted from the scientific published medical journals as well as grey literature from 2007 to 2017. Two reviewers independently screened various databases including PubMed, MEDLINE, EMBASE, and the Cochrane Library. 441 ICU specific studies were analyzed. Data was streamlined and organized using Covidence.

 

Results: 54 countries represented the 441 critical care antimicrobial resistance studies that were identified. The studies utilized a wide range of data to assess AMR including clinical data, laboratory and antibiotic stewardship study results.  Nine percent of the studies reported antibiotic use, 23% of studies reported a source of funding, 153 papers were surveillance studies, and 33% were multicenter studies.  Various ICU settings included: burn, pediatric, general, medical, neurology, neurosurgery, trauma, anesthesia and reanimation, cardiac and respiratory ICUs.  Resistance was assessed in 78% of the studies, and various techniques were used across the countries including MIC assessment or disc diffusion. There was wide variability in resistance rates reported across the multiple studies in the different jurisdictions. Major gaps in AMR surveillance data was identified in Sub-Saharan Africa, Central Asia and some countries in Central and Latin America.

 

Conclusions: The burden of AMR is much more difficult to quantify in AMR-rich and resource-poor countries owing to a lack of information, publications and data. Global patterns of AMR have to be adequately understood and recorded to develop strategies to reduce the global burden of this worldwide threat.


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