CoChat
Sign Up
Cited by 149Antibiotic Use and ResistanceSurgical site infection preventionAntibiotic Resistance in Bacteria

Antibiotic Use in Low and Middle-Income Countries and the Challenges of Antimicrobial Resistance in Surgery

Open access
Sartelli, Massimo, C. Hardcastle, Timothy, Catena, Fausto, Chichom-Mefire, Alain, Coccolini, Federico, Dhingra, Sameer, Haque, Mainul, Hodonou, Adrien +5 more·2020·Antibiotics
DOI 10.3390/antibiotics9080497PMC PMC7459633
Open this paper in CoChat — free accountOpen PDF

Abstract

Antimicrobial resistance (AMR) is a phenomenon resulting from the natural evolution of microbes. Nonetheless, human activities accelerate the pace at which microorganisms develop and spread resistance. AMR is a complex and multidimensional problem, threatening not only human and animal health, but also regional, national, and global security, and the economy. Inappropriate use of antibiotics, and poor infection prevention and control strategies are contributing to the emergence and dissemination of AMR. All healthcare providers play an important role in preventing the occurrence and spread of AMR. The organization of healthcare systems, availability of diagnostic testing and appropriate antibiotics, infection prevention and control practices, along with prescribing practices (such as over-the-counter availability of antibiotics) differs markedly between high-income countries and low and middle-income countries (LMICs). These differences may affect the implementation of antibiotic prescribing practices in these settings. The strategy to reduce the global burden of AMR includes, among other aspects, an in-depth modification of the use of existing and future antibiotics in all aspects of medical practice. The Global Alliance for Infections in Surgery has instituted an interdisciplinary working group including healthcare professionals from different countries with different backgrounds to assess the need for implementing education and increasing awareness about correct antibiotic prescribing practices across the surgical pathways. This article discusses aspects specific to LMICs, where pre-existing factors make surgeons’ compliance with best practices even more important.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.3390/antibiotics9080497

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The rapid emergence of antimicrobial-resistant pathogens is often accelerated by the inappropriate use and overuse of antimicrobial agents, especially antibiotics, in humans, animals, and agriculture or the environment.

    “Indeed, the rapid emergence of antimicrobial-resistant pathogens is often accelerated by the inappropriate use and overuse of antimicrobial agents, especially antibiotics, in humans, animals, and agriculture/the environment.”

    From Antimicrobial Resistance Rates and Surveillance in Sub-Saharan Africa: Where Are We Now? (2022) · cites this paper as [18]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

No references could be resolved yet.

Research works printed but not linked: 45

  1. [2]Rice L.B. Federal funding for the study of antimicrobial resistance in nosocomial pathogens: No ESKAPE J. Infect. Dis. 2008 197 1079 1081 10.1086/533452 18419525 · DOI
  2. [3]Boucher H.W. Talbot G.H. Bradley J.S. Edwards J.E. Gilbert D. Rice L.B. Scheld M. Spellberg B. Bartlett J. Bad bugs, no drugs: No ESKAPE! An update from the Infectious Diseases Society of America Clin. Infect. Dis. 2009 48 1 12 10.1086/595011 19035777 · DOI
  3. [4]Deege M.P. Paterson D.L. Reducing the development of antibiotic resistance in critical care units Curr. Pharm. Biotechnol. 2011 12 2062 2069 10.2174/138920111798808301 22188438 · DOI
  4. [5]Septimus E.J. Owens R.C. Jr. Need and potential of antimicrobial stewardship in community hospitals Clin. Infect. Dis. 2011 53 S8 S14 10.1093/cid/cir363 21795728 · DOI
  5. [6]Sartelli M. Kluger Y. Ansaloni L. Carlet J. Brink A. Hardcastle T.C. Khanna A. Mefire A.C. Nathwani D. Mendelson M. A Global Declaration on Appropriate Use of Antimicrobial Agents across the Surgical Pathway Surg. Infect. 2017 18 846 853 29173054
  6. [7]McEwen S.A. Collignon P.J. Antimicrobial Resistance: A One Health Perspective Microbiol. Spectr. 2018 6 10 PMC11633550 29600770
  7. [8]Ramsamy Y. Muckart D.J.J. Mlisana K.P. Antimicrobial stewardship in South Africa: A fruitful endeavour Lancet Infect. Dis. 2016 16 982 983 10.1016/S1473-3099(16)30052-4 27312578 · DOI
  8. [9]Hernando-Amado S. Coque T.M. Baquero F. Martínez J.L. Defining and combating antibiotic resistance from One Health and Global Health perspectives Nat. Microbiol. 2019 4 1432 1442 10.1038/s41564-019-0503-9 31439928 · DOI
  9. [11]Hope D. Ampaire L. Oyet C. Muwanguzi E. Twizerimana H. Apecu R.O. Antimicrobial resistance in pathogenic aerobic bacteria causing surgical site infections in Mbarara regional referral hospital, Southwestern Uganda Sci. Rep. 2019 9 17299 10.1038/s41598-019-53712-2 31754237 PMC6872727 · DOI
  10. [14]Ramsamy Y. Hardcastle T.C. Muckart D.J.J. Surviving Sepsis in the Intensive Care Unit: The Challenge of Antimicrobial Resistance and the Trauma Patient World J. Surg. 2017 41 1165 1169 10.1007/s00268-016-3531-0 27146052 · DOI
  11. [15]De Kraker M.E. Stewardson A.J. Harbarth S. Will 10 million people die a year due to antimicrobial resistance by 2050? PLoS Med. 2016 13 e1002184 10.1371/journal.pmed.1002184 27898664 PMC5127510 · DOI
  12. [16]Sartelli M. Coccolini F. Abu-Zidan F.M. Ansaloni L. Bartoli S. Biffl W. Borghi F. Chouillard E. Cui Y. De Oliveira Nascimento R. Hey surgeons! It is time to lead and be a champion in preventing and managing surgical infections! World J. Emerg. Surg. 2020 15 28 10.1186/s13017-020-00308-1 32306979 PMC7168830 · DOI
  13. [17]Charani E. Tarrant C. Moorthy K. Sevdalis N. Brennan L. Holmes A.H. Understanding antibiotic decision making in surgery-a qualitative analysis Clin. Microbiol. Infect. 2017 23 752 760 10.1016/j.cmi.2017.03.013 28341492 · DOI · Paper page
  14. [18]Makoka M.H. Miller W.C. Hoffman I.F. Cholera R. Gilligan P.H. Kamwendo D. Malunga G. Joaki G. Martinson F. Hosseinipour M.C. Bacterial infections in Lilongwe, Malawi: Aetiology and antibiotic resistance BMC Infect. Dis. 2012 12 67 10.1186/1471-2334-12-67 22436174 PMC3342226 · DOI
  15. [19]Iskandar K. Sartelli M. Tabbal M. Ansaloni L. Baiocchi G.L. Catena F. Coccolini F. Haque M. Labricciosa F.M. Moghabghab A. Highlighting the gaps in quantifying the economic burden of surgical site infections associated with antimicrobial-resistant bacteria World J. Emerg. Surg. 2019 14 50 10.1186/s13017-019-0266-x 31832084 PMC6868735 · DOI
  16. [20]Sartelli M. Weber D.G. Ruppé E. Bassetti M. Wright B.J. Ansaloni L. Catena F. Coccolini F. Abu-Zidan F.M. Coimbra R. Antimicrobials: A global alliance for optimizing their rational use in intra-abdominal infections (AGORA) World J. Emerg. Surg. 2016 11 33 10.1186/s13017-016-0089-y 27429642 PMC4946132 · DOI
  17. [22]Essack S.Y. Connolly C. Sturm A.W. Antibiotic use and resistance in public-sector hospitals in KwaZulu-Natal S. Afr. Med. J. 2005 95 865 870 16344884
  18. [23]Agyepong N. Govinden U. Owusu-Ofori A. Essack S.Y. Multidrug-resistant gram-negative bacterial infections in a teaching hospital in Ghana Antimicrob. Resist. Infect. Control 2018 7 37 10.1186/s13756-018-0324-2 29541448 PMC5845144 · DOI · Paper page
  19. [24]Holloway K. Mathai E. Gray A. Surveillance of community antimicrobial use in resource-constrained settings—Experience from five pilot projects Trop. Med. Int. Health 2011 16 152 161 10.1111/j.1365-3156.2010.02695.x 21138507 · DOI
  20. [25]Pereko D.D. Lubbe M.S. Essack S.Y. Surveillance of antibiotic use in the private sector in Namibia using sales and claims data J. Infect. Dev. Ctries. 2016 10 1243 1249 10.3855/jidc.7329 27886038 · DOI
  21. [26]Essack S.Y. Desta A.T. Abotsi R.E. Agoba E.E. Antimicrobial resistance in the WHO African region: Current status and roadmap for action J. Public Health 2017 39 8 13 10.1093/pubmed/fdw015 26944074 PMC5939661 · DOI
  22. [27]Farah R. Lahoud N. Salameh P. Saleh N. Antibiotic dispensation by Lebanese pharmacists: A comparison of higher and lower socio-economic levels J. Infect. Public Health 2015 8 37 46 10.1016/j.jiph.2014.07.003 25139454 · DOI
  23. [28]Cheaito L. Azizi S. Saleh N. Salameh P. Assessment of self-medication in population buying antibiotics in pharmacies: A pilot study from Beirut and its suburbs Int. J. Public Health 2014 59 319 327 10.1007/s00038-013-0493-y 23942698 · DOI
  24. [29]El Khoury G. Ramia E. Salameh P. Misconceptions and malpractices toward antibiotic use in childhood upper respiratory tract infections among a cohort of Lebanese parents Eval. Health Prof. 2018 41 493 511 10.1177/0163278716686809 28692318 · DOI
  25. [31]Brink A.J. Messina A.P. Maslo C. Swart K. Chunnilall D. van den Bergh D. Netcare Antimicrobial Stewardship and Infection Prevention Study Alliance Implementing a multi-faceted framework for proprietorship of hand hygiene compliance in a network of South African hospitals: Leveraging the Ubuntu philosophy J. Hosp. Infect. 2020 104 404 413 10.1016/j.jhin.2019.11.004 31738987 · DOI
  26. [32]Richards G.A. Brink A.J. Messina A.P. Feldman C. Swart K. van den Bergh D. Netcare Antimicrobial Stewardship and Infection Prevention Study Alliance Stepwise introduction of the ‘Best Care Always’ central-line-associated bloodstream infection prevention bundle in a network of South African hospitals J. Hosp. Infect. 2017 97 86 92 10.1016/j.jhin.2017.05.013 28549778 · DOI
  27. [33]Labricciosa F.M. Sartelli M. Correia S. Abbo L.M. Severo M. Ansaloni L. Coccolini F. Alves C. Melo R.B. Baiocchi G.L. Emergency surgeons’ perceptions and attitudes towards antibiotic prescribing and resistance: A worldwide cross-sectional survey World J. Emerg. Surg. 2018 13 27 10.1186/s13017-018-0190-5 29988647 PMC6027784 · DOI
  28. [34]Mondelo García C. Gutiérrez Urbón J.M. Pérez Sanz C. Martín Herranz M.I. Auditing and Improving Surgical Antibiotic Prophylaxis Surg. Infect. 2018 19 679 683 10.1089/sur.2018.097 30095373 · DOI
  29. [35]Bratzler D.W. Dellinger E.P. Olsen K.M. Perl T.M. Auwaerter P.G. Bolon M.K. Fish D.N. Napolitano L.M. Sawyer R.G. Slain D. Clinical practice guidelines for antimicrobial prophylaxis in surgery Surg. Infect. 2013 14 73 156 10.1089/sur.2013.9999 23461695 · DOI
  30. [36]Bassetti M. Righi E. Astilean A. Corcione S. Petrolo A. Farina E.C. De Rosa F.G. Antimicrobial prophylaxis in minor and major surgery Minerva Anestesiol. 2015 81 76 91 24561611
  31. [38]Steinberg J.P. Braun B.I. Hellinger W.C. Kusek L. Bozikis M.R. Bush A.J. Dellinger E.P. Burke J.P. Simmons B. Kritchevsky S.B. Timing of antimicrobial prophylaxis and the risk of surgical site infections: Results from the trial to reduce antimicrobial prophylaxis errors Ann. Surg. 2009 250 10 16 10.1097/SLA.0b013e3181ad5fca 19561486 · DOI
  32. [39]Eriksen H.M. Chugulu S. Kondo S. Lingaas E. Surgical-site infections at Kilimanjaro Christian Medical Center J. Hosp. Infect. 2003 55 14 20 10.1016/S0195-6701(03)00225-1 14505604 · DOI
  33. [40]Brink A.J. Messina A.P. Feldman C. Richards G.A. van den Bergh D. Netcare Antimicrobial Stewardship Study Alliance From guidelines to practice: A pharmacist-driven prospective audit and feedback improvement model for peri-operative antibiotic prophylaxis in 34 South African hospitals J. Antimicrob. Chemother. 2017 72 1227 1234 10.1093/jac/dkw523 27999061 · DOI
  34. [41]Ramsamy Y. Muckart D.J. Bruce J.L. Hardcastle T.C. Han K.S. Mlisana K.P. Empirical antimicrobial therapy for probable v. directed therapy for possible ventilator-associated pneumonia in critically injured patients S. Afr. Med. J. 2016 106 196 200 10.7196/SAMJ.2016.v106i2.9870 26821903 · DOI
  35. [42]Sartelli M. Kluger Y. Ansaloni L. Coccolini F. Baiocchi G.L. Hardcastle T.C. Moore E.E. May A.K. Itani K.M.F. Fry D.E. Knowledge, awareness, and attitude towards infection prevention and management among surgeons: Identifying the surgeon champion World J. Emerg. Surg. 2018 13 37 10.1186/s13017-018-0198-x 30140304 PMC6098571 · DOI
  36. [43]Ayukekbong J.A. Ntemgwa M. Atabe A.N. The threat of antimicrobial resistance in developing countries: Causes and control strategies Antimicrob. Resist. Infect. Control 2017 6 47 10.1186/s13756-017-0208-x 28515903 PMC5433038 · DOI · Paper page
  37. [44]Brink A.J. Messina A.P. Feldman C. Richards G.A. Becker P.J. Goff D.A. Bauer K.A. Nathwani D. van den Bergh D. Netcare Antimicrobial Stewardship Study Alliance Antimicrobial stewardship across 47 South African hospitals: An implementation study Lancet Infect. Dis. 2016 16 1017 1025 10.1016/S1473-3099(16)30012-3 27312577 · DOI
  38. [45]Schellack N. Benjamin D. Brink A. Duse A. Faure K. Goff D. Mendelson M. Meyer J. Miot J. Perovic O. A situational analysis of current antimicrobial governance, regulation, and utilization in South Africa Int. J. Infect. Dis. 2017 64 100 106 10.1016/j.ijid.2017.09.002 28893672 · DOI
  39. [46]Ramsamy Y. Mlisana K.P. Allam M. Amoako D.G. Abia A.L.K. Ismail A. Singh R. Kisten T. Han K.S. Muckart D.J.J. Genomic Analysis of Carbapenemase-Producing Extensively Drug-Resistant Klebsiella pneumoniae Isolates Reveals the Horizontal Spread of p18-43_01 Plasmid Encoding blaNDM-1 in South Africa Microorganisms 2020 8 137 10.3390/microorganisms8010137 31963608 PMC7023316 · DOI
  40. [48]Kakkar A.K. Shafiq N. Singh G. Ray P. Gautam V. Agarwal R. Muralidharan J. Arora P. Antimicrobial Stewardship Programs in Resource Constrained Environments: Understanding and Addressing the Need of the Systems Front. Public Health 2020 8 140 10.3389/fpubh.2020.00140 32411647 PMC7198767 · DOI
  41. [49]Van Dijck C. Vlieghe E. Cox J.A. Antibiotic stewardship interventions in hospitals in low-and middle-income countries: A systematic review Bull. World Health Organ. 2018 96 266 280 10.2471/BLT.17.203448 29695883 PMC5872012 · DOI
  42. [50]Ramsamy Y. Muckart D.J. Han K.S. Microbiological surveillance and antimicrobial stewardship minimise the need for ultrabroad-spectrum combination therapy for treatment of nosocomial infections in a trauma intensive care unit: An audit of an evidence-based empiric antimicrobial policy S. Afr. Med. J. 2013 103 371 376 10.7196/SAMJ.6459 23725954 · DOI
  43. [51]Wilkinson A. Ebata A. MacGregor H. Interventions to Reduce Antibiotic Prescribing in LMICs: A Scoping Review of Evidence from Human and Animal Health Systems Antibiotics 2018 8 2 10.3390/antibiotics8010002 30583566 PMC6466578 · DOI
  44. [52]Cox J.A. Vlieghe E. Mendelson M. Wertheim H. Ndegwa L. Villegas M.V. Gould I. Levy Hara G. Antibiotic stewardship in low- and middle-income countries: The same but different? Clin. Microbiol. Infect. 2017 23 812 818 10.1016/j.cmi.2017.07.010 28712667 · DOI · Paper page
  45. [53]Rickard J. Beilman G. Forrester J. Sawyer R. Stephen A. Weiser T.G. Valenzuela J. Surgical Infections in Low- and Middle-Income Countries: A Global Assessment of the Burden and Management Needs Surg. Infect. 2019 10.1089/sur.2018.125 31816263 · DOI

Cited by

Sorted by citations

Authors
Sartelli, M., C. Hardcastle, T., Catena, F., Chichom-Mefire, A., Coccolini, F., Dhingra, S., Haque, M., Hodonou, A., Iskandar, K., Labricciosa, F. M., Marmorale, C., Sall, I., & Pagani, L.
Affiliations
  • Ospedale di Macerata (IT)
  • Trauma Service, Inkosi Albert Luthuli Central Hospital and Department of Surgery, Nelson R. Mandela School of Clinical Medicine, Durban 4058, South Africa
  • Ospedale di Parma (IT)
  • Department of Surgery and Obs/Gyn, Faculty of Health Sciences University of Buea, Buea P.O. Box 63, South West Province, Cameroon
  • Ospedale Cisanello (IT)
  • University of the West Indies (TT)
  • National Defence University of Malaysia (MY)
  • Université de Parakou (BJ)
  • Lebanese International University (LB)
  • Global Alliance for Infections in Surgery, 4400-001 Vila Nova de Gaia, Portugal
  • Marche Polytechnic University (IT)
  • General Surgery Department, Military Teaching Hospital, Dakar 3006, Senegal
  • Infectious Diseases Unit, Bolzano Central Hospital, 39100 Bolzano, Italy
Corresponding author
Sartelli, Massimo
ORCID
Venue
Antibiotics
Publisher
MDPI AG
Published
2020-08-09
Volume
9
Issue
8
Pages
497
ISSN
2079-6382 (ISSN-L)
DOI
10.3390/antibiotics9080497
PMC
PMC7459633
OpenAlex
W3048808839
Cited by
149
References
0
Citations by year
2026: 18 · 2025: 30 · 2024: 26 · 2023: 37 · 2022: 23 · 2021: 14
FWCI
2.73
Type
journal article
Language
en
Open access
Licence
Locations
  • Antibiotics (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Università Politecnica delle Marche (Università Politecnica delle Marche) (submittedVersion, cc-by)
  • HAL (submittedVersion, cc-by)
  • CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion, cc-by)
  • Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
  • Health Sciences › Medicine › Surgery › Surgical site infection prevention
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
Keywords
antimicrobial resistance, antibiotic use, low- and middle-income countries, surgery, infection control, antibiotic prescribing, surgical infections, over-the-counter antibiotics, health system organization

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review