Epidemiology of antimicrobial resistance and its clinical, economic and humanistic outcomes in developing countries

The important therapeutic role played by antimicrobial agents is seriously being threatened by the continually increasing antibacterial resistance (AMR) across the globe. Efforts at stemming the increment is grossly suboptimal in most developing countries. Epidemiology of the commonly encountered bacterial isolates and their respective susceptivity/resistance patterns is highly essential in supply chain decision making, patient management and in policy formulation. The most prevalent resistant bacterial isolates in Nigeria include Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae among others. For instance, the incidence of methicillin resistant S. aureus is skyrocketing. It has increased from less than 2.0% in 2005 to more than 40.0% in 2020 across the country. In addition, resistance to affordable antimicrobial agents is gradually overwhelming the fragile health care system mostly being financed from out-of-pocket expenses. Treatment costs of resistant isolates is huge and not sustainable, apart from its impacts on disease complications, morbidity, mortality and human capital development. Overall, it grossly reduces health related quality of life. In consonant with the global pledge of the World Health Assembly, improved awareness and an understanding of its implications should be a priority. Strengthening diagnosis and surveillance activities as related to AMR is imperative. The primary health care (PHC) basic roles, which include provision of portable water, sanitation, immunization, and nutrition need to be strengthened as long advocated. Research into new antimicrobial agents as well as evidence-based re-purposing/rational usage of the existing ones should also be topical at all levels. Standard Treatment Guidelines and drug formularies equally need to be reviewed at regular intervals to include updated resistant/susceptibility patterns. Formulating adequate legal frame work and policy to facilitate implementation of strategies are of utmost important as well. And lastly, there should be relevant incentives to encourage implementation of AMR related stewardship activities and its sustainability.