Diagnostic Bacteriology in District Hospitals in Sub-Saharan Africa: At the Forefront of the Containment of Antimicrobial Resistance
This review provides an update on the factors fuelling antimicrobial resistance and shows the impact of these factors in low-resource settings. We detail the challenges and barriers to integrating clinical bacteriology in hospitals in low-resource settings, as well as the opportunities provided by t...
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doaj-3809bd8de74c4a488fd9a25f92556a842020-11-25T00:32:49ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2019-09-01610.3389/fmed.2019.00205459158Diagnostic Bacteriology in District Hospitals in Sub-Saharan Africa: At the Forefront of the Containment of Antimicrobial ResistanceJan Jacobs0Jan Jacobs1Liselotte Hardy2Makeda Semret3Octavie Lunguya4Octavie Lunguya5Thong Phe6Dissou Affolabi7Cedric Yansouni8Olivier Vandenberg9Olivier Vandenberg10Olivier Vandenberg11Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, BelgiumDepartment of Microbiology and Immunology, KU Leuven, Leuven, BelgiumDepartment of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, BelgiumJD MacLean Centre for Tropical Diseases, McGill University, Montreal, QC, CanadaDepartment of Clinical Microbiology, National Institute of Biomedical Research, Kinshasa, Democratic Republic of CongoService of Microbiology, Kinshasa General Hospital, Kinshasa, Democratic Republic of CongoSihanouk Hospital Center of HOPE, Phnom Penh, CambodiaClinical Microbiology, Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA, Cotonou, BeninJD MacLean Centre for Tropical Diseases, McGill University, Montreal, QC, CanadaCenter for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, BelgiumInnovation and Business Development Unit, LHUB - ULB, Pôle Hospitalier Universitaire de Bruxelles (PHUB), Université Libre de Bruxelles (ULB), Brussels, Belgium0Division of Infection and Immunity, Faculty of Medical Sciences, University College London, London, United KingdomThis review provides an update on the factors fuelling antimicrobial resistance and shows the impact of these factors in low-resource settings. We detail the challenges and barriers to integrating clinical bacteriology in hospitals in low-resource settings, as well as the opportunities provided by the recent capacity building efforts of national laboratory networks focused on vertical single-disease programmes. The programmes for HIV, tuberculosis and malaria have considerably improved laboratory medicine in Sub-Saharan Africa, paving the way for clinical bacteriology. Furthermore, special attention is paid to topics that are less familiar to the general medical community, such as the crucial role of regulatory frameworks for diagnostics and the educational profile required for a productive laboratory workforce in low-resource settings. Traditionally, clinical bacteriology laboratories have been a part of higher levels of care, and, as a result, they were poorly linked to clinical practices and thus underused. By establishing and consolidating clinical bacteriology laboratories at the hospital referral level in low-resource settings, routine patient care data can be collected for surveillance, antibiotic stewardship and infection prevention and control. Together, these activities form a synergistic tripartite effort at the frontline of the emergence and spread of multi-drug resistant bacteria. If challenges related to staff, funding, scale, and the specific nature of clinical bacteriology are prioritized, a major leap forward in the containment of antimicrobial resistance can be achieved. The mobilization of resources coordinated by national laboratory plans and interventions tailored by a good understanding of the hospital microcosm will be crucial to success, and further contributions will be made by market interventions and business models for diagnostic laboratories. The future clinical bacteriology laboratory in a low-resource setting will not be an “entry-level version” of its counterparts in high-resource settings, but a purpose-built, well-conceived, cost-effective and efficient diagnostic facility at the forefront of antimicrobial resistance containment.https://www.frontiersin.org/article/10.3389/fmed.2019.00205/fullantimicrobial resistance (AMR)antimicrobial stewardship (AMS)infection prevention and control (IPC)low-resource settings (LRS)clinical and bacteriologySub-Saharan Africa |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jan Jacobs Jan Jacobs Liselotte Hardy Makeda Semret Octavie Lunguya Octavie Lunguya Thong Phe Dissou Affolabi Cedric Yansouni Olivier Vandenberg Olivier Vandenberg Olivier Vandenberg |
spellingShingle |
Jan Jacobs Jan Jacobs Liselotte Hardy Makeda Semret Octavie Lunguya Octavie Lunguya Thong Phe Dissou Affolabi Cedric Yansouni Olivier Vandenberg Olivier Vandenberg Olivier Vandenberg Diagnostic Bacteriology in District Hospitals in Sub-Saharan Africa: At the Forefront of the Containment of Antimicrobial Resistance Frontiers in Medicine antimicrobial resistance (AMR) antimicrobial stewardship (AMS) infection prevention and control (IPC) low-resource settings (LRS) clinical and bacteriology Sub-Saharan Africa |
author_facet |
Jan Jacobs Jan Jacobs Liselotte Hardy Makeda Semret Octavie Lunguya Octavie Lunguya Thong Phe Dissou Affolabi Cedric Yansouni Olivier Vandenberg Olivier Vandenberg Olivier Vandenberg |
author_sort |
Jan Jacobs |
title |
Diagnostic Bacteriology in District Hospitals in Sub-Saharan Africa: At the Forefront of the Containment of Antimicrobial Resistance |
title_short |
Diagnostic Bacteriology in District Hospitals in Sub-Saharan Africa: At the Forefront of the Containment of Antimicrobial Resistance |
title_full |
Diagnostic Bacteriology in District Hospitals in Sub-Saharan Africa: At the Forefront of the Containment of Antimicrobial Resistance |
title_fullStr |
Diagnostic Bacteriology in District Hospitals in Sub-Saharan Africa: At the Forefront of the Containment of Antimicrobial Resistance |
title_full_unstemmed |
Diagnostic Bacteriology in District Hospitals in Sub-Saharan Africa: At the Forefront of the Containment of Antimicrobial Resistance |
title_sort |
diagnostic bacteriology in district hospitals in sub-saharan africa: at the forefront of the containment of antimicrobial resistance |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Medicine |
issn |
2296-858X |
publishDate |
2019-09-01 |
description |
This review provides an update on the factors fuelling antimicrobial resistance and shows the impact of these factors in low-resource settings. We detail the challenges and barriers to integrating clinical bacteriology in hospitals in low-resource settings, as well as the opportunities provided by the recent capacity building efforts of national laboratory networks focused on vertical single-disease programmes. The programmes for HIV, tuberculosis and malaria have considerably improved laboratory medicine in Sub-Saharan Africa, paving the way for clinical bacteriology. Furthermore, special attention is paid to topics that are less familiar to the general medical community, such as the crucial role of regulatory frameworks for diagnostics and the educational profile required for a productive laboratory workforce in low-resource settings. Traditionally, clinical bacteriology laboratories have been a part of higher levels of care, and, as a result, they were poorly linked to clinical practices and thus underused. By establishing and consolidating clinical bacteriology laboratories at the hospital referral level in low-resource settings, routine patient care data can be collected for surveillance, antibiotic stewardship and infection prevention and control. Together, these activities form a synergistic tripartite effort at the frontline of the emergence and spread of multi-drug resistant bacteria. If challenges related to staff, funding, scale, and the specific nature of clinical bacteriology are prioritized, a major leap forward in the containment of antimicrobial resistance can be achieved. The mobilization of resources coordinated by national laboratory plans and interventions tailored by a good understanding of the hospital microcosm will be crucial to success, and further contributions will be made by market interventions and business models for diagnostic laboratories. The future clinical bacteriology laboratory in a low-resource setting will not be an “entry-level version” of its counterparts in high-resource settings, but a purpose-built, well-conceived, cost-effective and efficient diagnostic facility at the forefront of antimicrobial resistance containment. |
topic |
antimicrobial resistance (AMR) antimicrobial stewardship (AMS) infection prevention and control (IPC) low-resource settings (LRS) clinical and bacteriology Sub-Saharan Africa |
url |
https://www.frontiersin.org/article/10.3389/fmed.2019.00205/full |
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