NEW ORLEANS, La – Low- and middle income countries have lower per-capita consumption of antibiotics than high income countries yet bear a larger burden of antimicrobial resistance, panelists said at IDWeek. While high-income countries are looking to develop innovative stewardship programs and new drugs to combat antimicrobial resistance, low- and middle-income countries often have limited capacity to address reducing antimicrobial resistance, and will be the most affected by it over the coming decades, with estimates that half of all deaths from antimicrobial resistance by 2050 will occur in Africa and Asia, Sumanth Gandra of the Center for Disease Dynamics, Economics and Policy said.
By 2050, it is estimated that 300,000 may die as a result of antimicrobial resistance in North America, but over four million deaths in Africa and five million in Asia may be attributable to antimicrobial resistance, Benjamin Park of the Centers for Disease Control and Prevention said.
Already 38,000 people die in Thailand every year, a number that is disproportionately high considering Thailand’s population, Park said.
Many low- and middle-income countries don’t have the laboratory capacity to correctly diagnose illnesses or detect resistance, which leaves healthcare providers with no choice but to guess and empirically treat patients and place them on antibiotics that may not be necessary, Park said.
“The culture of culturing is highly variable,” Park said, noting that conducting blood or urine cultures are expensive, and those costs are transmitted to patients who can’t afford to pay them. Healthcare providers will only culture when there’s treatment failure, Park said.
Microbiology labs require resources that aren’t available to low- and middle-income countries, Park said. “Labs need equipment, reagents and supplies, maintenance and trained staff,” Park said.
Park recalled the difficulty in conducting a stewardship program by describing the Thika district hospital in Kenya, where there are “gleaming new ICU units” next to older general care units which experience overcrowding. “How do you do infection control where there are multiple patients per bed?” he said.
While the hospital’s laboratory had proper equipment, “the machines weren’t functional because their maintenance agreements had expired, so machines were not maintained and left unused,” he said.
Conducting surveillance for antimicrobial resistance is even more challenging, Park said. “Surveillance is dependent on multiple steps, from obtaining specimens to labs processing and testing specimens, to collecting and compiling data to report to international authorities, to reporting data back to the sites,” he said.
“Something can go wrong at each step,” Park said.
This lack of laboratory capacity means only 15 percent of African countries conduct antimicrobial resistance surveillance while over 60 percent of the Americas and Europe do surveillance, Park said.
The CDC, under the Global Health Security Agenda, is taking steps to address poor lab capacity in low- and middle income countries, Park said, by conducting laboratory assessments in partner countries and identifying existing gaps and what partner countries can do to fill them.
On top of assessing lab capacity, Park said, “We need to invest in making diagnostics that are useful in conflict and resource limited areas.”
“Until we find better diagnostics,” he said, “people and public health will suffer.