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This was revealed in an article published in The Lancet Global Health. Today, the African continent is hardest hit by the development of antimicrobial resistance (AMR), marking a turning point in the health challenges faced by the region. A reality that calls for an urgent response. Dr. Daouda Sissoko, infectious disease specialist and Director of Medical Affairs for bioMérieux Africa, discusses the causes and consequences of this major public-health issue.

According to the study led by Mohsen Naghavi and his colleagues, antibiotic resistance caused more than a million deaths on the African continent in 2019, particularly among patients suffering from lower respiratory tract and chest infections (48% of deaths), septicemia, intra-abdominal infections and tuberculosis. “This study shows that Africa pays the heaviest price in terms of mortality linked to antibiotic resistance,” underlines Daouda Sissoko. “Ironically, while the known AMR prevalence is relatively low in the WHO African region, the AMR-related mortality rate is the highest.” So why is this region so hard hit? “It is in Africa that mortality from infection is the highest,” explains Daouda Sissoko. “The study shows that 25% of these deaths can be attributed to bacterial resistance to antibiotics.Given the number of patients, the toll quickly becomes particularly heavy.»

Antibiotic resistance is often considered a laboratory concept, disconnected from a patient’s fate. Yet, this study makes it possible to directly associate antibiotic resistance and mortality. “With an actual measurement of the phenomenon, albeit imperfect, instead of simple projections, we’re confronted with evidence that can no longer be ignored.” While antibiotic resistance is far deadlier than malaria and HIV combined, it has so far been the object of far less concrete action by national and international authorities. “This clearly shows a lack of awareness,” underlines Daouda Sissoko. 

Why is Africa the main victim of antibiotic resistance?

The Lancet article reveals that the four pathogens encountered most frequently in African countries are Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli and Staphylococcus aureus. Specifically, pneumococcal infections are particularly deadly there. “This should not happen because there is a vaccine against pneumococci,” laments Daouda Sissoko.

In his view, in addition to insufficient vaccination, the reasons for the heavy price paid by Africa can be found in multiple factors, both structural and behavioral. In particular, populations are overexposed to infections: sanitary conditions are poor, infections are diagnosed late and, when they are, the antibiotics available to treat them are not always effective. Adding to these factors is poor infection control in many hospitals, as well as lack of training among health professionals. Medical laboratories are few in number, and test results take longer than necessary because there is little or no interaction between clinicians and biologists. Furthermore, the empirical prescription of antibiotics is a common practice, whether or not tests are available to doctors; this is an old, well-established habit that dates back to the days when there were no laboratories.

Another initiative, the Mapping Antimicrobial Resistance and Antimicrobial Use Partnership (MAAP) looked at laboratory data on antibiotic consumption and resistance in 14 African countries from 2016 to 2019. It revealed that only 1.3% of laboratories in these countries perform bacteriological analyses, that 80% of laboratories participating in the study perform fewer than 1000 antimicrobial susceptibility tests per year, and that only a third of resistant pathogens considered high priority by WHO were systematically tested in these countries. Therefore, monitoring systems – when they exist – are not robust.

The situation in African countries is all the more critical as it is magnified by poverty, as shown by the comparison in the Lancet article of different countries in the area. The lower the socio-economic level of the population, the higher the antibiotic resistance. “Resistant infection creates even more poverty, trapping patients in a vicious cycle with soaring healthcare costs: care is more expensive, treatments take longer, and patients cannot go to work to pay for them “, explains Daouda Sissoko.

How can diagnosis help fight this crisis? 

Reducing morbidity and mortality linked to infections requires greater awareness of prevention, better therapeutic care, and the establishment of robust monitoring systems to inform medical practices and health policies.

“Diagnosis is an essential tool to reduce untargeted therapies and the burden of uninformed treatments,” says Daouda Sissoko. “It makes it possible to immediately provide key information allowing doctors to stop prescribing antibiotics indiscriminately, correctly guide patient treatment and fight against epidemics, while preventing resistance from taking hold and spreading in hospitals. And by spending less time in hospitals, patients are less exposed to pathogens.” Diagnosis can thus contribute not only to reducing mortality but also to lowering patient care costs.

An essential pillar of pathogen surveillance, diagnosis allows greater precision in the information collected to facilitate corrective actions and promote the reasonable use of antibiotics. The goal: to give the right antibiotic, to the right patient, at the right time, and for the right duration.

What actions should be prioritized?

For Daouda Sissoko, several actions are fundamental to fight against the problem of antibiotic resistance in Africa:

  • Intensify the efforts in prevention and public awareness.
  • Train health professionals.
  • Establish the necessary infrastructure so that hospitals have permanent access to quality biological diagnosis, and so that the final diagnosis of infections ceases to be a presumptive diagnosis, based solely on very indiscriminate clinical hypotheses.
  • Develop public policies that facilitate the implementation of these corrective actions.

“The actions put in place must be monitored, assessed, and readjusted, knowing that setting up an effective monitoring system is complex and requires time and support. It involves many actors and is based on collective ownership.”

Daouda Sissoko

bioMérieux offers its expertise in monitoring and rational use of antibiotics to countries wishing to develop a national plan to combat antibiotic resistance. We also participate in raising awareness among health professionals regarding the issue of antibiotic resistance, strengthening their expertise in the management of infections and developing interactions between doctors and laboratory professionals. This includes numerous medical education programs, in partnership with local experts.