抗生物質耐性：ウガンダでの増大する懸念

タイトル: Antibiotic Resistance related Mortality, Length of Hospital Stay, and Disability-Adjusted Life Years at select Tertiary Hospitals in Uganda: A retrospective study

概要: BackgroundAntimicrobial Resistance (AMR) is a major global health threat but its burden has not been extensively described in Uganda. We aimed to investigate the antibiotic resistance related mortality, length of hospital stays (LOS) and Disability Adjusted Life Years (DALYs). MethodsThis was a retrospective study of clinical records of patients with infectious syndromes admitted at Arua, Jinja and Mbale regional referral hospitals between October 2022 and September 2023. Data was abstracted from clinical records and analyzed to derive the mortality, LOS, DALYs, and factors associated with AMR and mortality using the modified Poisson regression model. ResultsOf the 291 participants included in the analysis, 56.6% were males, 10% were living with HIV, and their median age was 35 years (IQR: 21-56). The most common infectious syndromes were sepsis (43.6%) and diarrhea (9.6%). The prevalence of antibiotic-resistant infections (ARI) was 29.6%, while that for multi-drug resistant infections (MDRI) was 17.9%. Patients at Jinja and Mbale RRHs exhibited a 2.42 and 2.65 higher risk of ARI respectively compared to those at Arua RRH. Overall, mortality due to an infectious syndrome was 44.7%, of which 34.9% was due to ARI while 30.8% of the ARI related mortality was due to MDR infections. Most deaths were due to sepsis (42.3%), followed by pneumonia (15.4%) and meningitis (6.2%). Participants with comorbidities had higher risk of mortality due to ARI (45% vs. 31% for those without comorbidities). Among Gram-negative bacteria, Escherichia coli and Klebsiella spp contributed most to mortality, while among Gram-positives, Staphylococcus aureus and Enterobacter spp contributed equally. Patients with ARIs LOS was 1.2 times higher than that for those without ARI while a longer LOS was associated with a 21% higher ARI risk but a 24% decline in risk of death. ARI was associated with higher DALYs, 235.4, compared to 147.0 for non-ARI. ConclusionThe study revealed a high burden of AMR in Uganda, including a high prevalence of MDR and associated mortality, particularly among patients with comorbidities. This indicates an urgent need for stewardship and infection prevention strategies to control the AMR burden.