Trends in resistance to AWaRe drugs in Africa Data Challenge

Antimicrobial resistance has proliferated worldwide, even where access limits antibiotic use. Antibiotics in the environment because of waste management practices, and in food animals for prophylaxis and growth promotion allows for drug resistant bacteria to reach even remote areas in Africa. The approach to treating infections in most low- and middle-income countries (LMIC) is based on empirical and clinical decision making without laboratory support. Antibiotic choice is often based on economic factors and drug availability rather than on surveillance-based antibiograms. A framework for these choices has been developed by the World Health Organization, called AWaRe, for Access, Watch, and Reserve. Access drugs are the empiric drugs of choice because of their narrow spectrum, tolerability and lower cost, while Watch antibiotics have a broader spectrum and are intended for use in hospitalized patients. Reserve drugs are meant for use only in critically ill patients with multi-drug resistant infections. Sporadic prevalence reports suggest however that, despite this characterization, rates of resistance in LMIC to Access drugs are extremely high. We will use the available surveillance data for 3 purposes with major implications for patient outcomes and public health. 1) Even with the data available through Vivli, surveillance is incomplete for many countries in Africa, where laboratory capacity is limited. A review of changes over time in resistance for Access, Watch and Reserve drugs will raise awareness and help to inform more rigorous surveillance studies to fill gaps in knowledge. 2) A review of the available evidence will be used to construct data-informed antibiograms for African countries contributing to the ATLAS dataset. These antibiograms can then be used to inform guideline revisions for treatment of routine infectious syndromes. 3) Evidence from this analysis can inform strategies for access to new antibiotics to improve clinical outcomes for patients where microbiology capacity is limited.