Trends in antimicrobial resistance amongst pathogens isolated from blood and cerebrospinal fluid cultures in Pakistan (2011-2015): a retrospective cross-sectional study
Only a few studies have presented long-term trends in antimicrobial resistance (AMR) at a nationwide level in Pakistan. This study presents a comprehensive situational analysis of AMR trends among pathogens isolated from blood and cerebrospinal fluid (CSF) cultures, between 2011 and 2015, in Pakistan. Methods: A retrospective analysis of AMR data on pathogens isolated from Blood and CSF over a five year period was carried out. Susceptibility data on these pathogens was obtained from Chughtai
... ed from Chughtai Laboratory (CL). Then, proportion of the resistant pathogens were calculated and analyzed. Results: Our results show that highest resistance rates against all tested antimicrobials were observed in Acinetobacter species. We observed a steep rise in carbapenem resistant Acinetobacter species from 50 to 95.5% between 2011 and 2015. Our results also highlight the emergence of third and fourth generation cephalosporins resistance in Salmonella enterica serovar Typhi in Pakistan. While we observed a rise in AMR in other major pathogens, we unexpectedly found decreasing resistance trends in Staphylococcus aureus. Conclusions: Taken together, our results show an overall increase in AMR in pathogens isolated from blood and CSF cultures in Pakistan between 2011 and 2015. Attributes of pathogens isolated from blood and cerebrospinal fluid (CSF) cultures between 2011 and 2015 in Pakistan. Data are n (%). A total of 3068 microorganisms were isolated from blood and CSF cultures between 2011 and 2015. These cases were reported from 44 cities in 4 provinces. Highest number of cases were reported from Punjab (87.9%), followed by Khyber Pakhtunkhwa (11%), Sindh (1%) and Baluchistan (0.033%). The median number of cases from a city was 4 with an interquartile range of 2-15. Out of 44 cities, less than 11 cases were reported from 31 cities during the five-year study period. Highest number of cases were reported from Lahore (60.5%), Faisalabad (18.3%), and Abbottabad (8.3%). Detailed distribution of cases over geographic location is given in the Supplementary Material (S1 Table) .