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Review ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Med. | doi: 10.3389/fmed.2019.00205

Diagnostic bacteriology in district hospitals in sub-Saharan Africa: at the front-line of containment of antimicrobial resistance.

Jan Jacobs1, 2*,  Liselotte Hardy1,  Makeda Semret3, Octavie Lunguya4, 5, Thong Phe6, Dissou Affolabi7,  Cedric Yansouni3 and Olivier Vandenberg8, 9
  • 1Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Belgium
  • 2Department of Microbiology and Immunology, KU Leuven, Belgium
  • 3JD MacLean Centre for Tropical Diseases, McGill University, Canada
  • 4Department of Clinical Microbiology, National Institute of Biomedical Research, Democratic Republic of Congo
  • 5Service of Microbiology, Kinshasa General Hospital, Democratic Republic of Congo
  • 6Sihanouk Hospital Center of HOPE, Cambodia
  • 7Clinical Microbiology, Centre National Hospitalier et Universitaire Hubert Koutoukou MAGA, Benin
  • 8Center for Environmental Health and Occupational Health, School of Public Health, Free University of Brussels, Belgium
  • 9Innovation and Business Development Unit, LHUB - ULB, Free University of Brussels, Belgium

This review provides an update on the factors fuelling antimicrobial resistance and shows the impact of these factors in low-resource settings. We detail the challenges and barriers to integrating clinical bacteriology in hospitals in low-resource settings, as well as the opportunities provided by the recent capacity building efforts of national laboratory networks focused on vertical single-disease programmes. The programmes for HIV, tuberculosis and malaria have considerably improved laboratory medicine in sub-Saharan Africa, paving the way for clinical bacteriology. Furthermore, special attention is paid to topics that are less familiar to the general medical community, such as the crucial role of regulatory frameworks for diagnostics and the educational profile required for a productive laboratory workforce in low-resource settings. Traditionally, clinical bacteriology laboratories have been a part of higher levels of care, and, as a result, they were poorly linked to clinical practices and thus underused. By establishing and consolidating clinical bacteriology laboratories at the hospital referral level in low-resource settings, routine patient care data can be collected for surveillance, antibiotic stewardship and infection prevention and control. Together, these activities form a synergistic tripartite effort at the frontline of the emergence and spread of multi-drug resistant bacteria. If challenges related to staff, funding, scale and the specific nature of clinical bacteriology are prioritized, a major leap forward in the containment of antimicrobial resistance can be achieved. The mobilization of resources coordinated by national laboratory plans and interventions tailored by a good understanding of the hospital microcosm will be crucial to success, and further contributions will be made by market interventions and business models for diagnostic laboratories. The future clinical bacteriology laboratory in a low-resource setting will not be an “entry-level version” of its counterparts in high-resource settings, but a purpose-built, well-conceived, cost-effective and efficient diagnostic facility at the forefront of antimicrobial resistance containment.

Keywords: Antimicrobial resistance (AMR), Antimicrobial stewardship (AMS), Infection prevention and control (IPC), low-resource settings (LRS), Clinical bacteriology < Bacteriology

Received: 09 Mar 2019; Accepted: 03 Sep 2019.

Copyright: © 2019 Jacobs, Hardy, Semret, Lunguya, Phe, Affolabi, Yansouni and Vandenberg. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Jan Jacobs, Institute of Tropical Medicine Antwerp, Department of Clinical Sciences, Antwerp, Antwerp, Belgium, jjacobs@itg.be