Antimicrobial susceptibility trends of WHO critical Gram-negative pathogens in Fijian Hospitals, 2016-2021.

INTRODUCTION: Understanding antimicrobial susceptibility patterns is essential for guiding clinical management and informing surveillance strategies. This study aimed to analyse antimicrobial susceptibility trends of WHO-designated critical Gram-negative pathogens in Fijian hospitals. METHODS: We conducted a retrospective study of antimicrobial susceptibility among Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae isolated from three hospitals in Fiji from 1 January 2016 to 31 December 2021. Data were stratified by hospital, hospital setting, and specimen type. Only the first isolate per patient was included. Chi-square tests and linear regression were used to assess group differences and temporal trends. RESULTS: A total of 44 524 isolates were analysed: K. pneumoniae 17 016 (38.2%), E. coli 14 935 (33.5%), P. aeruginosa 6632 (14.9%), and A. baumannii 5941 (13.3%). Specimens included blood 4612 (10.4%), urine 13 369 (30.0%), and other types 26 543 (59.6%). Meropenem susceptibility declined significantly in A. baumannii (60.4% to 40.8%, P = 0.0004) and P. aeruginosa (100% to 40.8%, P = 0.005). Ceftriaxone susceptibility was low in E. coli (49.8%) and K. pneumoniae (32.7%). Meropenem susceptibility remained high in K. pneumoniae (96.6% in 2021) and E. coli (>80%). ESBL production was identified in 18.2% of E. coli and 37.6% of K. pneumoniae. CONCLUSIONS: These findings highlight substantial AMR challenges in Fijian hospitals, including declining carbapenem susceptibility and high ceftriaxone resistance, underscoring the need for strengthened antimicrobial stewardship, infection control, and surveillance systems.

Duke Scholars

Author John Andrew Crump Medicine, Infectious Diseases