Antimicrobial Resistance Surveillance among Nosocomial Pathogens in South Africa: Systematic Review of Published Literature

There has been a significant increase in the prevalence of antimicrobial drug resistance in sub-Saharan Africa. This may increase health-care costs due to patients' needs for more diagnostic tests, longer hospitalization, and poor outcome. Therefore, monitoring systems for resistance patterns are needed to effectively minimize poor outcome. A systematic review was conducted to find out the prevalence of antimicrobial drugs' resistance among Staphylococcus aureus, Klebsiella pneumoniae, and Pseudomonas aeruginosa, and to understand whether or not such data were part of an ongoing surveillance system for nosocomial infections in South Africa. An online search of main databases, including Cochrane Library, PUBMED, and MEDLINE, was done using the following search terms: “antimicrobial resistance” and “surveillance”; “antimicrobial susceptibility” and “surveillance”; Staphylococcus aureus or Klebsiella pneumoniae or Pseudomonas aeruginosa; “nosocomial” or “hospital acquired”; or South Africa or Africa. We also performed manual search of local conferences, theses, and dissertations to identify relevant articles. In total, 41 manuscripts were identified of which eight were analyzed. There is no evidence of any ongoing antimicrobial resistance surveillance for nosocomial pathogens in South Africa. Data reported in this review seem to have been analyzed on an ad hoc basis and do not show a particular resistance pattern; however, data show evidence of resistance to commonly used antimicrobial drugs in this population: for S aureus, resistance to cloxacillin was 29% and to erythromycin 38%; for K pneumoniae, resistance to ciprofloxacillin was 35% and to ampicillin 99%; and for P aeruginosa, the mean resistance to ciprofloxacillin was 43% and to amikacin 35%. Surveillance of antimicrobial resistance is essential to better understand the complexity of antimicrobial resistance development. Such evidence would be used in developing an effective surveillance program to monitor patterns and trends of resistance over time.