Monitoring antimicrobial resistance trends to save lives
Kinshasa – Nathalie* looked upon her convalescent baby, hope slowly wiping away distress. Her 12-month-old boy had been admitted to St Luc Hospital in Kisantu, a town in the south of the Democratic Republic of the Congo’s capital Kinshasa, when initial treatment proved ineffective.
“For three days he suffered so much that I thought he would not recover,” says Nathalie. The fever, diarrhoea and vomiting persisted despite medication.
It took the hospital staff four days to finally find a suitable treatment for the child. Analysis revealed that the infant was not responding to treatment due to antimicrobial resistance.
Antimicrobial resistance is among the top 10 public health threats in the world. It occurs when bacteria, viruses, fungi, and parasites adapt over time and no longer respond to drugs, making it more complex to treat infections and increasing the risk of spread, severe illness, and death. The phenomenon is largely due to excessive or abusive use of drugs.
Dr Daniel Vita Mayimona, who works at St Luc Hospital, says that three years ago they observed a spike in cases unresponsive treatment.
“We were seeing a strange phenomenon that attacked only under 5 children,” recalls Dr Mayimona. “After analysing samples taken from patients, we were able to identify the bacteria that was causing this situation.”
Sub-Saharan Africa has the highest mortality rate worldwide due to antimicrobial resistance, with 99 deaths per 100 000 people. Across the African region, World Health Organization (WHO) is working with governments and health authorities to reinforce measures against antimicrobial resistance.
In the Democratic Republic of the Congo, WHO in September 2022 trained 26 medical analysis technicians from eight pilot laboratories in the use of WHONET software, an application designed by WHO to manage and analyse microbiology laboratory data through an antimicrobial surveillance lens.
“One of WHO's major roles is to equip laboratory and health staff with adequate capacity to improve surveillance and effectively document antimicrobial resistance in decision-making in the face of this public health threat,” says Dr Amédée Prosper Djiguimdé, WHO Representative in the Democratic Republic of the Congo.
For Professor Octavie Lunguya, Head of the Microbiology Department at the country’s National Institute for Biomedical Research, data gathered through the WHONET paves a clear path to tracking and responding to antimicrobial resistance.
“WHONET instantly gives us an immediate sense of the quality of the data, the pathogens, their origin, the resistance profile of the different germs, and even tracks the isolation of certain germs,” he says.
A month after the WHONET software training, the National Institute for Biomedical Research submitted 5500 antimicrobial resistance data—including 4720 from Kisantu—from 2021. WHONET, in conjunction with the Global System for Surveillance of Antimicrobial Resistance and Use (GLASS), allows real-time monitoring of antimicrobial resistance trends and detection of emerging resistance. It also facilitates the estimation of the antimicrobial resistance burden on states.
At St Luc Hospital, the 2019 spike in antimicrobial resistance among children prompted the adoption of a new treatment protocol put in place with support from the National Institute for Biomedical Research and the University Clinics of Kinshasa. The new protocol helped save the lives of 212 children.
“Today, if we’re able to save many lives, it’s thanks to WHO trainings that have allowed us to better monitor resistance and respond to it in less than a week,” says Dr Mayimona.
Antimicrobial resistance takes a heavy toll on both patients and healthcare workers. In addition to complicating treatment when known therapies no longer respond, leading to death and disability, there are long periods of hospitalization and prohibitively expensive treatments.
“If we are to ensure healthy lives and promote well-being at all ages, we must continue to focus on early warning, reduction and risk management of antimicrobials, while stressing the importance of a multisectoral approach that includes human and animal medicine in infection prevention and control,” Dr Djiguimdé says.
With the resistant bacteria identified and treatment adapted, Nathalie's son is now on his way to better health.
“We’ll be heading home in a few days,” she says, as her son plays with his blanket. “And when we do, I’ll be encouraging my neighbours to stop self-medication, especially for antibiotics without a doctor's prescription.”
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