Implementation of WHO Global Antimicrobial Resistance Surveillance System in Uganda: National Surveillance Report, 2015 to 2020 (Preprint)

BACKGROUND Antimicrobial resistance is an emerging public health crisis in Uganda. The WHO Global Action Plan recommends that countries develop and implement National Actions Plans for AMR. We describe the establishment of the national AMR program in Uganda and present earlier sensitivity results from the program. OBJECTIVE The objective of the national surveillance programme is the systematic, continuous collection, analysis and interpretation of antimicrobial resistance data. METHODS A systematic qualitative description of the process and progress made in the establishment of the national AMR program is provided, detailing progress made since 2015 to 2020. This is followed with reporting of the findings of the isolates that are collected from the sentinel AMR surveillance sites. The identification and AST of bacterial isolates presented was done using standard methods at both the sentinel sites and the national reference laboratory. RESULTS Progress has been made in establishment of the national AMR program and implementation of the GLASS protocol is ongoing. A national coordinating centre and focal person have been established, a national reference laboratory has been designated, WHO net set up, sentinel AMR surveillance sites have been established with both data and laboratory quality assurance incorporated. Uganda has progressively submitted data to the GLASS reporting system. 19,216 isolates from WHO GLASS priority specimens were collected of which 22.95% (n=4,411) were community acquired infections (CAIs), 9.5% (n=1,818) had hospital acquired infections (HAIs) with 68.57% (n=12,987) being of unknown origin. The highest proportion of the specimens was blood (n=12,398, 64.5%) followed by urine (n=5,278, 27.5%), and then by stool (n=1,266, 6.6%), while, the least proportion were uro-genital swabs (n=274, 1.4%). The mean age was 19.1 (SD=19.8) years while the median was 13 (IQR: 28). Approximately 49.1% of the participants were female and 50.5% were male. Participants with CAIs were older than those with HAIs i.e. Mean: 28.0 (SD=18.6), Median: 26, IQR: 20.5 vs. Mean: 17.3 (SD=20.9) Median 8 IQR: 26. All gram-negative (E. coli, K. pneumoniae, N. gonorhoeae) and gram-positive (S. aureus, Enterococcus sp.) bacteria with AST done showed resistance to each of the tested antibiotics. CONCLUSIONS We demonstrate that systematic capacity building for implementation of the WHO GLASS protocol is feasible in a low resource setting. CLINICALTRIAL NA