Clinical bacteriology in low-resource settings: today's solutions

Sien Ombelet, Jean-Baptiste Ronat, Timothy Walsh, Cedric P Yansouni, Janneke Cox, Erika Vlieghe, Delphine Martiny, Makeda Semret, Olivier Vandenberg, Jan Jacobs, Bacteriology in Low Resource Settings working group

Research output: Contribution to journalA1: Web of Science-article

Abstract

Low-resource settings are disproportionately burdened by infectious diseases and antimicrobial resistance. Good quality clinical bacteriology through a well functioning reference laboratory network is necessary for effective resistance control, but low-resource settings face infrastructural, technical, and behavioural challenges in the implementation of clinical bacteriology. In this Personal View, we explore what constitutes successful implementation of clinical bacteriology in low-resource settings and describe a framework for implementation that is suitable for general referral hospitals in low-income and middle-income countries with a moderate infrastructure. Most microbiological techniques and equipment are not developed for the specific needs of such settings. Pending the arrival of a new generation diagnostics for these settings, we suggest focus on improving, adapting, and implementing conventional, culture-based techniques. Priorities in low-resource settings include harmonised, quality assured, and tropicalised equipment, consumables, and techniques, and rationalised bacterial identification and testing for antimicrobial resistance. Diagnostics should be integrated into clinical care and patient management; clinically relevant specimens must be appropriately selected and prioritised. Open-access training materials and information management tools should be developed. Also important is the need for onsite validation and field adoption of diagnostics in low-resource settings, with considerable shortening of the time between development and implementation of diagnostics. We argue that the implementation of clinical bacteriology in low-resource settings improves patient management, provides valuable surveillance for local antibiotic treatment guidelines and national policies, and supports containment of antimicrobial resistance and the prevention and control of hospital-acquired infections.

Original languageEnglish
JournalLancet Infectious Diseases
Volume18
Issue number8
Pages (from-to)E248-E258
Number of pages11
ISSN1473-3099
DOIs
Publication statusPublished - 2018

Keywords

  • Journal Article
  • Review

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