Antimicrobial Resistance in Zambia: A Systematic Review

Purpose: Antimicrobial resistance (AMR) is widely acknowledged as a global health problem, yet its extent is not well evaluated, especially in low-middle income countries (LMICs). The SARS-COV-2 pandemic demonstrates the link between humans, animals, and the environment. It is challenging to promote policies without focusing on healthcare systems at a local level, therefore a baseline assessment of the AMR prevalence is a priority. This study reviewed published studies of AMR prevalence across human-animal-environmental domains in Zambia. Methods & Materials: PubMed, Cochrane Libraries, Medical Journal of Zambia and African Journals Online databases were searched from inception to April 2021 for articles published in English in accordance with the PRISMA guidelines. Retrieval and screening of article was done using a structured search protocol with strict inclusion/exclusion criteria. Results: A total of 716 articles were retrieved, of which 25 articles met inclusion criteria for final analysis. AMR data was not available for six of the ten provinces of Zambia. Twenty-one different isolates from the human health, animal health and environmental health sectors were tested against 36 antimicrobial agents, across 13 classes of antibiotics. All the studies showed a degree of resistance to more than one class of antimicrobials. Majority of the studies focused on antibiotics, with only three studies (12%) highlighting antiretroviral resistance. Antitubercular drugs were addressed in only five studies (20%) despite an epidemic in sub-Saharan Africa. No studies focused on antifungals. The most common organisms tested, across all three sectors, were Staphylococcus aureus, with a diverse range of resistance patterns found; followed by Escherichia coli with a high resistance rate found to cephalosporins (24%-100%) and fluoroquinolones (20%-100%). Conclusion: This review highlights three important findings. Firstly, AMR is understudied in the country as whole. Secondly, the level of resistance to commonly prescribed antibiotics is significant across the human, animal and environmental sectors. Thirdly, this review suggests that improved standardization of antimicrobial susceptibility testing in Zambia could help to better delineate AMR patterns, allow comparisons across different locations and tracking of AMR evolution over time.