The changing epidemiology of antimicrobial resistance in Fiji: a descriptive analysis of antimicrobial susceptibility and trends of endemic and emerging pathogens, 2019–2022

Background There is a paucity of data on antimicrobial resistance in Fiji. The aim of this study was to determine the
antimicrobial susceptibility profile of bacterial isolates from clinical samples at Colonial War Memorial Hospital
in Fiji.
Methods This retrospective study reviewed four-year of data from January 1, 2019, through December 31, 2022.
Laboratory testing was carried out using locally approved protocols. Selective antimicrobial susceptibility testing
was performed whereby only isolates resistant to first line antimicrobials were tested against second line
antimicrobials. Only the first isolate of a given species per patient in a single year were included in the analysis.
WHONET software and Microsoft Excel were used for analysis.
Findings A total of 29,222 bacterial isolates were included, 62% (n = 18,084) were Gram-negative bacteria.
K. pneumoniae was the most common (n = 5363), followed by E. coli (n = 4321). Extended spectrum beta
lactamase (ESBL) production increased from 30% in 2019 to 43% in 2022 amongst K. pneumoniae, and 10%–23%
in E coli. There were 733 carbapenem-resistant isolates identified from clinical samples, 61% (n = 445) were A.
baumannii, 15% (n = 110) E. coli and 14% (n = 101) P. aeruginosa. Amongst the E. coli isolates tested,
susceptibility to meropenem declined from 99% (272/274) in 2019 to 79% (255/325) in 2022. The rate of
methicillin resistance amongst Staphylococcus aureus was steady, remaining between 11% and 13%.
Interpretation This study demonstrated a high rate of MDR amongst Gram-negative bacteria, especially ESBL
producing K. pneumoniae and E. coli and carbapenem-resistant A. baumannii. The emergence and rapid spread of
carbapenemase producing E. coli in Fiji’s largest hospital is of particular concern. There is an urgent need to
allocate resources to improve existing capacity and to develop effective multimodal strategies to detect, manage
and control the spread of MDR organisms.