Antimicrobial resistance in Democratic Republic of Congo: the way forward : IJS Global Health

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Antimicrobial resistance in Democratic Republic of Congo: the way forward

Akilimali, Aymar MDa,; Awuah, Wireko Andrew MBBSb; Cakwira, Hugues MDa,c; Mirindi, Michel K. MPH, PhDa; Masimango, Gaston MDa; Amani, Toussaint MDa,d; Elembwe, Hardy MDa,e; Kitumaini, Chris MDa,d; Machara, Heritier MDa,c; Oduoye, Malik Olatunde MBBSf,h; Javed, Binish MDh; Kibukila, Fabrice MDa; Nyakio, Olivier MD, PhDa

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International Journal of Surgery: Global Health 6(3):e0150, May 2023. | DOI: 10.1097/GH9.0000000000000150
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Some microorganisms termed normal flora, are necessary for human life, whereas others are pathogenic and thus harmful to humans; as a result of contamination, these microbes cause infections that can lead to infectious diseases1–4. Infections that were once fatal can now be cured, and the use of antimicrobial agents has advanced global health; however, antimicrobials are the most mishandled of all drugs, which reduces their effectiveness in treatment4,5. Antimicrobial resistance (AMR) has become a significant threat to global public health and medical development, including the health system of the Democratic Republic of Congo (DR Congo). The DR Congo lacks comprehensive data on AMR, with limited surveillance on bacteria for example, Salmonella spp. and Staphylococcus aureus, whereas prospects for other bacteria remain unknown1,2.

Amidst economic crises, conflicts, and many irregularities ongoing in Democratic Republic of Congo (DRC), AMR keeps increasing day by day and posing more public health challenges to the Congolese population. AMR remains a real challenge in resource-limited countries, for example, DR Congo because of a lack of available antibiotics, with multidrug-resistant (MDR) isolates being labeled on the basis of a small number of antibiotics tested. This has economic consequences and yet the use of the old molecules is very effective. The consequences of AMR are not limited to patients with infections but to a whole system including the environmental and agropastoral sectors that encompass enough resistance genes6. In the coming years, microbes may become resistant to many more spectrums of antibiotics. For example, several studies have shown that there is AMR to date, mainly to β-lactam antibiotics, Cephalosporins, Carbapenems, Colistin, and Tigecycline in DR Congo2,4,7. Researchers found that bacterial resistance to antibiotics concerned both gram-negative and gram-positive bacteria; MDR prevalence was the same in half of Streptococcus pneumoniae isolates; a worrying prevalence of methicillin-resistant S. aureus was noted, which is associated with coresistance to several other antibiotics; and resistance to third-generation cephalosporins was very high in Enterobacteriaceae, mainly because of blaCTX-M-1 group and blaSHV genes5–9. Data on carbapenem and colistin resistance were not available in DR Congo until recently. Salmonella spp. is the most studied bacterial genus in DR Congo as a result of the research set up and is still ongoing since 2008 on bacteremia. Indeed, since the first publications on bacteremia, the prevalence of resistance to ampicillin, chloramphenicol, and cotrimoxazole popularly called sceptrin is particularly high (90%–100%)10–12. Further work is required to set up a surveillance system for antibiotic resistance in DRC. Also, AMR, being a major global threat, has increased health care costs and poor health-seeking behaviors among the Congolese5. The World Health Organization recommends a minimum of $35 per capita to safeguard a country’s population. But unfortunately, out of the 424 hospitals in DR Congo, very few have organized a microbiology service because of a lack of electricity, infrastructure, and specially qualified personnel, as the only university in DR Congo that trains them markets 2–4 clinical microbiologists per year4. This serious threat of AMR in DR Congo is the ineffectiveness of the antibacterial molecules available in the market, which means that the use of old molecules, which prove to be more active with MDR isolates elsewhere should quickly orient the regulatory authorities to change procurement policies5. AMR also poses the risk that some treatable and curable diseases or minor infections, for example, cellulitis, meningitis, tuberculosis, etc could become incurable. This could further impose a greater economic burden on vulnerable families and DR Congo’s health care system, resulting in increased suffering, morbidities, and mortalities6.

There are many other contributing factors to AMR in DR Congo, including uncontrolled and irrational antimicrobial use, the availability of dubious or poor-quality antimicrobial products, the sale of antimicrobials without a proper medical prescription, a lack of control over pharmaceutical regulations, and noncompliance with prescribed drugs or a lack of supply of these drugs due to unaffordable prices among the Congolese population4. Infectious diseases are currently the leading cause of death in our health care systems, and antibiotics alleviate these burdens, saving millions of lives. The failure to treat infections is the primary consequence of AMR, and this therapeutic failure leads to an increase in the number of deaths.

To combat AMR in DR Congo, it is crucial to establish a national surveillance system for antimicrobial consumption and AMR. The Congolese government should make a drastic improvement in the AMR research implementation policy to eliminate unnecessary antibiotic dispensations among medical personnel and citizens while promoting antibiotic dispensations through medical prescriptions7. Antibiotic prescriptions should be based on clinical data or arguments, which is made possible by effective, rapid, and low-cost diagnostic tools. This is important for the optimal and rational use of antimicrobials in DR Congo. In DR Congo, there are several uncontrolled reasons, especially for socioeconomic reasons for the use of antibiotics in the community. To make matters worse, many antimicrobial prescribers and sellers in the country are not well-trained pharmaceutical professionals, resulting in inappropriate therapeutic regimens. In this case, we recommend that the health system and the Ministry of Public Health of DR Congo strengthen antimicrobial consumption regulation, as well as adequate sensitization of data providers on the importance of surveillance, antimicrobial coadministration, and antimicrobial coadministration4,6. Also, there should be an improved collaboration between the national pharmaceutical regulatory authority and the general directorate of customs to ensure the traceability of drug imports, particularly antimicrobials, and to encourage local antimicrobial production by pharmaceutical industries established in DR Congo. Most importantly, there should be strict monitoring of antimicrobial use in health care facilities and the establishment of a quality assurance system for data collection and processing.

As AMR continues to be a major threat to DR Congo’s already destabilized and fragile health system, we believe that this critical and neglected issue needs to be addressed critically. Hence, the health authorities of the DRC need to consider the negative effects of AMR in the future and devise well-implemented strategies, especially in areas of antimicrobial research implementation and through the One Health approach to mitigate these consequences. Some of these implementations and the One Health approach include the involvement of the religious and traditional leaders including the market women in DRC. These people should be trained in AMR. Conversely, they could pass the training across to other citizens during religious worship, cultural events, market forums, etc. Also, there is an urgent need to create collaborative and partnership networks with all microbiology laboratories across the country, as well as the international communities who are experts in AMR, which will then be linked to external laboratories to effectively address the AMR problem5. If all these recommendations are put in place in the DRC, there should be a positive outcome and a high yield against AMR in the country, which would put a smile on the face of the citizens and the government

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Author contributions

Conceptualization; M.O.O. and A.A. Manuscript preparation; A.A. Project administration; A.A.. Funding acquisition; A.A. Writing of initial draft; All authors, except M.O.O. Writing; review and comments; M.O.O. and B.J. Supervision; M.O.O. Final approval of manuscript for publication; All authors.

Conflict of interest disclosures

The authors declare that they have no financial conflict of interest with regard to the content of this report.

Research registration unique identifying number (UIN)

Not applicable.


Malik Olatunde Oduoye.


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