Journal of Antimicrobial Agents

Background: Combating antibiotic resistance is a high priority for the World Health Organization (WHO). In order to optimize the use of antimicrobials and ensure sustainable investment in the fight against antimicrobial resistance, the WHO has updated the 19th List of Essential Medicines (EML) with new recommendations on antibiotic use by 2017. Since the launch of the first Model of the WHO EML in 1977, many countries adopted the concept of essential medicines and developed their own lists. Mozambique published its first edition in May 2017. To our knowledge, this study is the first to analyzing the antibacterial resistance pattern of the National List of Essential Medicines (EMNL) against bacteria isolated from patients admitted to the Intensive Care Unit (ICU) of the Central Hospital of Maputo (HCM) in 2017.
Methods: This was a cross-sectional, epidemiological, quantitative approach, with a retrospective analysis of secondary data, performed at the ICUs in Maputo Central Hospital.
Results: The mean resistance was 62.4%, 63.2% in the ICU-Pediatrics and 60.2% in the ICU-Adults. In ICUPediatric, the beta-lactams had a resistance of 69.3%, being higher in Gram-positive (75.8%) and Enterobacteriaceae (74.2%). In this class of antibiotics, the penicillins and cephalosporins presented high resistance rates with 80.6% and 78.6%, respectively; Carbapenems showed good antibiotic activity with a sensitivity of 73.6%. In ICU-Adults, the penicillins presented a good antibiotic activity against the isolated bacteria, with more prominence the cloxacillin with resistance ratio of 4.8%; in this sector, cephalosporins (70.0%), quinolones (81.8%), aminoglycosides (69.9%) and macrolides (69.6%) were the classes of antibiotics with high resistance rates.
Conclusion: There is a need for EMNL to be updated with the introduction of new drugs considered as last resort options and used only under the most severe circumstances when all alternatives failed.