# Multicentric Surveillance of Antimicrobial Resistance to Generate Data-Driven Regional Antibiograms: A Laboratory-Based Cross-Sectional Study in Pakistan

## TL;DR

This study tracks antibiotic resistance in Pakistan to create regional antibiograms, helping guide better antibiotic use and reduce resistance.

## Contribution

The study provides a multicenter surveillance of AMR in Northern Punjab, Pakistan, generating a data-driven regional antibiogram.

## Key findings

- Gram-positive bacteria caused 60% of infections, with S. aureus and S. pneumoniae being the most common.
- High resistance rates were observed against first-line antibiotics like third-generation cephalosporins and fluoroquinolones.
- Meropenem and vancomycin/linezolid showed high efficacy against resistant isolates.

## Abstract

Background: The escalating burden of antimicrobial resistance (AMR) poses a critical threat to public health in Pakistan, with rates of high antibiotic consumption and limited standardized surveillance on AMR rates. Our study aimed to carry out a multicentric surveillance of AMR to generate regional antibiograms for Northern Punjab, Pakistan, to guide empirical antimicrobial therapy and stewardship efforts. Methods: A laboratory-based, retrospective cross-sectional study was conducted over a six-month period across three tertiary care hospitals. Socio-demographic, clinical, and microbiological data (including specimen type and antibiotic prescription rates) were collected from N = 485 patients with confirmed bacterial infections. Antimicrobial susceptibility testing was performed based on Clinical Laboratory Standards Institute (CLSI) recommendations. Statistical analyses were carried out using SPSS v.22.0. Results: In our study setting, Gram-positive bacteria were common causes (60.0%) of infections, with Staphylococcus aureus (12.2%) and Streptococcus pneumoniae (10.3%) being the most relevant. Among Gram-negative bacteria (40.0%), Escherichia coli (14.0%) and Pseudomonas aeruginosa (5.8%) were shown to be important pathogens. Overall, 25.0% of S. aureus isolates were methicillin-resistant (MRSA), while ~30% of E. coli showed resistance to third-generation cephalosporins (3GCs). Enterobacterales species had highly variable susceptibility rates (40–70%) for fluoroquinolones. Meropenem and vancomycin/linezolid retained high efficacy (>90%) against most Gram-negative and Gram-positive isolates, respectively. In all healthcare settings studied, ceftriaxone was the most frequently prescribed antibiotic. Conclusions: High levels of resistance against first-line antibiotics were noted in our setting of Northern Punjab, Pakistan, underscoring the critical need for robust antimicrobial stewardship programs, tailored to local institutional contexts, capabilities, and needs. The regional antibiogram developed based on our data may provide vital evidence for informing local empirical treatment guidelines, which need to be continuously updated.