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The World Health Organization has identified surveillance as a key objective in the containment of antimicrobial resistance. Local antimicrobial resistance surveillance data are used to generate antibiograms to monitor resistance patterns and inform clinicians in the selection of the appropriate empiric treatment when culture results are pending, or if laboratory diagnosis is unavailable. However, producing robust bacteriology data is challenging for Pacific Island Countries and Territories with limited microbiology laboratory capacity. The aim of this study is to describe pathogen occurrence and antibiotic resistance in specimens cultured at the main referral hospital in Vanuatu. We reviewed specimen culture results for the period from January 1, 2017 to December 31, 2019. Demographic and clinical data were extracted from printed and electronic registers and described and analysed. A total of 5816 specimens were cultured, of which 21% were culture positive. Staphylococcusaureus was the predominant pathogen overall (41%), and 3% of the isolates were the methicillin-resistant Staphylococcus aureus. Escherichia coli and Klebsiella pneumoniae were the most frequently isolated gram-negative pathogens, of which 14% and 26% were extended-spectrum β-lactamase-producing, respectively. Our results suggest there is a need for other Pacific Island Countries and Territories to conduct similar studies. There are gaps in knowledge about antimicrobial resistance in Pacific Island Countries and Territories. Antibiograms based on reliable data will define and inform local and national actions for containing antimicrobial resistance. There is also a need to establish a regional surveillance network to strengthen national efforts and to link surveillance data for collaborative action against antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Several studies have investigated antimicrobial resistance in low- and middle-income countries, but to date little attention has been paid to the Pacific Islands Countries and Territories (PICTs). This study aims to review the literature on antibiotic resistance (ABR) in healthcare settings in PICTs to inform further research and future policy development for the region. Following the PRISMA-ScR checklist health databases and grey literature sources were searched. Three reviewers independently screened the literature for inclusion, data was extracted using a charting tool and the results were described and synthesised. Sixty-five studies about ABR in PICTs were identified and these are primarily about New Caledonia, Fiji and Papua New Guinea. Ten PICTs contributed the remaining 21 studies and nine PICTs were not represented. The predominant gram-positive pathogen reported was community-acquired methicillin resistant S. aureus and the rates of resistance ranged widely (>50% to <20%). Resistance reported in gram-negative pathogens was mainly associated with healthcare-associated infections (HCAIs). Extended spectrum beta-lactamase (ESBL) producing K. pneumoniae isolates were reported in New Caledonia (3.4%) and Fiji (22%) and carbapenem resistant A. baumannii (CR-ab) isolates in the French Territories (24.8%). ABR is a problem in the PICTs, but the epidemiology requires further characterisation. Action on strengthening surveillance in PICTs needs to be prioritised so strategies to contain ABR can be fully realised. [ABSTRACT FROM AUTHOR]