Building Capacity in Infection Prevention and Antimicrobial Stewardship in Low- and Middle-Income Countries: the Role of Partnerships Inter-countries

  • Tyler Prentiss
  • Kate Weisberg
  • John Zervos
Infection Prevention and Safety in Low and Middle Income Countries (C Bardossy, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Infection Prevention and Safety in Low and Middle Income Countries

Opinion statement

Antimicrobial resistance is increasing globally at a rapid pace, and patients in low- and middle-income countries are at high risk. The need for inter-country partnerships with the ultimate goal of building capacity in the fields of infection prevention and antimicrobial stewardship in these settings is of utmost importance. Reciprocal, long-term, supported relationships between collaborators from low- and middle-income countries and high-income countries will have high benefit to all partners. This paper looks at recent literature in antimicrobial stewardship and infection prevention and offers recommendations for building sustainable partnerships benefitting all collaborators working to reduce antimicrobial resistance.


Antimicrobial resistance Antimicrobial stewardship Infection control and prevention International partnerships Low- and middle-income countries Capacity building 


Compliance with Ethical Standards

Conflict of interest

Tyler Prentiss declares that he has no conflict of interest. Kate Weisberg declares that she has no conflict of interest. John Zervos declares that he has no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: •    Of importance ••   Of major importance

  1. 1.
    •• Cox JA, Vlieghe E, Mendelson M, Wertheim H, Ndegwa L, Villegas MV, et al. Antibiotic stewardship in low-and middle-income countries: same, but different? Clin Microbiol Infect. 2017;23(11):812–8. very recent look at antimicrobial stewardship programs in low- and middle-income countries. Looks and classifies different implementations of AMS programs in low- and middle-income countries.
  2. 2.
    • Tiong JJ, Loo JS, Mai CW. Global antimicrobial stewardship: a closer look at the formidable implementation challenges. Front Microbiol. 2016;7:1860. recent overview of the difficulties seen in implementation of global AMS work.
  3. 3.
    Outterson K, Rex JH, Jinks T, Jackson P, Hallinan J, Karp S, et al. Accelerating global innovation to address antibacterial resistance: introducing CARB-X. Nat Rev Drug Discov. 2016;15(9):589–90.
  4. 4.
    Technological challenges in antibiotic discovery and development: a workshop summary. The National Academies Collection: reports funded by National Institutes of Health. Washington (DC) 2014.Google Scholar
  5. 5.
    Pulcini C, Morel CM, Tacconelli E, Beovic B, de With K, Goossens H, et al. Human resources estimates and funding for antibiotic stewardship teams are urgently needed. Clin Microbiol Infect. 2017;23(11):785–7.
  6. 6.
    Nathwani D, Sneddon J, Patton A, Malcolm W. Antimicrobial stewardship in Scotland: impact of a national programme. Antimicrob Resist Infect Control. 2012;1(1):7. Scholar
  7. 7.
    Gerbin CS. Enhancing US-Japan cooperation to combat antimicrobial resistance. Biosecur Bioterror. 2014;12(6):337–45. Scholar
  8. 8.
    Allerberger F, Gareis R, Jindrak V, Struelens MJ. Antibiotic stewardship implementation in the EU: the way forward. Expert Rev Anti-Infect Ther. 2009;7(10):1175–83. Scholar
  9. 9.
    World Health Organization. At UN, global leaders commit to act on antimicrobial resistance. New York. 2016. Accessed 2017 August.
  10. 10.
    Drugs for Neglected Diseases Initiative. Global Antibiotic Research and Development Partnership (GARDP) 2016.
  11. 11.
    Global Antibiotic Resistance Partnership—India Working G. Rationalizing antibiotic use to limit antibiotic resistance in India(+). Indian J Med Res. 2011;134(3):281–94.Google Scholar
  12. 12.
    Nguyen KV, Thi Do NT, Chandna A, Nguyen TV, Pham CV, Doan PM, et al. Antibiotic use and resistance in emerging economies: a situation analysis for Viet Nam. BMC Public Health. 2013;13(1):1158.
  13. 13.
    Mendelson M, Whitelaw A, Nicol M, Brink A. Wake up South Africa! The antibiotic ‘horse’ has bolted. S Afr Med J. 2012;102(7):607–8. Scholar
  14. 14.
    Perez F, Villegas MV. The role of surveillance systems in confronting the global crisis of antibiotic-resistant bacteria. Curr Opin Infect Dis. 2015;28(4):375–83. Scholar
  15. 15.
    Hernandez-Gomez C, Motoa G, Vallejo M, Blanco VM, Correa A, de la Cadena E, et al. Introduction of software tools for epidemiological surveillance in infection control in Colombia. Colomb Med (Cali). 2015;46(2):60–5.Google Scholar
  16. 16.
    Huttner B, Harbarth S, Nathwani D. Policies ESGfA. Success stories of implementation of antimicrobial stewardship: a narrative review. Clin Microbiol Infect. 2014;20(10):954–62. Scholar
  17. 17.
    • Bebell LM, Muiru AN. Antibiotic use and emerging resistance: how can resource-limited countries turn the tide? Glob Heart. 2014;9(3):347–58. review article that discusses the level of antimicrobial resistance in low- and middle-income countries which offersrecommendations and a "road map for the future.
  18. 18.
    Curcio D. Antibiotic stewardship: the “real world” when resources are limited. Infect Control Hosp Epidemiol. 2010;31(6):666–8. Scholar
  19. 19.
    Lopardo G, Titanti P, Berdinas V, Barcelona L, Curcio D. Antimicrobial stewardship program in a developing country: the epidemiological barrier. Rev Panam Salud Publica. 2011;30(6):667–8. Scholar
  20. 20.
    Amdany H, McMillan M. Metronidazole intravenous formulation use in in-patients in Kapkatet District Hospital, Kenya: a best practice implementation project. JBI Database of System Rev Implement Rep. 2014;12(3):419–32. Scholar
  21. 21.
    World Health Organization. Driving change in antimicrobial stewardship in a low-resource setting. 2017.Google Scholar
  22. 22.
    Sastry S, Masroor N, Bearman G, Hajjeh R, Holmes A, Memish Z, et al. The 17th International Congress on Infectious Diseases workshop on developing infection prevention and control resources for low- and middle-income countries. Int J Infect Dis. 2017;57:138–43.
  23. 23.
    Laxminarayan R, Duse A, Wattal C, Zaidi AK, Wertheim HF, Sumpradit N, et al. Antibiotic resistance-the need for global solutions. Lancet Infect Dis. 2013;13(12):1057–98. Scholar
  24. 24.
    Biswal M, Mewara A, Appannanavar SB, Taneja N. Mandatory public reporting of healthcare-associated infections in developed countries: how can developing countries follow? J Hosp Infect. 2015;90(1):12–4. Scholar
  25. 25.
    Johnson H, Gordon W. North-South/South-North partnerships: closing the ‘mutuality gap’. Public Adm Dev. 2006;26(1):71–80. Scholar
  26. 26.
    Planta MB. The role of poverty in antimicrobial resistance. J Am Board Fam Med. 2007;20(6):533–9. Scholar
  27. 27.
    Chambers R. Participatory rural appraisal (PRA): challenges, potentials and paradigm. World Dev. 1994;22(10):1437–54. Scholar
  28. 28.
    Crisp B, Swerissen H, Duckett SJ. Four approaches to capacity building in health: consequences for measurement and accountability. Health Promot Int. 2000;15(2):99–107. Scholar
  29. 29.
    Cantas L, Shah SQ, Cavaco LM, Manaia CM, Walsh F, Popowska M, et al. A brief multi-disciplinary review on antimicrobial resistance in medicine and its linkage to the global environmental microbiota. Front Microbiol. 2013;4:96. Scholar
  30. 30.
    Shafiq N, Praveen Kumar M, Gautam V, Negi H, Roat R, Malhotra S, et al. Antibiotic stewardship in a tertiary care hospital of a developing country: establishment of a system and its application in a unit-GASP Initiative. Infection. 2016;44(5):651–9.
  31. 31.
    World Health Organization. Antimicrobial resistance. Geneva, Switzerland. 2016. Accessed August 2017.
  32. 32.
    Allegranzi B, Pittet D. Healthcare-associated infection in developing countries: simple solutions to meet complex challenges. Infect Control Hosp Epidemiol. 2007;28(12):1323–7. Scholar
  33. 33.
    • Shallcross LJ, Howard SJ, Fowler T, Davies SC. Tackling the threat of antimicrobial resistance: from policy to sustainable action. Philos Trans R Soc Lond Ser B Biol Sci. 2015;370(1670):20140082. UK-specific look at how to impact antimicrobial resistance; while all of the lessons repeated in the artcile are not directly applicable to persons in low- and middle-income countries, it highlights the importance for people at all levels to be involved in AMS.
  34. 34.
    Gilchrist M, Wade P, Ashiru-Oredope D, Howard P, Sneddon J, Whitney L, et al. Antimicrobial stewardship from policy to practice: experiences from UK antimicrobial pharmacists. Infect Dis Ther. 2015;4(Suppl 1):51–64.
  35. 35.
    VanDeusen Lukas C, Koppelman E, Ostrowsky B, Sumer Z, Jalon H, Araujo C et al. Developing the capacity to implement antimicrobial stewardship: opportunities for the future. In: Battles J, Cleeman J, Kahn K, Weinberg D, editors. Advances in the prevention and control of HAIs. Rockville, MD 2014.Google Scholar
  36. 36.
    Renwick MJ, Simpkin V, Mossialos E. Targeting innovation in antibiotic drug discovery and development: the need for a one health-one Europe-one world framework. Copenhagen: WHO Health Policy Series; 2016.Google Scholar
  37. 37.
    Tegos GP, Hamblin MR. Disruptive innovations: new anti-infectives in the age of resistance. Curr Opin Pharmacol. 2013;13(5):673–7. Scholar
  38. 38.
    Rogers E. Diffusion of innovations. New York, NY: Simon and Schuster; 2003.Google Scholar
  39. 39.
    Syed SB, Dadwal V, Martin G. Reverse innovation in global health systems: towards global innovation flow. Glob Health. 2013;9(1):36. Scholar
  40. 40.
    Govindarajan V, Trimble C. Reverse innovation: create far from home, win everywhere. Boston, MA: Harvard Business Review Press; 2012. Scholar
  41. 41.
    Depasse JW, Lee PT. A model for ‘reverse innovation’ in health care. Glob Health. 2013;9(1):40. Scholar
  42. 42.
    •• Harris M, Weisberger E, Silver D, Macinko J. ‘They hear “Africa” and they think that there can’t be any good services’—perceived context in cross-national learning: a qualitative study of the barriers to reverse innovation. Glob. Health. 2015;11.A look at reverse innovation and the importace of collaboration across cultures and the exchange of ideas.Google Scholar
  43. 43.
    • King A, Cresswell KM, Coleman JJ, Pontefract SK, Slee A, Williams R, et al. Investigating the ways in which health information technology can promote antimicrobial stewardship: a conceptual overview. J R Soc Med. 2017;110(8):320–9. primer on how health IT opportunities have the ability to make impact on antimcirobial stewardship around the world.
  44. 44.
    Cresswell K, Mozaffar H, Shah S, Sheikh A. Approaches to promoting the appropriate use of antibiotics through hospital electronic prescribing systems: a scoping review. Int J Pharm Pract. 2017;25(1):5–17. Scholar
  45. 45.
    Wentzel J, van Velsen L, van Limburg M, de Jong N, Karreman J, Hendrix R, et al. Participatory eHealth development to support nurses in antimicrobial stewardship. BMC Med Inform Decis Mak. 2014;14(1):45.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.The Global Health InitiativeHenry Ford Health SystemDetroitUSA

Personalised recommendations