Prospective characterisation of drug-resistant bloodstream infections in Africa and Asia (ACORN2): a surveillance network assessment
Issued Date
2025-01-01
Resource Type
eISSN
26665247
Scopus ID
2-s2.0-105025159592
Journal Title
Lancet Microbe
Rights Holder(s)
SCOPUS
Bibliographic Citation
Lancet Microbe (2025)
Suggested Citation
Hopkins J., Lee S.J., Waithira N., Painter C., Ling C.L., Roberts T., Miliya T., Obeng-Nkrumah N., Opintan J.A., Abbeyquaye E.P., Hamers R.L., Saharman Y.R., Sinto R., Karyanti M.R., Ibrahim R.F., Akech S.O., Ashley E.A., Douangnouvong A., Choumlivong K., Feasey N.A., Kululanga D., Lissauer S., Karkey A., Kunwar N., Erakhaiwu J.E., Okeke I.N., Adebiyi I., Adekanmbi O.A., Oduola A.B., Ogunbosi B.O., Ojifinni K.A., Tongo O.O., Ude I.A., Aboderin A.O., Adekanle O., Adeyemo A.T., Edward S.S., Osagie U., Nguyen T.H., Pham N.T., Tran V.G., Hoàng T.L.H., Trịnh H.T., van Doorn H.R., Turner P., Hopkins J., Lee S.J., Waithira N., Painter C., Ling C.L., Roberts T., Miliya T., Obeng-Nkrumah N., Opintan J.A., Abbeyquaye E.P., Hamers R.L., Saharman Y.R., Sinto R., Karyanti M.R., Ibrahim R.F., Akech S.O., Ashley E.A., Douangnouvong A., Choumlivong K., Feasey N.A., Kululanga D., Lissauer S., Karkey A., Kunwar N., Erakhaiwu J.E., Okeke I.N., Adebiyi I., Adekanmbi O.A., Oduola A.B., Ogunbosi B.O., Ojifinni K.A., Tongo O.O., Ude I.A., Aboderin A.O., Adekanle O., Adeyemo A.T., Edward S.S., Osagie U., Thi H.N., Pham N.T., Tran V.G., Hoang Thi L.H., Trinh H.T., Rogier van Doorn H., Turner P., Lubell Y., Celhay O., Chamsukhee V., Wannapinij P., Bran S., Ngoun C., Sar P., Bediako-Bowan A.A.A., Labi A.K., Dankwah T. Prospective characterisation of drug-resistant bloodstream infections in Africa and Asia (ACORN2): a surveillance network assessment. Lancet Microbe (2025). doi:10.1016/j.lanmic.2025.101228 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/113671
Title
Prospective characterisation of drug-resistant bloodstream infections in Africa and Asia (ACORN2): a surveillance network assessment
Author(s)
Hopkins J.
Lee S.J.
Waithira N.
Painter C.
Ling C.L.
Roberts T.
Miliya T.
Obeng-Nkrumah N.
Opintan J.A.
Abbeyquaye E.P.
Hamers R.L.
Saharman Y.R.
Sinto R.
Karyanti M.R.
Ibrahim R.F.
Akech S.O.
Ashley E.A.
Douangnouvong A.
Choumlivong K.
Feasey N.A.
Kululanga D.
Lissauer S.
Karkey A.
Kunwar N.
Erakhaiwu J.E.
Okeke I.N.
Adebiyi I.
Adekanmbi O.A.
Oduola A.B.
Ogunbosi B.O.
Ojifinni K.A.
Tongo O.O.
Ude I.A.
Aboderin A.O.
Adekanle O.
Adeyemo A.T.
Edward S.S.
Osagie U.
Nguyen T.H.
Pham N.T.
Tran V.G.
Hoàng T.L.H.
Trịnh H.T.
van Doorn H.R.
Turner P.
Hopkins J.
Lee S.J.
Waithira N.
Painter C.
Ling C.L.
Roberts T.
Miliya T.
Obeng-Nkrumah N.
Opintan J.A.
Abbeyquaye E.P.
Hamers R.L.
Saharman Y.R.
Sinto R.
Karyanti M.R.
Ibrahim R.F.
Akech S.O.
Ashley E.A.
Douangnouvong A.
Choumlivong K.
Feasey N.A.
Kululanga D.
Lissauer S.
Karkey A.
Kunwar N.
Erakhaiwu J.E.
Okeke I.N.
Adebiyi I.
Adekanmbi O.A.
Oduola A.B.
Ogunbosi B.O.
Ojifinni K.A.
Tongo O.O.
Ude I.A.
Aboderin A.O.
Adekanle O.
Adeyemo A.T.
Edward S.S.
Osagie U.
Thi H.N.
Pham N.T.
Tran V.G.
Hoang Thi L.H.
Trinh H.T.
Rogier van Doorn H.
Turner P.
Lubell Y.
Celhay O.
Chamsukhee V.
Wannapinij P.
Bran S.
Ngoun C.
Sar P.
Bediako-Bowan A.A.A.
Labi A.K.
Dankwah T.
Lee S.J.
Waithira N.
Painter C.
Ling C.L.
Roberts T.
Miliya T.
Obeng-Nkrumah N.
Opintan J.A.
Abbeyquaye E.P.
Hamers R.L.
Saharman Y.R.
Sinto R.
Karyanti M.R.
Ibrahim R.F.
Akech S.O.
Ashley E.A.
Douangnouvong A.
Choumlivong K.
Feasey N.A.
Kululanga D.
Lissauer S.
Karkey A.
Kunwar N.
Erakhaiwu J.E.
Okeke I.N.
Adebiyi I.
Adekanmbi O.A.
Oduola A.B.
Ogunbosi B.O.
Ojifinni K.A.
Tongo O.O.
Ude I.A.
Aboderin A.O.
Adekanle O.
Adeyemo A.T.
Edward S.S.
Osagie U.
Nguyen T.H.
Pham N.T.
Tran V.G.
Hoàng T.L.H.
Trịnh H.T.
van Doorn H.R.
Turner P.
Hopkins J.
Lee S.J.
Waithira N.
Painter C.
Ling C.L.
Roberts T.
Miliya T.
Obeng-Nkrumah N.
Opintan J.A.
Abbeyquaye E.P.
Hamers R.L.
Saharman Y.R.
Sinto R.
Karyanti M.R.
Ibrahim R.F.
Akech S.O.
Ashley E.A.
Douangnouvong A.
Choumlivong K.
Feasey N.A.
Kululanga D.
Lissauer S.
Karkey A.
Kunwar N.
Erakhaiwu J.E.
Okeke I.N.
Adebiyi I.
Adekanmbi O.A.
Oduola A.B.
Ogunbosi B.O.
Ojifinni K.A.
Tongo O.O.
Ude I.A.
Aboderin A.O.
Adekanle O.
Adeyemo A.T.
Edward S.S.
Osagie U.
Thi H.N.
Pham N.T.
Tran V.G.
Hoang Thi L.H.
Trinh H.T.
Rogier van Doorn H.
Turner P.
Lubell Y.
Celhay O.
Chamsukhee V.
Wannapinij P.
Bran S.
Ngoun C.
Sar P.
Bediako-Bowan A.A.A.
Labi A.K.
Dankwah T.
Author's Affiliation
Monash University
University of Liverpool
Universitas Indonesia
University of Ibadan
Nuffield Department of Medicine
University of Ghana
Obafemi Awolowo University
Liverpool School of Tropical Medicine
University College Hospital, Ibadan
Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo
Kamuzu University of Health Sciences
Hanoi Medical University
Mahidol Oxford Tropical Medicine Research Unit
College of Medicine, University of Ibadan
Wellcome Trust Research Laboratories Nairobi
School of Medicine
Oxford University Clinical Research Unit
Obafemi Awolowo University Teaching Hospitals Complex
Mahosot Hospital, Lao
Angkor Hospital for Children
Children's Hospital 2
Rumah Sakit Universitas Indonesia
37 Military Hospital
National Hospital of Tropical Diseases
Hue Central Hospital
Setthathirath Hospital
Pelni Hospital
University of Liverpool
Universitas Indonesia
University of Ibadan
Nuffield Department of Medicine
University of Ghana
Obafemi Awolowo University
Liverpool School of Tropical Medicine
University College Hospital, Ibadan
Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo
Kamuzu University of Health Sciences
Hanoi Medical University
Mahidol Oxford Tropical Medicine Research Unit
College of Medicine, University of Ibadan
Wellcome Trust Research Laboratories Nairobi
School of Medicine
Oxford University Clinical Research Unit
Obafemi Awolowo University Teaching Hospitals Complex
Mahosot Hospital, Lao
Angkor Hospital for Children
Children's Hospital 2
Rumah Sakit Universitas Indonesia
37 Military Hospital
National Hospital of Tropical Diseases
Hue Central Hospital
Setthathirath Hospital
Pelni Hospital
Corresponding Author(s)
Other Contributor(s)
Abstract
Background Antimicrobial resistance (AMR) is a major global health threat, but there is scarcity of laboratory surveillance data linked to clinical information to determine burden and inform interventions, especially from low-income and middle-income countries. The ACORN2 study sought to address this through prospective case-based surveillance in 19 hospitals across Africa and Asia to characterise drug-resistant infections by origin, clinical syndrome, patient age, outcome, and geographical location. Methods Patients were enrolled on selected wards and clinical data were collected daily for community-acquired infections (CAIs). Point prevalence surveys for hospital-acquired infections (HAIs) were conducted weekly. Mortality was assessed at discharge and after 28 days. Linked microbiology data were extracted from local laboratory databases. Primary descriptive analyses focused on WHO Global Antimicrobial Resistance and Use Surveillance System pathogen (target organism) bloodstream infections (BSIs). Comparisons were adjusted for clustering by site using random effects models. Findings Over 31 months, 41 907 infections were characterised from 41 032 admissions. Two-thirds were children (19 351; 47·2%) or neonates (6649; 16·2%). There were marked differences in pathogen incidence and antibiotic resistance when clinical infections were stratified by patient age category and infection origin (CAI/HAI). The highest rates of target organism AMR BSI were third-generation cephalosporin-resistant (3GC-R) Escherichia coli (718 56/100 000 blood cultured infection episodes), meticillin-resistant Staphylococcus aureus (586 89/100 000 blood cultured infection episodes), and 3GC-R Klebsiella pneumoniae (364 92/100 000 blood cultured infection episodes). In-hospital mortality was 13·1% (166/1265) in patients with target organism BSI versus 6·2% (1357/21 845) in those with negative blood cultures, p<0·0001. Interpretation ACORN2 has shown practical implementation of collecting linked clinical-laboratory AMR data in low-income and middle-income countries and identified a significant burden of WHO GLASS BSI. Adoption of the ACORN2 approach at scale might enhance use of diagnostic microbiology and improve the volume of clinical data included in national and global AMR surveillance datasets. Funding Wellcome.