Tackling antimicrobial resistance through enhanced laboratory diagnostic stewardship: scaling up the use of culture and sensitivity testing in Malawi
1
Antimicrobial Resistance National Coordinating Center, Public Health Institute of Malawi, Lilongwe, Malawi
2
Antimicrobial Resistance, Fleming Fund, University of North Carolina, Project Malawi, Lilongwe, Malawi
3
Research Division, Clinical Research Education and Management Systems (CREAMS), Malawi, Lilongwe, Malawi
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
ABSTRACT:
In 2019, 1.27 million deaths were reported globally as being directly attributable to antimicrobial resistance (AMR) while Malawi reported 157001,2. Additionally, Malawi ranks 23rd in age-standardized mortality rate per 100000 population associated with AMR among 204 countries2. The World Bank estimates that if no interventions are implemented by 2050, bacterial AMR will cause ten million annual deaths globally and increase global healthcare expenditures by $3.4 trillion per year3. In Malawi, AMR is strongly driven by empiric antibiotic prescriptions due to the low uptake of culture and sensitivity testing thereby exerting selection pressure on bacteria. This leads to a higher prevalence of resistant strains that survive and multiply. Malawi lacks comprehensive data on antimicrobial prescribing patterns and the utilization of microbiological testing4. In the last quarter of 2024, the Public Health Institute of Malawi collected data on antimicrobial use patterns using the Global Point Prevalence Survey (GPPS) methodology across four central hospitals. Data was collected from 2,285 files whose patients’ were receiving antimicrobials before 08:00am on the day of the survey. Quantitative data analysis was done using IBM SPSS version 23.0. Of the 2285 inpatients, 35% were prescribed antimicrobials where antibiotics accounted for 84.6% of all antimicrobial prescriptions, followed by antimalarials at 4.4%, antifungals at 1.3%, and antivirals at 0.2%. Ceftriaxone, classified under as a Watch category in the World Health Organization’s AWaRe classification, was the most frequently prescribed antibiotic, representing 38% of all prescriptions across the four central hospitals. Only 5.9% of all antibiotic prescriptions were targeted, while 94.1% were prescribed empirically. Excessive empirical antimicrobial prescribing and under-utilization of laboratory diagnostics undermine treatment outcomes and accelerate AMR. To halt the spread of AMR in Malawi, clinicians’ demand for culture and sensitivity testing must increase and that culture and that it must be incorporated into routine patient care practice.
In 2019, 1.27 million deaths were reported globally as being directly attributable to antimicrobial resistance (AMR) while Malawi reported 157001,2. Additionally, Malawi ranks 23rd in age-standardized mortality rate per 100000 population associated with AMR among 204 countries2. The World Bank estimates that if no interventions are implemented by 2050, bacterial AMR will cause ten million annual deaths globally and increase global healthcare expenditures by $3.4 trillion per year3. In Malawi, AMR is strongly driven by empiric antibiotic prescriptions due to the low uptake of culture and sensitivity testing thereby exerting selection pressure on bacteria. This leads to a higher prevalence of resistant strains that survive and multiply. Malawi lacks comprehensive data on antimicrobial prescribing patterns and the utilization of microbiological testing4. In the last quarter of 2024, the Public Health Institute of Malawi collected data on antimicrobial use patterns using the Global Point Prevalence Survey (GPPS) methodology across four central hospitals. Data was collected from 2,285 files whose patients’ were receiving antimicrobials before 08:00am on the day of the survey. Quantitative data analysis was done using IBM SPSS version 23.0. Of the 2285 inpatients, 35% were prescribed antimicrobials where antibiotics accounted for 84.6% of all antimicrobial prescriptions, followed by antimalarials at 4.4%, antifungals at 1.3%, and antivirals at 0.2%. Ceftriaxone, classified under as a Watch category in the World Health Organization’s AWaRe classification, was the most frequently prescribed antibiotic, representing 38% of all prescriptions across the four central hospitals. Only 5.9% of all antibiotic prescriptions were targeted, while 94.1% were prescribed empirically. Excessive empirical antimicrobial prescribing and under-utilization of laboratory diagnostics undermine treatment outcomes and accelerate AMR. To halt the spread of AMR in Malawi, clinicians’ demand for culture and sensitivity testing must increase and that culture and that it must be incorporated into routine patient care practice.
| eISSN: | 2654-1459 |
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