The Lancet regional health. Western Pacific · 2026
Emergence of antimicrobial resistance in New Caledonia: 20-year trends from laboratory-based surveillance (2005-2024).
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Antoniolli Andrea, Ruge Tiffany, Biron Antoine, Rahi Praveen, Flamand Claude, Bourles Alexandre, Goarant Cyrille, Colot Julien
Аннотация
BACKGROUND: Antimicrobial resistance (AMR) issues have emerged in New Caledonia, particularly involving methicillin-resistant Staphylococcus aureus (MRSA), and carbapenem-resistant Acinetobacter baumannii (CR-AB). However, a comprehensive overall picture is still required to guide an antimicrobial stewardship.
METHODS: A prospective collection of antimicrobial susceptibility testing results was performed over a 20-year period (2005-2024) in the Territorial Hospital Center, the main hospital in New Caledonia. This surveillance encompassed 22 different pathogens and 28 antimicrobial agents, covering 157 pathogen-drug combinations. Resistance rates over time were analyzed using logistic models. A focus was placed on high-priority pathogens, including MRSA, CR-AB, vancomycin-resistant Enterococcus faecium, ceftazidime-resistant Pseudomonas aeruginosa, extended-spectrum β-lactamase Enterobacterales (ESBL-E), and carbapenemase-producing Enterobacterales (CPE). Multidrug-resistant (MDR) and possible extensively drug-resistant (pXDR) isolates were also identified and characterized.
FINDINGS: Across 111,022 included isolates, emergences of resistance were observed, notably to penicillins, third-generation cephalosporins, tetracycline, and fusidic acid. Temporal resistance trends were described, along with outbreaks of MRSA and CR-AB, and the emergence of ESBL-E and CPE, representing 3.7% [95% CI: 3.5-3.8] (N = 2208), and 0.1% [95% CI: 0.1-0.2] (N = 85) of the 59,954 Enterobacterales isolates, respectively. Overall, 11% [95% CI: 10.8-11.1] were MDR and 0.6% [95% CI: 0.5-0.6] were pXDR.
INTERPRETATION: Through trend analyses, this surveillance highlighted both the emergence and decline of AMR across diverse bacterial pathogens, helping inform which antibiotics may remain appropriate as first-line options and addressing the lack of data from Pacific Island settings.
FUNDING: This work received financial support from the Pierre Ledoux Jeunesse Internationale scholarship (Fondation de France) and the Institut Pasteur, Paris.
METHODS: A prospective collection of antimicrobial susceptibility testing results was performed over a 20-year period (2005-2024) in the Territorial Hospital Center, the main hospital in New Caledonia. This surveillance encompassed 22 different pathogens and 28 antimicrobial agents, covering 157 pathogen-drug combinations. Resistance rates over time were analyzed using logistic models. A focus was placed on high-priority pathogens, including MRSA, CR-AB, vancomycin-resistant Enterococcus faecium, ceftazidime-resistant Pseudomonas aeruginosa, extended-spectrum β-lactamase Enterobacterales (ESBL-E), and carbapenemase-producing Enterobacterales (CPE). Multidrug-resistant (MDR) and possible extensively drug-resistant (pXDR) isolates were also identified and characterized.
FINDINGS: Across 111,022 included isolates, emergences of resistance were observed, notably to penicillins, third-generation cephalosporins, tetracycline, and fusidic acid. Temporal resistance trends were described, along with outbreaks of MRSA and CR-AB, and the emergence of ESBL-E and CPE, representing 3.7% [95% CI: 3.5-3.8] (N = 2208), and 0.1% [95% CI: 0.1-0.2] (N = 85) of the 59,954 Enterobacterales isolates, respectively. Overall, 11% [95% CI: 10.8-11.1] were MDR and 0.6% [95% CI: 0.5-0.6] were pXDR.
INTERPRETATION: Through trend analyses, this surveillance highlighted both the emergence and decline of AMR across diverse bacterial pathogens, helping inform which antibiotics may remain appropriate as first-line options and addressing the lack of data from Pacific Island settings.
FUNDING: This work received financial support from the Pierre Ledoux Jeunesse Internationale scholarship (Fondation de France) and the Institut Pasteur, Paris.