Antimicrobial resistance among uropathogens in the Asia-Pacific region: a systematic review Adhi Kristianto Sugianli 1 *, Franciscus Ginting 2 , Ida Parwati 1 , Menno D. de Jong 3 , Frank van Leth 4,5 and Constance Schultsz 3,4,5 1 Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia; 2 Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Adam Malik General Hospital, Medan, Indonesia; 3 Department of Medical Microbiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; 4 Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands; 5 Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands *Corresponding author. E-mail: adhi.kristianto@unpad.ac.id Received 21 July 2020; accepted 4 January 2021 Background: Antimicrobial resistance (AMR) in urinary tract infections (UTI) is a global public health problem. However, estimates of the prevalence of AMR, required for empirical treatment guidelines, are lacking for many regions. Objectives: To perform a systematic review and summarize the available information about AMR prevalence among urinary Escherichia coli and Klebsiella pneumoniae, the two priority uropathogens, in the Asia-Pacific region (APAC). Methods: PubMed, EBSCO and Web of Science databases were searched for articles (2008–20), following PRISMA guidelines. The prevalence of resistance was calculated and reported as point estimate with 95% CI for antimicrobial drugs recommended in WHO treatment guidelines. Data were stratified by country and surveil- lance approach (laboratory- or population-based surveillance). The quality of included articles was assessed using a modified Newcastle-Ottawa Quality Assessment Scale. Results: Out of 2400 identified articles, 24 studies, reporting on 11 (26.8%) of the 41 APAC countries, met the in- clusion criteria. Prevalence of resistance against trimethoprim/sulfamethoxazole, ciprofloxacin, and ceftriaxone ranged between 33% and 90%, with highest prevalence reported from Bangladesh, India, Sri Lanka and Indonesia. Resistance against nitrofurantoin ranged between 2.7% and 31.4%. Two studies reported data on fosfomycin resistance (1.8% and 1.7%). Quality of reporting was moderate. Conclusions: We show very high prevalence estimates of AMR against antibiotics commonly used for the empir- ical treatment of UTI, in the limited number of countries in the APAC for which data are available. Novel feasible and affordable approaches that facilitate population-based AMR surveillance are needed to increase knowledge on AMR prevalence across the region. Introduction Antimicrobial resistance (AMR) is a global public health threat. 1,2 Most of the direct and indirect burden of AMR is antici- pated in low- and middle-income countries due to several fac- tors, including lack of surveillance capacity and systematic data collection of AMR. 3,4 The Asia-Pacific region (APAC), which comprises the South-East Asia and Western Pacific Regions, is considered at high risk and a hotspot for the spread of AMR. 4 The AMR in APAC affects both the low-to-middle-income countries and high-income countries in this region. Urinary tract infections (UTIs) are common bacterial infec- tions that occur both in the community and in hospitals. UTIs are mostly treated empirically and lead the rising prevalence of AMR. 5,6 The effectiveness of empirical treatment is depend- ent on the underlying prevalence of resistance in the most common causative pathogens, which is often unknown due to V C The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. 1 of 12 JAC Antimicrob Resist doi:10.1093/jacamr/dlab003 JAC- Antimicrobial Resistance Downloaded from https://academic.oup.com/jacamr/article/3/1/dlab003/6153836 by guest on 21 December 2023