Macrophages and kidney transplantation / 器官移植

Kidney transplantation is the optimal treatment for patients with end-stage renal disease, whereas long-term survival of renal allografts remains a challenging issue. Renal ischemia-reperfusion injury (IRI) and rejection of renal allografts are considered as important influencing factors of long-term survival of renal allografts, which are regulated by innate and adaptive immune cells. Macrophages are one type of innate immune cells that could assist initiating adaptive immunity and are divided into M1, M2 and regulatory macrophages. Previous studies have revealed that M1 macrophages may aggravate renal IRI and acute T cell-mediated rejection (TCMR). However, M2 macrophages may mitigate renal IRI and acute TCMR, whereas it is positively correlated with antibody-mediated rejection (AMR). Regulatory macrophages are a special subgroup of macrophages, which may induce immune tolerance in organ transplantation and have promising clinical application prospects and basic scientific research value. In this article, the relationship among macrophage typing, macrophages and renal IRI, rejection of renal allografts, regulatory macrophages and immune tolerance was reviewed, and the potential mechanism was analyzed, aiming to induce changes in macrophage subtypes or eliminate specific subtypes of macrophages, thereby improving clinical prognosis of the recipients and long-term survival of renal allografts.

Monitoring progress on antimicrobial resistance response in the WHO African Region: insights from the TrACSS 2021. Results for the Human Health Sector

Background: Antimicrobial resistance (AMR) is a major 21st Century global health challenge. The WHO African Region Member States committed to develop and implement multisectoral national action plans (NAPs) that address AMR, in line with the Global Action Plan (GAP). Objective: The aim of this paper is to present the progress of AMR response in the WHO African Region based on the annual Tracking AMR Country Self-Assessment Survey (TrACSS), with a focus on human health indicators. Methods: This was a secondary data analysis of responses from forty-one countries that participated in the 2021 TrACSS. Results: Of the 41 countries that responded to the 2021 TrACSS, 35(85%) have developed NAPs. 15 (37%) of countries have functional AMR multisector working groups. 55% (21/41) of countries are collating data nationally on AMR surveillance. Forty nine percent of countries conducted small-scale AMR awareness campaigns and 53% (21/41) covered AMR in some pre- and in-service training for huBackground: Antimicrobial resistance (AMR) is a major 21st Century global health challenge. The WHO African Region Member States committed to develop and implement multisectoral national action plans (NAPs) that address AMR, in line with the Global Action Plan (GAP). Objective: The aim of this paper is to present the progress of AMR response in the WHO African Region based on the annual Tracking AMR Country Self-Assessment Survey (TrACSS), with a focus on human health indicators. Methods: This was a secondary data analysis of responses from forty-one countries that participated in the 2021 TrACSS. Results: Of the 41 countries that responded to the 2021 TrACSS, 35(85%) have developed NAPs. 15 (37%) of countries have functional AMR multisector working groups. 55% (21/41) of countries are collating data nationally on AMR surveillance. Forty nine percent of countries conducted small-scale AMR awareness campaigns and 53% (21/41) covered AMR in some pre- and in-service training for Background: Antimicrobial resistance (AMR) is a major 21st Century global health challenge. The WHO African Region Member States committed to develop and implement multisectoral national action plans (NAPs) that address AMR, in line with the Global Action Plan (GAP). Objective: The aim of this paper is to present the progress of AMR response in the WHO African Region based on the annual Tracking AMR Country Self-Assessment Survey (TrACSS), with a focus on human health indicators. Methods: This was a secondary data analysis of responses from forty-one countries that participated in the 2021 TrACSS. Results: Of the 41 countries that responded to the 2021 TrACSS, 35(85%) have developed NAPs. 15 (37%) of countries have functional AMR multisector working groups. 55% (21/41) of countries are collating data nationally on AMR surveillance. Forty nine percent of countries conducted small-scale AMR awareness campaigns and 53% (21/41) covered AMR in some pre- and in-service training for human health workers. While 83% of countries reported having laws and regulations on the prescription and sale of antimicrobials, only 32% (13/41) have national systems for monitoring antimicrobial use. Twenty-three (58%, 23/41) reported having Infection Prevention and Control (IPC) programs at select health facilities. Conclusion: Countries have developed and are implementing AMR NAPs. Gaps still exist across key indicators monitored through TrACSS. Effective AMR response requires established functional multisectoral governance mechanism sin the One Health approach; political commitment, sustainable funding, and clear monitoring and reporting is critical. human health workers. While 83% of countries reported having laws and regulations on the prescription and sale of antimicrobials, only 32% (13/41) have national systems for monitoring antimicrobial use. Twenty-three (58%, 23/41) reported having Infection Prevention and Control (IPC) programs at select health facilities. Conclusion: Countries have developed and are implementing AMR NAPs. Gaps still exist across key indicators monitored through TrACSS. Effective AMR response requires established functional multisectoral governance mechanisms in the One Health approach; political commitment, sustainable funding, and clear monitoring and reporting is critical. man health workers. While 83% of countries reported having laws and regulations on the prescription and sale of antimicrobials, only 32% (13/41) have national systems for monitoring antimicrobial use. Twenty-three (58%, 23/41) reported having Infection Prevention and Control (IPC) programs at select health facilities. Conclusion: Countries have developed and are implementing AMR NAPs. Gaps still exist across key indicators monitored through TrACSS. Effective AMR response requires established functional multisectoral governance mechanisms in the One Health approach; political commitment, sustainable funding, and clear monitoring and reporting is critical.

AMR Sign - An Arthroscopic S-shaped Fold Signifying Adequate Medial Meniscus Repair

@#Introduction: The preferred management of medial meniscus tears has notably moved from meniscectomies towards repair. With a higher volume of meniscal repairs being done all across the world with every passing day, the lack of an objective and definitive sign suggesting the adequacy of its repair is daunting. The purpose of our study was to introduce a unique and novel arthroscopic sign formed after adequate repair of the medial meniscus, the AMR (Adequacy of Medial meniscus Repair) sign. We hypothesised that it is not only the objective end point for repair, but can also form the indicator for excellent clinical, functional, and radiological outcome even in the long term. Materials and methods: This was a multicentric, prospective study initiated by the corresponding author, and the findings validated subsequently by the other authors. Overall, it included 804 patients of isolated medial meniscus tear operated with arthroscopic all-inside technique between January 2014 and December 2017. Patients were segregated into three groups based on whether an S-shaped curve in the free, inner edge of the medial meniscus sign was formed post-repair, lost after further tightening, or not formed upon subjective completion of repair. All the patients were followed-up and evaluated based of medial joint line tenderness, McMurray’s test for medial meniscus, IKDC score, WOMET score, and radiologically using an MRI at the terminal follow-up. Results: The mean terminal follow-up was 42.34±4.54 months. There was significant (p<0.01) improvement in all patients at the terminal follow-up post-surgery, irrespective of the group. The group in which AMR sign was formed and maintained showed a significantly better functional outcome on terminal follow-up as well as lower failure rates compared to the other two groups. Conclusion: AMR sign is an S-shaped fold at the inner, free edge of medial meniscus, formed after an adequate repair of isolated medial meniscus tear, as viewed on arthroscopy. It is an objective sign denoting regained integrity of the collagen architecture of the medial meniscus following repair. It is also a reliable indicator of excellent long term functional, clinical, and radiological outcome and also lower failure rates in patients after arthroscopic medial meniscus repair.

Oral Faropenem Sodium – Implications for Antimicrobial Resistance and Treatment Effectiveness

Rising antimicrobial resistance (AMR) is causing therapeutic failures with antibiotics. Inappropriate use is a contributing factor. One such antibiotic on the radar is faropenem, a broad spectrum antibiotic approved in 2005 in India. Recently, faropenem sodium suspension was approved for use in children. There is a potential danger of overuse due to the convenience of oral administration. Other carbapenems such as meropenem are used parenterally. Overuse of faropenem may promote cross-resistance with other carbapenems making them ineffective.

Disparity between cost variation of antibiotics in northern and western India: A cross - sectional study

Background - About 58% of India’s health expenditure is out of pocket expenditure. There is a wide variation in the cost of different brands of the same generic drug. Prescription of expensive brands of antibiotics contributes to the development of antibiotic resistanc e. There is literature available on the cost variation and cost ratio of antibiotics but none on the regional disparity. Materials and Methods - An observational cross - sectional study design was adopted. The study was conducted at the medical stores of Ali garh (Uttar Pradesh) and Mumbai (Maharashtra). The maximum and minimum cost/unit in Rupees (INR) of each antibiotic manufactured by multiple pharmaceutical companies was noted. Furthermore, Cost per daily defined dose (cost/DDD) was calculated for the most expensive and least expensive drug. Results - ALIGARH - The highest percent cost variation of 1897.14 and cost ratio of 19.97 was found for Piperacillin 4000mg + Tazobactam 500mg tablets. The least percent cost variation of 48.92 and cost ratio of 1.49 was found for ciprofloxacin 200mg vial. MUMBAI - The highest cost variation of 3031.05 and cost ratio of 31.31 was found for cefixime 200 mg tablets. The least percent cost variation of 6.43 and cost ratio of 1.06 was found for ciprofloxacin 200 mg vial. Concl usions - There is disparity in the cost variation and ratio between the two cities Aligarh and Mumbai in this study, which can be attributed to availability of different brands, under a generic group, in the different regions of the country

National action plan on antimicrobial resistance: An evaluation of implementation in the World Health Organization Africa region

In line with global instruments, within the last five years, two-thirds of all countries in the WHO Africa Region (WHO AFR) have developed a National Action Plan (NAP) on Antimicrobial Resistance (AMR). We sought to evaluate progress made across the countries implementing NAP for effective response to AMR. A semi-structured survey tool was administered to obtain information from national focal persons on the implementation of strategic elements of NAP on AMR. This was followed by a Lessons Learnt Workshop in June 2019 at Douala, Cameroon, where focal persons made presentations on the country's progress. Later, a desktop review of the LLW report and other key documents was conducted. Countries in WHO AFR that have set up a national surveillance system and are enrolled into the WHO global antimicrobial resistance surveillance system have progressively increased to 30 (of 47 countries), of which 15 are already submitting surveillance data. Of the 20 countries at the Lessons Learnt Workshop, 14 have infection prevention and control (IPC) policies and functional healthcare facility IPC programs, 15 participate in the commemoration of the annual world hand hygiene days. Although almost all countries surveyed have national standard treatment guidelines, only five have incorporated the WHO AWaRe classification into the national essential medicines list. Fourteen of 20 countries have established an active/functional national secretariat/coordinating center for AMR. Discernible progress is being made on the implementation of NAP in WHO AFR region. Gaps identified in the strategic elements of action plans need to be filled for effective AMR control.

Diagnostic criteria and research progress on lung allograft pathology / 器官移植

In recent years, the quantity of lung transplantation has been gradually increased in China along with the accumulation of surgical techniques and postoperative management experience of lung transplantation. Multiple lung allograft complications may occur after lung transplantation, mainly including primary graft dysfunction (PGD) caused by ischemia-reperfusion injury (IRI) of the lung allograft, acute and chronic rejection, opportunistic infection or lymphoproliferative disorder of lymphoid tissues induced by the decrease of host immunity due to postoperative use of immunosuppressants, etc. The diagnosis of complications after lung transplantation mainly relies on biopsy of the lung allograft. In this article, the brief history of lung allograft pathology, main approaches and pathological processing techniques of lung allograft biopsy, major complications after lung transplantation and pathological diagnostic criteria were elucidated, aiming to provide reference for targeted management of these complications in clinical practice.

Research progress and application of donor-derived cell-free DNA in diagnosis and treatment of kidney transplantation / 器官移植

Early diagnosis and treatment of rejection after kidney transplantation play a critical role in alleviating allograft injury. Detection of donor-derived cell-free DNA (dd-cfDNA) could be performed based on the next-generation sequencing and other techniques. The content of DNA fragments derived from necrotic and apoptotic donor kidney tissues in circulating body fluids could be determined by concentration and absolute quantitative methods, which has application potential in monitoring allograft injury in clinical practice. Compared with traditional serum creatinine and other indicators, dd-cfDNA detection may monitor allograft injury from several weeks to months in advance, providing a "time window" for clinical treatment and delaying graft failure. Along with deepening research of dd-cfDNA in recent years, dd-cfDNA has captivated widespread attention due to its non-invasiveness, high sensitivity and real-time evaluation of therapeutic effect. In this article, current study evidence and conclusions related to multidimensional application of dd-cfDNA detection in diagnosis and treatment of kidney transplantation were reviewed, and the future research and clinical application direction of dd-cfDNA were discussed, aiming to provide reference for widespread application of dd-cfDNA detection in clinical practice in China.

Diagnostic criteria and research progress on Banff classification of allograft pathology in composite tissue allotransplantation / 器官移植

Composite tissue allotransplantation (CTA) is a novel transplantation discipline to treat functional tissue or limb defects. Since a majority of CTA grafts were vascularized grafts, it is also known as vascularized composite allotransplantation (VCA). The grafts of CTA/VCA consist of two or more types of allogeneic skin, subcutaneous tissue, bone, muscle, nerve and vessel, etc. Most of CTA/VCA grafts contain skin tissues, which possess the highest antigenicity. Acute rejection after transplantation is the primary obstacle leading to CTA/VCA graft failure and primary graft dysfunction. Hence, histopathological characteristics of skin rejection in CTA/VCA grafts have become the primary hotspot. In this article, pathological features of CTA/VCA rejection, Banff classification in 2007 and related research progress were reviewed, aiming to provide reference for the diagnosis and treatment of rejection and other complications of CTA/VCA.

Diagnostic criteria and research progress on pancreas allograft pathology / 器官移植

Pancreas transplantation and pancreas-kidney transplantation are the optimal treatment for renal failure caused by type 1 diabetes mellitus, partial type 2 diabetes mellitus and their complications. Pancreas transplantation mainly includes simultaneous pancreas-kidney transplantation (SPK), pancreas transplantation after kidney transplantation (PAK) and pancreas transplantation alone (PTA). Among all types of pancreas transplantation, biopsy of pancreas allograft remains the best method for definitively diagnosing rejection and differentiate it from other complications. In this article, biopsy methods of pancreas allograft and related research progress, diagnostic criteria and research progress on rejection of pancreas allograft biopsy, and main complications and pathological manifestations of pancreas allograft were illustrated, aiming to provide reference for guiding the clinical diagnosis of the above mentioned complications and ensuring the long-term survival of pancreas allografts and recipients.

International frontier hotspots of basic and translational medicine research related to renal transplantation at the 2020 ATC / 器官移植

The American Transplant Congress (ATC) is an annual international academic conference in the field of transplantation, which includes the latest achievements of scholars around the world in transplantation, and also leads the frontier direction of transplantation research. In this paper, the international forefront hotspots in basic and translational medicine research associated with renal transplantation in 2020 ATC were summarized, including the new discoveries of memory cell function and immune memory mechanism, the latest discovery in the mechanism of rejection and immune tolerance, the current research status of xenotransplantation, the potential solutions of antibody-mediated rejection (AMR), and the application of nanomedicine and single-cell RNA sequencing in renal transplantation, etc.

Banff classification and progress on liver allograft pathology / 器官移植

The pathology of liver allograft biopsy is not only essential for the evaluation of liver donor, but also for the diagnosis and differential diagnosis of posttransplantation complications. With the development of liver transplantation in clinical practice, relevant studies of the pathological diagnosis of liver allograft complications have been deepened. Banff classification on liver allograft pathology have been gradually established within the international community. In China, pathological studies related to liver allograft pathology have been steadily carried out, and the pathological diagnostic basis of liver allograft pathology suitable for the clinical practice of liver transplantation in China has been gradually formed. This article reviews the history of Banff liver allograft pathology and major pathological lesions of liver allograft complications, aiming to provide reference for implementing pathological diagnosis of liver allograft pathology in China, assisting clinical diagnosis and targeted treatment of complications after liver transplantation, and further improving the survival of liver allograft and recipients.

Pathology of antibody-mediated rejection in renal allograft / 器官移植

Antibody-mediated rejection (AMR), also known as humoral rejection, is an immune injury caused by rejection involved with multiple humoral immune effectors, such as antibodies and complements, etc. AMR plays a pivotal role in hyperacute, acute and chronic rejection. In this article, the basic definition of AMR, the research progress and major achievements on AMR pathology according to Banff classification on allograft pathology (Banff classification), and main pathological characteristics of AMR in renal allograft were reviewed, aiming to provide reference for accurate diagnosis and timely treatment of AMR, and guarantee the long-term survival of renal graft and recipients.

Pathology of T cell-mediated rejection in renal allograft / 器官移植

T cell-mediated rejection (TCMR) is one of the main mechanisms of rejection in organ transplantation, which is also the most common type of acute rejection.Based on Banff classification on allograft pathology (Banff classification) in 2019, TCMR can be divided into acute TCMR (aTCMR) and chronic active TCMR (caTCMR) according to the characteristics of immune lesions.In this article, the basic definition of TCMR, the research progress on TCMR pathology according to Banff classification for renal allograft, and the basic pathological changes and diagnostic grading of TCMR were reviewed, aiming to provide evidence for early identification, diagnosis and treatment of TCMR and prevent the progression of TCMR into caTCMR, thereby guarantying the long-term survival of both the renal allograft and recipient.

Diagnostic criteria and research progress on heart allograft pathology / 器官移植

With the improvement of surgical technique of heart transplantation and clinical application of potent immunosuppressant, the quantity of heart transplantation and the survival time of heart allograft have been significantly improved. However, a series of complications, such as right ventricular failure, ischemia-reperfusion injury, acute rejection, "Quilty lesion", infection and chronic rejection characterized by transplant coronary artery disease (TCAD) may still occur at different stages after heart transplantation. The application of endomyocardial biopsy (EMB) makes it possible to observe and understand the pathological features of multiple complications of heart allograft including rejection, which has become the most accurate diagnostic tool for postoperative complications. In this article, the brief history of heart allograft pathology, main postoperative complications and pathological diagnostic criteria, and cutting edge research progress on diagnostic criteria of rejection were illustrated, aiming to bring clinical benefits to more recipients undergoing heart transplantation.

Assessment and monitoring of immune risk of kidney transplantation rejection / 器官移植

Kidney transplantation is the most efficacious treatment for end-stage renal failure. Although the shortterm survival and functional recovery of the kidney graft have been significantly improved, the long-term survival of the kidney graft remains to be enhanced. Antibody-mediated rejection (AMR) and T cell-mediated rejection (TCMR) caused by immune factors are still the most critical causes of kidney graft failure. In this article, the immune risk assessment and monitoring of kidney transplant recipients during the awaiting period, before and after kidney transplantation were reviewed. Through the evaluation of preexisting human leukocyte antigen (HLA) antibodies and non-HLA antibodies, HLA matching, lymphocytotoxicity cross-matching and immune memory cells in the recipients before kidney transplantation, programmed biopsy of the kidney graft of the recipients after kidney transplantation and monitoring of HLA antibodies, non-HLA antibodies and donor-derived cell-free DNA (dd-cfDNA), individualized immunosuppressive treatment and monitoring regimes could be established, and the incidence of rejection could be prevented, timely detected and diagnosed. According to the immune monitoring results, ineffective treatment or over-treatment could be avoided, thereby improving the long-term survival of kidney graft.

Anti-infective potential of a quorum modulatory polyherbal extract (panchvalkal) against certain pathogenic bacteria

BackgroundIn view of the gravity of the problem of antimicrobial resistance among pathogenic bacteria against conventional bactericidal agents, investigation on alternative approaches to combat bacterial infections is warranted.ObjectiveCurrent study aimed at investigating anti-infective potential of a polyherbal ayurvedic formulation namely panchvalkal against three different pathogenic bacteria.Materials and methodsThe panchvalkal formulation available as Pentaphyte P5® was tested for its possible in vitro quorum-modulatory potential against Chromobacterium violaceum, Serratia marcescens, and Staphylococcus aureus through broth dilution assay. Invivo efficacy was demonstrated employing Caenorhabditis elegans as the model host for test pathogens.ResultsThis formulation was found to exert quorum-modulatory effect on C. violaceum, S. marcescens, and S. aureus at 250–750 μg/ml. Besides altering production of the quorum sensing-regulated pigments in these bacteria, the test formulation also had in vitro effect on antibiotic susceptibility, catalase activity and haemolytic potential of the pathogens. Invivo assay confirmed the protective effect of this panchvalkal formulation on C. elegans, when challenged with the pathogenic bacteria. Repeated exposure of S. aureus to panchvalkal did not induce resistance in this bacterium.ConclusionTo the best of our awareness, this the first report on quorum-modulatory potential of panchvalkal formulation, validating the anti-infective potential and moderate prebiotic property of this polyherbal preparation.

Antibiotic resistance profile in intrahospital pediatric services at third level centers in Dominican Republic / Perfil de resistencia a antibióticos en servicios pediátricos intrahospitalarios en centros de tercer nivel en República Dominicana

Objectives: The Dominican Republic lacks reliable information on antimicrobial resistance (AMR), which would allow physicians to prescribe the best treatment for common infectious diseases. This study aimed to define the antimicrobial resistance profiles of the more common pathogens from pediatric services, where data is even more important due to the vulnerability of the population. Methods: We collected data from patients admitted in the pediatric unit of three third level hospitals in the city of Santiago de los Caballeros, Dominican Republic, showing positive bacterial cultures, during a period of two years. Results: Half of the Gram negative pathogens exhibited third generation cephalosporins (3GC) resistance, 17% were resistant to carbapenems. Serratia marcescens presented an exceptionally high proportion of resistance to 3GC (95.9%). Staphylococcus aureus showed elevated resistance to methicillin (58.4%) and even to clindamycin (35.8%). Conclusion: There are elevated levels of antimicrobial resistance among the Enterobacteriaceae family and the Staphylococcus genus isolated from the pediatric population. Necessary measures should be taken to tackle AMR in the country.

Objetivos: La República Dominicana carece de información confiable sobre las resistencias antimicrobianas en el país, lo que permitiría al personal médico prescribir los mejores tratamientos para infecciones comunes. El objetivo de este estudio es definir los perfiles de resistencia antimicrobiana de los patógenos más comunes en servicios pediátricos, donde esta información es esencial, debido a la vulnerabilidad de la población. Métodos: Se tomaron los datos de reportes microbiológicos con cultivo bacteriano positivo procedentes de pacientes admitidos en la unidad pediátrica de tres hospitales de tercer nivel en la ciudad de Santiago de los Caballeros, República Dominicana, durante un periodo de dos años. Resultados: La mitad de los patógenos Gram negativos mostraron resistencia a cefalosporinas de tercera generación (3GC), 17% eran resistentes a carbapenémicos. Serratia marcescens presentó una resistencia excepcionalmente elevada a 3GC (95.9%). Staphylococcus aureus mostró alta resistencia a meticilina (58.4%) e incluso a clindamicina (35.8%). Conclusión: Existen elevados niveles de resistencia antimicrobiana entre las enterobacterias y los estafilococos en la población pediátrica dominicana. Es necesario tomar medidas para abordar este problema en el país.

Application of chimeric antigen receptor-regulatory T cell immunotherapy in organ transplantation / 器官移植

Regulatory T cell (Treg) is a subset of T cells that negatively regulates immunity and has the function of inhibiting rejection. The specific modification of Treg by chimeric antigen receptor (CAR) technology can successfully chime donor-specific antigen onto the surface of Treg, thus regulating the immune function of the body in a real-time manner. It provides a novel and promising therapeutic option for inducing immune tolerance. In this article, research progresses on Treg in immune related diseases, main difficulties in the realization of CAR-Treg technology and its role in inducing transplantation immune tolerance were reviewed, and the opportunities and challenges of CAR-Treg application in the field of organ transplantation are prospected.

Quality microbiological diagnostics and antimicrobial susceptibility testing, an essential component of antimicrobial resistance surveillance and control efforts in Pacific island nations

Problem@#Emerging bacterial antimicrobial (antibiotic) resistance (AMR) is a global threat to human health. However, a majority of lower income countries do not have microbiological diagnostic testing for prompt, reliable confirmation of bloodstream infection and identification of AMR.@*Context@#Clinicians in Pacific island nations are increasingly challenged by patients who have infection due to antimicrobialresistant bacteria. Treatment of infection remains empirical because of a lack of diagnostic testing capacity and may follow guidelines that were formulated without reference to local measures of AMR prevalence. There is limited understanding among clinicians of microbiology testing and test interpretation.@*Action@#Examine the lessons learnt from pilot laboratory development programmes in two Pacific island nations that focused on establishing standard procedures for micrological diagnostics and antimicrobial susceptibility testing (AST) and on improving the training of clinicians to increase their use of laboratory services.@*Outcome@#The pilot programmes addressed a range of logistical difficulties and evaluated two blood culture systems. They also examined and improved internal QC implementation and evaluated the prevalence of AMR.@*Discussion@#Continued development of microbiological diagnostic capability in the Pacific region is paramount. Pacific Island nations need to develop the capability of at least one central laboratory to culture AMR pathogens and subject them to quality-controlled AST or arrange for suitable referral to a nearby country.