Antibiotic resistance in Tunisia: Monitoring, status, and means of prevention
Boutiba-Ben Boubaker Ilhem1-2

1- Université de Tunis El Manar, Faculté de Médecine de Tunis, LR99ES09, Laboratoire de recherche « Résistance aux antimicrobiens », 1007, Tunis, Tunisie.

2-Hôpital Charles Nicolle, Laboratoire de Microbiologie, 1006, Tunis, Tunisie

Antibiotic resistance is a global threat to public health that has not spared Tunisia. Indeed, in the last 20 years, our country has been facing an overall increase in bacterial resistance to antibiotics. New resistance mechanisms are emerging and spreading, and many currently available antibiotics are rendered ineffective in most clinical situations. This can be explained by bacterial overexposure to antibiotics linked to their overuse and misuse. Combined with the worldwide deceleration of research in the field of antibiotic discovery, the current situation leads to therapeutic difficulties, especially for vulnerable patients who frequently develop healthcare-associated infections. 

Solving this universal problem will necessitate concerted action among the concerned sectors and actors, notably the animal and agricultural fields, the environment, school environment, occupational health, etc. The effort must be global and inter-sectoral.

The Tunisian authorities have called for the development of a national plan of action to preserve the antibiotic efficiency. Accordingly, the One Health concept, implemented through the tripartite collaboration of WHO, OIE, and FAO, and concretized by the WHO global plan, FAO plan of action, and by the OIE antimicrobial resistance fight strategies, summarizes the approach to be implemented to counteract antibiotic resistance. Launched in May of 2015, the WHO plan recommends that all member states develop their inter-sectoral plan to face this challenge, which is now generally recognized as a high priority.

Tunisia complied without delay, creating in 2015 an antibiotic resistance prevention technical committee to develop a national plan of action, which soon became a reality as a result of the collaboration of diverse national and international experts, combined with support from the WHO, FAO, and OIE. This ambitious plan of action was established and validated and approved in September 2020.

Monitoring bacterial antibiotic resistance and improving microbiology laboratory practices on a national scale constitute the major axes of this plan of action. Thus, a national monitoring coordination center and a national reference laboratory were designated, with the primary mission of harmonizing regional data collected according to international standards. Regularly updated national monitoring of bacterial antibiotic resistance data offers the basis for implementing the various action plan activities and their follow-up.