Establishing carbapenem resistant organism surveillance, prevention, and control in a middle-income country: implementation of a hospital-based program in Fiji.

Antimicrobial resistance (AMR) is a major public health threat with the highest burden being estimated to be in low- and middle-income countries. Fiji is an upper-middle-income country in Oceania. Recent studies from Fiji highlighted the increasing burden of carbapenem resistant organisms (CRO) such as Acinetobacter baumannii, Pseudomonas aeruginosa and Escherichia coli. A project titled Preparing Fiji for Pathogens with Critical Antimicrobial Resistance was undertaken at the Colonial War Memorial Hospital, Fiji's main referral hospital, in 2022 and 2023. The overarching goal was to support the hospital's readiness for prompt detection, management and prevention of infections caused by pathogens with critical AMR including CRO. This paper describes the steps taken to establish CRO surveillance, prevention, and control interventions, outbreak response and healthcare workers' capacity building initiatives tailored to the hospital's need and capacity. It also shares the results, lessons learned and challenges in setting up the systems that may inform actions in other low- and middle-income countries in the Pacific Region and globally.