Antimicrobial resistance

Background

Antibiotic resistance poses a major threat to clinical medicine and public health, internationally. Antibiotics are not only essential for the treatment of infections such as bacterial pneumonia, sepsis or meningitis, but also opportunistic infections that may occur in patients predisposed to infections, particularly in hospitals. This is an interesting paradox that many advances in medical care have as an unintentional consequence. The fact that patients become more prone to contracting infections often caused by pathogens of low virulence that bear little threat to healthy people.

Medical procedures such as insertion of intravascular or urinary catheters, intubation or surgery break the body’s natural barriers to infection and allow pathogens direct access to sites such as the bloodstream, urinary tract, lung or abdominal cavity. In most cases, patients require prolong medical care in hospital wards, serving as a source of cross-infection to other patients.

The emergence and widespread occurrence of multidrug resistant bacteria threatens not only the treatment of common bacterial infectious diseases but also the management of patients in various clinical settings.

Surveillance for AMR is main component of combating antimicrobial resistance.

Two tier AMR surveillance approach is developed at the CHARM:

1. Laboratory based antimicrobial surveillance (LARS) for AMR established in 2010
   1. Selection of sentinel sites (as population-based surveillance was not feasible)
   2. National reference laboratory: confirm AST, detect unusual resistance and outbreak, implement national laboratory standards
   3. Development of laboratory network

2. Electronic surveillance established in 2013
   1. Alert system from laboratory information system compiled trough corporate data warehouse (CDW)
   2. Collection of data from laboratory information system (LIS) according case definition exclusion and inclusion criteria and defining denominator data from CDW
   3. Development of AMR dashboard
   4. Data reporting as resistance MAPs

AID model which is combined activities in Antimicrobial Stewardship Program (ASP), Infection Prevention and Control (IPC) and Diagnostic Stewardship Program (DSP) provide the good governance for combating AMR.

Click to access report : Guidelines on Implementation of the Antimicrobial Strategy in South Africa:One Health Approach & Governance