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PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

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Page 1: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 1

Pan American Health OrganizationPan American Sanitary Bureau

Regional Office for the Americas for the

World Health Organization

Page 2: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 2

What is Antimicrobial Resistance?

The ability of bacteria and other

microorganisms to survive an antibiotic to

which they were once sensitive (and were

once stalled or killed completely)

Page 3: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 3

Mechanism of resistance

• Natural or intrinsic resistance

• Acquired resistance

–Chromosomal mutation

–Transfer of genetic material

Page 4: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 4

Contributing Factors

• Human medicine

• Animal medicine

• Agriculture

Page 5: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 5

Page 6: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 6

Implications of Antimicrobial Resistance

• CLINICAL

•Morbidity

•Mortality

• COST

• LIMITED SOLUTIONS

Page 7: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 7

SURVEILLANCE

• Surveillance is the ongoing systematic

collection, analysis, interpretation and

dissemination of the health data to

those persons who have the

responsibility for disease prevention

and control

Page 8: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 8

Characteristics

• Quality data

• Timely

• Enables comparison

• Linked to policy and clinical practice

Page 9: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 9

Use of Surveillance

Estimate the magnitude of a health problem problem

Page 10: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 10

Percentage of S. pneumonie Resistant to penicillin, American Region

1993/4 - 1999

Total S I R

Country # # % # % # %

Mexico 426 209 49 127 30 90 21

Colombia 623 479 77 79 13 65 10

Brasil 1197 948 79 230 19 19 2

Argentina 1006 698 69 141 14 167 17

Chile 401 274 68 75 19 52 13

Uruguay 326 206 63 68 21 56 16

Total 3979 2814 71 720 18 448 11

Page 11: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 11

Use of Surveillance

Epidemic detection

Page 12: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 12

NICARAGUA, 1993-1999Vibrio cholerae: Antibiotic susceptibility

Percent o f suscept ib le i so la tes

Year No.isolates

AMP TMS CHLO TET CIP ERY

1993 120 100 100 100 100 ND 100

1995 143 70.7 70.7 100 100 ND 100

1996 111 22.6 22.6 100 100 ND 100

1997 26 0 0 100 100+ ND 100

1998 25 0 0 100 100+ 100 100

1999 77 0 0 100 0* 100 100

+ Resistance to 2 mg/ml. * Resistance to 16 mg/ml.

Page 13: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 13

Use of Surveillance

Follow trends and patterns of antimicrobial resistance

Page 14: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 14

Page 15: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 15

Percentage of Shigella spp. isolates resistant to different antibiotics.

Peru, 1996-1999.

Page 16: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 16

Percentage of Shigella flexneri isolates resistant to different

antibiotics. Ecuador, 1996-1999.

Page 17: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 17

Use of Surveillance

Determine geographical distribution and spread of antimicrobial resistance

Page 18: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 18

Page 19: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 19

Goal

• To preserve the effectiveness of currently available antimicrobial drugs

• Improve the availability of drugs of assured quality

• Ensure appropriate use of drugs when they are required

• Decrease use of drugs when they are not required

Page 20: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 20

Approaches to address AMR

• Health System strengthening

• Policy and regulation

• Provider and consumer behavior

Page 21: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 21

Antimicrobial Resistance Surveillance Program

IN 1996, PAHO’s DIRECTING BODIES RECOMMENDED THAT THE

ORGANIZATION PUT IN PLACE AN ANTIMICROBIAL RESISTANCE

SURVEILLANCE PROGRAM

Page 22: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 22

Participating Countries

} Caribbean Countries

Countries starting in 1996

Countries incorporated w/ USAID project

Page 23: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 23

• A network of national reference laboratories was established

• A database set for the American Region was created

• A web page in PAHO web site was created

Results

Page 24: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 24

Results

• Protocol for quality assurance and proficiency testing for antibiotic susceptibility

• Workshops to provide training in bacterial identification and testing for antimicrobial resistance were implemented

• Protocol for assessing the cost of hospital infections and selected antimicrobial resistance were developed and implemented

Page 25: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 25

Results

• TOT on rational use of antimicrobial drugs

• Training material

• Drugs therapeutics committees

• Regional treatment guidelines

Page 26: PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

PAHO 2001 26

Results

• Different materials on antimicrobial resistance were produced and distributed

• References on antimicrobial resistance were compiled into a bibliography, which will be published in a month