paho 2001 1 pan american health organization pan american sanitary bureau regional office for the...
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PAHO 2001 1
Pan American Health OrganizationPan American Sanitary Bureau
Regional Office for the Americas for the
World Health Organization
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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)
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Mechanism of resistance
• Natural or intrinsic resistance
• Acquired resistance
–Chromosomal mutation
–Transfer of genetic material
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Contributing Factors
• Human medicine
• Animal medicine
• Agriculture
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Implications of Antimicrobial Resistance
• CLINICAL
•Morbidity
•Mortality
• COST
• LIMITED SOLUTIONS
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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
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Characteristics
• Quality data
• Timely
• Enables comparison
• Linked to policy and clinical practice
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Use of Surveillance
Estimate the magnitude of a health problem problem
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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
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Use of Surveillance
Epidemic detection
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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.
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Use of Surveillance
Follow trends and patterns of antimicrobial resistance
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Percentage of Shigella spp. isolates resistant to different antibiotics.
Peru, 1996-1999.
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Percentage of Shigella flexneri isolates resistant to different
antibiotics. Ecuador, 1996-1999.
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Use of Surveillance
Determine geographical distribution and spread of antimicrobial resistance
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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
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Approaches to address AMR
• Health System strengthening
• Policy and regulation
• Provider and consumer behavior
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Antimicrobial Resistance Surveillance Program
IN 1996, PAHO’s DIRECTING BODIES RECOMMENDED THAT THE
ORGANIZATION PUT IN PLACE AN ANTIMICROBIAL RESISTANCE
SURVEILLANCE PROGRAM
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Participating Countries
} Caribbean Countries
Countries starting in 1996
Countries incorporated w/ USAID project
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• 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
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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
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Results
• TOT on rational use of antimicrobial drugs
• Training material
• Drugs therapeutics committees
• Regional treatment guidelines
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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