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1、Dr.Geeta Shakya Director,NPHL,TekuWorld Health Day7th April,2011Antimicrobial Resistance(AMR)One of the major challenges facing public health in this centurya threat to current and future medical advancesBigger problem in developing countries like Nepal Spreading across countries and regions resulti
2、ng increased cost of treatment increased morbidity and mortality ConstraintsOften,the use of practical guidelines in the management of key infectious diseases in the developing world is hampered by the lack of reliable antimicrobial surveillance dataWhen minimum requirements of AMR surveillance are
3、met,data obtained from Antimicrobial Susceptibility Testing(AST)are of great importance to provide more effective therapy and minimize treatment failureResistance is accelerated through inappropriate use of antimicrobialsStandard treatment guidelines not provided to physicians or provided but not ad
4、hered toDrugs available without prescriptionAccessible but poor qualityInadequate monitoringIrrational self-administration or prescriptionAntimicrobial resistance Importance of AMR Surveillance Antibiotics are valuable and most utilized therapeutic agents for life savingEmergence of multi-drug resis
5、tance has limited therapeutic optionsNeed for the development of newer drugs frequently which is very costly In vitro Antibiotic susceptibility testing(AST)is the mainstay for monitoring therapy and detecting resistanceReporting of AMR data is necessary for:selection of empirical therapy at the loca
6、l level assessing the scale of the resistance problem at the local,national or international levels monitoring changes in resistance rates detecting the emergence and spread of new resistances types Importance of AMR Surveillance contd.Activities of AMR surveillance Characterization of disease etiol
7、ogies and resistance trendsPrompt identification and investigation of new threats in resistance Guidance to policy makers in developing therapy recommendationsGuidance to public health authorities in responding to outbreaksEvaluation of the impact of therapy and infection control interventions on in
8、fection rates and cure ratesStrengthening of laboratory capacityCurrently Monitored OrganismsFor Diarrheal diseases:Vibrio cholerae Shigella speciesFor Respiratory Infection:Streptococcus pneumoniae Haemophilus influenzaeFor MDR UTI:ESBL E coli(included since September 2009)For STI infection :Neisse
9、ria gonorrhoeae For Typhoid Fever MDR Salmonella species(included since 2002)Participating laboratoriesTotal 11 labs are includedCentral Region-(6)1.National Public Health Laboratory(NPHL),Kathmandu2.Bir Hospital Laboratory,Kathmandu3.Patan Hospital Laboratory,Kathmandu4.Kanti Childrens Hospital(KCH
10、)Laboratory,Kathmandu5.Tribhuvan University Teaching Hospital(TUTH)Laboratory,Kathmandu6.Dhulikhel Hospital,KavreEastern Region-(1)7.B.P.Koirala Institute of Health Sciences(BPKIHS)Laboratory,Dharan Western Region-(4)8.Western Regional Hospital(WRH)Laboratory,Pokhara9.Manipal Teaching Hospital(MTH)L
11、aboratory,Pokhara10.United Mission Hospital(UMN)Laboratory,Tansen11.Lumbini Zonal Hospital(LZH)laboratory,ButwalStatus of Antimicrobial Resistance in NepalShigella speciesChange of species S.dysenteriae and S.flexneriiAntibiotic susceptibility pattern;Amoxycillin :Resistance 62%in 2005 to 100%in 201
12、0 Nalidixic acid:Resistance 50%-100%,Cotrimoxazole:Resistance:60%-100%,Mecillinam:Resistance:80%-100%Ciprofloxacin:Resistance 6.6%-33%Azithromycin:Resistance 0%-50%in 2010 Ofloxacin:Sensitivity 50%-100%in 2010 Ceftriaxone:Sensitivity 80%-100%in 2010 Status of Antimicrobial Resistance in NepalH.influ
13、enzae:Antibiotic susceptibility pattern;Penicillin:Resistance 23%-100%by 2009 Cotrimaxazole:Resistance 16%-59%Ampicillin:Resistance 19%-41%Azithromycin:Resistance 0%-13%Chloramphenicol:Resistance0%-15%Ciprofloxacin:Resistance0%-18%Ofloxacin:Resistance 0%-19%Status of Antimicrobial Resistance in Nepa
14、lNeiseria gonorrheae Antibiotic susceptibility pattern;Nalidixic acid:Resistance75%Ciprofloxacin:Resistance 7%-14%Ampicillin:Resistance 13%-33%Penicillin:Sensitivity 29%-50%Tetracycline:Sensitivity 67%-100%Azithromycin:Sensitivity 97%-100%Ceftriaxone:Sensitivity 100%Neisesria gonorrheae is very fast
15、idious organism,difficult to grow in comparison to other bacteria so it needs more emphasis to isolate this bacteria Status of Antimicrobial Resistance in NepalMDR Salmonella species:Antibiotic susceptibility patternNalidixic acid:resistance pattern 60%-83%Ciprofloxacin:Sensitivity 86%-100%Ceftriaxo
16、ne:Sensitivity 99%-100%Azithromicin:Sensitivity 89%-100%Ofloxacin:Sensitivity 97%-100%Chloramphenicol:sensitivity 41%in 2006 increased to 96%in 2010Salmonella other than typhi and paratyphi A showed higher resistance rate during the outbreakStatus of Antimicrobial Resistance in Nepal ESBL E.coli13 i
17、solates reported in 2009 and 86 isolates in 2010Isolates were found resistant to most of the common antibiotics and 3rd generation cefalosporin as;Amoxicillin 100%,Furadantin 100%,Ciprofloxacin 97%-100%,Ofloxacin 66%-100%,Ceftriaxone 92%,Cefopodoxime 99%Ceftazidine 99%,Cefotaxime 100%Sensitive drugs:Cefopodoxime,Ceftazidine and Cefotaxime become sensitive once these are combined with Clavunic acid Imipenem MeropenemPossible solutionsRationalize the use of available antimicrobial agents with support of Antimicrobial Susceptibility Testing(AST)for the prevention and containment of AMR