First WHO antimicrobial surveillance data reveal high levels of resistance globally

Implementation of a standardised and quality-assured enhanced gonococcal antimicrobial surveillance programme in accordance with WHO protocols in Kampala, Uganda

Sexually Transmitted Infections ◽

10.1136/sextrans-2020-054581 ◽

2020 ◽

pp. sextrans-2020-054581

Author(s):

Francis Kakooza ◽

Patrick Musinguzi ◽

Meklit Workneh ◽

Richard Walwema ◽

Peter Kyambadde ◽

...

Keyword(s):

Population Level ◽

Epidemiological Data ◽

Multidrug Resistant ◽

Surveillance Data ◽

Control Measures ◽

Epidemiological Surveillance ◽

Surveillance Programme ◽

Urethral Discharge ◽

Antimicrobial Surveillance ◽

Kampala City

ObjectivesThe emergence of multidrug-resistant Neisseria gonorrhoeae (NG) is a major global health threat necessitating response and control measures. NG antimicrobial resistance (AMR) surveillance data from sub-Saharan countries is exceedingly limited. This paper aims to describe the establishment, design and implementation of a standardised and quality-assured gonococcal surveillance programme and to describe the susceptibility patterns of the cultured gonococcal isolates in Kampala, Uganda.MethodsFrom March 2018 to September 2019, using the WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) protocol, consecutive males with urethral discharge syndrome were recruited from 10 surveillance sites in Kampala City, Uganda, in collaboration with the Ministry of Health. Males completed a questionnaire and provided a urethral swab specimen. Culture, identification and antimicrobial susceptibility testing (Etest) were performed.ResultsOf the 1013 males recruited, 73.1% (740/1013) had a positive Gram stain and 51.1% (n=518) were culture-positive for NG. Using Etest (458 isolates), the resistance to ciprofloxacin was 99.6%. Most isolates were susceptible to azithromycin, cefoxitin and gentamicin, that is, 99.8%, 98.5% and 92.4%, respectively, and all isolates were susceptible to ceftriaxone and cefixime.ConclusionsWe established a standardised, quality-assured WHO EGASP. Using Etest, 458 isolates were characterised, with associated epidemiological surveillance data, in 1.5 years, which by far exceed the minimum 100 isolates per year and country requested in the WHO Global GASP, to detect AMR levels with confidence. These isolates with the epidemiological data can be used to develop population level interventions.

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White Paper: Bridging the gap between human and animal surveillance data, antibiotic policy and stewardship in the hospital sector—practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa426 ◽

2020 ◽

Vol 75 (Supplement_2) ◽

pp. ii20-ii32

Author(s):

Maria Diletta Pezzani ◽

Elena Carrara ◽

Marcella Sibani ◽

Elisabeth Presterl ◽

Petra Gastmeier ◽

...

Keyword(s):

Hospital Setting ◽

Structural Heterogeneity ◽

White Paper ◽

Surveillance Data ◽

Flexible Tool ◽

Antibiotic Policy ◽

Antimicrobial Usage ◽

Modified Delphi ◽

Antimicrobial Surveillance ◽

Practical Guidance

Abstract Background Antimicrobial surveillance and antimicrobial stewardship (AMS) are essential pillars in the fight against antimicrobial resistance (AMR), but practical guidance on how surveillance data should be linked to AMS activities is lacking. This issue is particularly complex in the hospital setting due to structural heterogeneity of hospital facilities and services. The JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks have joined efforts to formulate a set of target actions for linking surveillance data with AMS activities. Methods A scoping review of the literature was carried out addressing research questions on three areas: (i) AMS leadership and accountability; (ii) antimicrobial usage and AMS; (iii) AMR and AMS. Consensus on the target actions was reached through a RAND-modified Delphi process involving over 40 experts in different fields from 18 countries. Results Evidence was retrieved from 51 documents. Initially 38 targets were proposed, differentiated as essential or desirable according to clinical relevance, feasibility and applicability to settings and resources. In the first consultation round, preliminary agreement was reached for 32 targets. Following a second consultation, 27 targets were approved, 11 were deleted and 4 were suggested for rephrasing, leading to a final approved list of 34 target actions in the form of a practical checklist. Conclusions This White Paper provides a pragmatic and flexible tool to guide the development of calibrated hospital-surveillance-based AMS interventions. The strength of this tool is that it is a comprehensive perspective that takes into account the hospital patient case-mix and the related epidemiology, which ultimately drives antimicrobial usage, and the feasibility in low-resource settings.

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