Abstract
BackgroundAntimicrobial resistance is particularly harmful to infectious disease management in low-income countries since expensive second-line drugs are not readily available. The objective of this study was to implement and evaluate a computerized system for surveillance of antimicrobial resistance at a tertiary hospital in Tanzania.MethodsA computerized surveillance system for antimicrobial susceptibility (WHONET) was implemented at the national referral hospital in Tanzania in 1998. The antimicrobial susceptibilities of all clinical bacterial isolates received during an 18 months' period were recorded and analyzed.ResultsThe surveillance system was successfully implemented at the hospital. This activity increased the focus on antimicrobial resistance issues and on laboratory quality assurance issues. The study identified specific nosocomial problems in the hospital and led to the initiation of other prospective studies on prevalence and antimicrobial susceptibility of bacterial infections. Furthermore, the study provided useful data on antimicrobial patterns in bacterial isolates from the hospital. Gram-negative bacteria displayed high rates of resistance to common inexpensive antibiotics such as ampicillin, tetracycline and trimethoprim-sulfamethoxazole, leaving fluoroquinolones as the only reliable oral drugs against common Gram-negative bacilli. Gentamicin and third generation cephalosporins remain useful for parenteral therapy.ConclusionThe surveillance system is a low-cost tool to generate valuable information on antimicrobial resistance, which can be used to prepare locally applicable recommendations on antimicrobial use. The system pinpoints relevant nosocomial problems and can be used to efficiently plan further research. The surveillance system also functions as a quality assurance tool, bringing attention to methodological issues in identification and susceptibility testing.
Highlights
Antimicrobial resistance is harmful to infectious disease management in low-income countries since expensive second-line drugs are not readily available
This paper describes the experience with the implementation of a computerized surveillance system for antimicrobial drug susceptibility at Tanzania's major referral hospital, and its use to analyze the susceptibility patterns of 7621 consecutively recorded clinical bacterial isolates
Consistent with observations from a number of other countries in the region [12,13,14,15] and elsewhere [16], Gramnegative bacilli displayed high rates of resistance to common inexpensive antibiotics. Priced antibiotics such as ampicillin, tetracycline, trimethoprimsulfamethoxazole and sulfonamides are of limited benefit in the treatment of infections caused by important Gram-negative bacteria such as E. coli, Klebsiella spp., Proteus spp. and Salmonella
Summary
Antimicrobial resistance is harmful to infectious disease management in low-income countries since expensive second-line drugs are not readily available. Emerging resistance to antimicrobial drugs increases morbidity and mortality by hampering the provision of effective chemotherapy, and makes treatment more costly [1,2,3]. The surge in antimicrobial resistance seen in many low-income countries is potentially disastrous because of the lack of resources for purchasing expensive second-line drugs [4]. It is widely held that surveillance of antimicrobial susceptibility is fundamental to combat the emergence of resistance [5]. Surveillance may help assessing the magnitude of the resistance problem locally, nationally and internationally, monitoring changes in resistance rates and detecting the emergence and spread of new resistance traits. Surveillance systems functions as a quality assurance tool and may help improving the quality of the susceptibility testing
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