Setting up a surveillance system of antimicrobial resistance and use in a low-resource setting: West Delhi, India

Abstract number: 1135_52

Wattal C., Kotwani A., Sharma A., Raveendran R., Bhandari S.K., Khanna S., Chaudhury R.R., Holloway K., Sorensen T.

Objectives:  

To set up a surveillance system for antimicrobial resistance and use of antimicrobials in the community in a low resource setting using E. coli as an indictor organism.

Methods:  

The study area was ‘Blocks’ in a 10 Km. radius of Sir Ganga Ram Hospital, New Delhi, India. Microbiology Surveillance: MSU's were collected from all cases not taking antimicrobials and without suspected complicated UTI attending the OPD from designated region. Once E. coli (pathogenic as well as contaminants) were isolated and identified using conventional biochemical reactions its susceptibility was determined using Kirby Baur disc diffusion method on Muller Hinton agar. Antimicrobial use surveillance: Monthly purchase of all antimicrobial drugs from 30 private retail pharmacies was collected and converted to DDD. The denominator for the drug use was the population of the administrative areas in which these pharmacies are based. In addition, exit interviews (prescription auditing) were done at each pharmacy to have information on 15–25 consecutive prescriptions per month having any antimicrobial agent. Data on use is presented as DDD's per total number of patients/prescriptions.

Results:  

During the study period (11/03–9/04) 3590 MSU samples were collected and 377 E. coli were isolated. 85% of the strains were resistant to ampicillin, and more than 50% were resistant to quinolones (60%), tetracycline, third generation cephalosporins, cotrimoxazole and ampicillin + sulbactam. Purchase data and exit interview data was analysed for 9 months and the results showed that fluoroquinolones are the most frequently sold antimicrobials. Exit interview data revealed that DDD/1000 prescriptions/patients/month for fluoroquinolones; penicillins, cephalosporins and macrolides are 2972,1296,1034,884 respectively.

Conclusions:  

The extensive usage of quinolones and penicillins are reflected in the antimicrobial resistance. A decrease in resistance to cephalexin from 85% to 41% could be noticed during the study period. The data collected on antimicrobial drug use and antimicrobial resistance in E. coli isolated from antenatal cases seems suitable for collection of information on the resistance and use in the community, valuable for planning targeted interventions. This is an on going project for one year. Funding agency: WHO, Geneva.