The critical importance of robust antimicrobial resistance (AMR)
surveillance in South Africa cannot be overemphasised. Without
knowing what the resistance situation is, it is impossible to develop
appropriate antibiotic treatment guidelines and associated essential
drug lists (EDLs) and to create and update evidence-based policies
both at institutional and national levels. The broader benefits of AMR
surveillance data include:
• Determining incidence rates of hospital-acquired infections
(HAIs) and identifying the associated causative organisms and
their AMR profile to feed into hospital guidelines and more
appropriate treatment for infected patients. This in turn allows
early interventions by infection prevention and control (IPC) so
as to minimise further spread of AMR organisms.
• Profiling local or regional AMR patterns to inform selection
of AMR screening practices in specific health care facilities
• Educating health care staff about the impact of AMR and about
issues in antibiotic use and misuse.
• Monitoring trends over time to signal whether interventions are
having the desired effect.
• Comparing South Africa with other countries in the region and
around the world to facilitate sharing intervention experience.
South Africa has a good start at AMR surveillance, but it can and
must be improved. For most AMR infections, surveillance data are
laboratory and therefore organism centred, which limits the ability
to differentiate between colonisation and infection with AMR
organisms. It is also not possible to determine the clinical impact of
AMR. A major shortcoming is that AMR surveillance is currently
limited to a minority of HCFs, which does not reflect the extent
of AMR across South Africa. The very limited profiling of AMR
in the community needs to be addressed. Finally, the variability of
surveillance methodology used makes it impossible to compare rates
and trends across institutions.
The first part of this section describes studies that have identified
serious AMR issues in South Africa which require urgent monitoring;
these have provided compelling evidence of the need, and possible
methods, for AMR surveillance.