Part V. Surveillance activities

Abstract

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 (HCFs). • 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.