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AMR Surveillance: Aga Khan University Hospital (AKUH)
Experience
Dr. Mutuku MakauProf Gunturu RevathiMicrobiology Division
Department of PathologyAga Khan University Hospital (Nairobi)
6th August 2009
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Objective
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Background
• AKUH: Tertiary referral teaching hospital
• Transited recently from a private hospital to a university hospital
• Hospital Plan: Cardiology and Oncology Center
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Aim
• Optimize the use of antimicrobials and assist in the prevention, control and containment of antimicrobial resistance by:
• defining/updating guidelines for empirical (syndromic) treatment and standard treatment guidelines
• Reassessing the drug formulary
• Identifying need for the implementation of infection control measures
• Monitor impact of interventions
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Surveillance System and Studies
• Surveillance System– Continuous passive surveillance, organism based
– Department of Microbiology (Laboratory)
– Infection Control Team
• Surveillance studies:– Faculty/ Residents/ Visiting Individuals
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Data Sources
• Patients’ specimens: Determined by physician
• High risk area surveillance– Patients and Environments :ICU, NICU, Surgical wards, Theatres
– Patients transferred from other institutions
• Satellite Laboratories: (Potential for wider surveillance)
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Standardization and Quality of Susceptibility Testing
• Quality Control Manager:
– Fulltime employee to ensure quality in the whole lab
• Internal Quality Control:
– Continuous training, Range of control strains e.t.c
• External Quality Control: NEQAS
– independent assessment of performance
• Accreditation??
– South African National Accreditation System (SANAS): ISO/IEC 17025
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Susceptibility Testing Methods
• Disc Diffusion Method(S): Done Routinely on most cultures
• E‐Test: Occasionally, e.g ongoing Streptococcus pneumoniae surveillance study.
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Data variables for Surveillance
• Yes:– Patient IDs
– Unit ID
– All Isolates
– Resistance or Sensitive
– Isolate Source
• No:– Quantitative Data (diameters)
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Information Management System
• Hospitals/Lab information management system:– C.A.R.E 2000 (Symphony Global Technologies PLC, UK )
• Advantages: Networked, Quick Feedback on individual patients
• Disadvantages: Difficult trend data retrieval
• Microbiology Surveillance Data Collection has required its own database
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Microbiology Surveillance Data Collection
• WHONET Experience:– Introduced
– Individuals involved in data entry found it difficult to use, less and less entries made…
• Currently:– Data Entered Directly into spreadsheets Excel (Microsoft®)
– Timely retrieval of DATA from C.A.R.E difficult
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• Tomorrow:– Currently developing a database system:
• Protocol to collect SOME data accurately and not ALL data.
• Friendly GUI
• Match Data Collection forms
• Have a similar coding system to WHONET
• Able to identify duplicates
• Timing of specimen collection >/< 48hrs of admission
– Incorporation of clinical/pharmacy data on antimicrobial use
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Challenges/ limitations
• Samples are random and dictated by physician choice
• Lack of clinical information
• Standardized sample collection
• Quality Control
• Duplicates or multiple isolates
• Quantitative data: detection only of broad trends
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Effect of limitations
• Very likely overestimated prevalence?
• Impacting on hospital policy made difficult
• Decision thresholds: Not developed and written down as SOPC
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Quenching our thirst for antibiotics?
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Some Results from AMR surveillance
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The Portrait
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Thank you…