1. PAHO 2001 1 Pan American Health Organization Pan American Sanitary Bureau Regional Office for the Americas for the World Health Organization

2. PAHO 2001 2 What is Antimicrobial Resistance? The ability of bacteria and other microorganisms to survive an antibiotic to which they were once sensitive (and were once stalled or killed completely)

3. PAHO 2001 3 Mechanism of resistance Natural or intrinsic resistance Acquired resistance –Chromosomal mutation –Transfer of genetic material

4. PAHO 2001 4 Contributing Factors Human medicine Animal medicine Agriculture

5. PAHO 2001 5

6. 6 Implications of Antimicrobial Resistance CLINICAL Morbidity Mortality COST LIMITED SOLUTIONS

7. PAHO 2001 7 SURVEILLANCE Surveillance is the ongoing systematic collection, analysis, interpretation and dissemination of the health data to those persons who have the responsibility for disease prevention and control

8. PAHO 2001 8 Characteristics Quality data Timely Enables comparison Linked to policy and clinical practice

9. PAHO 2001 9 Use of Surveillance Estimate the magnitude of a health problem problem

10. PAHO 2001 10 Percentage of S. pneumonie Resistant to penicillin, American Region 1993/4 - 1999

11. PAHO 2001 11 Use of Surveillance Epidemic detection

12. PAHO 2001 12 NICARAGUA, 1993-1999 Vibrio cholerae: Antibiotic susceptibility

13. PAHO 2001 13 Use of Surveillance Follow trends and patterns of antimicrobial resistance

14. PAHO 2001 14

15. PAHO 2001 15 Percentage of Shigella spp. isolates resistant to different antibiotics. Peru, 1996-1999.

16. PAHO 2001 16 Percentage of Shigella flexneri isolates resistant to different antibiotics. Ecuador, 1996-1999.

17. PAHO 2001 17 Use of Surveillance Determine geographical distribution and spread of antimicrobial resistance

18. PAHO 2001 18

19. PAHO 2001 19 Goal To preserve the effectiveness of currently available antimicrobial drugs Improve the availability of drugs of assured quality Ensure appropriate use of drugs when they are required Decrease use of drugs when they are not required

20. PAHO 2001 20 Approaches to address AMR Health System strengthening Policy and regulation Provider and consumer behavior

21. PAHO 2001 21 Antimicrobial Resistance Surveillance Program IN 1996, PAHO’s DIRECTING BODIES RECOMMENDED THAT THE ORGANIZATION PUT IN PLACE AN ANTIMICROBIAL RESISTANCE SURVEILLANCE PROGRAM

22. PAHO 2001 22 Participating Countries } Caribbean Countries Countries starting in 1996 Countries incorporated w/ USAID project

23. PAHO 2001 23 A network of national reference laboratories was established A database set for the American Region was created A web page in PAHO web site was created Results

24. PAHO 2001 24 Results Protocol for quality assurance and proficiency testing for antibiotic susceptibility Workshops to provide training in bacterial identification and testing for antimicrobial resistance were implemented Protocol for assessing the cost of hospital infections and selected antimicrobial resistance were developed and implemented

25. PAHO 2001 25 Results TOT on rational use of antimicrobial drugs Training material Drugs therapeutics committees Regional treatment guidelines

26. PAHO 2001 26 Results Different materials on antimicrobial resistance were produced and distributed References on antimicrobial resistance were compiled into a bibliography, which will be published in a month