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Antimicrobial Stewardship: The resistence summit - 01 Jun 2015
Implementing the antimicrobial resistence national startegy framework.
The first ever Antimicrobial Resistence Summit in South Africa took place on 16 October 2014. The purpose of the summit was to bring together all stakeholders involved in work related to infectious diseases and obtain their commitment to implementation of the Antimicrobial Resistence National Startegy Framework for South Africa. Speakers from various organisation and state department provided the view of their respective establishments on efforts currently undertaken to support antimicrobial stewardship (AMS) or iinfection prevention and control. In the event that AMS was new to their organisations, they wereasked to provide insight into how their existing efforts and strategic focus can be used to support AMS. Finally, organisations were aske to indicate what they would require in order to achieve the objectives and provide support for the AMS strategy.
During the first part of the summit, the minister of Health, Dr Aaron Motswaledi, and several international speakers addressed the audience on aspects of resistence to antimicrobial drugs, to set the tone for the deliberations during the rest of the summit. Dr Motswaledi pointed out that the summit took 2 years to come to fruition and that the entire country should be informed urgently that, if we do not change direction as far as the use of antimicrobial drugs is concerned, we will end up where we are heading, towards a post-antibiotic era.
Not only professional health workers, but also the general public must be informed that the extensive use of antimicrobial drugs will lower life expectancy significantly. In this respect it was pointed out that in South Africa, cases of multi-drugs resistant TB have doubled upbetween 2012 and 2013 and that carbapenems used against enterobacteria are becoming ineffective. Globally there are now more than 100 countries in which extensive drug resistant TB (XDR-TB) is present. In at least 10 countries, gonorrhea cannot be treated any more as effective drugs are available in those countries against the causative organisms.
Other speakers pointed out that approximately 200 citizens diee daily in the USA from multi-drug resistant (MOR) infections and that similar figures have been documented for the European Union and other large countries. Today, MOR is a truly global phenomenon and resistance genes have been spread all over the globe as a result of international movement of both humans and animals. At the end of the summit representative from several government departments, laboratory services, clinician societies, civil societies signed the Antimicrobial Resistance National Strategy Framework Commitments. Dr Boitshoko Ntshabele, president of the SAVC, signed on behalf of our profession.The purpose of the strategy is to provide a framework for managing antimicrobial resistance, to limit further increase in resistant microbial infections and improve patient (human and animal) outcome. The commitments include the establishment of an interministerial advisory committe, the establishment of a naitional surveillance syatem for amr, the enhancement of infection prevention and control programmes and antimicrobial stewardship, and the promotion of appropiate use of antimicrobial drugs through legislation. On 17 October, the day after the summit, a core-group workshop was held with the purpose to turn the commitments from the summit into firm actions, with the required financial and staffing resources. These actions will be driven by an alliance of the National Department of Health (NDOH) and South African Antibiotic Stewardship Programme (SAASP).
The role that animal health currently plays in antimicrobial stewardship is limited, but it is encouraging that organisationms involved in animal health are now part of the alliance and will no doubt start playing a more important role in these initiatives. A number of veterinarians with specific skills-sets are now involved in the activiesties of the South African Antibiotic Stewardship programme. The latter includes working groups with focus areas that include governance (strengthening organisational structures for appropaite decision making, authority and oversight), surveillance and reporting, infection control/ biosecurity, education and public campaigns (including the farming community).
In this regard the NDOH and SAASP alliance intend to communicate the AMS messege across all provinces through community forums, community radio and newspapers. The target audience include commuters, schools, parents and healthcare professionals in the public and private sectors. In the domain of human health care, plans are advancing for local CPD forums for specialists, lobbying with the specialists societies, presentation slots at specialist and general practitioner conferences, social media campaigns with Twitter, Facebook and Instagram and a dedicated page on AMS on NDOH website, with links to SAAAP and other organisations providing information to public and health care professionals.
By: Mritz van Vuuren, BVSc, MMedVet (Micro)