Community-Based Surveillance of Antimicrobial Use and ...

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3. Vellore, India3.3.1.2 Trends in AMR over timeIn phase 1a, 463 (42%) of these commensal isolates showed resistance to one or more ABMs.Similarly, 364 (39.1%) commensal isolates in phase 1b showed resistance to at least one of theABMs tested. As might have been expected, a higher proportion of isolates was resistant tothose ABMs that had been used for longer periods of time, such as ampicillin, cotrimoxazole,nalidixic acid and tetracyclines. Cross‐resistance to the three ABMs most commonly used totreat UTIs (ampicillin, cotrimoxazole and nalidixic acid) was seen in 92 isolates (8.4%) inphase 1a and 79 (8.5%) in phase 1b. This was the most common multidrug‐resistantphenotype observed. Aminoglycoside and cephalosporin resistance was observed in bothtime periods in isolates resistant to one or more of the three ABMs mentioned above. Only1.5% and 0.3% isolates, respectively, were resistant to nitrofurantoin. No differences betweenthe two phases were statistically significant. Monthly trends in resistance among commensalE. coli during the two time periods for selected ABMs are shown in Figure 3.2. There werevariations but none were significant, as can be seen from the overlapping confidenceintervals.31
Community-based surveillance of antimicrobial useand resistance in resource-constrained settingsFig.3.2 (A-G): Monthly percentage AMR rates in commensal E.coliPhase 1a Aug 2003 - Jul 2004 Phase 1b Jan 2005 - Dec 2005% resistance100A1. Ampicillin% resistance100A2. Ampicillin7575505025250Aug(66)Sep(97)Oct(97)Nov(93)Dec(94)Jan(94)Feb(85)Mar(90)Apr(95)May(95)Jun(95)Jul(94)0Jan(67)Feb(72)Mar(83)Apr May Jun(58) (76) (84)Jul(81)Aug(80)Sep(81)Oct Nov Dec(84) (80) (83)100B1. Cotrimoxazole100B2. Cotrimoxazole75755050252500100C1. Tetracycline100C2. Tetracycline7575505025250010075D1. Nalidixic acid10075D2. Nalidixic acid5050252500100E1. Ciprofloxacin100E2. Ciprofloxacin75755050252500100F1. Cephalexin100F2. Cephalexin75755050252500100G1. Gentamicin100G2. Gentamicin75755025050250The error bars indicate confidence intervals.The numbers within brackets are the total tested each month.32
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