Community-Based Surveillance of Antimicrobial Use and ...

Community-based surveillance of antimicrobial useand resistance in resource-constrained settingsTable 5.4: Compliance with STG/EDL in choice of therapyNot compliant No. of prescriptions withinformation availableNumber %β‐lactamase‐resistant penicillin 59 44.4 133β‐lactamase‐susceptible penicillin 48 25.1 191Fluoroquinolones 26 10.0 259Macrolide 44 33.6 131Metronidazole 87 38.2 228Extended‐spectrum penicillin 281 47.7 589Tetracycline 56 21.1 265Cotrimoxazole 174 30.3 574Total 775 32.7 23705.4 Lessons learnt from this site5.4.1 AMRThis pilot site based its surveillance method only on women suspected of having a UTI, inorder to obtain E. coli isolates. The feasibility of this method is in question, as it failed todeliver the required numbers to allow for time series analysis. The number of urinespecimens collected was not enough to obtain the required number of isolates. It would haveproven too costly to increase the number of specimens by incorporating more clinics andcollecting specimens on a daily basis. Specimen collection was also dependent on the clinicalacumen of the trained field workers, who might have included patients other than those withUTIs. The high rate of sexually transmitted infections in the population visiting the clinicsalso led to the exclusion of many such patients as being possible UTIs.The investigators identified a number of other constraints that may be specific to the site,rather than the method, including:• difficulties in negotiating collaboration from sites that have never before been included inany surveillance efforts;• the involvement of community partners, which also required extensive and lengthynegotiations, but also resulted in a high turnover of data collectors;• the long distances between the different facilities, some remote, and the lack of regularpublic transport;• health management changes and sensitivity towards research, due to South Africa’ssocial past, which significantly delayed the programme approval and start, andoccasioned an initial retraction of support due to staff shortages.5.4.2 ABM useSome differences were seen in the ABM use in the PHC clinics and the OPD of the districthospital. This emphasized the need to obtain data from a range of facilities. Importantly, thissite could provide no data on ABM use in the for‐profit private sector. Data on66