Community-Based Surveillance of Antimicrobial Use and ...

Community-based surveillance of antimicrobial useand resistance in resource-constrained settingsTable 7.1: Percentage of AMR in E. coli isolated from four centres10075% resistance50250Ampi Cotrim Ceph Genta Tetra Nal Cipro NitfurDelhi Pathogen Delhi Commensal Mumbai Vellore Pathogen Vellore Commensal BritsAMR rates among E. coli were high at all sites. At all sites, somewhat higher AMR rates wereobserved towards cotrimoxazole, ampicillin, tetracyclines and nalidixic acid, antibioticshistorically in longer use and AMR rates to these ABMs were lower among commensalbacteria than among pathogens. Resistance to fluoroquinolones and third‐generationcephalosporins was present in all areas, although the rates seemed to be much higher inIndia, especially among pathogens.Although the detection of trends over time was not a primary objective in the pilot projects,it was noted that no significant monthly variations in resistance rates during the period ofstudy were seen. However, it must also be noted that the monthly numbers of isolates wereoften inadequate. There were also inadequate data to reliably understand any differencesthat might have been present between locations and between facilities within a site. Ingeneral, where AMR rates among commensals and pathogens were studied separately, theAMR rates were lower among commensals.There are very few reports on AMR rates among commensal E. coli and those causingcommunity‐acquired UTI, collected systematically over a period of time from developingcountries. Data on the susceptibility of E. coli isolated from clinical samples submitted forroutine examination have been reported from two large international data sets (SENTRY andMYSTIC) 33 . These revealed definite geographical differences, as summarized in Table 7.2.Non‐susceptibility rates were generally higher in South Africa and Asia as compared tocountries such as the USA and Canada during the period 1997‐2001.80