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- 1. Surveillance of Antimicrobial Resistance in India: from research capacity building to policy Child Health Research Project Coordination Meeting January 2002
- 9. IndiaCLEN IBIS & CAMR Study Sites Chennai Delhi Vellor e Lucknow Nagpur Thiruvananthapuram Mumbai CChennaihennai Chennai
- 11. Phase I & II No. recruited Phase I 1993 - 1998 5,798 Phase II 2000-Aug 01 Total 1,458 7,256* No. of S. pneu- mo isolates 307 183 490 * 58% < 2 y.o.; 92% children
- 12. IBIS Phase II Update Meningitis & Lobar Pneumonia Cases 41 8 8 6 7 5 7 # QC tests 183 29 101 9 8 11 25 # S. pneumo 72 26 26 1 16 2 1 # H. influenz. 308 3 152 38 9 0 106 # other fluids 1,117 355 168 102 199 196 97 # CSF samples 1,458 385 398 141 209 196 129 # re-cruited TOTAL Trivan-drum Vellore Nag-pur Mum-bai Luck-now Delhi
- 13. AMR S.pneumoniae Time Trends
- 15. IBIS Phase II Update (2000 – Aug. 2001) Nasopharyngeal swabs from children without respiratory illnesses presenting at OPD 159 (20%) 32 45 0 5 48 29 # S. pneumo 106 (13.4%) 38 16 0 6 31 15 # H. influenz. 793 100 164 3 140 166 220 # of NP swabs TOTAL Trivan-drum Vellore Nag-pur Mum-bai Luck-now Delhi
- 18. CAMR Update (Aug. 28, 2000 – Sept. 31, 2001) Center Delhi Lucknow Nagpur Trivan- drum Vellore Total # tested 851 900 550 472 1,220 3,993 # S. pneumo 211 157 117 83 352 920 # H. infl. 94 54 51 64 47 310 # + both 181 26 26 107 285 625 Colonization rates (%) 57.1 31.6 35.3 53.8 56.1 48.3
- 19. Comparison of AMR Patterns: Invasive S. pneumo vs. IBIS NP & CAMR data (Thomas K & IBIS, 2002) IBIS p = 0.32 CAMR p = 0.08 IBIS p = 0.07 CAMR p = 0.001 IBIS p = 0.3 CAMR p = 0.005 IBIS p = 0.2 CAMR = 0.001 IBIS p = 0.9 CAMR p = 0.3 94 91 97 47 32 32 93 95 97 98 100 100 99 100 100
- 20. Comparison of AMR Patterns: Invasive H. influenzae vs. IBIS NP & CAMR data (Thomas K & IBIS, 2002) IBIS p = 0.06 CAMR p = 0.001 IBIS p = 0.3 CAMR p = 0.2 IBIS p = 0.001 CAMR p = 0.001 IBIS p = 0.04 CAMR p = 0.001 IBIS p = 1.0 72 87 93 45 46 57 53 87 86 80 65 36 100 100
- 21. Serotype/serogroup distributions Invasive S. pneumo vs. CAMR isolates Serotype/group IBIS Invasive CAMR Isolates (n = 407) (n = 1,064) 1 24.6% - 6 10.8% 7.3% 19 6.3% 10.2% 7 5.2% - 5 4.2% - 14 3.7% - 4 2.9% 2.9% 18 2.9% - 3 1.5% 4.0%
- 24. Other CHR Activities Related to AMR
- 29. From Research Capacity Building to Policy
Notas del editor
- Acute Respiratory infections has become the the most important cause of morbidity and mortality after the control of diarrheal diseases in the developing world. 3- 5 million people die anually due to ARI and most of them are children from the developing world. Most common etiological agents in community aquired ARI in children are S.pneumonia and H.infuenzae in ~60% and Respiroaty syncitial virus causing the bulk of the other infections. These are preventable infections at the present time.
- It is really been indeed a team effort by the investigators from different parts of India. Even though CMC has taken the leadership in microbiology and clinical coordination of the program. The success of the program has been the effort of all the members of the team.
- The inclusion criteria has changed over the last 7 years. In the first phase from 1993 to 1997 we laid a wide net to cast all the possible infections due to Pneumococci and H.influenzae. We noted that overall we had less than 3% prospective yeild from blood while there was about 15% yeild from CSF . While providing similar AMR and serotype data. So in the second phase of the study from 1998 we have concentrated more on meningitis as the source of our isolates. While keeping lobar pneumonia and frank septicemias also in the inclusion criteria. All subjects who had routine isolations in the laboratory from normaly sterile body fluids were also included in the study if they full filled in the clinical inclusion criteria.
- It is really been indeed a team effort by the investigators from different parts of India. Even though CMC has taken the leadership in microbiology and clinical coordination of the program. The success of the program has been the effort of all the members of the team.
- We can draw a number of important conclusions from the study: Pneumococcal resistance is currently low in the range of 3% in India. Emerging penicillin resistance is a cuase for concern and needs attention. ( referring to 6% intermediate resistance seen in 1999). Both the bacteria show very high levels of resistance to currently recommended drugs in the ARI program. Sero types included in the commercially available 9 or 11 valant vaccine give coverage for both adults and children.
- There is need to take steps to reduce emerging penicillin resistance in India. Development of antibiotic guidelines and hospital antibiotic policy some of the ways forward. We also need to control drug availability including that used in vetinary practice. There is need to systematically continue AMR surveillance so that we can evaluate the effect of interventional programs. And also provide information to guide rational antibiotic policy in the treatment of patient. There is no doubt that preventive strategies of reducing infections also reducing the antibiotic use and AMR development. The cost effectiveness of these vaccines in EPI program and high risk population will need to be evaluated.
- We are part of global AMR surveillance net work ANSOP We have initiated regional collaboration at South Asia level with ICDDRB
- It has been a very rewarding experience : Both in generating important data for the country But in developing the infrastructure for long term monitoring Lab strengthening, Reference centers in microbiology and data management.