The continuing emergence of pathogenic microorganisms that are resistant to first-line antimicrobials is a cause of increasing concern. This emergence is associated with higher levels of mortality and morbidity which not only impacts on patients but also increases the burden on health care services as a result of additional diagnostic testing, prolonged hospital stay and increased intensity and duration of treatment.
There is evidence to suggest that more prudent usage of antimicrobials particularly in the treatment of human disease could make a significant impact on the pace and extent to which resistance emerges in microorganisms pathogenic to man. Minimizing the emergence of antimicrobial resistance to second line broad-spectrum antibiotics (such as the five antibiotics listed in PHILHEALTH circular no. 15, series 2006) could be achieved by restricting their use in favor of first line narrower spectrum but effective antibiotics unless there is evidence to prove (i.e. through surveillance data) that significant antimicrobial resistance to the narrower spectrum antibiotics exist.
It is therefore essential that surveillance systems such as an antimicrobial resistance surveillance be in place to provide the information necessary to secure an approach to the management of communicable diseases that minimizes morbidity and mortality whilst also containing the emergence of pathogens resistant to antimicrobials. To be effective, such surveillance systems should:
1) be focused on diseases of greatest public health importance (i.e. with high mortality and/or morbidity) and where therapeutic options may be severely limited by antimicrobial resistance;
2) include diseases that are readily transmissible (i.e. may give rise to outbreaks and epidemics);
3) provide information on mortality and morbidity attributable to resistant strains of the organism in the context of that attributable to susceptible strains; and
4) provide information for action at the local, intermediate and national levels.
To provide reliable and valid information for action:
1) data on culture identification and antimicrobial resistance should be of a consistently appropriate quality hence the emphasis on adherence to international standards in bacteriology;
2) the capture, collation and analysis of data should be in accordance with protocols of appropriate quality and
3) information outputs should facilitate decision-making by clear presentation and timely distribution and should include a commentary on the limitations of the data presented as well as proposals for interventions.