Bamford garp sa 0

NASF public sector data and initiatives Dr Colleen Bamford NHLS Groote Schuur National Co-ordinator for Public Sector

NASF surveillance • Antimicrobial resistance patterns on isolates from blood and cerebro-spinal fluid • Public sector/NHLS laboratories • National basis • 2002-2008 • Information disseminated via publications in local journals or via website

Methods • Voluntary participation of laboratories, chiefly from academic centres • Decentralised data collection at each laboratory under the supervision of microbiologist, with checking and analysis of all data by national coordinator, supported by editorial committee • According to CLSI guidelines – No duplicates – Minimum of 30 isolates per species – No selective testing Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data: approved guideline- Third edition.

M39-A3. 2009

Susceptibility of Escherichia coli from blood culture 100

90

80

% susceptible

70

60

50

Ampicillin Gentamicin Ciprofloxacin

40

% ESBL 30

20

10

0 CHBH (n=401)

CMJAH (n=215)

SBAH (n=154)

DGM (n=94)

UNI (n=56) GSH (n=222) TBH (n=142) GP (n=148)

Laboratories

Susceptibility of Klebsiella pneumoniae from blood culture 100 90 80

% susceptible

70 60 50 Gentamicin Ciprofloxacin

40

% ESBL 30 20 10 0 CHBH (n=350)

CMJAH (n=289)

SBAH (n=249)

DGM (n=80) UNI (n=97) GSH (n=264) TBH (n=152) GP (n=119) Laboratories

Susceptibility of Pseudomonas aeruginosa from blood culture 100

90

80

% susceptible

70

60

Gentamicin Cefepime

50

Piptazobactam Ciprofloxacin Ceftazidime

40

Imipenem Meropenem

30

20

10

0 CHBH (n=119) CMJAH (n=74) SBAH (n=92)

DGM (n=46)

UNI (n=17)

Laboratories

GSH (n=72)

TBH (n=54)

GP (n=19)

Susceptibility of Acinetobacter baumannii complex from blood culture 80

70

60

% susceptible

50 Piptazobactam 40

Ciprofloxacin Ceftazidime Imipenem

30

Meropenem 20

10

0 CHBH (n-366)CMJAH (n-85) SBAH (n-168) DGM (n-20)

UNI (n-22)

Laboratories

GSH (n-153) TBH (n-132)

GP (n-23)

Susceptibility of Staphylococcus aureus from blood 100

90

80

% susceptible

70

60

50 Cloxacillin Erythromycin 40

Clindamycin

30

20

10

0 CHBH (n=540)

CMJAH (n=298)

SBAH (n=292)

DGM (n=139)

UNI (n=35) GSH (n=253)TBH (n=186) GP (n=132)

Laboratories

Limitations • Dependent on accurate identification and antimicrobial susceptibility testing at laboratory level • IT system • Laboratory based surveillance

In the future Ongoing efforts for quality assurance Regular review of data items and methods of data retrieval Include statistics – 95% confidence intervals to quantify precision of estimates – Determine statistical significance of differences between 2 rates

Conclusion NASF public sector antimicrobial susceptibility data • Monitors national and local resistance patterns • Supplies valuable information provided due recognition of its limitations • Thanks to all participating laboratories and to editorial committee