mudhune2

The netSPEAR experience: Pneumococcal and H influenzae isolates Sandra Mudhune Mike English, Caroline Mate, Anthony Scott Global Antibiotic Resistance Partnership GARP‐Kenya 6‐7 August 2009

Surveillance region

CSF

BC

9000

9,000

8000

8,000

7000

7,000

6000

6,000

5000

5,000

4000

Kenya

4,000

Uganda 3000

Tanzania

3,000

Ethiopia 2000

2,000

1000

1,000

0

0

Reported cases of invasive H. influenzae disease & disease caused by pneumococci CSF

BC

160

160

140

140

120

120

100

100 spn

80

hin

80

nme 60

60

40

40

20

20

0

0

90

80

70

60

50

40

30

BC CSF

20

Missing Other

10

0

900 800 700 600 500 400 300 200 100 0 Haemophilus Infuenzae

Streptoccus pneumoniae

Neisseria meningitidis

Salmonella

others

Pneumococcal resistance phenotypes by country Blood culture isolates

CSF Isolates

80.00 70.00

70.00

60.00

60.00

50.00

50.00

40.00

40.00

Cotrimoxazole

Chloramphenicol

Erythromycin

0.00 Amoxicillin

0.00 Cefotaxime

10.00

Benzypenicillin

10.00

Cotrimoxazole

20.00

Chloramphenicol

Uganda

Erythromycin

20.00

30.00

Cefotaxime

Tanzania

Benzypenicillin

Kenya

30.00

H. influenzae resistance phenotypes by country Blood culture

CSF

80.00 70.00

70.00

60.00

60.00

50.00

50.00

40.00

40.00 Kenya

30.00

30.00

Tanzania

Cotrimoxazole

Chloramphenicol

Cotrimoxazole

0.00 Chloramphenicol

0.00 Amoxicillin

10.00

Cefotaxime

10.00

Amoxicillin

20.00

Cefotaxime

Uganda

Benzypenicillin

20.00

Pneumococcal resistance phenotypes over time Blood culture

CSF

70.00

70.00

60.00

60.00

50.00

50.00

40.00 2003 2004

30.00

40.00 30.00

2005 20.00

2006

20.00

2007 10.00

2008

0.00

10.00

Cotrimoxazole

Chloramphenicol

Erythromycin

Cefotaxime

Benzypenicillin

Cotrimoxazole

Chloramphenicol

Erythromycin

Amoxicillin

Cefotaxime

Benzypenicillin

0.00

H. influenzae resistance phenotypes over time Blood culture

CSF

70.00

70.00

60.00

60.00

50.00

50.00

40.00 2003 2004

30.00

40.00 30.00

2005 20.00

2006

20.00

2007 10.00

2008

0.00

10.00

Cotrimoxazole

Chloramphenicol

Amoxicillin

Cefotaxime

Cotrimoxazole

Chloramphenicol

Amoxicillin

Cefotaxime

0.00

Discussion • Antibiotic resistance profiles of pneumococci are generally similar in the 3 countries • S pneumoniae isolates are susceptible to most of the antibiotics that are commonly used in the E Africa region with the exception of co‐ trimoxazole • There was a worrying increase in chloramphenicol resistance among meningitis cases in Kenya in 2004, but this has since decreased

Discussion • When data is pooled, prevalence of resistance to cefotaxime, erythromycin and amoxicillin was low • Data result from routine surveillance where differences in clinical practice and considerable variability in operational case definition in different hospitals

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