Diploma in Nursing Admission Test Question Solution 2023.pdf
Antimicro
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
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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
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
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.