Surveillance of antimicrobial resistance at a tertiary hospital in Tanzania.
BACKGROUND
Antimicrobial resistance is particularly harmful to infectious disease management in low-income countries since expensive second-line drugs are not readily available. The objective of this study was to implement and evaluate a computerized system for surveillance of antimicrobial resistance at a tertiary hospital in Tanzania.


METHODS
A computerized surveillance system for antimicrobial susceptibility (WHONET) was implemented at the national referral hospital in Tanzania in 1998. The antimicrobial susceptibilities of all clinical bacterial isolates received during an 18 months' period were recorded and analyzed.


RESULTS
The surveillance system was successfully implemented at the hospital. This activity increased the focus on antimicrobial resistance issues and on laboratory quality assurance issues. The study identified specific nosocomial problems in the hospital and led to the initiation of other prospective studies on prevalence and antimicrobial susceptibility of bacterial infections. Furthermore, the study provided useful data on antimicrobial patterns in bacterial isolates from the hospital. Gram-negative bacteria displayed high rates of resistance to common inexpensive antibiotics such as ampicillin, tetracycline and trimethoprim-sulfamethoxazole, leaving fluoroquinolones as the only reliable oral drugs against common Gram-negative bacilli. Gentamicin and third generation cephalosporins remain useful for parenteral therapy.


CONCLUSIONS
The surveillance system is a low-cost tool to generate valuable information on antimicrobial resistance, which can be used to prepare locally applicable recommendations on antimicrobial use. The system pinpoints relevant nosocomial problems and can be used to efficiently plan further research. The surveillance system also functions as a quality assurance tool, bringing attention to methodological issues in identification and susceptibility testing.
Centre for International Health, University of Bergen, N-5021 Bergen, Norway. bjorn.blomberg@cih.uib.no
Bjørn
B
Blomberg
Davis S M
DS
Mwakagile
Willy K
WK
Urassa
Samwel Y
SY
Maselle
Marcellina
M
Mashurano
Asbjørn
A
Digranes
Stig
S
Harthug
Nina
N
Langeland
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001424:Bacterial Infections / Q000145:classification / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D002984:Clinical Laboratory Information Systems; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D024881:Drug Resistance, Bacterial; D006785:Hospitals, University / Q000592:standards*; D006801:Humans; D008826:Microbial Sensitivity Tests; D011159:Population Surveillance / Q000379:methods*; D015995:Prevalence; D012984:Software; D013636:Tanzania / Q000453:epidemiology
D000900:Anti-Bacterial Agents