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Project ID: ICA4-CT-2001-10014
Finanziato nell'ambito di: FP5-INCO 2
Paese: Italy

Development of an antimicrobial use and resistance monitoring system, applied to healthy children (aged 6-72 months) and their families in LIC

Human antimicrobial use was investigated in the study population through Household Antimicrobial Use Survey (HAUS), based on previously used and validated methods for collecting both quantitative and qualitative data.

Quantitative data were collected performing Household interviews investigating carers of the selected study population by using a pre-tested questionnaire for assessing the families and the selected study population of children (aged 6-72 months) regarding issues of health seeking behaviour and consumption patterns of antimicrobials including self-medication. Qualitative data were collected by Focus group discussions with family representatives and local health care providers investigating their conceptions regarding views and ideas around antimicrobial use, self-medication, and community health care system.

Antimicrobial resistance screening (ARS) was performed on bacterial isolates from the commensal microbiota of the gut (Escherichia coli). Samples of the gut microbiota were obtained by rectal swabs or swabs from fresh stool from the youngest recruitable child in the target age cohort. The antimicrobial susceptibility of E. coli was analyzed by means of a validated and standardised rapid resistance screening method. Briefly, each swab was used to inoculate a plate of MacConkey agar and antimicrobial-containing discs were then applied onto the medium surface.

The antimicrobials tested are including ampicillin, ceftriaxone, teytracycline, trimethoprim-sulphamethoxazole, chloramphenicol, streptomycin, kanamycin, gentamicin, amikacin, nalidixic acid and ciprofloxacin. Results from MacConkey agar plates were recorded after a 18 h-incubation at 37°C. Colonies with a morphology resembling that of E. coli grown inside the zones of inhibition that define susceptibility to each antibiotic, were confirmed at species level and scored as resistant isolates.

The data collected on pre-printed HAUS and ARS forms were electronically stored and validated as foreseen in the Epi-Info 2000 programme.

Surveillance of resistance is not itself an intervention that will contain resistance, but which is of critical importance both to provide information on the magnitude and trends in resistance and to monitor the effect of interventions performed to control antimicrobial use and resistance. The developed monitoring system ARS and HAUS including the rapid resistance screening method, will be proposed to the national regulatory authorities for continuous or interval monitoring subsequent to this project.

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Reported by

University of Florence, Division of Infectious Diseases
Viale Morgagni 85
50134 Florence
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