Speakers and moderators of the NDF with AMU-PPS Lead Investigator Dr. Mari Rose De los Reyes (center) and AMU-PPS Co-Lead Investigator Dr. Jemelyn Garcia (4th from left).
In the recently conducted 5th National Dissemination Forum (NDF), hosted by the Department of Health’s Pharmaceutical Division (DOH PD) and the Research Institute for Tropical Medicine’s (RITM) Medical Department’s Antimicrobial Use-Point Prevalence Survey (AMU-PPS) Team, more than 500 medical and laboratory personnel tackled the significant developments and challenges on the use, prescription, and consumption of antimicrobials; and how it contributes to the growing issues on antimicrobial resistance (AMR).
The three-day forum on November 21-23, 2023 at Sequoia Hotel in Paranaque gathered 350 on-site and 200 online healthcare personnel from various healthcare facilities and institutions, centers for health development, and societies, including resource speakers from the Global Point Prevalence Survey (PPS) Network.
Updates on antimicrobial surveillance in the Philippines
The World Health Organization (WHO) declared antimicrobial resistance (AMR) as one of the top 10 global public health threats. Globally, 4.95 million people died due to drug-resistant infections in 2019. A total of 1.27 million out of the 4.95 million deaths were directly caused by AMR.
AMR happens when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines. The inappropriate or excessive use of antimicrobials is the main reason why target bacteria develop AMR.
During her Opening Remarks, RITM OIC-Director IV Atty/Dr. Ana Liza Hombrado-Duran, highlighted the significant role of RITM in promoting the prudent use of antimicrobials. In 2017, RITM initiated the conduct of AMU-PPS among several selected hospitals nationwide. Fast forward to the present, there are more than 80 hospitals, both government and private, participating in the AMR surveillance program.
With the increasing resistance rates among bacterial pathogens considered of public health importance, there is an alarming need for a strengthened antimicrobial stewardship practice and enhanced surveillance coverage worldwide.
In the Philippines, the RITM Antimicrobial Resistance Surveillance Reference Laboratory (ARSRL) acts as the central coordinating laboratory for the Antimicrobial Resistance Surveillance Program (ARSP) which has 26 sentinel sites in the country – 7 in Luzon, 8 in the National Capital Region (NCR), 5 in Visayas, and 6 in Mindanao. Among the 26 sentinel sites, 22 are government hospitals, 2 are private hospitals, and 2 are performing gonococcal surveillance.
In her presentation, RITM ARSRL Head Dr. Sonia Sia highlighted the significant role of the reference laboratory in AMR surveillance in the country. She explained that ARSP is a laboratory-based surveillance where case finding is based on priority specimens sent routinely to laboratories for clinical purposes. In the sentinel sites, when culture and susceptibility tests are done, Dr. Sia explained that data would then be generated and transmitted to the ARSRL on a monthly basis. She added that the Data Management Unit of the RITM ARSRL have implemented an automated data transfer for some sentinel sites whose resources allows them to transmit data daily to the ARSRL. Dr. Sia noted that daily transmittal is important in identifying the clustering of isolates in the sentinel sites.
RITM ARSRL uses WHONET to manage and analyze the results for the national AMR surveillance. WHONET is a free Windows-based database software developed by the WHO for the management and analysis of microbiology laboratory data with a special focus on the analysis of antimicrobial susceptibility test (AST) results. ARSRL also conducts regular data quality checks and implements an External Quality Assessment Scheme (EQAS) for the proficiency testing of its sentinel sites, through ARSP Accreditation Program. RITM ARSRL also participates in EQAsia, WHO Global Gonococcal Antimicrobial Surveillance Program (GASP), and the Enhanced Gonococcal Antimicrobial Surveillance Program (EGASP).
As the National Reference Laboratory for AMR, Dr. Sia recognized the significant role of RITM in the DOH AMR Surveillance Program, with the ARSP being tasked to provide critical inputs to the DOH’s effort to promote rational drug use by determining the current antimicrobial resistance trends; and developing trends of antimicrobial resistance of selected bacteria.
During her talk, she also discussed the list of antibiotic-resistant bacteria with a focus on the resistance rates of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. She also presented the resistance rates for Staphylococcus aureus, Enterococcus faecalis, Vibrio cholerae, and Neisseria gonorrhoeae. In her discussion, Dr. Sia emphasized the continued increase of AMR rates for most of the bacterial pathogens – particularly E. coli, K. pneumoniae, P. aeruginosa, and A. baumannii,which are considered of public health importance in view of the limited treatment options as well as infection control challenges for these pathogens.
The full ARSP Report for 2022 can be accessed via this link: https://ritm.gov.ph/arsp-2022-data-summary-report/
Dr. Sia’s presentation was followed by DOH PD Pharmacist V Ms. Johanna Mallari-Abella’s talk on the National AMS Program in the Philippines. Ms. Mallari-Abella gave an overview on the role and activities of the AMR Program in the country, particularly on how the Philippines is responding to the continuous rise of AMR cases, updates on the National AMS Program, as well as the plans of the program to address growing challenges on antimicrobial stewardship and resistance.