41
pneumoniae, Acinetobacter baumannii, Salmonella and Shigella spp. (Veeraraghavan
et al. 2018; Walia et al. 2019).
In response to national antimicrobial resistance crisis, Indian Council of Medical
Research constituted 6 nodal and 20 regional centres in 2012 for initiating surveillance of six pathogenic groups. Priority objective of the network was evidence
based treatment strategies, thus rationalising antimicrobial use. In addition to surveillance network, a nationwide antimicrobial stewardship programme was also
launched (Veeraraghavan et al. 2018). Accrediting the significance of Minimum
Inhibitory Concentration (MIC) monitoring for better therapeutic outcomes, the
network insists on determination of either carbapenem MIC or micro broth dilution
based MIC for colistin isolates collected from different anatomical sites. It further
covers molecular characterization of ESKAPE (Enterococcus faecium,
Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii,
Pseudomonas aeruginosa, and Enterobacter spp.) pathogens for formulation of
suitable empirical treatment guidelines giving proper indication for newly synthesized βL/βLI (betalactam betalactamase inhibitor) drugs. Efforts for training
regional labs are in process along with future goal to generate technical competency
for molecular characterization of multidrug resistant pathogens (Veeraraghavan
et al. 2018).
At present, enough evidence is attained from the country which is not only
restricted to trends and patterns but helps to monitor minimum inhibitory concentrations and resistance mechanisms from notable locations. The challenge in coming
years would be expansion of this capacity and its usage for creating national treatment strategy in order to prevent misuse of antimicrobials as an effort for antimicrobial stewardship. Documentation of changing trends of antimicrobial resistance
should be kept dedicatedly for future reference. Due to limited network sites in
current national surveillance system, there are loopholes in retrieving hospital based
literature. Improvement in surveillance networks by developing several sites at different locations will result in better data collection to highlight true picture of antimicrobial resistance in India (Walia et al. 2019; Wattal and Goel 2014).
2.7 Antimicrobial Resistance: A One Health Perspective
One Health is the combined effort of several health science professionals to conquer
optimal health for people, plants, wildlife, domestic animals, and environment (Fig.
2.1). The driving elements of antimicrobial resistance include antimicrobial use and
misuse in animal, human, and environment and the wide spread of resistant bugs
and factors conferring resistance within and between such segments and around the
globe (McEwen and Collignon 2018). Research and surveillance are essential
because they trace out antimicrobial resistance menace and how to deal with them
(WHO 2014, 2015). There are several gaps in our understanding of the multifarious
biology that characterizes the resistance associated with One Health dimensions,
but many innovation programs have been utilized in recent years that sustain
2 Global Surveillance Programs on Antimicrobial Resistance
pneumoniae, Acinetobacter baumannii, Salmonella and Shigella spp. (Veeraraghavan
et al. 2018; Walia et al. 2019).
In response to national antimicrobial resistance crisis, Indian Council of Medical
Research constituted 6 nodal and 20 regional centres in 2012 for initiating surveillance of six pathogenic groups. Priority objective of the network was evidence
based treatment strategies, thus rationalising antimicrobial use. In addition to surveillance network, a nationwide antimicrobial stewardship programme was also
launched (Veeraraghavan et al. 2018). Accrediting the significance of Minimum
Inhibitory Concentration (MIC) monitoring for better therapeutic outcomes, the
network insists on determination of either carbapenem MIC or micro broth dilution
based MIC for colistin isolates collected from different anatomical sites. It further
covers molecular characterization of ESKAPE (Enterococcus faecium,
Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii,
Pseudomonas aeruginosa, and Enterobacter spp.) pathogens for formulation of
suitable empirical treatment guidelines giving proper indication for newly synthesized βL/βLI (betalactam betalactamase inhibitor) drugs. Efforts for training
regional labs are in process along with future goal to generate technical competency
for molecular characterization of multidrug resistant pathogens (Veeraraghavan
et al. 2018).
At present, enough evidence is attained from the country which is not only
restricted to trends and patterns but helps to monitor minimum inhibitory concentrations and resistance mechanisms from notable locations. The challenge in coming
years would be expansion of this capacity and its usage for creating national treatment strategy in order to prevent misuse of antimicrobials as an effort for antimicrobial stewardship. Documentation of changing trends of antimicrobial resistance
should be kept dedicatedly for future reference. Due to limited network sites in
current national surveillance system, there are loopholes in retrieving hospital based
literature. Improvement in surveillance networks by developing several sites at different locations will result in better data collection to highlight true picture of antimicrobial resistance in India (Walia et al. 2019; Wattal and Goel 2014).
2.7 Antimicrobial Resistance: A One Health Perspective
One Health is the combined effort of several health science professionals to conquer
optimal health for people, plants, wildlife, domestic animals, and environment (Fig.
2.1). The driving elements of antimicrobial resistance include antimicrobial use and
misuse in animal, human, and environment and the wide spread of resistant bugs
and factors conferring resistance within and between such segments and around the
globe (McEwen and Collignon 2018). Research and surveillance are essential
because they trace out antimicrobial resistance menace and how to deal with them
(WHO 2014, 2015). There are several gaps in our understanding of the multifarious
biology that characterizes the resistance associated with One Health dimensions,
but many innovation programs have been utilized in recent years that sustain
2 Global Surveillance Programs on Antimicrobial Resistance