The Pan American Health Organization
Promoting Health in the Americas

 Safe Hospitals

Health Surveillance & Disease Prevention & Control — Communicable Diseases: 
Acute Respiratory Infections - Anthrax - Antimicrobial Resistance - Campylobacter - Chagas -
Cholera - Dengue - Diarrheal/Enteric Diseases - Disease Outbreak News -
Emerging/Reemerging Diseases - Filariasis - Hantavirus - InfluenzaAvian |  Pandemic |  Seasonal - International Health Regulations - Leishmaniasis - Leprosy - Malaria -
Neglected Diseases - Parasitic Diseases - Rabies - Research - Salmonella - Shigella - Smallpox -
Tuberculosis - West Nile Virus  - Yellow Fever  -
Health Analysis & Statistics - Chronic Diseases - Veterinary Public Health

Disease Prevention and Control / Communicable Diseases / Antimicrobial Resistance

Annual Report of the Monitoring/Surveillance Network for Resistance to Antibiotics 2003

Reuniˇn 2004

2003 Annual Report
(in Spanish, 91 pp, PDF, 8629 Kb; chapter headings translated below for user orientation)

1. Introduction (translation to right)

2. Information from the Countries

Costa Rica

El Salvador

3. Results of the Performance Evaluation of the Coordinating Institutions of the National Networks
3.1 National Laboratory for Enteric Pathogens, Health Canada: Enteric Bacteria: Salmonella spp., Shigella spp., Vibrio cholerae
3.2 Enteric and Non-Enteric Bacterias
4. Recommendations
4.1 Surveillance Results
List of Participants
Species to Watch and Antibiotics that Should be Tested/Tried as of 2005

Previous Reports: 2002 | 2001

PAHO Antimicrobial Resistance Page

- WHO Drug Resistance Page
- WHO Pharamaceutical Products Page

Introduction  |   Recommendations


The annual report on surveillance of resistance to antibiotics in participating countries of the Region of the Americas is discussed and analyzed for the purpose of taking measures for continuous quality improvement of data and its usefulness in orienting clinicians on the rational use of antibiotics.

Starting in 1997, surveillance was initially directed at enteric bacteria: Salmonella, Shigella, and Vibrio cholerae. From 2000 onwards, other species existing in the community and in hospitals were included.

The information provided by each country is a consolidated overview of the information obtained from various health-care centers and, sometimes, different geographical areas; this means that its epidemiological value is limited. However, we cannot underestimate the importance of this information as a trend indicator and as a technical basis justifying the need to implement measures for the prevention and control of resistance to antimicrobial drugs.

Recommendations: All the countries should strengthen supervision activities in network laboratories, to ensure that NCCLS standards be followed.

Surveillance Results

  1. Surveillance results for 2004 can be presented in the tables in use up to now or in tables on the sensitivity tests with the following antibiotics for the different community or hospital species (see Annex). From 2005 onwards, the latter will exclusively be used.
  2. Differentiate what type of samples come from the isolations of Salmonella spp.:
    1. Human: community and hospital
    2. Veterinary (chicken, swine, cattle)
    3. Environmental
    4. Animal feed
    5. Food for human consumption
  3. Add the disk of nalidixic acid to the group of drugs to test for Salmonella spp. and Shigella spp.
  4. For the report on E. coli of community origin, only the results of the urine isolations will be included. For the countries that have such information by gender, the results will be reported separately for men and women.
  5. For the report on the results of resistance to S. pneumoniae and H. influenzae, only the results of the invasive isolations should be taken into account and samples should be separated for minors and children over six years of age.
  6. In cases of S. pneumoniae from pneumonia, it will be necessary to establish the susceptibility of the isolates to amoxicillin via CIM, since this is the treatment of choice.
  7. The percentages of resistance of S. pneumoniae should be presented differentiating the origin of the isolations (for example, meningeal infection, pneumonia, other localizations).
  8. The 2004 reports will include the corresponding information on sensitivity to antimicrobial drugs of Streptococcus ▀-hemolytic, N. gonorrhoeae and Campylobacter. ▀-hemolytic antibiotics to test in case of Streptococcus are eurythromycin, clindamycin, penicillin, and tetracycline; eurythromycin alongside clindamycin to determine the present resistance mechanism.
  9. The information on susceptibility to antibiotics will only include data on species causing infection and not colonization, except for what is explicitly mentioned and reported separately. Thus, information on swabs will not be included for case-finding in colonization with Enterococcus NPV R, Staphylococcus coagulase negatively contaminated from hemocutlives, etc.
  10. In tests for Staphylococcus spp. it will be necessary to add the cefoxitin disk, without foregoing testing of oxacillin. If necessary, use the teicoplanin disk.
  11. Due to its importance in the etiology of the hospital-acquired infection, the species Serratia spp. and Proteus mirabilis should be included in hospital surveillance.
  12. In samples of hospital origin, as of 2005, there will be only be reporting on results corresponding to the surveillance of Acinetobacter baumannii and not Acinetobacter spp.
  13. In the next meeting of the Network, the following will be discussed:
    1. the criteria for information on the performance-evaluation results carried out in every country; and
    2. standards for reporting results on intermediate resistance to third-generation cephalosporins of in enterobacteria (detection and confirmation of BLEE).
  14. Whenever SIREVA II data are mentioned, reference will be made to the program.

Regional Office for the Americas of the World Health Organization
525 Twenty-third Street, N.W., Washington, D.C. 20037, United States of America
Tel.: +1 (202) 974-3000 Fax: +1 (202) 974-3663

ę Pan American Health Organization. All rights reserved.