The session highlights the patient centred surveillance of drug resistant pathogens through case study, antimicrobial resistance challenges and the efforts to tackle this. 

The Global Burden of Antimicrobial Resistance data has demonstrated that there were almost 1.27 million deaths attributed to antimicrobial resistance (AMR); 80% of these deaths were due to 6 pathogens only. By 2050, about 10 million deaths as a result of AMR  are predicted. Post the COVID-19 pandemic there is a rise in drug-resistant pathogens due to excessive use of antibiotics. On the other side, antimicrobial stewardship facilitated by technology is a positive step towards AMR. The technology can help in patient-centered surveillance. Tailored surveillance is the foundation of infectious disease management. It can help us with individual patient management nationally. It helps inform health policies globally and it warns us about emerging threats. However, the lack of standard reporting protocols does not allow us to compare data temporally or across geographic areas. For understanding the epidemiology of AMR, it is important to know the consumption of in humans and animals ideally, the resistance rates and make it patient centered with rapid molecular testing. This may improve empiric antibiotic therapy. With patient centered surveillance, one can delineate the pathogens that are associated with it along with the resistance patterns that are associated with that particular pathogen. In addition, novel antibiograms can give an empiric antibiotic combination choice which is likely to improve empiric therapy for patients.

There is a case fatality rate of 45% in patients with third generation cephalosporin resistant microbes. This creates problems in the management of sepsis. In the context of Malawi, life-threatening febrile illnesses are common and require antibiotic usage. However, frequently the wrong microbes are treated with ceftriaxone. As compared to drug susceptible disease, drug-resistant infection is associated with greater morbidity and economic cost. ESBL E. coli and K. pneumonia are very commonly found in Malawi. Azithromycin and ceftriaxone are most commonly used antibiotics to manage infections; however, ceftriaxone is promoting the carriage of ESBL bacteria out of the hospital. 

Despite pharmaceutical industry representatives assuring that their drug may have a lower propensity to induce antimicrobial resistance, the history of antimicrobials point towards the fact that antimicrobial resistance will always occur. AMR is causing deaths globally with a greater problem in some parts of the world versus others. Lower respiratory tract infections are associated with the greatest number of deaths associated with the resistance. Having the MIC data and dosing solutions for efficacy can help manage AMR.

SS11 International Society for Infectious Diseases (ISID) Congress 2022, 17^th-20^th Nov. 2022, Malaysia