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Phase 1 (2005 Deadline)
Antimicrobial Resistance in Pakistan: a Program to Develop and Strengthen Capacity for Surveillance, Containment, and Diagnosis through Public-Private Sector Partnership
Mary Brandt, Centers for Disease Control and Prevention
Rumina Hasan, The Aga Khan Medical University
Pakistani Funding (HEC): $500,000
US Funding: $ 75,000
Dates on US Side: January 1, 2006 - March 31, 2010 (Completed)
Project Overview
The rising infectious disease burden in Pakistan is a major source of concern, and efforts to control such diseases are hampered by the incessant increase in antimicrobial resistance (AMR) in the country. This project initiated a data collection and compilation system to assess the prevalence of AMR and conduct molecular typing on selected bacterial strains. Information on AMR was disseminated to healthcare providers and professional organizations to help promote data-driven programs for the containment of AMR. Infection control measures were also promoted as important intervention strategies. To carry out the project, the principal investigators assembled a diverse multidisciplinary team with strengths in clinical microbiology, infectious diseases, epidemiology, and infection control, as well as linkages to key national and international institutions, including major Pakistani hospitals, research centers, and government agencies.
Major Results
- Established the Pakistan Antimicrobial Resistance Network to educate health professionals throughout Pakistan on appropriate use of antimicrobial drugs
- Developed a website for sharing information on antimicrobial resistance and infection control www.parn.org.pk
- Provided training at CDC for two long-term AKU visitors (three months each) and three short-term visitors (one or two weeks each) and delivered critical supplies and reagents to AKU
- Provided training sessions in Karachi for nearly 500 participants on infection control practices, smear microscopy for tuberculosis diagnosis and fungal identification
- Produced 26 articles accepted for publication in professional journals, as well as 29 posters and 17 presentations at national and international scientific meetings
- Facilitated PhD studies of three students and impacted at least 20 other Pakistani researchers and technical personnel
Progress Report Summaries
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2009 Show summary || Hide summary || Download full report
Dr. Brandt's travel funds were reprogrammed to support a two-month training visit by a young researcher from AKU, Dr. Joveria Farooqi, who visited the Mycotic Diseases Branch at CDC from June 7 to July 31, 2009. Her research project was to describe the species distribution and prevalence of antifungal resistance in hospital-related fungal infections in the AKU hospital. She brought with her a set of fungal isolates collected at AKU through sentinel surveillance for serious yeast infections. At CDC, Dr. Farooqi received training in reference identification and antifungal susceptibility testing of these isolates. In addition to standard morphologic methods, she was able to employ a novel DNA-based technology called the Luminex xMAP multianalyte profiling system, which allows rapid and specific identification of unknown yeast isolates. She also learned to conduct DNA sequencing of isolates that could not be identified using any other method. She received preliminary training in two methods of antifungal susceptibility testing, so that the prevalence of antifungal resistance in these infections could be determined. Unfortunately a family emergency necessitated her premature return to Pakistan after a stay of 7 weeks. CDC personnel completed the study and returned the data to Dr Farooqi so that a manuscript describing the prevalence of fungal infections in AKU could be written. During 2009, the participants in this project reported 9 journal articles published or accepted, plus another 7 poster presentations on their work. Although no large-scale training workshops or conferences were held this year, the project nevertheless helped foster the PhD studies of three Pakistani students and involved 20 other Pakistani researchers and technical personnel.
2008 Show summary || Hide summary || Download full report
To disseminate and share the information learned during these visits, mycology, parasitology, infection control and biosafety workshops were planned for 2008. In addition, CDC sent more than $12,000 worth of supplies and materials to AKU in 2008 to facilitate establishment of an antifungals testing laboratory. Dr. Brandt was able to travel to Islamabad in August 2008 to participate in the S&T conference, which gave her the opportunity to meet with Dr. Hasan, who was also in attendance. However, she was unable to travel to AKU due to the increased restrictions on travel by government personnel that were instituted in September 2008.
2007 Show summary || Hide summary || Download full report
Continuing their project after a very active year in which nearly 500 participants were trained in 2006, the Pakistani partners on this effort launched the Pakistan Antimicrobial Resistance Network (PARN) in 2007. To extend surveillance for antimicrobial resistance beyond Karachi and increase awareness about antimicrobial usage and surveillance for resistance, a national-level meeting was also held in Karachi in March 2007. Participants included clinical microbiologists and infectious diseases experts from Lahore, Islamabad, and various Armed Forces hospitals in addition to representatives from the National Institutes of Health and Pakistan Medical Research Council. A follow-up meeting was held in Islamabad on June 26, 2007, to discuss extending awareness about antimicrobial stewardship and surveillance to a larger number of public sector health facilities in the country. The aim of the meeting was to establish a network of hospitals in which systems could be developed for monitoring antimicrobial resistance and where resistance information could be utilized to institute appropriate antimicrobial policies. Issues of antibiotic misuse, surveillance for antimicrobial resistance, as well as educational programs to encourage good antibiotic prescribing practices and to develop strategies for appropriate antimicrobial usage were discussed.
Five training sessions on infection control practices were also held during 2007, providing training to approximately 250 medical personnel and hospital auxiliary staff, and a five-day workshop was held in May 2007 focusing on smear microscopy for tuberculosis diagnostics, following up on a similar workshop in 2006. In 2007, Noureen Saeed of AKU, who had visited in the summer of 2006, returned to CDC for three more months of mycology training and analytical work on fungal samples (June-September 2007), and three other AKU researchers received training at CDC and elsewhere.
2006 Show summary || Hide summary || Download full report
The major emphasis during this first year was to initiate and strengthen our collaborative base and to develop the infrastructure for the work defined in the proposal and for long term continuation of the work commenced during the three year period of this grant. Those activities in the first year included: 1) developing the infrastructure for collection and analysis of antimicrobial data at AKU and collaborating units and sharing this information with health care providers; 2) Conducting M.tuberculosis genotyping to identify strain types which predominate locally; 3) Establishing the method for typing methicillin resistant Staphylococcus aureus; 4) Holding workshops to provide training in infection control at a national level; 5) Improving diagnostic capacity for tuberculosis in a field based program; 6) Strengthening the capacity of AKU staff to identify and manage fungal diseases through visits to the CDC; 7) Emphasizing the importance of safe laboratory practices through provision of training in handling biosafety level 3 (BSL3) pathogens. The project also provided many opportunities for training and research to a large number of individuals. A workshop focusing on smear microscopy for tuberculosis diagnostics was held in Pakistan in 2006. On the US side, CDC hosted two AKU staff members, Ms. Shahida Qureshi and Ms. Maqboola Dojki, for a BSL-3 laboratory safety training course at Emory University in November 2006, and Ms. Quereshi stayed on for an additional two weeks gaining practical experience in the clinical microbiology laboratories at Emory.
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