Light in the face of Darkness, the critical role of a Clinical Microbiologist in AMS in the South African landscape

The challenge of antimicrobial resistance (AMR) feeds into the Global Health Security Agenda and the implementation of antimicrobial stewardship (AMS) is a national imperative on the Antimicrobial Resistance National Strategy Framework for 2017-2024 in South Africa. This framework was compiled in response to the Global Action Plan in providing a structure for the management of AMR which include 4 strategic objectives viz., (1) the establishment of national and health establishment governance to address AMR (2) the coordination of surveillance and early detection of AMR which enable reporting of resistance trends to optimise empiric and targeted antibiotic choice, (3) to enhance infection prevention and control to prevent the spread of resistant pathogens within the healthcare settings, with emphasis on hand hygiene, patient isolation, sanitation and vaccination (4) the implementation of antimicrobial stewardship to promote appropriate use of antimicrobials in human and animal health. This talk focuses on South Africa’s journey with particular reference to KwaZulu-Natal (KZN), on the implementation of antimicrobial stewardship programs (ASPs) in line with the National Action Plan. Amongst other health related challenges such as HIV and TB, KZN has taken bold steps towards the implementation of ASPs amidst resource constraints. The setting up of the provincial KZN AMS Committee as part of a national strategy has been crucial in the execution of various AMS related activities such as educational workshops, launching of awareness campaigns, training of healthcare workers and community engagement addressing AMR applicable to the South African landscape. A baseline situational analysis of AMS activities within KZN was key in identify areas of need with regard to AMS implementation at facility level. Facilitating community awareness, encouraging crucial interactions between healthcare workers and infection control practitioners in combination with AMS educational programs enabled the setting up of ASPs. The revolutionary role of the clinical microbiologist is one that is dynamic and critical with regard to AMS implementation as they form an integral component of the AMS team along with the microbiology laboratory. Rapid and reliable diagnostics in the diagnosis of infectious diseases encompassing pathogen identification and antimicrobial susceptibility aid in antimicrobial stewardship by reducing the time to appropriate antimicrobial therapy. Implementation of AMS strategies in rural areas is especially challenging due to the lack of resources, however, making use of available resources, empowering the less empowered and commitment to the cause are essential for successful ASPs. It is encouraging to note that research addressing AMR in the “One Health” context encouraging interdisciplinary collaboration between, human, veterinary and environmental sector is currently being carried out in KZN, South Africa.