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In 2019 an estimated 4.95 million deaths were associated with bacterial AMR. Prof Perovic discussed the following AMR initiatives:

• One Health surveillance for AMR regional outlook
• Regional and global perspective on AMR
• NICD determination of AMR burden in South Africa
• Surveillance up-to-date release from NICD dashboard, and GERMS nested projects
• One Health approach SA.

ReAct Africa

Africa’s response to Antimicrobial Resistance was accelerating One Health National Action Plans implementation for the next five years, at the 2022 meeting in Zambia.

Regional and global initiatives

Regional and global initiatives include:

• CARB-X (Combating Antibiotic Resistant Bacteria)
• CARB-X Seeking preventatives, diagnostics and therapeutics that address neonatal sepsis, gonorrhoea and the most threatening antimicrobial-resistant bacterial infections
• WHO CCs network in African region, combating antimicrobial-resistant bacteria.

The NICD surveillance programme for AMR supports the National Department of Health: To support national surveillance for policy decision and to identify gaps in AMR strategy. To determine, consolidate and monitor trends in AMR over the years. To understand impact of AMR within the public health concept.

AMR prevalence and transmission between animal feed and humans, 2020

The aim of the study was to determine the prevalence of AMR, measure the association between antimicrobial usage and the emergence of AMR, as well as determine the risk of transmission of AMR genes between the farm environment, farm employees and animals in commercial pig farms in South Africa.

Results from pig faecal droppings:

• • 113 fresh faecal droppings from 23 production houses (mating, farrow, weaning and growing)
  • Campylobacter spp 75 (66%)
    • Campylobacter coli 69 (61%) 67 /69 (97%) performed AST
    • Campylobacter hyointestinalis 7 (6%) 2/7 (28%) performed AST
  • E. coli 99 (87%)
    • Total of 106 for AST and PFGE.

The NICD approach is to perform tests of public health importance through surveillance, outbreak investigations
and research.

One Health AMR approach socioeconomic contributors

In developing nations, key contributors to antibiotic resistance identified included: (1) Lack of surveillance of resistance development, (2) poor quality control of available antibiotics, (3) clinical misuse, and (4) ease of availability. In contrast, in developed countries, factors contributing to antibiotic resistance included: (1) poor hospital-level regulation and (2) overuse of antibiotics in food-producing animals.

Looking forward

The way forward involves:

• • • Continuous improvement of surveillance programs and strengthening evidence
    • Integrated AMR surveillance from human, animal and environmental sectors
    • Designing information system to optimise and sustain One Health surveillance
    • Quantification of antimicrobial usage to determine the selective pressure and determine the association between antibiotic use and resistance
    • Engaging laboratories for public health relevant surveillance for AMR
    • Relate surveillance experience towards guidelines and policies of public health importance.