Transcript Experiences from Regional Surveillance Networks
Antimicrobial Resistance Surveillance Latin America
Microbiology laboratories:
from routine clinical work to surveillance
The Latin American AMR Surveillance Network Focus: quality control in bacteriology & antimicrobial resistance
BOLIVIA ECUADOR PERU EL SALVADOR NICARAGUA Coordination PAHO/WHO GUATEMALA PARAGUAY COSTA RICA HONDURAS Supra national laboratories: INEI CG Malbran (ARGENTINA) Enteropathogens Lab (CANADA) PANAMA DOMINICAN REPUBLIC VENEZUELA URUGUAY CHILE MEXICO COLOMBIA BRAZIL CUBA 2011
TRINIDAD & TOBAGO
2013
THE BAHAMAS (?)
Pathogens under surveillance
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Nosocomial pathogens
Enterococcus spp.
Klebsiella pneumoniae
Acinetobacter spp.
Pseudomonas aeruginosa Staphylococcus aureus Escherichia coli Enterobacter spp.
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Community pathogens
Salmonella spp.
Shigella spp.
Vibrio cholerae Escherichia coli Neisseria meningitidis Neisseria gonorrhoeae Streptococcus pneumoniae H. influenzae
Campylobacter
S. β hemolítico S. aureus
CLSI Standards for susceptibility testing
Latin American AMR Surveillance Network (2012)
20 National Nat. Reference Labs Reference Labs Data reporting to the NRL National Microbiology Laboratory for Enteric Pathogens, Canada Instituto Nacional de Enfermedades Infecciosas, C. Malbrán, ANLIS, Argentina WHONET Information System 720 Centinel Labs 175,000 isolates
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Standardization and quality
Manuals for quality assurance & Training activities Biennial Meeting Annual Report
Common quality standards CLSI Spanish translation
QUALITY EVOLUTION INDICATORS OF THE LATIN AMERICAN COUNTRIES Susceptibiliy Testing Correlation
% C o n co rd a n cia 100
IDEAL 90%
80 60 40 20 0 Enc 1 Enc 2 Enc 3 Enc 4 Enc 5 Enc 6 Enc 7 Enc 8 Enc 9 Enc 10Enc 11Enc 12Enc 13Enc 14Enc 15 Enc 16Enc 17
Source: Alejandra Corso, INEI ANLIS Dr. Carlo G. Malbran, Argentina
Annual Reports
10 Methicillin Resistant Staphylococcus aureus ( hospital isolates ) Latin America AMR Surveillance Network, 2000 - 2005
Escherichia coli Ciprofloxacin resistance The Latin American AMR Surveillance Network, 2000-2005
Klebsiella spp Imipenem resistance The Latin American AMR Surveillance Network, 2000-2007
13 Title of the Presentation
Carbapenemases (KPC & NDM) 2013
Promotion of the rational use of antimicrobials
Epidemiological Alerts
KPC Argentina 2010 NDM Guatemala 2011
Guatemala
Roosvelt Hospital, Guatemala City 733 beds High-complexity hospital MRSA IMP-resistant A.
baumanii
IMP-resistant P.
aeruginosa
ESBL + K.
pneumoniae
Cost of treating HAIs caused by multi-resistant bacteria
18 16 14 12 10 8 6 4 2 0
MRSA IMP-R IMP-R ESBL
S. aureus A. baumannii P. aeruginosa K.
pneumoniae S R
Guatemala
Roosvelt Hospital, Guatemala City 733 beds High-complexity hospital MRSA IMP-resistant A.
baumanii
IMP-resistant P.
aeruginosa
ESBL + K.
pneumoniae
Cost of treating HAIs caused by multi-resistant bacteria
18 16 14 12 10 8 6 4 2 0
MRSA IMP-R IMP-R ESBL
S. aureus A. baumannii P. aeruginosa K.
pneumoniae S R
Conclusion & Challenges
• The LAC network has facilitated an extraordinary improvement in the quality of the laboratories, but still challenges are ahead: • • • Improve the quality of data (representative data and ensure validity of laboratory results) Foster analysis and publication of results at country level Use of the information: • • Advocacy at national level Strengthening the regional and national initiatives for rational use of antibiotics
Challenges
• • Continuos improvement of the quality of the laboratories • Timely dissemination of information • Molecular biology Linking surveillance & AMR containment
The basics and the bases to start AMR and HAI surveillance
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Agreement on the goal & main activities of the surveillance Need of technical coordination Communication mechanisms and commitments among the members of the network Agreement on relevant partners and its role Define the operational / technical details