antimicrobial resistance surveillance latin america
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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
GUATEMALA
NICARAGUAEL SALVADOR
ECUADOR
PERU
BOLIVIA
PARAGUAYSupra national laboratories:INEI CG Malbran (ARGENTINA)
Enteropathogens Lab (CANADA)
Coordination
PAHO/WHO
COSTA RICAHONDURAS
PANAMADOMINICAN REPUBLIC
VENEZUELAURUGUAY
CHILE
2000
2002
2003
MEXICOCOLOMBIABRAZILCUBA2
005 2011 TRINIDAD & TOBAGO
2013 THE BAHAMAS (?)
Pathogens under surveillance
Nosocomial pathogens• Enterococcus spp.• Klebsiella pneumoniae• Acinetobacter spp.• Pseudomonas
aeruginosa• Staphylococcus aureus• Escherichia coli• Enterobacter spp.
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)
WHONET
Information System
Nat. Reference Labs
Data reporting to the NRL
20 National
Reference Labs 720 Centinel Labs
175,000 isolates
National Microbiology Laboratory for Enteric Pathogens, Canada
Instituto Nacional de Enfermedades Infecciosas, C. Malbrán, ANLIS, Argentina
Standardization and quality
1. Manuals for quality assurance & Training activities
2. Biennial Meeting 3. Annual Report
Common quality standardsCLSI Spanish translation
Susceptibiliy Testing Correlation
% Concordancia
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 170
20
40
60
80
100 IDEAL 90%
Source: Alejandra Corso, INEI ANLIS Dr. Carlo G. Malbran, Argentina
QUALITY EVOLUTION INDICATORS OF THE LATIN AMERICAN
COUNTRIES
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
Carbapenemases (KPC & NDM)2013
Title of the Presentation13
Promotion of the rational use of antimicrobials
Epidemiological Alerts
KPC Argentina 2010
NDM Guatemala 2011
Guatemala
Roosvelt Hospital, Guatemala City733 beds
High-complexity hospital
- MRSA- IMP-resistant A.
baumanii- IMP-resistant P.
aeruginosa - ESBL + K.
pneumoniae
0
2
4
6
8
10
12
14
16
18
S. aureus A. baumannii P. aeruginosa K.pneumoniae
Thousands (U
S$)
S
R
Cost of treating HAIs caused by multi-resistant bacteria
MRSA
IMP-RIMP-R
ESBL
Guatemala
Roosvelt Hospital, Guatemala City733 beds
High-complexity hospital
- MRSA- IMP-resistant A.
baumanii- IMP-resistant P.
aeruginosa - ESBL + K.
pneumoniae
0
2
4
6
8
10
12
14
16
18
S. aureus A. baumannii P. aeruginosa K.pneumoniae
Thousands (U
S$)
S
R
Cost of treating HAIs caused by multi-resistant bacteria
MRSA
IMP-RIMP-R
ESBL
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
1. Agreement on the goal & main activities of the surveillance
2. Need of technical coordination 3. Communication mechanisms and
commitments among the members of the network
4. Agreement on relevant partners and its role
5. Define the operational / technical details
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