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
2000
BOLIVIA
ECUADOR
2003
2002
GUATEMALA
PARAGUAY
2005
Coordination
PERU
EL SALVADOR
NICARAGUA
COSTA RICA
HONDURAS
PAHO/WHO
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
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)
20 National
720 Centinel Labs
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
175,000 isolates
Standardization and quality
1. Manuals for quality assurance & Training
activities
2. Biennial Meeting
3. Annual Report
Common quality standards
CLSI Spanish translation
QUALITY EVOLUTION INDICATORS OF THE
LATIN AMERICAN COUNTRIES
Susceptibiliy Testing Correlation
% Concordancia
100
IDEAL 90%
80
60
40
20
0
En c 1En c 2En c 3En c 4En c 5En c 6En c 7En c 8En c 9En c 1En
0 c 1En
1 c 1En
2 c 1En
3 c 1En
4 c 1 En
5 c 1En
6 c 17
Source: Alejandra Corso, INEI ANLIS Dr. Carlo G. Malbran, Argentina
Annual Reports
Methicillin Resistant Staphylococcus aureus
(hospital isolates)
Latin America AMR Surveillance Network, 2000 - 2005
10
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
13
Title of the Presentation
Promotion of the rational use of
antimicrobials
Epidemiological Alerts
KPC Argentina 2010
NDM Guatemala 2011
Guatemala
High-complexity
hospital
-
MRSA
IMP-resistant A.
baumanii
IMP-resistant P.
aeruginosa
ESBL + K.
pneumoniae
Cost of treating HAIs caused by multi-resistant
bacteria
Thousands (US$)
Roosvelt Hospital,
Guatemala City
733 beds
18
IMP-R
16
IMP-R
14
12
10
8
S
MRSA
R
6
ESBL
4
2
0
S. aureus
A. baumannii P. aeruginosa
K.
pneumoniae
Guatemala
High-complexity
hospital
-
MRSA
IMP-resistant A.
baumanii
IMP-resistant P.
aeruginosa
ESBL + K.
pneumoniae
Thousands (US$)
Roosvelt Hospital,
Guatemala City
733 beds
Cost of treating HAIs caused by multi-resistant bacteria
18
IMP-R
16
IMP-R
14
12
10
8
S
MRSA
R
6
ESBL
4
2
0
S. aureus
A. baumannii P. aeruginosa
K.
pneumoniae
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