CAESAR
Central Asian and Eastern European
Surveillance on Antimicrobial Resistance
Dr Nienke van de Sande
Technical officer AMR
On behalf of the AMR programme
WHO Regional Office for Europe
Surveillance
of Antimicrobial
Resistance
for for
Local
and
Global
Surveillance
of Antimicrobial
Resistance
Local
and
GlobalAction
Action
Strengthening the fight against antimicrobial resistance in Bosnia
and
Herzegovina:
Stockholm,
Stockholm,Sweden
Sweden
current situation and future challenges, 29 October 2013
December2-3,
2-3,2014
2014
December
European Strategic action plan
on antibiotic resistance
1. Strengthen intersectoral coordination
2. Strengthen surveillance of antibiotic resistance
3. Promote rational use and strengthen surveillance
of antibiotic consumption
4. Strengthen infection prevention and control and
surveillance in health care settings
5. Prevent emerging resistance in veterinary and food sectors
6. Promote innovation and research on new drugs
7. Improve awareness, patient safety, and partnership
Surveillance
of Antimicrobial
Resistance
Local
and
GlobalAction
Action
Surveillance
of Antimicrobial
Resistance
for for
Local
and
Global
Stockholm,
Sweden
Strengthening the fight against antimicrobial resistance in Bosnia
and Herzegovina:
Stockholm,
Sweden
December
2-3, 2013
2014
current situation and future challenges,
29 October
December 2-3, 2014
CAESAR
Central Asian and Eastern European Surveillance on Antimicrobial Resistance
Network of national surveillance systems for antibiotic resistance in all countries of
the WHO European Region that are not part of EARS-Net (European Antimicrobial
Reistance Surveillance Network) run by ECDC (European Centre for Disease
Prevention and Control).
Provide comparable and validated data on the prevalence and trends of
antimicrobial resistance in a core group of invasive bacteria.
CAESAR methodology is fully compatible with EARS-Net
Surveillance
of Antimicrobial
Resistance
Local
and
GlobalAction
Action
Surveillance
of Antimicrobial
Resistance
for for
Local
and
Global
Stockholm,
Sweden
Strengthening the fight against antimicrobial resistance in Bosnia
and Herzegovina:
Stockholm,
Sweden
December
2-3, 2013
2014
current situation and future challenges,
29 October
December 2-3, 2014
EARS-Net
European Antimicrobial Resistance Surveillance Network at ECDC
P. aeruginosa Acinetobacter
6%
spp
S. pneumoniae
2%
7%
Pathogens under surveillance
 S. aureus (MRSA)
 S. pneumoniae (Pen R)
 E. coli (ESBL, Carbapenemases)
K. pneumoniae
10%
 K. pneumoniae (ESBL, Carbapenemases)
 E. faecium and E. faecalis (VRE)
 P. aeruginosa (MDR)
Enterococcus
 Acinetobacter spp. (MDR)
11%
E. coli
42%
S. aureus
22%
Methodology
 Blood and CSF isolates
 Sensitive (S), Intermediate (I), Resistant (R) interpretation
Percentage isolates per bacteria, 2013
 MIC, Zone diameter, Etest results
Data from EARS-Net, ECDC
 Basic patient characteristics (Age, Gender, ICU)
Surveillance
of Antimicrobial
Resistance
Local
and
GlobalAction
Action
Surveillance
of Antimicrobial
Resistance
for for
Local
and
Global
Stockholm,
Sweden
Strengthening the fight against antimicrobial resistance in Bosnia
and Herzegovina:
Stockholm,
Sweden
December
2-3, 2013
2014
current situation and future challenges,
29 October
December 2-3, 2014
Example of EARS-Net data.
K. pneumoniae: percentage of invasive isolates resistant
to carbapenems, 2005, 2010 and 2013. EARS-net data from ECDC
2013
2005
Arrows indicate significant
decreasing and increasing
national trends for 2010-2013
Colistin
resistance
8.8%
2010
Surveillance
of Antimicrobial
Resistance
Local
and
GlobalAction
Action
Surveillance
of Antimicrobial
Resistance
for for
Local
and
Global
Stockholm,
Sweden
Strengthening the fight against antimicrobial resistance in Bosnia
and Herzegovina:
Stockholm,
Sweden
December
2-3, 2013
2014
current situation and future challenges,
29 October
December 2-3, 2014
CAESAR & EARS-Net structure
Laboratories
National level
Data collection and Laboratory
procedures standardized:
- CAESAR manual/EARS-Net
reporting protocol
- Standard Operating Procedures
- EUCAST or CLSI guideline
- Quality assurance (national and
international)
- Reference laboratory/National
coordination center
International level
Surveillance
of Antimicrobial
Resistance
Local
and
GlobalAction
Action
Surveillance
of Antimicrobial
Resistance
for for
Local
and
Global
Stockholm,
Sweden
Strengthening the fight against antimicrobial resistance in Bosnia
and Herzegovina:
Stockholm,
Sweden
December
2-3, 2013
2014
current situation and future challenges,
29 October
December 2-3, 2014
CAESAR & EARS-Net structure
Laboratories
National level
International level
Feedback to National level and
Laboratories:
- Summary of AMR data
- Data quality and Confirmation of
results
- Unusual resistance phenotypes
CAESAR/EARS-Net EQA:
- 6 strains send to laboratories by
UK-NEQAS (PHE)
- Laboratories receive Individual
feedback reports
Surveillance
of Antimicrobial
Resistance
Local
and
GlobalAction
Action
Surveillance
of Antimicrobial
Resistance
for for
Local
and
Global
Stockholm,
Sweden
Strengthening the fight against antimicrobial resistance in Bosnia
and Herzegovina:
Stockholm,
Sweden
December
2-3, 2013
2014
current situation and future challenges,
29 October
December 2-3, 2014
CAESAR & EARS-Net
• Only blood isolates and
CSF are collected
• Countries are encouraged
to expand national AMR
surveillance according to
local needs and capacity
• Tip of the iceberg, but a
good start!
Surveillance
of Antimicrobial
Resistance
Local
and
GlobalAction
Action
Surveillance
of Antimicrobial
Resistance
for for
Local
and
Global
Stockholm,
Sweden
Strengthening the fight against antimicrobial resistance in Bosnia
and Herzegovina:
Stockholm,
Sweden
December
2-3, 2013
2014
current situation and future challenges,
29 October
December 2-3, 2014
Country situation analysis
• Country situation analysis
– Visit key Ministries, institutions, agencies, laboratories
– Mission report with observations and recommendations
• Goal
– Appointment of National AMR Focal Point (ToR)
– Installation of Intersectoral Coordination Mechanism (ToR)
– Development of national AMR action plan (Country examples)
– Define needed steps to start participating in CAESAR
• Follow-up activities: Consultancy, Twinning,
Stakeholder meetings, …
Surveillance
of Antimicrobial
Resistance
Local
and
GlobalAction
Action
Surveillance
of Antimicrobial
Resistance
for for
Local
and
Global
Stockholm,
Sweden
Strengthening the fight against antimicrobial resistance in Bosnia
and Herzegovina:
Stockholm,
Sweden
December
2-3, 2013
2014
current situation and future challenges,
29 October
December 2-3, 2014
National and Multi-country
workshops
Main topics national workshops:
-
EUCAST guidelines, principles of antmicrobial susceptibility testing
and interpretations
-
Quality control and the Role of a National AMR reference center
-
CAESAR methodology, national AMR surveillance, epidemiology,
WHONET
Surveillance
of Antimicrobial
Resistance
Local
and
GlobalAction
Action
Surveillance
of Antimicrobial
Resistance
for for
Local
and
Global
Stockholm,
Sweden
Strengthening the fight against antimicrobial resistance in Bosnia
and Herzegovina:
Stockholm,
Sweden
December
2-3, 2013
2014
current situation and future challenges,
29 October
December 2-3, 2014
CAESAR - Expanding AMR
surveillance throughout Europe
Countries submitting data to CAESAR
Countries visited for CAESAR participation
Countries to be visited for CAESAR participation
Countries participating in EARS-Net
13 countries participated in
the CAESAR-EQA in 2014
Surveillance
of Antimicrobial
Resistance
Local
and
GlobalAction
Action
Surveillance
of Antimicrobial
Resistance
for for
Local
and
Global
Stockholm,
Sweden
Strengthening the fight against antimicrobial resistance in Bosnia
and Herzegovina:
Stockholm,
Sweden
December
2-3, 2013
2014
current situation and future challenges,
29 October
December 2-3, 2014
Main CAESAR challenges
• Laboratory capacity: appropriate species ID,
standardized AST, harmonization of breakpoints, EQA
• Education of laboratory personnel
• Implementation of updated guidelines
and SOP in laboratory practice
• Improve sampling habits and utilisation
of medical microbiologic diagnostics
• Improve laboratory information management
Health System Strengthening / Quality Control / Sustainability
Surveillance
of Antimicrobial
Resistance
Local
and
GlobalAction
Action
Surveillance
of Antimicrobial
Resistance
for for
Local
and
Global
Stockholm,
Sweden
Strengthening the fight against antimicrobial resistance in Bosnia
and Herzegovina:
Stockholm,
Sweden
December
2-3, 2013
2014
current situation and future challenges,
29 October
December 2-3, 2014
Upcoming CAESAR activities
• National AMR workshops and Country situation analysis
• First CAESAR Annual Report 2014
• Feedback CAESAR EQA 2014 & prepare EQA 2015
• Pilot Proof-of-principle study to Improve sampling habits and
utilisation of medical microbiologic diagnostics in Tbilisi, Georgia
• Multi-country workshop with focus on the role of an AMR reference
centre, February 2015, Copenhagen, Denmark
• CAESAR Network meeting at ECCMID, 25-28 April 2015,
Copenhagen, Denmark
Surveillance
of Antimicrobial
Resistance
Local
and
GlobalAction
Action
Surveillance
of Antimicrobial
Resistance
for for
Local
and
Global
Stockholm,
Sweden
Strengthening the fight against antimicrobial resistance in Bosnia
and Herzegovina:
Stockholm,
Sweden
December
2-3, 2013
2014
current situation and future challenges,
29 October
December 2-3, 2014
Partnership
Surveillance of Antimicrobial Resistance for Local and Global Action
Strengthening the fight against antimicrobial resistance in Bosnia
and Herzegovina:
Stockholm,
Sweden
current situation and future challenges, 29 October 2013
December 2-3, 2014
CAESAR project group
CAESAR Project Group
ESCMID - Assoc. Prof Christian Giske, Dr. Robert Skov
RIVM – Dr. Tjalling Leenstra, Jos Monen
WHO Europe – Dr. Danilo Lo Fo Wong, Dr. Saskia Nahrgang,
Dr. Nienke van de Sande
Pool of experts
Dr Bela Kosciz (Hungary), Roman Kozlov (Russia), Prof Arjana
Tamic (Croatia), Dr Iva Butic (Croatia), Dr Oskar Ekelund
(Sweden), Ass. Prof. Onur Karatuna (Turkey), Katja Seme
(Slovenia), Prof Waleria Hryniewicz (Poland), Prof Jan Prins (The
Netherlands), Prof Murat Akova (Turkey), Dr Nandine Shetty
(United Kingdom), Marieke van der Lubben (The Netherlands),
Rob Riesmeijer (The Netherlands), Dr Peet Tul (Sweden), Dr
Osman Cirit (Turkey), …
Surveillance of Antimicrobial Resistance for Local and Global Action
Strengthening the fight against antimicrobial resistance in Bosnia
and Herzegovina:
Stockholm,
Sweden
current situation and future challenges, 29 October 2013
December 2-3, 2014
Acknowledgments WHO Europe
•
•
•
•
Division of Communicable Disease, Health
Security & Environment
– Guenael Rodier
– Cristiana Salvi
AMR Coordination
– Danilo Lo Fo Wong
– Nienke van de Sande-Bruinsma
– Saskia Nahrgang
Food Safety
– Hilde Kruse
Alert and Response Operations
– Ana Paula Coutinho
– Jukka Pukkila
•
•
•
•
•
Health Technologies and Pharmaceuticals
– Hanne Bak Pedersen
– Nina Sautenkova
– Ganna Bolokhovets
Health Systems and Public Health
– Hans Kluge
Influenza & other Respiratory Pathogens
– Caroline Brown
Vaccine Preventable Diseases & Immunization
– Robb Butler
WHO Country offices
Surveillance of Antimicrobial Resistance for Local and Global Action
Strengthening the fight against antimicrobial resistance in Bosnia
and Herzegovina:
Stockholm,
Sweden
current situation and future challenges, 29 October 2013
December 2-3, 2014
CAESAR/AMR focal points
Non-EU member states: Dr Lindita Molla (Albania) Dr Kristina Gyurjyan (Armenia), Dr Nazifa Mursalova
(Azerbaijan), Prof Leonid Titov (Belarus), Prof Mirsada Hukic, Dr Amela dedeic-Ljubovic & Dr Pava Dimitrijevic
(Bosnia Herzegovina), Prof Paata Imnadze (Georgia), (Israel), Dr Lul Raka (Kosovo*), Dr Baktygul Ismailova &
Dr Baktygul Kambaralieva (Kyrgyzstan), Dr Golubinka Bosevska (FYR Macedonia), Dr Radu Cojocaru
(Moldova), Prof Gordana Mijovic (Montenegro), Prof Roman Kozlov (Russia), Prof Zora Jelesic (Serbia), Dr
Andreas Kronenberg (Switzerland), Dr Azamjon Safolovich Mirzoev (Tajikistan), Dr Husniye Simsek (Turkey), Dr
Gurbangul Ovliyakulova (Turkmenistan), Dr Aidyn Salmanov (Ukraine), Dr Gulnora Abdukhalilova (Uzbekistan)
*in accordance with the United Nations Security Council Resolution 1244 (1999)
Surveillance
of Antimicrobial
Resistance
Local
and
GlobalAction
Action
Surveillance
of Antimicrobial
Resistance
for for
Local
and
Global
Stockholm,
Sweden
Strengthening the fight against antimicrobial resistance in Bosnia
and Herzegovina:
Stockholm,
Sweden
December
2-3, 2013
2014
current situation and future challenges,
29 October
December 2-3, 2014