building a public national system for antimicrobial ... · pdf filebuilding a public national...

Building a public national system

for antimicrobial resistance

surveillance in Argentina

“THE MICROBIAL

CHALLENGE – AN EMERGING THREAT TO

HUMAN / ANIMAL HEALTH”

Marcelo Galas

Buenos Aires

Argentina

República Argentina

Towards a Global Research Agenda for AMR

OBJECTIVES 3 April 2014 |Brussels|Belgium

Systemic new antibiotics aproved by fda between 1983-2012

Boucher H. Clinical Infectious Diseases 2013;56(12):1685–94

Increasing of CIP Non Susceptibility in

NG between 1995 and 2008

0,02,04,06,08,010,012,014,016,018,020,022,024,0

Iso

late

, %

Resistance Intermediate

In 1993, CIP was reccomended as first line drug to treat gonorrhoea by the

Ministry of Health of Argetnina and begun the resistance monitoring

Between 1993 and 1995, the isolates were highly susceptibles to this drug

In 1996 was detected the first strain with reduced susceptibility in Buenos Aires

National Network for Surveillance of STI. Dr P. Galarza

Increasing of CIP NS in NG 2007 – 2011 by region

Antimicrobial resistance In ACI for commonly

used antibiotics between 2000 and 2011

Nosocomial acquired isolates. 89 hospitals. N=1411

Dissemination of carbapenemases (oxas) responsible for XDR

“To obtain reliable, appropriate and reproducible microbiological data, to

be used for the improvement of patient care and the strengthening of the surveillance program through the

implementation of sustainable quality guaranty programs”

Mission of Argentinian Network for Antimicrobial Resistance Surveillance

O

B

J

E

C

T

I

V

E

S

Surveillance of Antimicrobial Resistance.

WHONET – Argentina Network

Orientation of empirical therapy

Collaboration in prevention, detection and control of

Health care asociated infections

Local, Regional and National strategies for

antimicrobial agents use

Early detection of new resistance mechanisms and

dissemination control

Design and evaluation of strategies for the antimicrobial

resistance control

Strengthening of Provincial and Regional Reference

Centers for AR surveillance and QC for peripherals Hosp

Representative and stable network

WHONET Argentina

Network

characteristics

and mode of

operation

WHONET – Argentina

Network 2013

96 laboratories

20

11

2 3

2

8

2

3

2

2

2

2

2 4

3

4

2

2

2

2

7

3

2

4

20

11

2 3

2

8

2

3

2

2

2

2

2 4

3

4

2

2

2

2

7

3

2

4

Laboratories Members 1/3 HOSPITAL FOCAL POINT

HOSPITAL HIGA PRESIDENTE PERON MARIA ADELAIDA ROSSETTI

HOSPITAL ZONAL MATERNO INFANTIL ARGENTINA DIEGO ANA MOLA

HOSPITAL HIGA "DR JOSE PENNA" MARIA LUZ BENVENUTTI - MABEL RIZZO

HOSPITAL LEONIDAS LUCERO DINA PEDERSEN

HIGA VICENTE LOPEZ Y PLANES HEBE GULLO

HOSPITAL NACIONAL PROF.DR. ALEJANDRO POSADAS ADRIANA DI BELLA y ADRIANA FERNANDEZ LAUSI

HOSPITAL GOBERNADOR MERCANTE SANDRA KARINA BOGNANI

HIGA "DR. A. PIÑEYRO" - JUNIN MONICA MACHAIN

HOSPITAL DE AGUDOS SOR MARIA LUDOVICA CECILIA VESCINA - MARISA BETTIOL

HOSPITAL SAN JUAN DE DIOS ANDREA SILVIA PACHA - RICARDO CABRERA

HOSPITAL INTERZONAL GENERAL DE AGUDOS “EVITA” ANA TOGNERI

HOSPITAL DR. CARLOS BOCALANDRO NORY CERDA - CAROLINA VACCINO

HOSPITAL PRIVADO DE LA COMUNIDAD VALLEJO MONICA ALICIA

INSTITUTO NACIONAL DE EPIDEMIOLOGÍA JUAN JARA SILVINA LAVAYEN

HOSPITAL AUSTRAL VIVIANA VILCHES

HOSPITAL INTERZONAL DE AGUDOS EVA PERON MARISA ALMUZARA - ALICIA TUDURI

HOSPITAL SANTAMARINA MONICA SPARO

HOSPITAL MUNICIPAL "DR. PEDRO T. ORELLANA" MARIA CECILIA BARRACCHIA

HOSPITAL ANTONIO A. CETRANGOLO ANA SANGOY - LAURA BIGLIERI

HOSPITAL ZONAL DE AGUDOS VIRGEN DEL CARMEN ADRIANA MELO

BUENOS AIRES

HOSPITAL FOCAL POINT

FLENI NORA ORELLANA

HOSPITAL DE CLINICAS "JOSE DE SAN MARTIN" ANGELA FAMIGLIETTI - CARLOS VAY

HOSPITAL DE INFECCIOSAS FRANCISCO JAVIER MUÑIZ MIRIAM MORTARINI - RAQUEL ROLLET

HOSPITAL DE PEDIATRIA S.A.M.I.C. PROF.DR. JUAN GARRAHANCLAUDIA HERNANDEZ

HOSPITAL DONACION F. SANTOJANNI CLAUDIA ALFONSO - CECILIA ORMAZABAL

HOSPITAL ELIZALDE ROXANA PEREDA

HOSPITAL FERNANDEZ LAURA ERRECALDE - SARA KAUFMAN

HOSPITAL GRAL. DE AGUDOS PARMENIO PIÑERO CELESTE LUCERO - FLAVIA AMALFA

HOSPITAL GRAL.DE AGUDOS DR.COSME ARGERICH NORA ALEJANDRA GOMEZ

HOSPITAL NIÑOS DR.RICARDO GUTIERREZ MIRIAM VAZQUEZ - ESTEFANIA BIONDI

HOSPITAL UNIVERSITARIO FUNDACIÓN FAVALORO PATRICIA ANDRES - ANALIA FERNANDEZ

CAPITAL FEDERAL


HOSPITAL DE NIÑOS DE CATAMARCA SILVIA MARIELA FARFAN

HOSPITAL INTERZONAL SAN JUAN BAUTISTA VIVIANA DEL VALLE DAVID

CATAMARCA


HOSPITAL 4 DE JUNIO - DR. RAMON CARRILLO NORMA ESTHER CECH

HOSPITAL "DR JULIO PERRANDO" ISABEL ANA MARQUES

HOSPITAL PEDIATRICO "AVELINO LORENZO CASTELLAN" ANA MARIA ZALOFF DAKOF

CHACO


HOSPITAL REG "DR. SANGUINETTI" COMODORO RIVADAVIA MARCIA BERNALDO DE QUIROS - SUSANA ORTIZ

HOSPITAL ZONAL ESQUEL OMAR DAHER

CHUBUT

20

11

2 3

2

8

2

3

2

2

2

2

2 4

3

4

2

2

2

2

7

3

2

4


CLINICA PRIVADA "REINA FABIOLA" MARINA BOTTIGLIERI

CLINICA PRIVADA VELEZ SARSFIELD LIDIA WOLFF DE JAKOB

HOSPITAL DE NIÑOS DE LA SANTISIMA TRINIDAD DE CORDOBAPATRICIA MONTANARO - PAREDES MARISA

HOSPITAL DOMINGO FUNES LILIA CAMISASSA

HOSPITAL GUILLERMO RAWSON ANA MARIA LITTVIK - TERESA NILDA LOPEZ

HOSPITAL INFANTIL MUNICIPAL DE CORDOBA LILIANA LORENA GONZALEZ

HOSPITAL PEDIATRICO DEL NIÑO JESUS PAULO CORTES - PATRICIA GONZALEZ

HOSPITAL PASTEUR CLAUDIA AIMARETTO DE COSTABELLA

CORDOBA


HOSPITAL ANGELA I. LLANO ANA MARIA PATO

HOSPITAL JUAN PABLO II SANDRA MARISA PIERLORENZI

CORRIENTES


HOSPITAL MASVERNAT NORMA YOYA - MARIA OFELIA MOULINS

HOSPITAL MATERNO INFANTIL SAN ROQUE MARIA SILVIA DIAZ - LORENA SOLEDAD DEL BARCO

HOSPITAL SAN MARTIN FRANCISCO SALAMONE

ENTRE RIOS


HOSPITAL CENTRAL DE FORMOSA NANCY PEREYRA

HOSPITAL DE LA MADRE Y EL NIÑO MARIA SILVANA VIVALDO

FORMOSA


HOSPITAL DE NIÑOS DR. HECTOR QUINTANA MARCELO TOFFOLI

HOSPITAL PABLO SORIA MARIA SILVIA WEIBEL, SILVIA GROSSO

JUJUY


ESTABLECIMIENTO ASISTENCIAL GOBERNADOR CENTENO ADRIANA PEREYRA

HOSPITAL LUCIO MOLAS GLADYS MARGARITA ALMADA

LA PAMPA


HOSPITAL DE LA MADRE Y EL NIÑO KARINA CONTRERAS

HOSPITAL REGIONAL "DR ENRIQUE VERA BARROS" SONIA FLORES DE GALIMBERTI

LA RIOJA


HOSPITAL CENTRAL DE MENDOZA LORENA CONTRERAS - MIGUEL ANGEL DISTEFANO

HOSPITAL NOTTI BEATRIZ CRISTINA GARCIA

HOSPITAL TEODORO SCHESTAKOW ADRIANA ACOSTA - ADA ZANUSO

MENDOZA


HOSPITAL SAMIC ELDORADO MISIONES ANA MARÍA MIRANDA

HOSPITAL DE NIVEL III OBERÁ CRISTINA ALICIA GONZALEZ - ERICA GERLACH

HOSPITAL DR. RAMON MADARIAGA VIVIANA CLAUDIA VILLALBA - GLADYS BELLO VELAZQUEZ

HOSPITAL PROVINCIAL DE PEDIATRIA "Dr. Fernando Barreyro". MARTHA HELENA VON SPECHT

MISIONES


HTAL DE JUNÍN DE LOS ANDES ABEL ZURSCHMITTEN

HOSPITAL HELLER HERMAN FRANCISCO SAUER

HOSPITAL PROVINCIAL NEUQUEN "DR. CASTRO RENDON" MARIA ROSA NUNEZ - MARIA MARTA SCHINCHIRIMINI

NEUQUEN

20

11

2 3

2

8

2

3

2

2

2

2

2 4

3

4

2

2

2

2

7

3

2

4


HOSPITAL ZONAL BARILOCHE NESTOR BLAZQUEZ, SABRINA DE BUNDER

HOSPITAL AREA CIPOLLETTI MARIELA RONCALLO -CRISTINA CARRANZA

HOSPITAL GENERAL ROCA DANIELA ALEJANDRA DURANY - GONZALO CROMBAS

HOSPITAL ARTEMIDES ZATTI GRACIELA STAFFORINI

RIO NEGRO


HOSPITAL SAN VICENTE DE PAUL SILVIA GRACIELA AMADOR

HOSPITAL PUBLICO MATERNO INFANTIL ANA BEREJNOI - NORMA SPONTON

SALTA


HOSPITAL MARCIAL QUIROGA HUGO CASTRO - NANCY RUTH VEGA

HOSPITAL GUILLERMO RAWSON ROBERTO NAVARRO

SAN JUAN


POLICLINICO CENTRAL DE SAN LUIS HUGO ARMANDO RIGO

POLICLINICO REGIONAL DE VILLA MERCEDES CARINA CHIRINO

SAN LUIS


HOSPITAL ZONAL CALETA OLIVIA "PADRE TARDIVO" GUILLERMO RAMÓN GARCÍA - JOSEFINA VILLEGAS

HOSPITAL REGIONAL RIO GALLEGOS WILMA KRAUSE - ALEJANDRA VIVIANA VARGAS

SANTA CRUZ


ABC HOSPITAL ESPAÑOL DE ROSARIO NOEMI BORDA - RODOLFO NOTARIO

CEMAR MONICA BORGO - STELLA MURA

FACULTAD BIOQUIMICA ROSARIO, HTAL CENTENARIO PATRICIA MARCHIARO - EMA SUTICH

HOSPITAL DE NIÑOS V. J. VILELA ADRIANA ERNST -ANDREA BADANO

HOSPITAL ROQUE SAENZ PENA GRACIELA ARCIERO - ADRIANA DI COSCO

HOSPITAL DE NIÑOS "DR. O. ALLASIA" MARIA ROSA BARONI

HOSPITAL DR. JOSE MARIA CULLEN EMILCE MENDEZ - ANALIA MOLLERACH

SANTA FE


HOSPITAL DE NIÑOS EVA PERON MARIA ELISA PAVON

HTAL. REGIONAL "DR. RAMON CARRILLO" ANA MARIA NANNI - MARIANA CRAGNOLINO

SANTIAGO DEL ESTERO


HOSPITAL REGIONAL RIO GRANDE MARCELA FABIANA VARGAS

HOSPITAL REGIONAL DE USHUAIA MANUEL FABIAN BOUTUREIRA

TIERRA DEL FUEGO


CENTRO DE MICROBIOLOGIA MEDICA MARIA ANGELA JURE

HOSPITAL DEL NIÑO JESUS ANA CRISTINA VILLAGRA - JOSE DANIEL ASSA

HOSPITAL PADILLA AMALIA DEL VALLE AMILAGA

HOSPITAL AVELLANEDA NORMA MERCEDES CUDMANI

TUCUMAN

0

50

100

150

200

250

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

Isolates by year (thousands)

años

Evolution of WHONET – Argentina Network

1992 – 2013

0

10

20

30

40

50

60

70

80

90

100N Hosp

17% have VITEK or PHOENIX and account for the 40 % of isolates collected


Agreed common protocol

WHONET Argentina

Network

characteristics

and mode of

operation

Salmonella sp, Shigella spp

Antibiograma de mínima sólo para diarreas (una placa)

1. Ampicilina

2. Trimetoprima /sulfametoxazol

3. Ciprofloxacina1

4. Cefpodoxima2,3

5. Ac. Nalidíxico4

6. Fosfomicina 7. Cloranfenicol (sólo para Salmonella) 7’. Nitrofurantoína (sólo para Shigella)


Standardized methodology (CLSI)

Internal and external Quality Control

WHONET Argentina

Network

characteristics

and mode of

operation


INTERNAL QUALITY CONTROL

Susceptibility Test

Standards ATCC:

E. coli ATCC ® 25922

E. coli ATCC ® 35218

P. aeruginosa ATCC ® 27853

S. aureus ATCC ® 25923

E. faecalis ATCC ® 29212

IDEAL WEEKLY

ACEPTABLE EACH TWO WEEK

Standards ATCC

K. pneumoniae ATCC ® 700603

S. aureus ATCC ® 43300

E. faecalis ATCC ® 51299

H. influenzae ATCC ® 49247

H. influenzae ATCC ® 49766

S. pneumoniae ATCC ® 49619

EACH TIME THE TEST IS PERFORMED

Standards ATCC K. pneumoniae ATCC ® 700603

H. Influenzae ATCC ® 10211

EACH TIME A NEW BACH OF DISKS IS MADE

(C3G+CLAV) OR LOT OF HTM IS PREPARED

From 1990….

Funded by Dr. Alicia Rossi



Data dissemination

Alerts Systems


Building capacities and Research projects

Focus on Improving Clinical Diagnostic

WHONET Argentina

Network

characteristics

and mode of

operation


Training strategies Building capacities

•Courses

•Workshops

•On web

•Bulletins

•Training in LNR

•Technical visits

- MIDAS Project – Early Outbreak detection. Modeling Infectious Diseases Agent

Study

- Characterization study of mechanisms of resistance to quinolones in ETB

- Molecular characterization of serotype 19A of Streptococcus pneumoniae

causing invasive infections in children from Arg between the 1994-2013 period

- Epidemiological and molecular characterization of carbapenemase producing

clinical isolates. This project collect isolates through the country

- Molecular characterization and virulence factors in methicillin resistant

Staphylococcus aureus isolates recovered in hospitals and in the community of

Argentina

- Characterization of Enterococci and Staphylococci clinical isolates recovered

from national hospitals

- Characterization of ESBLs in Enterobacteriaceae of Argentine

- Characterization of MLS resistance in Staphylococcus and β-haemolitic

Streptococcus

- Phenotipic and Molecular Characterization of resistance to ß-lactamic antibiotics

in clinical isolates of Enterobacteriaceae and no fermenters gram - bacilli in Arg

- Characterization of all the strains that the labs send us



Data dissemination

Alerts Systems




Referential Diagnostic - Provincial Networks


Data collected monthly

WHONET Argentina

Network

characteristics

and mode of

operation

WHONET Argentina

Network

characteristics

and mode of

operation



Data dissemination

Alerts Systems



Referential Diagnostic - Provincial Networks


Data collected monthly

Software WHONET


http://www.whonet.org

Structure of the Argentinian Laboratory Networks

System

Ministry of Health

Secretariat of Policies, Regulations and

Institutes

National Administration of Laboratories and

Health Institutes

National Institute of Infectious

Diseases

National Centre of Laboratory

Networks

Other Health

Institutes

Thematics Laboratory

Networks

(Reference Labs)

Provincial

Laboratory

Networks

Thematics

network member

(Hospitals)

Jurisdictional

Coordinators (Prov.

Ministry of Health)


System

Jurisdictional

Coordinators (Prov.

Ministry of Health)

1 by Province

Coordinate all the public

Provincial Laboratories

Officials of the

Provincial Min of

Health

Administrative

functions

Articulate with national

Thematic Networks at

INEI and Centre of

Laboratory Networks


System

Thematics

network member

(Hospitals)

More than 20 Thematic Networks

In charge of surveillance

of specific infectious

diseases

Clinical Microbiologist Technical

features

Articulate with national

Thematic Networks at INEI

and Jurisdictional

coordinators

WHONET-Argentina

Network is one of the

Surveillance Networks

Referential

functions

Operational Strategy of WHONET-Argentina

Network

Ministry of Health

Secretariat of Policies, Regulations and

Institutes

National Administration of Laboratories and

Health Institutes

National Institute of Infectious

Diseases

National Centre of Laboratory

Networks

Other Health

Institutes

Thematics Laboratory

Networks

(Reference Labs)

Provincial

Laboratory

Networks

Thematics

network member

(Hospitals)

Jurisdictional

Coordinators (Prov.

Ministry of Health)

ANTIMICROBIAL RESISTANCE SURVEILLANCE SYSTEM AND QUALITY

GUARANTY ACROSS THE COUNTRY

FLUX OF TRAINING, INFORMATION AND ADVICE

SECURE AND FAST

Flux of training, information and advice

secure and fast

i

i

i i

i

i i

LNR

Guaranty of Information

Reliable

Standardized

Homogeneous

= EQUITY

Clinical experience

Detection of Emergencies

Lab data

Failure Hypothesis

Characterization of resistance mechanism

Clinical correlation

Prevalence evaluation

Strategies of detection and report

Depth knowledge of circulating mechanisms

Identification of emergency of new profiles

WHONET-Argentina Network

National Reference Lab

funding

ANLIS/Min of Health

-100% Ref diagnostic -100% Standards supply -80% EQAS -50% of Research

-20% EQAS

-50% of Research

Private labs

Min Science and Techn

Clinical Labs -100% Clinical diagn Prov Min

of Health

-100% Activities

Jurisdictional Coordinators

Prov Min of Health

http://www.msal.gov.ar/

Canada

Surveillnace

American Antimicrobial Resistance Surveillance Network

Mexico

El Salvador

Guatemala

Nicaragua

Costa Rica

Cuba

Panama

Colombia

Venezuela

Ecuador

Perú

Bolivia

Chile

Paraguay

Brasil

Argentina

Canada Argentina

Reference Centers

For Quality Assurance

Coordinator

PAHO

Uruguay

Honduras

Rep. Dominicana

United States

2004

American networks for antimicrobial resistance surveillance by paho

•RELAVRA •SIREVA •GFN

•PULSENET Each one with its own EQAS

thank you very much for your attention!!!!

National Network Workshop. Buenos Aires May 2013

building a public national system for antimicrobial ... · pdf filebuilding a public national...

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