Download Introduction to the Proposed Standards

Introduction to Proposed Standards
Global Surveillance of AMR in Humans
Jean B. Patel, PhD, D(ABMM)
WHO Collaborating Centre for International Monitoring of Bacterial Resistance to
Antimicrobial Agents
Centers for Disease Control and Prevention
Atlanta, GA
The Objective
• Collect, analyze and report data with
standardized definitions of infection and AMR
• Estimate the extent of AMR infections
• Detect new resistance
• Implement prevention measures
Disease Surveillance
• Bloodstream Infections: A serious infection with
easily implemented definitions. Mostly healthcareassociated
• Urinary Tract Infections: A common infection and
an opportunity to capture resistance not identified in
BSI surveillance. Community and healthcareassociated infections
• Diarrhoea: Tracking human infections from
potential animal/food sources
• Gonorrhoea: Expanding existing surveillance to
new countries
Diagnostic Stewardship
• Use of microbiological diagnostics to identify
pathogens and guide therapeutic decisions.
• Appropriate selection & collection of specimens
• Accurate and timely testing
• Accurate and timely reporting of results
Laboratories should implement a quality management systems which includes
quality control testing and participation in external proficiency testing programs.
Priority Pathogens & Resistance
• Enterobacteriaceae resistant to carbapenems,
extended-spectrum β-lactamases and
fluoroquinolones
• Neisseria gonorrhoeae resistant to
aminoglycosides, extended-spectrum
cephalosporins, fluoroquinolones and macrolides
• Staphylococcus aureus resistant to methicillin
• Streptococcus pneumoniae resistant to
penicillin
Epidemiological Measures
• The goal: Standardized metrics for monitoring
trends and measuring the impact of prevention
programmes.
• Metric: % Resistant or % Non-susceptible
• Numerator: Number of patients with infection due to a
resistant organisms
• Denominator: divided by the total number of patients with
infection due to the same organism in the same period and
region
• The easiest metric to implement
• May over estimate resistant if only the sickest patients are
cultured
• Labs should report the number of cultures performed
Epidemiological Measures
• A Population-Based Measure
• Metric: The number of infection/population at risk
• A measure of incidence
• Denominator:
• 100 000 people in a catchment area or
• 1000 patient-days or 100 hospital admissions for
hospitalized patients
• A more labor-intensive metric to implement, but it is
useful for estimating the incidence in a populations
• Laboratories/hospitals should report the number of
cultures performed & the number of hospital admissions
(for BSI)
Minimal Data to be Collected Per
Infection
• Pathogen identification
• Susceptibility data
• Patient unique identifier
• Patient gender
• Patient date of birth
• Date and site of specimen collection
• Date of hospitalization (if applicable)
A National Framework
A Global Framework
The Standards
• The current list of infections and pathogen/drug
combinations should not interfere with more
comprehensive surveillance programs at the
local or national level:
• Examples of additional data needs:
• Local data needs – antibiogram data to guide empiric
treatment decisions
• National data needs – surveillance for pathogen/drug
combinations or infection types that is identified as a
national priority
Acknowledgments
Members of the WHO technical working group:
Celia Alpuche Aranda
Olov Aspevall
Sigaugque Betuel
Carolee Carson
Tejinder Chowdhary
Liselotte Diaz Hӧgberg
So Hyun Kim
Sergey Eremin
Hajo Grundmann
Shashi Khare
Roman S. Kozlov
Tjalling Leenstra
Ali Mafi
Jorge Matheu
Saskia Nahrgang
Christopher Oxenford
Olga Perovic
Carmem Pessoa da Silva
Pilar Ramon-Pardo
John Baptiste Ronat
Neinke van de Sande
Nalini Singh
John Stelling
Johan Struwe
Danilo Lo Fo Wong
Yonghong Xiao
Thank You
[email protected]