1. Northern Dimension Antibiotic Resistance Study NoDARS Prof Jaana Vuopio, M.D., Ph.D., PAC 11 side-event, 19 November 2015, Berlin, Germany

2. NoDARS project Collaboration between 7 countries in Northern Europe Finland, Norway, Sweden, Latvia, Poland, Germany and Russia Focus on antibiotic resistance in society Led by the NDPHS secretariat Co-funded by the European commission (Contract reference 2014/344-660, in total 430,000 EUR)

3. Project lead and partners Lead partner: NDPHS secretariat, Sweden Sweden: The Public Health Agency of Sweden (Work package leader) Finland: University of Turku Russia: Smolensk State Medical Academy Latvia: Pauls Stradins Clinical University Hospital Norway: Norwegian Institute of Public Health Poland: Institute of Occupational Medicine and Environmental Health Germany: Robert Koch Institute

4. Timeline Three year project (2014-2017) Year one: Agreement and Setting-up of common study protocols (2015) - 2 workshops in Stockholm with all partners Year two: Recruitment of study subjects and collection of samples (2016) Year three: Analysis and publication of results (2017)

5. Background Traditionally AMR-surveillance is based on data on isolates from clinical infections  Risk of bias in resistance levels  Do we use too powerful antibiotics to treat common infections such as uncomplicated UTIs? Burden of antibiotic resistance in society/on population-level?  Need for international cooperation and surveillance initiatives Is there a link between AMR levels and national strategies towards containing AMR? First study on AMR situation in the Northern Dimension Partnership

6. Purpose To investigate antibiotic resistance levels in society of each participating country by:  studying antimicrobial susceptibility of bacteria causing uncomplicated UTIs in women  studying asymptomatic stool carriage of ESBL-producing bacteria in healthy individuals To evaluate:  current national guidelines for treatment of uncomplicated UTI’s  AMR strategies in each participating country Results will be used by health-care professionals, authorities and policy makers to improve and facilitate their work on AMR

7. Investigation of resistance level in uncomplicated urinary tract infections in women One of the most common reasons for antibiotic prescription and consumption, but bacterial cultures are not taken as routine in many countries Focus on E. coli (ca 80 % of infections) Recruit study subjects from primary care Test susceptibility against panel of antibiotics Compare levels between countries Estimate: Identify antibiotics that have <20% resistance and compare to national treatment recommendations

8. Investigation of stool carriage rates of ESBL, AmpC and carbapenemase-producing E. coli and K. pneumoniae Recruitment of study subjects from three different groups of individuals: Students/Job seekers Primary-care patients Elective surgery patients Same laboratory methods are used by each partner in the project Estimate: Incidence of specific resistance determinants in the healthy population

9. Sample collection 500 bacterial cultures from uncomplicated UTIs from each partner country (in total 3500 samples):  Antimicrobial susceptibility testing  Questionnaire on risks factors known to connect to infections caused by MDR strains  Each country recruits and selects the study subjects based on their own health care practices 250 fecal samples from each partner country (in total 1750 samples):  Screen for ESBL-carriage  Questionnaire on risk factors known to link to becoming a ESBL carrier

10. Outcome  Better international cooperation: sharing of methods and expertise  Better understanding on antibiotic resistance in society: indication if treatment guidelines overestimate resistance levels  New information on AMR to health-care professionals, authorities and policy makers with comparable methods  Synergy with other ongoing global and regional AMR surveillance initiatives

11. Expected impact of the actions  lower the selective pressure on resistance as exerted by antibiotic use and increase the appropriateness of the treatment and actions taken  a favourable effect on the development and spread of antibiotic resistance

12. Thank you! http://www.ndphs.org/?database,view,project,1468 http://www.ndphs.org/enewsletter/NDPHS_e-Newsletter_2015_1.pdf