1. Antimicrobial Resistance Surveillance Latin America

2. Microbiology laboratories: from routine clinical work to surveillance

3. The Latin American AMR Surveillance Network
Focus: quality control in bacteriology & antimicrobial resistance
BOLIVIA
ECUADOR
Coordination
PAHO/WHO
PERU
2000
EL SALVADOR
NICARAGUA
GUATEMALA
PARAGUAY
Supra national laboratories:
INEI CG Malbran (ARGENTINA)
Enteropathogens Lab (CANADA)
COSTA RICA
2002
HONDURAS
PANAMA
Laboratory strengthening, including quality assurance program
Internal quality control
External assurance program
National Public Health Laboratories coordinate and provide EQA to the national networks
Promotion of WHONET as basis for the data collection
Collect and analyze information
DOMINICAN REPUBLIC
VENEZUELA
2003
URUGUAY
CHILE
MEXICO
COLOMBIA
BRAZIL
CUBA
2011 TRINIDAD & TOBAGO
2013 THE BAHAMAS (?)
2005

4. Pathogens under surveillance
Community pathogens
Salmonella spp.
Shigella spp.
Vibrio cholerae
Escherichia coli
Neisseria meningitidis
Neisseria gonorrhoeae
Streptococcus pneumoniae
H. influenzae
Campylobacter
S. β hemolítico
S. aureus
Nosocomial pathogens
Enterococcus spp.
Klebsiella pneumoniae
Acinetobacter spp.
Pseudomonas aeruginosa
Staphylococcus aureus
Escherichia coli
Enterobacter spp.
CLSI Standards for susceptibility testing

5. 20 National Reference Labs
Latin American AMR Surveillance Network (2012)
20 National Reference Labs
720 Centinel Labs
Nat. Reference Labs
National Microbiology Laboratory for Enteric Pathogens, Canada
Instituto Nacional de Enfermedades Infecciosas, C. Malbrán, ANLIS, Argentina
Data reporting to the NRL
WHONET
Information System
175,000 isolates 5 5

6. Standardization and quality
Manuals for quality assurance & Training activities
Biennial Meeting
Annual Report

7. Common quality standards CLSI Spanish translation

8. QUALITY EVOLUTION INDICATORS OF THE LATIN AMERICAN COUNTRIES
Susceptibiliy Testing Correlation
IDEAL 90%
Source: Alejandra Corso, INEI ANLIS Dr. Carlo G. Malbran, Argentina

9. Annual Reports

10. Methicillin Resistant Staphylococcus aureus (hospital isolates)
Latin America AMR Surveillance Network,

11. Escherichia coli Ciprofloxacin resistance The Latin American AMR Surveillance Network, 2000-2005
Community acquired

12. Klebsiella spp Imipenem resistance The Latin American AMR Surveillance Network, 2000-2007

13. Carbapenemases (KPC & NDM) 2013
Title of the Presentation

14. Promotion of the rational use of antimicrobials
Elaborado por especialistas de la Región. Estamos lanzando la 5ª edición.
Incluye pediatría y neonatología-
En la última edición, se distribuyeron más de copias en la Región.
Se ha evaluado su implementación en el tratamiento de neumonías en pediatría en Paraguay (W Basualdo, 2010), con gran cumplimiento de las indicaciones de antibioterapia por parte de residentes.

15. Epidemiological Alerts
KPC Argentina 2010
NDM Guatemala 2011

16. Guatemala Roosvelt Hospital, Guatemala City 733 beds
High-complexity hospital
MRSA
IMP-resistant A. baumanii
IMP-resistant P. aeruginosa
ESBL + K. pneumoniae
Cost of treating HAIs caused by multi-resistant bacteria
IMP-R
IMP-R
MRSA
The cost for treating a case of infection with methicillin-resistant strains of S. aureus was US$ 7.893,91,2 while that of the respective control was $ 5.137,60 ($ 2, less). Treating a case of infection with imipenem-resistant strains of A. baumannii cost $ 16, and of imipenem-sensitive A. baumannii was $ 6.693,70. In other words, there was a difference of $ 9.588,74. The cost of treating a case of infection with imipenem-resistant strains of P. aeruginosa was $ ,94 and the respective control was $ 5.745,46. This means that the cost
of treating the case was $ 8.851,48 higher than for the control. Finally, the cost of treating a case of infection with extended spectrum betalo lactamasa (ESBL+) K. pneumoniae-isolates was $ , whereas the cost for the corresponding control was $ 3.932,80. There was a difference of $ 713,38 between the two.
ESBL

17. Guatemala Roosvelt Hospital, Guatemala City 733 beds
High-complexity hospital
MRSA
IMP-resistant A. baumanii
IMP-resistant P. aeruginosa
ESBL + K. pneumoniae
Cost of treating HAIs caused by multi-resistant bacteria
IMP-R
IMP-R
MRSA
The cost for treating a case of infection with methicillin-resistant strains of S. aureus was US$ 7.893,91,2 while that of the respective control was $ 5.137,60 ($ 2, less). Treating a case of infection with imipenem-resistant strains of A. baumannii cost $ 16, and of imipenem-sensitive A. baumannii was $ 6.693,70. In other words, there was a difference of $ 9.588,74. The cost of treating a case of infection with imipenem-resistant strains of P. aeruginosa was $ ,94 and the respective control was $ 5.745,46. This means that the cost
of treating the case was $ 8.851,48 higher than for the control. Finally, the cost of treating a case of infection with extended spectrum betalo lactamasa (ESBL+) K. pneumoniae-isolates was $ , whereas the cost for the corresponding control was $ 3.932,80. There was a difference of $ 713,38 between the two.
ESBL

18. 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

19. Challenges Continuos improvement of the quality of the laboratories
Timely dissemination of information
Molecular biology
Linking surveillance & AMR containment

20. The basics and the bases to start AMR and HAI surveillance
Agreement on the goal & main activities of the surveillance
Need of technical coordination
Communication mechanisms and commitments among the members of the network
Agreement on relevant partners and its role
Define the operational / technical details