(in Spanish, 106 pp, PDF, divided into 5 files, 1061–3146 Kb; chapter names translated for user orientation)
Cover in color
File 1 (pp. 1–19)
- Glossary of Terms, Abbreviations, & Symbols
- Introduction (text to right)
- Recommendations (text to right)
Archivo 2 (pp. 20–40)
- Costa Rica
File 3 (pp. 41–56)
- El Salvador
File 4 (pp. 57–79)
File 5 (pp. 80–106)
- Caribbean Epidemiology Center (CAREC)
Results of the Performance Evaluation by the Institutions Collaborating in the National Network
I. Enteric Bacteria: Salmonella spp., Shigella spp. & Vibrio cholerae
II. Enteric and Non-Enteric Bacteria
- List of Participants
- Annex: Expert Committee for Defining Performance-Evaluation Standards in the Antibiogram (Kirby-Bauer): Areas of Inhibition or Interpretation
Other Annual Reports
2004 | 2003 | 2001 | 2000
- Antimicrobial Resistance
- Diarrheal/Enteric Diseases
- Emerging/Reemerging Diseases
- Food Safety
- Food Safety
- Pharmaceutical Products
Introduction | Recommendations
As part of the body of knowledge needed to combat the development of resistance to antimicrobials, since 1997 19 countries of the Region have been part of a network that makes yearly reports on the percentages of resistance to enteric bacteria: Salmonella, Shigella and Vibrio cholerae. Since the year 2000, surveillance has expanded to other species that are found in the community and in hospitals, as listed below:
|Prevention and Control of Resistance to Antibiotics:
Species Subject to Surveillance
- Enterococcus spp.
- Klebsiella pneumoniae
- Acinetobacter spp.
- Pseudomonas aeruginosa
- Staphylococcus aureus
- Escherichia coli
- Enterobacter spp.
- Salmonella spp.
- Shigella spp.
- Vibrio cholerae
- Escherichia coli
- Neisseria meningitidis
- Streptococcus pneumoniae
- Haemophilus influenzae
The information provided by each country is an aggregate of the information obtained from various centers involved and occasionally from different geographical areas, such that their epidemiological value is limited. However, one cannot underestimate the importance of this information as an indicator of trends and also as a technical basis on which to justify the need to take measures for the prevention and control of antimicrobial resistance.
As a prerequisite for their participation in the network, the countries must make a commitment to having a center to coordinate the national network, which at the same time will be made up of sentinel sites. In most countries, the coordinating institution is the National Reference Laboratory specializing in the area covered by the network. Its function is as follows:
- Organize and coordinate the surveillance program on the antimicrobial susceptibility of pathogens of importance to public health.
- Act as a reference and counter-reference center, which consists of confirming diagnoses, carring out complementary studies, and clarifying any doubt arising from the activities carried out by national participants in the network.
- Organize and carry out Quality Assurance (internal quality control, auditing and external performance evaluation) to guarantee diagnostic quality and determine susceptibility to antimicrobials. This includes the formulation of quality-assurance guidelines, supervision to ensure compliance with these guidelines, and the distribution of strains to the American Type Culture Collection (ATCC) for controlling the quality of the antibiogram and the implementation of performance-evaluation programs in the institutions participating in the network.
- Standardize diagnostic techniques, serotyping, and antimicrobial susceptibility.
- Train technicians and professionals from the institutions participating in the Network.
- Organize and maintain a strains bank.
- Routinely consolidate, analyze, and disseminate the information provided by the sentinel sites.
At the same time, the sentinel sites should do the following:
- Carry out checks on and periodic maintenance of equipment.
- Comply with biosafety guidelines.
- Follow quality-control guidelines, including those of the National Committee for Clinical Laboratory Standards (NCCLS) , USA, in order to make up antibiograms based on the Kirby-Bauer methodology (see the annex at the end of the report), including the periodic use of ATCC strains.
- Disseminate any subsequent findings.
Considering the fact the the treatments followed are empirical in nature, any local knowledge dissemination on the resistance patterns of the microorganisms subject to surveillance is fundamental for the rational use of antibiotics.
External performance evaluation of the national coordinating institutions, the National Reference Centers, is carried out annually by the National Laboratory for Enteric Pathogens / NLEP), Canada, by means of an annual shipment of 15 unknown strains of Salmonella, Shigella and Vibrio cholerae (five of each). In addition, the National Institute of Infectious Diseases of the National Administration of Laboratories and Health Institutes "Dr. Carlos G. Malbrán" (Instituto Nacional de Enfermedades Infecciosas, la Administración Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán" / INEI/ANLIS) , Argentina, sends a panel of 10 unknown enteric and non-enteric strains twice a year to Bolivia, the Dominican Republic, Ecuador, Guatemala, Paraguay, Peru, and Nicaragua.
At the meeting held in Buenos Aires in 2003, the results obtained in 2002 were presented, by country, as can be seen in the report.
The participants additionally made the following recommendations:
- International Performance Evaluation (enteric agents)
- Reiterate the recommendations made at the annual meeting in 2002 (in Bolivia) and analyze compliance with these recommendations at the 2004 meeting, as well as those made at this one.
- For the countries: Make an effort to have the antisera needed for serotyping of Salmonella and Shigella, even the exotic types.
- For the national laboratories: Observe the trends from the results in order to see the different serotypes circulating in the Region and determine the existing capacity in each country to identify these strains.
- For the countries: Determine the bacterial ecology at local and regional levels with the goal of better utilizing national resources and in order to prioritize which antisera need to be obtained.
- Explore the possibility of purchasing antisera produced by national laboratories in the Region (for example, Argentina and Mexico), of proven quality and at a more accessible cost.
- For the international reference laboratory: Take into account the most frequent serotypes in the Region in order to prepare the performance-evaluation panels, which should include about 20 serotypes.
- Performance Evaluation and Quality Assurance
- Adopt the recommendations of the Expert Committee on the making of guidelines for performance evaluation and quality assurance, included in the annex (Doc. OPS/DPC/CD/274/03, in Spanish, with the exact title Comité de expertos para definir estándares de evaluación del desempeño en el antibiograma [Kirby-Bauer]: áreas de inhibición o interpretación, which can be found in the last file of the report).
- Review the evaluation questionnaire for the bacteriology laboratories, adopt a consensus form, and have available an electronic version of this form for its application, following its validation by the national networks.
- For the Regional Reference Laboratory (located within the National Institute of Infectious Diseases (Instituto Nacional de Enfermedades Infecciosas / INEI, Argentina): Update the list of antibiotics to be used for each bacterial agent under surveillance and distribute it to all the participating countries.
- For the countries: Be ready to begin or have already begun surveillance of enterohemorrhagic Escherichia coli, presenting their protocols and results at the next annual meeting of the netowork (in 2004).
- For the countries: Begin preparations for the surveillance of Campylobacter spp.
- For PAHO/WHO
- Promote the countries' including reporting on resistance to antibiotics as part of their compulsory disease reporting.
- Support the distribution of a computer program to analyze quality-control data compiled by INEI, Argentina.