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Health Surveillance & Disease Prevention & Control — Communicable Diseases: 
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Spanish version containing full-text report (105 pp, PDF) and data by country (contents below)

Definitions, acronyms and symbols
I. Introducción
II. Information from the countries

Argentina
Bolivia
Brasil
Caribe Inglés
Chile
Colombia
Costa Rica
Cuba
Ecuador
El Salvador
Guatemala
México
Nicaragua
Paraguay
Perú
Venezuela

III. Results of the Performance Evaluation of the Coordinating Institutions of the National Network
IV. Recommendations
V. List of participants


Recommendations

To the Countries

  1. That the National Reference Laboratory carry out the performance evaluation of the participating national laboratories of the network of surveillance by shipping at least five unknown strains twice a year .
  2. That the national reference laboratories exhaustively determine the cause for any errors in the interpretation of susceptibility/resistance to antibiotics in the strains sent to them for performance evaluation by the LNEP/CAN and/or the INEI/ARG .
  3. That the national reference laboratories disseminate the consolidated information on resistance to antibiotics, of bacteria under surveillance, via either web pages or other media. Furthermore, that they promote the dissemination of local resistance profiles. Considering the fact that the treatments with antibiotics are for the most part empirical, it is necessary that health professionals be acquainted with these resistance profiles of so that the use of antibiotics might become more rational .
  4. That national capacity in bacterial identification be strengthened.
  5. That manuals on sampling be distributed (or in some countries, prepared) in order to unify procedures .
  6. That the countries incorporate in their routine work, to the full measure of their capabilities, the antibiotics test to enable the establishment of a potential mechanism to detect resistance to the ß-lactámicos (detection of BLEA and BLEE) and enzymatic resistance in Haemophilus to aminopenicillins and chloramphenicol .
  7. That, according to the capabilities of each country, the following antibiotics and species be incorporated into monitoring procedures:
    1. S. aureus: erythromycin and clindamicin
    2. Enterobacterias: quinolonas
    3. Enterococcus spp.: high-load glycopeptids and aminoglycosides.
  8. That checks be run on the internal quality control of antibiogram disks, in both the national reference laboratories and the participating laboratories of the national networks.

To PAHO

That a technical group be organized to the conditions in which performance evaluation on antibiograms can be carried out, considering the current indicators being used and the performance shown by the countries to date. The recommendations of this technical group will be submitted at the next annual meeting.

Informe AMR

Annual Regional Report of the Countries Participating in the Network for Monitoring/Surveillance of Resistance to Antibiotics

(Santa Cruz de la Sierra, Bolivia, 17-19 April 2002)

Introduction

As a part of the knowledge necessary for combating the development of resistance to antimicrobial drugs, since 1997 20 countries of the Region have participated in a network that annually reports on the percentages of resistance for enteric bacteria: Salmonella, Shigella, and Vibrio cholerae. From the year 2000 onwards, surveillance was expanded to other species in the community and in hospitals (Table 1).

Table 1: Prevention and Control of the Resistance to Antibiotics—
Species Subject to Surveillance

Hospitals Community
  • 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 consolidates the information obtained from various health-care centers and, at times, different geographical areas, which means that its epidemiological value is limited. However, the following applies:
  1. The availability of this information indicates that the latter is also available in the corresponding geographical areas to the different sentinel institutions (if truly important).
  2. One should not underestimate the importance that this information has as a trend indicator and as a technical basis justifying the need for implementing prevention and control measures for resistance to antimicrobial drugs.

The participating countries, as a prerequisite of the network, commit to having a center that serves as the coordinator of their national network, which in turn would be made up of sentinel institutions. In the majority of the countries, the coordinating institution is a national reference center specialized in the subject matter of the network. Its function are as follows:

  1. Organize and to coordinate the program for monitoring antimicrobial susceptibility of the pathogens of importance to public health.
  2. Serve as a referral and cross-referral institution, which consists of confirming diagnoses, conducting complementary studies, and clarifying every doubt that may arise from the activities of the participating national networks.
  3. Carry out, organize, and implement quality-control programs (both direct and indirect) to assure diagnostic quality and determine susceptibility to antimicrobial drugs. This includes elaborating standards for quality assurance and the necessary supervision to ensure that these standards be met, as well as distributing strains of the American Type Culture Collection (ATCC) for quality assurance of the antibiogram and carrying out programs of performance evaluation within the institutions participating in the network.
  4. Standardize techniques for diagnosis, serotyping, and antimicrobial susceptibility.
  5. Train technicians and professionals from the institutions participating in the network.
  6. Organize and maintain strain bank.
  7. Periodically consolidate, analyze, and disseminate the information provided by the sentinel institutions.

In turn, the sentinel institutions are obliged to do the following:

  1. Follow established quality-assurance standards for antibiograms, including the standards of the National Commitee Clinical Laboratory Standards (NCCLS) according to Kirk Bauer's methodology, including the periodic use of ATCC strains.
  2. Disseminate subsequent findings: Considering that the treatment of the patient is usually empirical, locally disseminating knowledge on the resistance profile of the microorganisms subject to surveillance is fundamental for the rational use of antibiotics.

Performance evaluation of the national coordinating institutions and National Reference Centers is carried out annually by the National Laboratory of Enteric Pathogens, Canada, through an annual shipment of 15 samples of Salmonella, Shigella, and Vibrio cholerae (5 of each). Furthermore, twice a year the National Institute of Infectious Diseases of the ANLIS, "Dr. C.G. Malbrán", Argentina, sends a panel of 10 unknown, enteric, and non-enteric strains to Bolivia, Ecuador, El Salvador, Guatemala, Paraguay, Peru and Nicaragua.


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