|2006 Annual Report of the Antimicrobial Resistance Network|
The annual report by the countries of the Americas on monitoring of resistance to antibiotics in the Region provides data for discussing and analyzing measures to take to continuously enhance data quality and their usefulness in guiding clinicians in the rational use of antibiotics. This comprehensive 144-page report contains the 2006 data presented by the countries at the 2007 meeting.
A total of 20 countries presented their data: Argentina, Bolivia, Brazil, Canada, Chile, Costa Rica, Cuba, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, the United States, Uruguay, and Venezuela. Performance evaluation results were also presented by coordinating institutions from the national networks in Canada and Argentina.
The annual report by the countries of the Americas on monitoring resistance to antibiotics in the Region provides data for discussing and analyzing measures to take to continuously enhance data quality and their usefulness in guiding clinicians in the rational use of antibiotics.
Surveillance was initially directed (starting in 1997) at enteric bacteria: Salmonella, Shigella, and Vibrio cholerae. Starting in 2000, other species were included that are present in the community and in hospitals. The information provided by each country is a consolidation of information obtained from various healthcare centers and occasionally different geographical areas as well, which means that its epidemiological value is limited. However, the importance of this information cannot be underestimated as a trend indicator or as a technical justification of the need to implement measures to prevent and control resistance to the antimicrobial drugs.
Species Subject to Surveillance
Hospital: Enterococcus spp., Klebsiella pneumoniae, Acinetobacter spp., Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Enterobacter spp., Neiseria gonorrhoeae, hemolytic Streptococcus, and Staphylococcus aureus.
Community: Salmonella spp., Shigella spp., Vibrio cholerae, Escherichia coli, Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, and Campylobacter spp.
The coordinating laboratories of the network are charged with the function of managing and assuring data quality, identifying the species subject to surveillance, detecting susceptibility to antimicrobial drugs. The participating countries, as a prerequisite for their involvement in the network, make a commitment to having a center that serves as coordinator of the national network, made up of sentinel institutions. In the majority of the countries, the coordinating institution is the national reference center specialized in the area of the network, which has six main functions:
Organizing and coordinating the program to monitor susceptibility to antimicrobial drugs of pathogens of importance to public health.
Serving as an institution for referrals and cross-referrals, which consists of confirming diagnoses, conducting complementary studies, and clarifying any doubt that arises from the activities carried out by national participants in the network.
Organizing and carrying out quality management (internal quality control, audits, and external performance evaluation) in order to guarantee the quality of diagnoses and to determine susceptibility to antimicrobial drugs. This includes setting standards for quality assurance, carrying out supervision to ensure that these standards are met, distributing strains of the American Type Culture Collection (ATCC) for quality control of the antibiogram, and implementing programs for performance evaluation in the institutions participating in the network.
Standardizing diagnostic techniques, serotyping, and susceptibility to antimicrobial drugs.
Training technical personnel and professionals from institutions participating in the network.
Organizing and maintaining a strain bank.
Periodically consolidating, analyzing, and disseminating information provided by the sentinel institutions.
In turn, the sentinel institutions should meet the following four requirements:
Carrying out control and periodic maintenance of equipment.
Meeting biosafety standards.
Following up on quality control standards, including those of the Clinical Laboratories Standards Institute (CLSI), to formulate antibiograms using the Kirby-Bauer method, including the periodic use of ATCC strains.
Considering that the majority of the treatments administered are empirical, local dissemination of the information on patterns of resistance to the microorganisms subject to surveillance is essential for the rational use of antibiotics. The annual external performance evaluation of the national coordinating institutions (national reference centers) is the responsibility of the National Microbiology Laboratory for Enteric Pathogens in Canada, through an annual shipment of unknown samples of Salmonella, Shigella, and Vibrio cholerae. Furthermore, the Dr. C. G. Malbrán National Institute of Infectious Diseases of ANLIS- Argentina sends a panel of unknown 10 enteric and non-enteric strains twice a year to the members of the network.
Regional Office for the Americas of the World Health Organization