relavra

The Latin American Network for Antimicrobial Resistance Surveillance (ReLAVRA by its Spanish acronym) was formally established in 1996 by the WHO/PAHO regional office and partnering member states. The goal was to inform AMR prevention and control policies and interventions in the region, through the ongoing collection of reliable, comparable, and reproducible AMR data [1].

Initially, the network constituted 8-designated national reference laboratories (NRLs), in 8-member states. The surveillance scope was limited to reporting AMR data for few targeted foodborne pathogens (Salmonella, Shigella and V. cholerae). Each NRL, reported antimicrobial susceptibility testing information (mainly for stool specimens isolates) from sentinel laboratories in each of the participating countries in addition to isolates analyzed in theses NRLs.

During the following years, the network size, as well as the scope of surveillance, continued to expand. By the year 2000, 15 NRLs, in 15-member states were reporting on an additional 7 nosocomial pathogens (E. coli, Staphylococcus aureus, Acinetobacter baumannii, Klebsiella spp. Pseudomonas aeruginosa, Enterobacteriaceae, Enterococci spp.); and 5 community acquired pathogens (Salmonella, Shigella, S. pneumoniae, N. meningitidis, Haemophilus influenzae).

Currently, the network is one of the oldest, and largest regional AMR surveillance networks in the world. It constitutes 19 countries, namely: Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Dominican Republic, Uruguay, and Venezuela). Each country is represented by a national reference laboratory (NRL), officially designated by each the national authority in that country. Aggregates level data on antibiotic resistance is collected and reported annually, on number of priority pathogens-drugs combination (see dashboard link).

The number of participating microbiology laboratories varies between countries, as well as within a country from year-to-year. PAHO estimates that between the years 2000-2014, over 750 laboratories within the region have reported AST data on a total of ~2,633,000 isolates, to the ReLAVRA network through their corresponding NRLs. Compiled AST data are reported to PAHO regional office through the PAHO country offices in each of the 19 countries in the network.

The pathogen-drug combinations are reported to PAHO in accordance with the ReLAVRA surveillance protocol. These combinations are determined based on evidence and expert consultations within the ReLAVRA countries and in coordination with NRL focal points. The development of theses pathogen-drugs combinations takes the context into account (regional situational analyses), country needs and current and future capacities. The protocol is reviewed and updated periodically (last reviewed in 2015).

A reporting template was created and is designed to ensure standardized and accurate reporting. Guidelines for species identification and antimicrobial susceptibility testing (AST) such as CLSI, are used across countries in the region, to enable comparisons between countries.