Surveillance of the resistance to antibiotics
in the Republic of MoldovaCAESAR progress review and upcoming activities
Radu Cojocaru MD, PhD, Associate Professor
National Center for Public Health, MoH Republic of Moldova
Chisinau, 5-6 November 2014
European Strategic action plan on antibiotic resistance
1. Strengthen intersectoral coordination
2. Strengthen surveillance of antibiotic resistance
3. Promote rational use and strengthen surveillance of antibiotic consumption
4. Strengthen infection prevention and control and surveillance in health care settings
5. Prevent emerging resistance in veterinary and food
sectors
6. Promote innovation and research on new drugs
7. Improve awareness, patient safety, and partnership
AMR Surveillance
Needed to:
Detect resistant strains of public health importance
Support prompt notification and investigation of outbreaks
Inform clinical treatment decisions
Guide policy recommendations
Monitor efficacy of interventions (incl. infection control measures)
CAESAR objectiveCentral Asian and Eastern European Surveillance on Antimicrobial Resistance
Maintain a comprehensive surveillance system that links national networks and provide comparable and
validated data on the prevalence and trends of antimicrobial resistance in
a core group of invasive bacteria.
CAESARCentral Asian and Eastern European Surveillance on Antimicrobial Resistance
Network of national surveillance systems for antibiotic resistance in all countries of
the WHO European Region that are not part of EARS-Net of ECDC.
Organisms under surveillance are S. pneumoniae, S. aureus, E. faecalis, E.
faecium, E. coli, K. pneumoniae, P. aeruginosa, Acinetobacter species,
representing pathogens of public health importance.
CAESAR methodology is fully compatible with EARS-Net (ECDC).
CAESAR collaboration – country missions
WHO EURO – Political expertise
ESCMID – Laboratory expertise RIVM – IT/EPI expertise
National coordination
Laboratory practice
Quality control
Data management
Laboratory infrastructure
Guidelines and Protocols
Mission report (conclusions)
Follow-up (recommendations and action plan)
AMR Country Assessments and Workshops
Focus on:
• National coordination
• National strategic action plan
• Surveillance (CAESAR methodology)
• Laboratory capacity and quality (EUCAST,
SOP, QA, Education)
• Sampling habits, awareness
Spin-off:
• Recommendations and action steps
• Follow-up activities
• Technical support
CAESAR progress
Countries submitting data to
CAESAR; BLR, SWI, MKD, TUR,
SRB
Countries visited to define the
steps for CAESAR participation;
RUS, MDA, GEO, ARM, AZE,
KGZ, UZB, BIH, MNE
Countries that are/will be
invited to participate in CAESAR;
ALB, UKR, KAZ, TJK, TKM.
Countries participating in
EARS-Net
Main CAESAR challenges
Laboratory capacity: appropriate species ID, standardized AST, harmonization of breakpoints, EQA
Education of laboratory personnel
Implementation of updated guidelines and SOP in laboratory practice
Improve sampling habits and utilisation of medical microbiologic diagnostics
Improve laboratory information management* Discussed during country assessments and national AMR workshops
External Quality Assessment
To assess the accuracy of susceptibility test results reported by participating laboratories
CAESAR laboratories are invited to participate in the EARS-Net/CAESAR EQA
EQA 2013: 9 countries participated (131 laboratories, 92% responded)
EQA 2014: 13 countries (185 laboratories)
CAESAR annual report 2014
Include as many countries as possible.
Data submission before July 31, 2014
Feedback report from Jos Monen (with additional questions; specific strains, numbers etc)
Confirmation by national AMR focal points before published in the report
Publishing planned November/December 2014
Upcoming CAESAR activities
National AMR workshops and Country assessments
First CAESAR Annual Report, Fall 2014
Feedback CAESAR EQA 2014
Multi-country workshop, February 2015, Copenhagen, Denmark
CAESAR Network meeting at ECCMID, 28-28 April 2015, Copenhagen, Denmark
Republic of Moldova
Population: 3.9 million
Area: 33.7 sq. km
Life expectancy:• men – 65.5 years• women – 73.3 years
Population with income below subsistence minimum: 20.8 %
GNI per capita: 1560 US$
Unemployed: 8.1%
Migration: 25% of working-age people
Laboratory Network:
34+2 Public Health microbiological laboratory (district level)
17 Central Hospital and University laboratory (national level)
3 Reference laboratory (national level) Communicable diseases/TB/STD
R.Moldova – Amoxicillin (AMX) – 42,1% * total
Ampicillin (AMP) 438/236 – 53,9% * total
Blood, CSF
R.Moldova – Gentamicin (GEN) 1416/439 - 31% * total
Blood, CSF
R.Moldova – Vancomycin (VAN) 46,5% - * total
Blood, CSF
R.Moldova – Amoxicillin (AMX) – *not data
Ampicillin (AMP) – *not data
R.Moldova – Vancomycin (VAN) – *not data
• Blood, CSF
R.Moldova – Cefotaxim(CTX) 983/259 - 36,5% * total
Ceftriaxone (CRO) -* not data
Ceftazidime (CAZ) -* not data
Blood, CSF
R.Moldova – Amikacin (AMK) – *not data
Gentamicin (GEN) 2223/469 – 22,3% * total
Tobramycin (TOB) 794/160 *- 20,1% * total
Blood, CSF
R.Moldova – Amoxicillin (AMX) – *not data
Ampicillin (AMP) 1026/738 – 71,9% – *total
Blood, CSF
R.Moldova – Imipenem (IMP) 317/40 – 12,6% *total
Meropenem (MEM) 325/63 – 19,4% – *total
Blood, CSF
R.Moldova – Ciprofloxacin (CIP) 2568/370 – 14,4% *total
Ofloxacin (OFX) 1568/232 – 14,8% – *total
Levofloxacin (LVX) – * not data
Blood, CSF
R.Moldova – Cefotaxim(CTX) 983/259 - 26,3% * total
Ceftriaxone (CRO) -* not data
Ceftazidime (CAZ) 913/239 - 32,1% * total
Blood, CSF
R.Moldova – Amikacin (AMK) – *not data
Gentamicin (GEN) 1111/256 – 23,0% * total
Tobramycin (TOB) 641/46 *- 7,1% * total
Blood, CSF
R.Moldova – Imipenem (IMP) – *not data
Meropenem (MEM) – *not data
Blood, CSF
R.Moldova – Ciprofloxacin (CIP) 1254/207 – 16,5% *total
Ofloxacin (OFX) 701/113 – 16,1% – *total
Levofloxacin (LVX) – * not data
Blood, CSF
R.Moldova – Cefotaxim(CTX) 983/259 - 26,3% * total
Ciprofloxacin (CIP) 1254/207 – 16,5% *total
Ofloxacin (OFX) 701/113 – 16,1% – *total
Tobramycin (TOB) 641/46 *- 7,1% * total
Blood, CSF
R.Moldova – Amikacin (AMK) 174/36 - 20,7% * total
Blood, CSF
R.Moldova – Gentamicin (GEN) 307/56 – 18,2% * total
Tobramycin (TOB) 129/38 *- 29,4% * total
Blood, CSF
R.Moldova – Imipenem (IMP) 244/24 – 9,8% * total
Meropenem (MEM) 80/19 – 23,7% * total
Blood, CSF
R.Moldova – Ceftazidime (CAZ) 198/97 – 49,0% * total
Blood, CSF
R.Moldova – Ciprofloxacin (CIP) 331/42 – 12,7% *total
Ofloxacin (OFX) – not data
Levofloxacin (LVX) – not data
Blood, CSF
R.Moldova – Piperacillin/Tazobactam (TZP) – not data
Blood, CSF
R.Moldova – Methicillin (MET), Dicloxacillin (DIC), Cefoxitin(FOX), Flucloxacillin (FLC), Cloxacillin (CLO)– not data
Oxacillin (OXA) 2434/1368 – 56,2% * total
Blood, CSF
R.Moldova – Rifampin (RIF) – not data
Blood, CSF
R.Moldova – Erytromycin (ERY) 966/343 – 45,3% *total
Clarithromycin (CLR) – not data
Azithromycin (AZM) 23/6 – 26,1% * total
Blood, CSF
R.Moldova – Penicyllins (PEN) 804/385 – 47,9% *total
Oxacillin (OXA) 419/305 – 72,9% * total
Blood, CSF
Participation in international EQAP 2014
SEEHN network for antibiotic resistance
International cooperation networks
CLIN-Net LAB-Net
Conclusions
• There is an irrational use of antimicrobial medicines in thehealth care settings of the Republic of Moldova that providesfavorable conditions for AMR to persist;
• Infection prevention and control in hospitals; surveillance onAMR and antimicrobial consumption in human medicines;awareness on the appropriate use of antimicrobials have tobe improved to combat AMR in Moldova;
The National Surveillance System collect data for AMR based national protocol not adapted to the WHO and EU requirement;
The quality of the data need improvement and validation by external EQAP.
Perspectives • Integration of the national Surveillance system (public health
laboratory network, private laboratory) in one system;
• Integration of the national Surveillance system into regionaland global Surveillance networks (WHO, ECDC);
• Strengthening of the national lab capacity (implementation ofnew laboratory equipment and technology) with reviewingthe standard and protocols for laboratory diagnosis andsurveillance system;
• Training of the personnel (lab, epi, physician) in accordingwith international requirement;
• Extending participation in the international EQAP;
• Extending collaboration in the research programs.
Thank you
