The Experience of Implementing a National Antimicrobial Resistance Surveillance System in Brazil

Abstract

Antimicrobial resistance (AMR) is a major public health threat of global proportions, which has the potential to lead to approximately ten million deaths per year by 2050. Pressured by this wicked problem, in 2014, the World Health Organization launched a call for member states to share AMR data through the implementation of the Global Antimicrobial Resistance Surveillance System (GLASS), to appropriately scale and monitor the general situation world-widely. In 2017, Brazil joined GLASS and, in 2018, started its own national antimicrobial surveillance program (BR-GLASS) to understand the impact of resistance in the country. We compiled data obtained from the complete routine of three hospitals' microbiology labs during the year of 2018. This pilot data sums up to 200,874 antimicrobial susceptibility test results from 11,347 isolates. It represents 119 different microorganisms recovered from 44 distinct types of clinical samples. Specimens came from patients originating from 301 Brazilian cities, with 4,950 of these isolates from presumed Healthcare-Associated Infections (HAIs) and the other 6,397 community-acquired cases. The female population offered 58% of the collected samples, while the other 42% were of male origin. The urinary tract was the most common topography (6,372/11,347 isolates), followed by blood samples (2,072/11,347). Gram-negative predominated the bacterial isolates: Escherichia coli was the most prevalent in general, representing 4,030 isolates (89.0% of these from the urinary tract). Coagulase-negative Staphylococci were the most prevalent bacteria in blood samples. Besides these two species, the ESKAPE group have consolidated their prevalence. Regarding drug susceptibility results, 141,648 (70.5%) were susceptible, 9,950 (4.9%) intermediate, and 49,276 (24.5%) resistant. Acinetobacter baumannii was the most worrisome microorganism, with 65.3% of the overall antimicrobial susceptibility tests showing resistance, followed by ESBL-producing Klebsiella pneumoniae, with a global resistance rate of 59%. Although this is a pilot project (still limited to one state), this database shows the importance of a nation-wide surveillance program,[153mm][-12mm] Q14 especially considering it already had patients coming from 301 distinct counties and 18 different states. The BR-GLASS Program is an ongoing project that intends to encompass at least 95 hospitals distributed in all five geographical regions in Brazil within the next 5 years.

Electronic information systems for One Health surveillance of antimicrobial resistance: a systematic scoping review

“…12 23–25 One study included the analysis of 2 EIS, 26 resulting in a total of 27 EIS overall included in this systematic scoping review from 26 studies and reports. Of the 27 EIS, the country of implementation was specified for 21: Uganda, 27 India, 28 Portugal, 29 Italy, 23 Australia, 30–32 Netherlands, 33 Germany, 34 Brazil, 35 UK, 36 USA, 24 37 38 Argentina, 25 Taiwan, 39 France, 26 Russia, 40 Switzerland 41 and Denmark. 42 Three EIS described utilisation across multiple countries, 12 43 44 and three EIS are not specific to a location.…”

Quality Assessment of an Antimicrobial Resistance Surveillance System in a Province of Nepal

“…In Nepal, Malla et al [ 14 ] had, by 2014, already highlighted the challenges to AMR surveillance implementation, giving high importance to data collection, compilation, and storage. Many others later noted that the availability of an electronic data collection system with data back-up, as opposed to manual paperwork collection, would result in a smoother workflow and better data flow from the surveillance sites to a central reporting site [ 15 , 16 , 17 , 18 ]. The use of WHONET software, with its uniform and standardized format, would facilitate an easy compilation for GLASS reporting [ 19 ].…”

Country data on AMR in Brazil in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome

“…A long-term surveillance programme exists in Brazil, led by the National Health Regulatory Agency (ANVISA), but it compiles data from healthcare-associated infections and a gap remains about overall AMR, especially considering the WHO One Health initiative where not only resistant nosocomial bacteria are monitored but also bacteria from the community. 12 Between 2016 and 2017, national discussions took place to prepare the Brazilian NAP and an important objective included joining the Global Antimicrobial Resistance and Use Surveillance System (GLASS) and to significantly expand the scope, which resulted in 2017 in Brazil joining GLASS and starting its National Surveillance Program on Antimicrobial Resistance (BR-GLASS). 12 …”

“… 12 Between 2016 and 2017, national discussions took place to prepare the Brazilian NAP and an important objective included joining the Global Antimicrobial Resistance and Use Surveillance System (GLASS) and to significantly expand the scope, which resulted in 2017 in Brazil joining GLASS and starting its National Surveillance Program on Antimicrobial Resistance (BR-GLASS). 12 …”