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

Frontiers in Public Health

Regiane Tigulini de Souza Jordão¹  Fabiano Barreto Rocha¹  André Luiz de Abreu¹  Amanda Dal Lin²  Mayara Caroline Onishi³  Viviane Maria de Carvalho Hessel Dias⁴  Bernardo Montesanti Machado de Almeida⁵  Keite da Silva Nogueira⁵  Gabriel Savogin Andraus⁶  Ricardo Bergamo⁷  Marcelo Pillonetto⁸ 

[1] General Coordination for Public Health Laboratories, Health Surveillance Secretary, Ministry of Health, Brasília, Brazil;Infection Control Team and Clinical Microbiology Laboratory, Hospital Marcelino Champagnat, Marista Group, Curitiba, Brazil;Infection Control Team and Clinical Microbiology Laboratory, Hospital Nossa Senhora das Graças, Curitiba, Brazil;Infection Control Team and Clinical Microbiology Laboratory, Hospital Nossa Senhora das Graças, Curitiba, Brazil;Infection Control Team and Clinical Microbiology Laboratory, Hospital Marcelino Champagnat, Marista Group, Curitiba, Brazil;Infection Control Team and Clinical Microbiology Laboratory, Hospital de Clínicas, Federal University of Parana, Curitiba, Brazil;Laboratory of Medical Microbiology, School of Medicine, Pontifical Catholic University, Curitiba, Brazil;State Laboratory for Public Health, Department of Health Assistance and Surveillance, Secretary of Health, Curitiba, Brazil;State Laboratory for Public Health, Department of Health Assistance and Surveillance, Secretary of Health, Curitiba, Brazil;Laboratory of Medical Microbiology, School of Medicine, Pontifical Catholic University, Curitiba, Brazil;

关键词: surveillance;    antimicrobial resistance;    multiresistant bacteria;    antimicrobial susceptibility tests;    public health;    GLASS - Global Antimicrobial Resistance Surveillance System;    BR-GLASS;    Brazil;   

DOI  :  10.3389/fpubh.2020.575536

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

CC BY