CAESAR: the example of Turkey. Serap Suzuk (Turkey)

Public Health Institution of Turkey Ministry of Health

CAESAR: the example of Turkey

Serap Süzük Clinical Microbiologist

On behalf of Public Health Institution of Turkey

3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks

Courtyard Stockholm Kungsholmen, Stockholm, 11-13 February 2015


National AMR Team

• Hüsniye Şimşek, National AMR Focal Point – Infectious Diseases and Clinical Microbiologist

• Serap Süzük – Clinical Microbiologist

• Dilber Aktaş – Epidemiologist

• Murad Bayram – IT Specialist

• Şeref Işık – Technical Staff


Demographic Information

• Turkey – 81 cities – 75 million population – 1500 hospitals


AMR in Turkey


National AMR Surveillance System

National Nosocomial Infections Surveillance

National Surveillance of Antibiotic Consumption




Methodology


CAESAR (Central Asian and Eastern European Surveillance of Antimicrobial Resistance)


CAESAR (Central Asian and Eastern European

Surveillance of Antimicrobial Resistance) Network


CAESAR

• Aim: – to strengthen national surveillance of AMR in the non-

EU countries of Europe • by providing technical support in the field of laboratory

methods, • surveillance methodology

• Collaboration: – RIVM (National Institute for Public Health and the Environment, The Netherlands)

– ESCMID (European Society of Clinical Microbiology and Infectious Disease)

– WHO Europe (World Health Organization Regional Office for Europe)


CAESAR • Albania • Armenia • Azerbaijan • Belarus • Bosnia Herzegovina • Georgia • Israel • Kosovo* • Kyrgyzstan • FYR Macedonia • Moldova • Montenegro • Russia • Serbia • Switzerland • Tajikistan • Turkey • Turkmenistan • Ukraine • Uzbekistan in accordance with the United Nations Security Council Resolution 1244 (1999)

Figure is taken from presentation of Zsuzsanna Jakab, The Global Action Plan to combat AMR, Challenges of AMR on a global and regional level


Methodology

Clinical samples • Blood • CSF

Pathogens • Escherichia coli • Klebsiella pneumoniae • Pseudomonas aeruginosa • Streptococcus pneumoniae • Staphylococcus aureus • Enterococcus faecium/faecalis • Acinetobacter spp. (Added in 2014)

Antibiotics


Turkey’ Cities in CAESAR

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* 2013-2014 Participating Cities

* 2015 Participating Cities


Participating Laboratories

Years The

Number of Cities

Participating Laboratories

State Hospital

University Hospital

Private Hospital

2013-2014 45 77 42 35 0

New in 2015 14 28 15 10 3

Total 59 105 57 45 3


Legislation

• Scientific committee working procedures and principles

• Inclusion criteria for the surveillance network • The duties and responsibilities of National AMR

Laboratory • Selection criteria for surveillance system • Surveillance objectives and content • Data collection criteria


Scientific commission

• Select participating laboratory • Prepare Standard Operating Procedure • Prepare annual report • Choose isolates for National External Quality

Assessment • Training of participating laboratory (the

courses…)


Selecting participating laboratory

First stage: evaluating laboratory capacity Tool: Questionnaire • Test capacity • Staff capacity • Equipment capacity

Second stage: evaluating laboratory performance Tool: EQA • Identification methods • AST methods


National EQA System • Since 2011 • On-line system • One cycle per year (4 isolates) • Each isolate is scored: 100 point

– Identification:30 points – AST: 70 points

• Max 400 points, min 280 points • Report


NEQAS-CAESAR • In 2013

– 73 participating laboratories

• In 2014 – 77 participating laboratories


Data

• Collecting data (Excel) – Electronic system

• Pre-assessment • Backlink-WHONET • Data analysis • Draft report • Annual report (on-line)


Training / Meeting • Laboratory network meeting twice a year - introduction of the participating laboratories - annual report (analysis, comments…)

• Implementation of EUCAST standards in 2015


www.uamdss.thsk.gov.tr

• Announcement • SOP • EUCAST in Turkish • EQA Results • Annual report • Training documentation


Summary

• Surveillance system is important • WHY ?

– shows the current status – allows the determination of target – determine the roadmap – allows comparisons

• National and international


Thank you…

CAESAR: the example of Turkey. Serap Suzuk (Turkey)

Health & Medicine

national surveillance

challenges of amr

participating cities

rivm national institute

number of cities

technical support

non eu countries of

regional level