Surveillance antibiotic resistance in Algeria: challenges - PowerPoint PPT Presentation

Surveillance antibiotic resistance in Algeria: challenges achievements and prospects Pr. Hassiba TALI MAAMAR Founding member of the AARN Network Institut Pasteur d’Algérie 1st Annual congress of the Algerian Society of Infectiology – 5th congress of Federation Arab Societies of Clinical Microbiology and Infectious diseases - Algiers – 27 october 2018

Antibiotics (with vaccines, nutrition and education for health) have improved life expectancy ….. However…!

« It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them … . There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant » Sir A. Fleming - 1945

Microbiol Mol Biol Rev. 2010 Sep; 74(3): 417 – 433

Microbiol Mol Biol Rev. 2010 Sep; 74(3): 417 – 433

Antibiotics are not drugs like others ... .. Need to monitor! Microbiol Mol Biol Rev. 2010 Sep; 74(3): 417 – 433

• « Guidelines for antimicrobial susceptibility testing for intermediate – level laboratories in countries with limited resources » WHO Technical report series N° 850, 1995 – 138 pages

• « Guidelines for antimicrobial susceptibility testing for intermediate – level laboratories in countries with limited resources » WHO Technical report series N° 850, 1995 – 138 pages

What about the antibiotic resistance surveillance system in Algeria? OR The fabulous destiny of antibiogram ….

First publications since 1970th Source: https://www.ncbi.nlm.nih.gov/pubmed/

• « Guidelines for antimicrobial susceptibility testing for intermediate – level laboratories in countries with limited resources » WHO Technical report series N° 850, 1995 138 pages 1994 1996 1999 2002 2013

Standardization of antimicrobial susceptibility testing at national level Revised every three years by a committee of 1994 microbiologists http://www.sante.dz/aarn/publications.htm 1996 - Standardization of the antibiotic list 1999 - Quality control - External evaluation of quality 2002 2013 In human and veterinary medicine

1994 - Training Workshop for the microbiologist, 1996 - Creation of the Algerian Antimicrobial Resistance Network A.A.R.N. 1999 - Required: microbiologiste, practice susceptibility testing, to use WHONET 2002 2013

1994 Décision ministérielle (MSPRH) portant sur la création du réseau 1996 national de surveillance de la résistance aux antibiotiques: 1999 24 laboratoires médicaux et 8 laboratoires vétérinaires (INMV). 2002 2013

Arrêté ministériel n°85 du 25 Juin 2013 relatif à l'organisation 1994 du Réseau National de la Surveillance de la Résistance des Bactéries aux Antibiotiques 1996 1999 Direction Générale de l'INMV décide de créer un réseau de la surveillance de la résistance aux antibiotiques « RESARVET » (7 laboratoires vétérinaires, 2002 S/Direction de la pharmacie vétérinaire). (Décision? arrêté? ) http://www.minagri.dz/pdf/BMI/INMV/FLASH_INFO_Mai_2013.pdf 2013

28 laboratories with annual meeting More than 16 training workshop Health education External evaluation for the rational use quality control of antibiotics Reference works in Study of microbiological antibiotic technique consumption antibiotiques Multiresistance bacteria alert http://www.ands.dz/aarn/index.htm

Dates Themes Lieu 2017 Role of the laboratory in moritoring of vaccine-preventable bacterial infection IPA 2016 Highly resistant emerging bacteria (BHRe) role of the laboratory and therapeutic IPA alternatives Point sur la brucellose IPA 2015 Monitoring of pneumococcal infection in the laboratory IPA 2014 Diagnosis and prevention of pertussis IPA 2013 Diagnosis and prevention of the meningococcal infections IPA 2012 Impact of the PK/PD on the interpretation criteria of antibiotic susceptibility testing IPA 2011 Contrôle bactériologique du lavage des mains IPA 2010 Automating of the antibiotic susceptibility testing IPA 2009 Training on the molecular biology testing (PCR) (3 sessions) IPA 2009 Training on the antibiotic consumption IPA 2008 Training on the molecular biology testing (training of trainers) IPA 2007 Formation des biologistes exerçant dans le privé (ALAM) INSP 2004 First antibiotic seminar: Typhoid Fever CHU T.Ouzou

Dates Thèmes Lieu 2017 Place du laboratoire dans la surveillance des maladies bactérienne évitable par la IPA vaccination 2016 Les bactéries hautement résistantes émergentes (BHRe) rôle du laboratoire et IPA alternatives thérapeutiques Point sur la brucellose IPA 2015 Surveillance microbiologique des infections pneumococciques IPA 2014 Diagnostic et prévention de la coqueluche IPA 2013 Diagnostic et prévention des infections méningococciques IPA 2012 Impact des paramètres PK/PD sur l'interprétation des antibiogrammes IPA 2011 Contrôle bactériologique du lavage des mains IPA 2010 Antibiogramme automatisé IPA 2009 Ateliers de Biologie moléculaire (3 sessions) IPA 2009 Formation des pharmaciens hospitaliers: Consommation des antibiotiques IPA 2008 Formation de formateurs en Biologie moléculaire IPA 2007 Formation des biologistes exerçant dans le privé (ALAM) INSP 2004 1ere journée antibiothérapie: Fièvre typhoïde CHU T.Ouzou

28 laboratories with annual meeting More than 16 training workshop Health education External for the rational use evaluation quality of antibiotics control Reference works in Study of microbiological antibiotic technique consumption antibiotiques Multiresistance bacteria alert http://www.ands.dz/aarn/index.htm

Quality control External evaluation of quality control • Weekly, since 1999 • Annual, Since 1999. • Control strains obligatory: – S.aureus ATCC 25923, – E.coli ATCC 25922, • Organized by IPA – P.aeruginosa ATCC 27853, – S.pneumoniae ATCC 49619, – H.influenzae ATCC 49247. • Free and obligatory for all the members of the laboratories network. • Results criteria validation: • ≥ 30 tests par souche de référence, par an • One strain for identification and two for et par laboratoire susceptibility testing. • Au moins 80% de conformité par molécule d’antibiotique, en test d’antibiogramme. • For M.I.C., QC for each test.

28 laboratories with annual meeting More than 16 training workshop Health education External evaluation for the rational use quality control of antibiotics Reference works in Study of microbiological antibiotic technique consumption antibiotiques Multiresistance bacteria alert http://www.ands.dz/aarn/index.htm

28 laboratories with annual meeting More than 16 training workshop Health education External evaluation for the rational use quality control of antibiotics Reference works in Study of microbiological antibiotic technique consumption antibiotiques Multiresistance bacteria alert http://www.ands.dz/aarn/index.htm

Taux de résistance à l’imipénème Consommation d’imipénème Source: http://www.sante.dz/aarn/rapports.htm

28 laboratories with annual meeting More than 16 training workshop Health education External evaluation for the rational use quality control of antibiotics Reference works in Study of microbiological antibiotic technique consumption antibiotiques Multiresistance bacteria alert http://www.ands.dz/aarn/index.htm

http://www.sante.dz/aarn/in index.htm Sensibilisation contre l’usage irrationnel des antibiotiques

28 laboratories with annual meeting More than 16 training workshop Health education External evaluation for the rational use quality control of antibiotics Reference works in Study of microbiological antibiotic technique consumption antibiotiques Multiresistance bacteria alert http://www.ands.dz/aarn/index.htm

In 2018 (october) …. The AARN represents 28 laboratories (26 hospital laboratories) 10 of 48 Wilaya 20,8%

Surveillance and alert http://www.ands.dz/aarn/rapports.htm

Evolution of MRSA in Algerian Hospitals ( from 2006 to 2016) 50 46,3 45 44 43 40 38 37,5 36 35,7 35 Percentage 36,1 32,7 32,5 30 29 25 20 15 10 5 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Years Source: http://www.sante.dz/aarn/rapports.htm

Evolution of ESBLE in Algerian Hospitals ( from 2006 to 2016) 40 35 33,6 32,7 32,5 32 30 30 30 30,4 Percentage 25 24 23 22 20 17 15 10 5 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Years Source: http://www.sante.dz/aarn/rapports.htm

Evolution of P. aeruginosa ceftazidime resistant in Algerian Hospitals ( from 2006 to 2016) 18 17 16 16 15 15 15 14 13,4 Percentage 13 13 12 12 11 10 10,08 8 6 4 2 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Years Source: http://www.sante.dz/aarn/rapports.htm

Evolution of Acinetobacter imipenem resistant in Algerian Hospitals ( from 2006 to 2016) 80 75 70 67 65 60 Percentage 54,2 50 50,2 45 40 39 31 30 23 20 20 16 10 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Years Source: http://www.sante.dz/aarn/rapports.htm