Surveillance antibiotic resistance in Algeria: challenges - - PowerPoint PPT Presentation

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Surveillance antibiotic resistance in Algeria: challenges - - PowerPoint PPT Presentation

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Surveillance antibiotic resistance in Algeria: challenges achievements and prospects Pr. Hassiba TALI MAAMAR Founding member of the AARN Network Institut Pasteur dAlgrie 1st Annual congress of the Algerian Society of Infectiology 5th

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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

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

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« 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

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

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

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Antibiotics are not drugs like others ... .. Need to monitor!

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

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  • « Guidelines for antimicrobial susceptibility testing for

intermediate – level laboratories in countries with limited resources » WHO Technical report series N° 850, 1995 – 138 pages

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  • « Guidelines for antimicrobial susceptibility testing for

intermediate – level laboratories in countries with limited resources » WHO Technical report series N° 850, 1995 – 138 pages

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What about the antibiotic resistance surveillance system in Algeria? OR The fabulous destiny

  • f antibiogram ….
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Source: https://www.ncbi.nlm.nih.gov/pubmed/

First publications since 1970th

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  • « 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

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Standardization of antimicrobial susceptibility testing at national level Revised every three years by a committee of microbiologists

http://www.sante.dz/aarn/publications.htm

  • Standardization of the antibiotic list
  • Quality control
  • External evaluation of quality

In human and veterinary medicine

1994

1996

1999 2002 2013

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  • Training Workshop for the microbiologist,
  • Creation of the Algerian Antimicrobial Resistance Network

A.A.R.N.

  • Required: microbiologiste, practice susceptibility testing, to use

WHONET

1994 1996

1999

2002 2013

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

1994 1996 1999

2002

2013

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Arrêté ministériel n°85 du 25 Juin 2013 relatif à l'organisation du Réseau National de la Surveillance de la Résistance des Bactéries aux Antibiotiques

1994 1996 1999 2002

2013

Direction Générale de l'INMV décide de créer un réseau de la surveillance de la résistance aux antibiotiques « RESARVET » (7 laboratoires vétérinaires, S/Direction de la pharmacie vétérinaire). (Décision? arrêté? )

http://www.minagri.dz/pdf/BMI/INMV/FLASH_INFO_Mai_2013.pdf

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More than 16 training workshop External evaluation quality control Reference works in microbiological technique Multiresistance bacteria alert Study of antibiotic consumption antibiotiques Health education for the rational use

  • f antibiotics

28 laboratories with annual meeting

http://www.ands.dz/aarn/index.htm

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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 alternatives

IPA 2015 Point sur la brucellose IPA 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

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Dates Thèmes Lieu 2017

Place du laboratoire dans la surveillance des maladies bactérienne évitable par la vaccination

IPA 2016

Les bactéries hautement résistantes émergentes (BHRe) rôle du laboratoire et alternatives thérapeutiques

IPA 2015 Point sur la brucellose IPA 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

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More than 16 training workshop External evaluation quality control Reference works in microbiological technique Multiresistance bacteria alert Study of antibiotic consumption antibiotiques Health education for the rational use

  • f antibiotics

28 laboratories with annual meeting

http://www.ands.dz/aarn/index.htm

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  • Weekly, since 1999
  • Control strains obligatory:

– S.aureus ATCC 25923, – E.coli ATCC 25922, – P.aeruginosa ATCC 27853, – S.pneumoniae ATCC 49619, – H.influenzae ATCC 49247.

  • Results criteria validation:
  • ≥ 30 tests par souche de référence, par an

et par laboratoire

  • Au moins 80% de conformité par molécule

d’antibiotique, en test d’antibiogramme.

  • For M.I.C., QC for each test.
  • Annual, Since 1999.
  • Organized by IPA
  • Free and obligatory for all the members of

the laboratories network.

  • One strain for identification and two for

susceptibility testing.

Quality control External evaluation of quality control

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More than 16 training workshop External evaluation quality control Reference works in microbiological technique Multiresistance bacteria alert Study of antibiotic consumption antibiotiques Health education for the rational use

  • f antibiotics

28 laboratories with annual meeting

http://www.ands.dz/aarn/index.htm

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More than 16 training workshop External evaluation quality control Reference works in microbiological technique Multiresistance bacteria alert Study of antibiotic consumption antibiotiques Health education for the rational use

  • f antibiotics

28 laboratories with annual meeting

http://www.ands.dz/aarn/index.htm

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Consommation d’imipénème Taux de résistance à l’imipénème

Source: http://www.sante.dz/aarn/rapports.htm

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More than 16 training workshop External evaluation quality control Reference works in microbiological technique Multiresistance bacteria alert Study of antibiotic consumption antibiotiques Health education for the rational use

  • f antibiotics

28 laboratories with annual meeting

http://www.ands.dz/aarn/index.htm

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

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More than 16 training workshop External evaluation quality control Reference works in microbiological technique Multiresistance bacteria alert Study of antibiotic consumption antibiotiques Health education for the rational use

  • f antibiotics

28 laboratories with annual meeting

http://www.ands.dz/aarn/index.htm

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

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http://www.ands.dz/aarn/rapports.htm

Surveillance and alert

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44 37,5 38 29 35,7 32,5 46,3 32,7 43 36

36,1

5 10 15 20 25 30 35 40 45 50 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Evolution of MRSA in Algerian Hospitals ( from 2006 to 2016)

Percentage Years

Source: http://www.sante.dz/aarn/rapports.htm

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Evolution of ESBLE in Algerian Hospitals ( from 2006 to 2016)

Percentage Years

Source: http://www.sante.dz/aarn/rapports.htm

22 17 24 23 32 30 32,7 32,5 33,6 30

30,4

5 10 15 20 25 30 35 40 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

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Evolution of P. aeruginosa ceftazidime resistant in Algerian Hospitals ( from 2006 to 2016)

Percentage Years

Source: http://www.sante.dz/aarn/rapports.htm

12 13 13 17 15 15 13,4 11 15 16

10,08

2 4 6 8 10 12 14 16 18 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

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Evolution of Acinetobacter imipenem resistant in Algerian Hospitals ( from 2006 to 2016)

Percentage Years

Source: http://www.sante.dz/aarn/rapports.htm

16 31 20 23 39 45 50,2 54,2 65 75

67

10 20 30 40 50 60 70 80 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

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Evolu lutio ion du du taux de de consommatio ion de de l’imipénème et et celu lui de de la la rési ésistance à l’imipénème * (c (coefficie ient de de corr

  • rréla

latio ion = 0,96 96)

2 4 6 8 10 12 2004 2005 2006 2007 2008 Années DDJ / 1000 jours d'hospitalisation 0,00% 5,00% 10,00% 15,00% 20,00% 25,00%

Poucentage de résistance à l'imipénème

* : Il s’agit du taux cumulé du de résistance à l’imipénème chez Pseudomonas aeruginosa et Acinetobacter

Consommation d’imipénème Taux de résistance à l’imipénème

Source: http://www.sante.dz/aarn/rapports.htm

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Evolution of ciprofloxacin resistant in Algerian Hospitals ( from 2006 to 2016)

Percentage Years

Source: http://www.sante.dz/aarn/rapports.htm

32,1 31 42,6 51,4 65,2 74,5 76 82,2 81,2 85,4

77,5

6,6 5 7 13 14 8,6 13,6 7,8 11,2 10,2 12

10 20 30 40 50 60 70 80 90 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Acinetobacter

  • P. aeruginosa
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Evolution of emergence of bacterial resistance in Algerian Hospitals ( from 2013 to 2016)

Percentage Years

Source: http://www.sante.dz/aarn/rapports.htm

1,8 0,83 0,9

2,14

7,75 8,7

9,3

0,08 1 2 3 4 5 6 7 8 9 10 2013 2014 2015 2016

VRE CPE

VRE: E.faecium vancomycin resistant - CPE: carbapenemase producing enterobacteriaceae - Entero CS: enterobacteriaceae resistant to colistin

Entero CS

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http://www.ands.dz/aarn/rapports.htm

MDR Top 7 in 2016 …

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56,37% 18,80% 12,50% 6,40% 4,10% 1,70% 0,13%

0,00% 10,00% 20,00% 30,00% 40,00% 50,00% 60,00%

EBLSE (1309/2322) Acinetobacter imipenem Resistant (437/2322) SARM (291/2322)

  • P. aeruginosa Imipenem resistant (148/2322)

Enterobacteriaceae Carbapenem resistants (95/2322)

  • E. faecium Vanvo R (39/2322)
  • E. faecalis Vanco R (3/2322)

Percentage of BMR distribution in Algerian hospitals in Year 2016 ( n= 2322)

Source: http://www.sante.dz/aarn/rapports.htm

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  • Espèce habituellement sensible
  • Espèce inconstamment sensible
  • Espèce résistante

Spectrum of activity of antibiotics

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Prospects …..

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Photo : 17 march 2011

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Prospects …..

Integrated surveillance of bacterial diseases under national surveillance Better knowledge of bacterial ecology We Need  Strengthening laboratory facilities, equipment and reagents,  improve laboratory diagnosis Training and Technology Transfer …

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  • Décret exécutif n° 17-310 du 4

Safar 1439 correspondant au 24

  • ctobre 2017

National Multisectoral Committee Against Antimicrobial Resistance

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Thank you for your attention