combacte epi-net showcase · (israel national center for infection control), nandini shetty (phe)...
TRANSCRIPT
COMBACTE
EPI-Net Showcase
General Assembly
Bucharest, Romania
12 MARCH 2019 EVELINA TACCONELLI
FRANK SIFAKIS
CUONG VUONG
ACADEMIC LEAD
Evelina Tacconelli, UNIVR
Jesús Rodríguez Baño, SAS
Andreas Voss, RNMC/CWH
Nisar Malek, EKUT
EFPIA
Frangiscos Sifakis, AZ/MI
Cuong Vuong, AiCuris
CORE RESEARCH TEAM
• Nithya Babu Rajendran, EKUT
• Beryl Primrose Gladstone, EKUT
• Zaira Palacios, SAS
• Blanca Anaya, SAS
• Virginia Paloma, SAS
• Nuñez-Nuñez, SAS
University Medical Centre Utrecht
Université de Genève
PENTA
Centre Hospitalier Universitaire de Limoges
University Hospital of Bellvitge
University Medical Center Freiburg
VetEffecT
Basilea
Sanofi
GlaxoSmithKline
EPI-Net team
3
Wellcome to the new EPI-Net UNIVR team
Monica Compri Fabiana Arieti
Diletta Pezzani
Fulvia Mazzaferri
Liliana Galia
4
• Optimise surveillance of Antimicrobial
Resistance (AMR) and Healthcare
Associated Infections (HAI)
• Develop a consensus programme
and homogenous approach on current
and future epidemiologic surveillance
strategies in Europe
• Inform Public Health Action
• Guide Antimicrobial Development
OBJECTIVES 2018 WP2 Goals
1. Launch, maintain and improve
epidemiology web-based
platform
2. Update EPI-Net surveillance
database to receive, maintain and analyse epidemiology data
3. Develop tools for use of large-
scale clinical care data for
automated surveillance of HAI
4. Development collaboration and a consensus document on
antimicrobial resistance
surveillance
OPTIONAL TEXT EPI-Net Showcase
OPTIONAL TEXT EPI-Net Showcase
EPI-Net website construction: Road map
LSN, Heidelberg, Germany
Phase 2
Phase 3
Maintanence
• Data update • Data correction • Static pages content
development • Alpha version Test • Feedback
• Optimization (or) • Design change • Private Beta version
Test • Feedback • Polishing • Errors and bugs fix
• Open Beta version Test
• Feedback • Official Release • Support • Additional
applications • Sustainability plan
Completed
31 January 2018
Completed
01 Feb 2018-
31 March 2018
Completed
01 April- 31 May 2018
Completed
• Website public release
12 September 2018
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Are you a veterinary?
EPI-Net: a European surveillance One Health platform
HAVE A LOOK AT THE HAI SECTION
LOOK INTO “ANTIBIOTIC RESISTANCE
ACROSS EUROPE”
CHECK IT OUT IN “OUTBREAKS
ACROSS EUROPE” SECTION
CHECK IT OUT IN “ANTIBIOTIC
RESISTANCE BY COUNTRY” SECTION
CHECK IT OUT IN THE “EMERGING
RESISTANCES” SECTION
Are you a
clinician?
Are you a healthcare
administrator?
Are you a
journalist?
Do you work in
public health?
Are you an R&D
researcher?
CHECK OUT OUR
AMR ANIMAL DATA!
One-Health platform to retrieve up-to-date surveillance data on antimicrobial resistance from humans and animals in Europe ECCMID 2019 (13th April 10 :00, oral presentation)
Outbreak
reports
ND4BB
studies
Surveillance
systems
Surveillance
studies
23 patterns of
resistance 11 bacteria
28 European Union (EU)
4 European Free Trade Association (EFTA)
Countries
Continous data
extraction (updates every 6 months) Studies on
emerging resistances
EPI-NET SURVEILLANCE DATABASE
WHAT‘S NEW IN 2018?
NEW data extraction protocols for data collection
to accommodate new pathogens and resistant mechanisms
• Colistin resistance
• Molecular mechanisms (genes, enzymes)
Data quality
control
EPI-Net website
launch
11
EPI-Net data overview
National AMR surveillance
systems
Number of systems: 25
Number of countries: 16
International AMR
surveillance systems
Number of systems: 3
Number of countries: 30
AMR surveillance studies
Number of studies: 22
Number of countries: 14
National HAI surveillance systems Number of systems: 22
Number of countries: 15
International HAI surveillance systems Number of systems: 1
Number of countries: 20
HAI surveillance studies Number of studies: 2
Number of countries: 2
Humans
32.273.875 strains
Years included
Surveillance reports:up 2014
Surveillance studies: up 2005
262.009 strains
Animals
National AMR surveillance systems Number of systems: 10 Number of countries: 11
AMR surveillance studies
Number of studies: 109 Number of countries: 24
International AMR surveillance systems Number of systems: 1
Number of countries: 31
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Pathogens
Methicillin-resistant Staphylococcus aureus
Vancomycin-intermediate and resistant Staphylococcus aureus
Vancomycin-resistant Enterococci
Carbapenem-resistant Escherichia coli
Carbapenem-resistant Klebsiella pneumoniae
Carbapenem-resistant Enterobacter spp
Carbapenem-resistant Acinetobacter baumannii group
Carbapenem-resistant Pseudomonas aeruginosa
Third generation cephalosporin-resistant Escherichia coli
Third generation cephalosporin-resistant Klebsiella pneumoniae
Third generation cephalosporin-resistant Enterobacter spp
Clarithromycin-resistant Helicobacter pylori
Metronidazole-resistant Helicobacter pylori
Third generation cephalosporin-resistant Neisseria gonorrhoeae
Fluoroquinolone-resistant Neisseria gonorrhoeae
Fluoroquinolone-resistant Salmonella spp
Fluoroquinolone-resistant Campylobacter spp
Colistin-resistant Escherichia coli
Colistin-resistant Klebsiella pneumoniae
Colistin-resistant Salmonella spp
Colistin-resistant Enterobacter spp
Colistin-resistant Acinetobacter baumannii group
Colistin-resistant Pseudomonas aeruginosa
Updated list of Pathogens
13
AMR GENE LIST
We thank the following colleagues and stakeholders for the active contribution to the realization of the gene list:
Rafael Canton Moreno (IRYCIS), Francesca Chiara (Wellcome Trust), Surbhi Malhotra-Kumar (COMBACTE
LAB-Net), Elena Mazzolini (IZSVe), Nico Mutters (EUCIC), Remco Schrijever (VetEffecT), Mitchell Schwaber
(Israel National Center for Infection Control), Nandini Shetty (PHE)
14
Outbreaks
Number of outbreaks: 528
Number of countries: 24
Years included: first report-2017
Emerging resistances
new antibiotics
o Ceftaroline Fosamil
o Dalbavancin
o Tedizolid phosphate
o Oritavancin
o Ceftolozane sulfate/ Tazobactam
o Ceftazidime/Avibactam
Number of studies: 62
Coverage: global
Years included: any first report-
2018
Humans
EPI-Net data overview
Coming soon - Linezolid-resistant S. aureus - Azithro-resistant N. gonorrhoea - Fungi
OPTIONAL TEXT EPI-Net Showcase
Surveillance for control of antimicrobial
resistance
Lancet Infect Dis (2018), Tacconelli et al.
• Burden of health-care-associated infections and antimicrobial resistance in the 3
compartments
• Limitations of active national and international European surveillances
• Impact of these limitation on patients’ management
• Recommendations on areas which need focusing for improved monitoring and control of AMR and HAI
SURVeillance of Antimicrobial resistance In
Livestock (SURVAIL)
CMI 26 (2018), Schrijver et al.
o Characterization of AMR genes in livestock is
applied heterogeneously among countries
o Most antibiotics of human interest are included in
animal surveillance, although results are difficult to compare as a result of lack of representativeness of animal samples
WP2 Publications, Communication & Dissemination 2018
Methodology of surveillance for
antimicrobial resistance and
healthcare-associated infections in
Europe (SUSPIRE)
CMI 24 (2018), Nuñez-Nuñez et al. Publicly available information on
important methodologic aspects and indicators measured are frequently
lacking Low frequency of systems including
indicators based on incidence and
clinical information Wide heterogeneity in procedures and
indicators High heterogeneity in AMR surveillance
in comparison to HAI
Surveillance methodologies not useful to design RCT
Social media posts and online search behaviour as early-warning system for
MRSA outbreaks
Antimicrobial Resistance & Infection Control 2018, van de Belt et al.
Key conclusions
• The use of social media and online search behaviour missed many of the hospital
outbreaks that were reported to the official notification system
• However screening of social media posts and/or online search behaviour would help
to identify outbreaks in healthcare institutions with a low notification compliance (nursing homes)
WP2 Publications, Communication & Dissemination 2018
Mandatory reporting and
antimicrobial resistance
18
EPI-Net publications/ dissemination 2018 Coming soon
Income status and antimicrobial
resistance
N. Babu-Rajedran et al. A. Savoldi et al.
Epi determinants of outbreaks due to CRE Beryl & Pezzani et al.
OPTIONAL TEXT EPI-Net Showcase
EpiNet Pilot Study
Semi-automated HAI surveillance
• 3 hospitals
• Surveillance of SSI colon/cardiac/orthopedic & CLABSI
• Years ranging from 2012-2016
• Main analyses:
• SSI 3 hospitals
• CLABSI 1 hospital
20
Maaike van Mourik and Stephanie van Rooden, UMCU
21
Maaike van Mourik and Stephanie van Rooden, UMCU
General conclusions
• With framework design semi-automated surveillance feasible
• High detection rate of HAI possible
• Similar algorithms applicable various hospitals
• Limited number data sources required
ECCMID oral presentation 16-4-2019 Session: Preventing surgical site infections in the era of increased antibiotic resistance
OPTIONAL TEXT EPI-Net Showcase
surveillance drives
empiric therapy
Pathogen coverage
Consensus group on antimiCrObial surveillAnCe to drive stewardsHip
COACH White paper on recommendations for surveillance of AMR in humans with special focus on outcome measures and connection with antimicrobial stewardship TARGET: stewardship teams
24
37 INTERNATIONAL EXPERTS
CoAch project
1. Systematic review
Systematic review of all studies assessing usage of surveillance data within an antimicrobial stewardship intervention
2. Theoretical framework
Based on the evidence, evaluation of advantages and disadvantages of different aspects of assessing and reporting microbiological surveillance data to an antimicrobial stewardship team
3. Agreement
Using the theoretical framework, a series of key questions have been developed to be discussed among experts and provide specific recommendations
4. Development of specific tool
Recommendations will be explained in simplified checklist available in electronic format including handy version
Work plan Composition of the team
Organisation of reporting
Microbiological indicators
Stratification
Timeline
Thresholds
Selective reporting
Data communication and release
Reporting surveillance data on antibiotic resistance to inform stewardship teams: a call for guidance document ECCMID 2019 (15th April, 13:30, poster presentation)
Electronic Surveillance of Antimicrobial
Resistance to Drive Stewardship (ENSURE)
• To develop an automated, web-based tool capable of producing
stratified cumulative hospital antibiograms and displaying this
information in a user-friendly format to support empiric antibiotic
therapy decisions.
• To conduct an observational study to estimate the impact of
implementing the tool at a regional level on the prescribing habits
of hospital clinicians for blood stream infections.
Goals
PENTA in collaboration with UNIVR
OPTIONAL TEXT EPI-Net Showcase
A study on the burden and outcomes of
infections due to MDR organism
ABOUT-MDRO
To estimate the BURDEN of VAP, HAP, cIAI, cUTI, SSI and BSI caused
by CRKP, CRAB and VRE linking INCIDENCE DATA with CLINICAL
OUTCOMES
Goals
• Define incidence rates of VAP, HAP, cIAI, cUTI and bacteremia caused by
MDRO in different countries/areas/patient populations
• Attributable outcomes (mortality, length of stay, microbiological cure,
treatment failure)
• Evaluate the impact of estimates on study design, country, infection type
28
SAS in collaboration with UNIVR
OPTIONAL TEXT EPI-Net Showcase
OPTIONAL TEXT
Collaborative projects
30
7th JPIAMR Joint Call
- ARCH: Bridging the gap between humAn and animal suRveillance data, antibiotic poliCy, and stewardship (guidance documents series: “Survey to Treat”) 8th JPIAMR Joint Call
- GAP-ONE: Global Antimicrobial resistance Platform for ONE Burden Estimates
- CONNECT: inCreasing cOmmunicatioN, awareNEss and data sharing in a global
approaCh against resistance
EARS-Vet: European Antimicrobial Resistance Surveillance network in diseased
animals (guidance document on veterinary surveillance)
Extend the focus on LTCFs and ambulatory settings
Define surveillance indicators for burden estimates
- Extend link with surveillance networks in diseased animals
RESCUING
first data sharing between ND4BB studies and EPI-Net
31
1148 isolates
ROMANIA: 3GCeph-resistant E. coli
o ASPIRE-SSI o ASPIRE-ICU o ANTICIPATE o EURECA o ARTHR-IS
OPTIONAL TEXT EPI-Net Showcase
A network of hospitals sharing epidemiological data to improve gold standard for patients management and perform sound research
33
EPI-NET EXCELLENT CENTERS
• Tool enabling batch data submission
• Concept design for new visualization tools
• Coding and testing
34
(currently recruiting)
MODELLING
Based on evidences of
effectiveness of the following infection control measures on
AMR rate:
1. Hand hygiene
2. Education 3. Screening environment
4. Screening at admission
5. Antimicrobial stewardship
Calculation of the
EFFECT of possible infection
control measures
on prevalence of
resistance
-n. of patients admitted
-n. of hospitalizations
-n. of blood cultures
-n. of isolation rooms
-n. of hand hygiene devises
-mortality rate
-resistance rate
…
Send data to EPI-Net
Calculation of effectiveness of
interventions
Results are sent
back to centres for
IC-ATBS teams
/hospital
administration
Variables
i EPI-NET EXCELLENT CENTERS
OPTIONAL TEXT EPI-Net Showcase
36
EPI-Net goes global
International collaboration to share experiences and compare data on AMR from surveillance systems in different settings
OPTIONAL TEXT EPI-Net Showcase
• Workshop on surveillance implementation
• Info graphics on Surveillance
• A&Q sessions and quizzes
• Webinars
• On-line educational videos on AMR
surveillance
38
Development of educational
and training opportunities
39
Surveillance reports
International, national and local data
Annual report
tailored on specific topics of interest
(pathogens,
infections…)
Statistical calculations
of the effect of infection control measures on prevalence of
resistance
Standardized
templates on epidemiological
data to drive
surveillance reporting
Guidelines to drive
stewardship
Web-based tools
to support clinical decisions
Excellent
centres
ND4BB
studies
ENSURE-
CORIS
Data analysis
and publications
EU-JAMARAI
Surveillance studies
https://epinet-net.eu
2015: EPI- Net….
“What else?”
HAPPY-Net
Looking for new collaborations
Contact us!