ESCMID Online Lecture Library. by author. Surveillance of resistance in Europe. What are the requirements of a contemporary surveillance system

Transcriptie

1 1 31 maart 2012 Surveillance of resistance in Europe What are the requirements of a contemporary surveillance system Dr. Nienke van de Sande Bruinsma National Institute of Public Health and the Environment (RIVM), Bilthoven, NL

2 MoU between WHO/EURO, ESCMID and RIVM EARS-Net (ECDC) is a well developed and accepted surveillance network. However to fully understand and curtain current trends there is a need to develop a similar harmonized network in all 53 countries of the WHO European Region. Collaborate in developing a network of national surveillance systems of antibiotic resistance in all countries of the WHO European Region that are not part or affiliated with the EU. In close collaboration with ECDC, the surveillance system should be harmonized with the EU EARS-Net system, so as to enable comparison of data throughout the whole WHO European Region. 2

3 Requirements of a surveillance system 3 Set up of the national surveillance system ISIS-AR, from the start in June 2007 till now Practical examples how a national surveillance system can be used by clinicians and public health Important lessons learned

4 Requirements Requirement is a singular documented physical and functional need that a particular product or service must be or perform. It is a statement that identifies a necessary attribute, capability, characteristic, or quality of a system for it to have value and utility to a user. 4

5 Requirements 5 How the costumer explained it How the Project Leader understood it How the Analyst designed it How the Programmer wrote it How the Business Consultant described it

6 Requirements 6 How the project was documented What operations installed How the costumer was billed How it was supported What the costumer really needed

7 The ISIS-AR experience Dutch surveillance system on antimicrobial resistance 7 START: July 2007 Multidisciplinairy team formulated: Medical microbiologist Epidemiologist Data management

8 The ISIS-AR experience PROJECTPLAN WHEN time path HOW WHY GOALS 8 methodology & technical development Monitor AMR trends (Nethmap, EARS-net) Produce mirror data (improve patient care) Feedback reports ISISweb Early detection of (multi-)institutional elevations Active response to new resistance development (guidelines)

9 HOW: ISIS-AR methodology Only standardised data are collected, no free text Clinically relevant micro-organismen (>50) All positive cultures with an antibiogram For analysis purposes; first isolate per patient per year, but all successive cultures per patient are collected Included: Culture site (material), Distinction between screening and clinical isolates S I R interpretation, MIC-values, diameters (if available) and E-test and Confirmation results are collected Patient information, Institution (Hospital, OPD, GP, Nursinghomes) Department (at least ICU/non-ICU) 9

10 HOW: Dataflow ISIS-AR and ISISweb 10 ISISweb LIS query Feedback report Standard. Monthly file ISIS-AR database -RIVM

11 The ISIS-AR experience SURVEILLANCE SYSTEM GUIDELINE 11 Methodology Data flow Standardized data collection Steps for laboratories to connect. First step: Introductory meeting Appointments/Responsibilities of parties

12 The ISIS-AR experience LABORATORY COLLABORATION CONTRACTS 12 Communication structure (advisory board) Responsibilities Use of data (registration-cie) Co-signed by the national society of medical microbiologist (NVMM) Important issues that needed to be clear: Public law / Traceability of data to the lab, hospital (company level) Data protection / Traceability of personal data (individual level)

13 Added value for the participating lab/hospital Awareness Feedback report with unusual resistances Interactive website (ISISweb) for data analysis at national/local level Comparing data with surrounding labs/hospitals and national level Improve data quality and laboratory information system This year standard reports downloadable for the hospital board 13

14 Example of monthly feedback report 14

15 ISISweb Joint initiative of the RIVM and the Dutch Society of medical Microbiology (NVMM) New features: First isolate/first blood isolate/first urine isolate per patient per year View unusual resistances and Multidrug resistances Coming up: Incidences: nr (R) isolates/ patient days per year Standard reports for Hospital board 15

16 Source:

17 Added value for Ministry of Health Awareness & Transparency National overview of AMR situation and unusual resistances Multi-insititutional elevations 17

18 Added value for Public Health (population level) Improve patient care Data are used to develop antibiotic guidelines (SWAB) Network is used when developing/updating laboratory guidelines (NVMM) Back up for reference laboratories representative sample 18

19 Current status ISIS-AR 30 laboratories participating >15 on waiting list Extending goals from a representative sample for the Dutch AMR situation to a full coverage Laboratories should be able to participate, but we need the funds to do this Guarantee quality EUCAST transition - use MICs instead SIR to be able to continue to compare data retrospectively 19

20 Future ISIS-AR New developments due to the Maasstad affaire: ISIS-AR will contribute to a newly set up signalling meeting of AMR and HAI (provide signals that might be of concern) Wish list: 20 Algorithm to structurally detect elevations Full coverage: Not only a representative sample of the Dutch AMR situation but be able to track transmission between hospitals Ask financial contribution of labs/hospitals

21 Future ISIS-AR ISIS-AR is not an early warning system = real time surveillance: Two months delay of data: System functions as a backup/catch net system Should detect elevations that are not directly visible at the local level or might have been missed Why no real time surveillance yet?: Complete standardization at various levels The Netherlands is still quite diverse concerning: laboratory information systems way of coding and reporting automated systems (Vitek/Phoenix) Really know what you are doing! 21

22 Most important lessons learned Start small Do not underestimate the technical challenges of an automated surveillance system at both the laboratory and national level Communicate and collaborate Be transparant Stay realistic: Surveillance is no Rocket science 22

23 Dr. F. Vlaspolder Medisch Centrum Alkmaar Alkmaar Dr. B.C. van Hees Gelreziekenhuizen Apeldoorn Dr. A.A. van Zwet Rijnstate Arnhem Drs. R.G.F. Wintermans Lievensberg Ziekenhuis Bergen op Zoom Dr. P. van Keulen Amphia ziekenhuis Breda Dr. J Kluytmans Dr. R.W. Vreede Diagnostisch Centrum SSDZ Delft Dr. N.H.M. Renders Jeroen Bosch Ziekenhuis, lokatie Groot Ziekengasthuis Den Bosch Dr. C.L. Jansen Medisch Centrum Haaglanden Den Haag Dr. R. Brimicombe HagaZiekenhuis Den Haag Drs. F.W. Sebens Deventer Ziekenhuis Deventer Dr. J. Keijman RLM Dordrecht / Gorinchem Dordrecht Dr. B. Mulder Streeklaboratorium voor Medische Microbiologie Enschede Dr. L.J.M. Sabbe Admiraal De Ruyter Ziekenhuis Goes Dr. J.F.P. Schellekens Laboratorium voor Infectieziekten Groningen Dr. B.P. Overbeek Dr. B. Diederen Streeklaboratorium voor de Volksgezondheid Haarlem Dr. J.H.T. Wagenvoort Atrium Medisch Centrum Parkstad Heerlen Dr. F. Stals Dr. J.W. Dorigo-Zetsma Centraal Bacteriologisch en Serologisch Laboratorium Hilversum Dr. L.J. Bakker Dr. J.H. van Zeijl Izore, Centrum Infectieziekten Friesland Leeuwarden 23 Thanks to all participating laboratories! Dr. A.T. Bernards Leids Universitair Medisch Centrum Leiden Dr. B.M. de Jongh St. Antonius Ziekenhuis Nieuwegein Dr. A.M. Horrevorts Canisius Wilhelmina Ziekenhuis Nijmegen Dr. P.D. Sturm UMC St. Radboud Nijmegen Drs. R.G.F. Wintermans St. Franciscus Ziekenhuis Roosendaal Dr. B. Moffie Vlietland Ziekenhuis Schiedam Dr. B.G.A. Hendrickx Dr. A. Buiting St. Streeklaboratorium Zeeland, locatie Terneuzen Streeklaboratorium voor de Volksgezondheid Terneuzen Tilburg Drs. J.A. Kaan Diakonessenhuis Utrecht Utrecht Dr. S. Thijsen Dr. M. Deege SALTRO Utrecht Dr. A. Weersink UMC Utrecht Utrecht Dr. C.H.E. Boel Dr. H.T. Tjhie Stichting PAMM Veldhoven Dr. M.J.H.M. Wolfhagen ISALA Klinieken Zwolle Dr. G.J.H.M. Ruijs

24 Thanks to: ISIS-AR team: ISIS-AR advisory board: Maurine Leverstein-van Hall Akke van der Bij Daan Notermans Jeroen Alblas Jos Monen Marlieke de Kraker Jan Muilwijk Nienke van de Sande Gijs Ruijs Edwin Boel Marianne van der Sande Nienke van de Sande Registration-cie: Christina Vandebroucke-Grauls Jan van Zeijl Sabine de Greeff Annet Troelstra ISISweb working group: Steven Thijsen Gijs Ruijs Jan Arends Edwin Boel 24