EUCAST and National Antimicrobial Susceptibility Testing Committees
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Presentation of the 16th NMFP meeting held on 4-5 May 2017 in Stockholm
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EUCAST and National Antimicrobial Susceptibility Testing Committees
- 1. EUCAST and the NACs Christian G. Giske Chairman of EUCAST Stockholm, 4 May 2017
- 2. • Organised by the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and European Centre for Disease Control and Prevention (ECDC) • Utilized by European Medicines Agency (EMA) for setting breakpoints on new agents and European Food Safety Agency (EFSA) for setting epidemiological cut-off values • Financed by ESCMID and ECDC. No commercial activity or dependency • Steering Committee and General Committee – both with international representation • Network of National AST Committees (NACs) for national implementation of guidelines and dor consultation • Subcommittees with wide international participation EUCAST
- 3. • Systematic review (and revision) process for all breakpoints • Open consultation on all major decisions except on breakpoints for new agents where confidentiality is respected • Rapid turnaround time on all decisions – 5 meetings per year; not restricted by industry or national agencies; turnaround time on questions normally 1 h – 24 h • All output free of charge on website (www.eucast.org) • Laboratory facilities for development • Increasing international reach EUCAST – the process
- 4. EUCAST SC 2017 • Christian G. Giske, chair • John Turnidge, scientific secretary • Rafael Canton, clinical data coordinator • Gunnar Kahlmeter, technical data coordinator/webmaster • Sören Gatermann, Germany • Christoffer Lindemann, Norway • Johan Mouton, The Netherlands • Alasdair MacGowan, UK • Gerard Lina, France • Arjana Tambic, Croatia • Deniz Gur, Turkey • Additionally: visiting members from NACs (max one per meeting)
- 5. EUCAST Subcommittees • STANDING – Antifungal susceptibility testing – Veterinary susceptibility testing – Antimycobacterial Susceptibility testing • AD HOC – Intrinsic Resistance and Expert Rules – MIC distributions and ECOFFs – Polymyxins breakpoints and methods (joint with CLSI) – Detection of resistance mechanisms – Relationship between WGS (NGS) and phenotypic susceptibility testing • UNDER RESTRUCTURING – Anaerobes
- 6. Implementation of EUCAST breakpoints, April 2016 Denmark Finland Poland France Germany Spain Portugal Greece Italy Turkey Switzer- land Austria Czech Republic Estonia Latvia Lithuania Belarus Ukraine Romania Hungary Slovakia Moldova Bulgaria Russia Ireland Great Britain Monte- negro Serbia Slovenia Croatia Bosnia- Herze- govina Mace- donia Albania Norway Nether- lands Malta Belgium Luxembourg Sweden >50% <10% 10-50% No information Australia Iceland IsraelCountries not on this map: % Laboratories South Africa USAMoroccoBrazil New Zealand Kosovo Armenia Georgia Azerbaijan Canada
- 7. Implementation of EUCAST breakpoints, April 2017 Denmark Finland Poland France Germany Spain Portugal Greece Italy Turkey Switzer- land Austria Czech Republic Estonia Latvia Lithuania Belarus Ukraine Romania Hungary Slovakia Moldova Bulgaria Russia Ireland Great Britain Monte- negro Serbia Slovenia Croatia Bosnia- Herze- govina Albania Norway Nether- lands Malta Belgium Luxembourg Sweden >50% <10% 10-50% No information % Laboratories Kosovo Armenia Georgia Azerbaijan FYR Mace- donia Australia Iceland IsraelOther countries: South Africa USAMoroccoBrazil New ZealandCanadaChina
- 8. Implementation of EUCAST disk diffusion, April 2016 Denmark Finland Poland France Germany Spain Portugal Greece Italy Turkey Switzer- land Austria Czech Republic Estonia Lithuania Belarus Ukraine Romania Hungary Slovakia Moldova Bulgaria Russia Ireland Great Britain Monte- negro Serbia Slovenia Croatia Bosnia- Herze- govina Mace- donia Albania Norway Nether- lands Malta Belgium Luxembourg Sweden >50% <10% 10-50% No information % Laboratories Latvia Australia Iceland IsraelCountries not on this map: South Africa USAMoroccoBrazil New Zealand Kosovo Armenia Georgia Azerbaijan Canada
- 9. Implementation of EUCAST disk diffusion, April 2017 Denmark Finland Poland France Germany Spain Portugal Greece Italy Turkey Switzer- land Austria Czech Republic Estonia Lithuania Belarus Ukraine Romania Hungary Slovakia Moldova Bulgaria Russia Ireland Great Britain Monte- negro Serbia Slovenia Croatia Bosnia- Herze- govina Albania Norway Nether- lands Malta Belgium Luxembourg Sweden >50% <10% 10-50% No information % Laboratories Latvia Kosovo Armenia Georgia Azerbaijan FYR Mace- donia Australia Iceland IsraelOther countries: South Africa USAMoroccoBrazil New ZealandCanadaChina
- 11. The EUCAST NAC SOP • Structure: – independent committee or a subcommittee of a group with a wider antimicrobial remit • Membership: – experts and stakeholders in antimicrobial susceptibility testing: • Individual experts • Representatives of professional organisations/societies Representatives of government • Representatives of antibiotic use, resistance surveillance committees • Representatives of quality assurance agencies
- 12. NAC objectives • To formulate strategy at a national level – Action through government, professional organisations or societies – Inclusive decision to follow EUCAST breakpoints • To implement breakpoints and methods – Identify stakeholders and provide information – Communicate with device manufacturers to ensure no practical limitations – Communicate with laboratory staff to ensure that all are informed – Communicate with clinicians on consequences of breakpoint changes – Communicate with government to ensure that they are on board – Communicate with professional organisations/societies – Communicate with quality assurance agencies to ensure that they use • EUCAST breakpoints – Provide guidance and support to clinical laboratories. – Provide practical guidelines for introducing methods – Provide breakpoint tables, method descriptions
- 13. Overview of NACs, April 2016 Denmark Finland Poland France Germany Spain Portugal Greece Italy Turkey Switzer- land Austria Czech Republic Estonia Latvia Lithuania Belarus Ukraine Romania Hungary Slovakia Moldova Bulgaria Russia Ireland Great Britain Monte- negro Serbia Mace- donia Albania Norway Nether- lands Malta Belgium Luxembourg Sweden Yes No In the process of forming a NAC No information Slovenia Croatia Bosnia- Herze- govina Australia Iceland IsraelCountries not on this map: South Africa USAMoroccoBrazil New Zealand Kosovo Armenia Georgia Azerbaijan Canada
- 14. Overview of NACs, April 2017 Denmark Finland Poland France Germany Spain Portugal Greece Italy Turkey Switzer- land Austria Czech Republic Estonia Latvia Lithuania Belarus Ukraine Romania Hungary Slovakia Moldova Bulgaria Russia Ireland Great Britain Monte- negro Serbia FYR Mace- donia Albania Norway Nether- lands Malta Belgium Luxembourg Sweden Yes No In the process of forming a NAC No information Slovenia Croatia Bosnia- Herze- govina Australia Iceland IsraelOther countries: South Africa USAMoroccoBrazil New Zealand Kosovo Armenia Georgia Azerbaijan CanadaChina
- 15. NACs outside Europe Countries with a NAC operating under EUCAST standards Countries with interest to establish a NAC under EUCAST standards
- 16. NAC and EUCAST SC interaction VS National exceptions do occur, but should be few NACs should present the rationale for the decision for publication on the EUCAST website Buffet dinner Fixed menu
- 17. Can NACs attend SC meetings? • All NACs can opt for attending meetings if they cover own meeting costs • Normally only one NAC is allowed per meeting • The interest in participating in SC meetings has been modest in many countries, partly for financial reasons • Many countries have NACs with limited experience with setting breakpoints • One way of obtaining experience is to serve as General Committee representative in the Steering Committee
- 18. EUCAST expectations from NACs • Increased level of contact is desirable • Hybrid breakpoint tables are not a good way forward – Let us discuss until we agree – Or there is (rarely) a reason not to harmonise (e.g. different available dosing regimens) – NACs should have few exceptions from the published EUCAST table – We can discuss about agents not currently available in the breakpoint tables
- 19. Acknowledgements The EUCAST Steering Committee members, past and present EUCAST Development Laboratory, Dr Erika Matuschek and Ms Jenny Åhman All EUCAST NACs