The document summarizes Turkey's national antimicrobial resistance (AMR) surveillance system called CAESAR. It describes the system's methodology which involves collecting clinical samples and testing pathogens for resistance to antibiotics. Samples are collected from hospitals across Turkey's cities. The system is coordinated by Turkey's Public Health Institution and involves numerous hospitals, laboratories, and staff. It aims to strengthen AMR surveillance in non-EU countries. Data is collected, analyzed, and published in annual reports on a dedicated website to inform AMR monitoring and policy efforts.

1. Public Health Institution of Turkey
Ministry of Health
CAESAR: the example of Turkey
Serap Süzük
Clinical Microbiologist
On behalf of Public Health Institution of Turkey
3rd Joint Meeting of the Antimicrobial Resistance and
Healthcare-Associated Infections (ARHAI) Networks
Courtyard Stockholm Kungsholmen, Stockholm, 11-13 February 2015

2. Public Health Institution of Turkey
Ministry of Health
National AMR Team
• Hüsniye Şimşek, National AMR Focal Point
– Infectious Diseases and Clinical Microbiologist
• Serap Süzük
– Clinical Microbiologist
• Dilber Aktaş
– Epidemiologist
• Murad Bayram
– IT Specialist
• Şeref Işık
– Technical Staff

3. Public Health Institution of Turkey
Ministry of Health
Demographic Information
• Turkey
– 81 cities
– 75 million population
– 1500 hospitals

4. Public Health Institution of Turkey
Ministry of Health
AMR in Turkey

5. Public Health Institution of Turkey
Ministry of Health
National AMR Surveillance System
National Nosocomial Infections Surveillance
National Surveillance of Antibiotic Consumption

6. Public Health Institution of Turkey
Ministry of Health
National AMR Surveillance System

7. Public Health Institution of Turkey
Ministry of Health
Methodology
National
AMR
Surveillance
System
CAESAR
(Central Asian
and Eastern
European
Surveillance of
Antimicrobial
Resistance)

8. Public Health Institution of Turkey
Ministry of Health
CAESAR
(Central Asian and Eastern European
Surveillance of Antimicrobial
Resistance) Network

9. Public Health Institution of Turkey
Ministry of Health
CAESAR
• Aim:
– to strengthen national surveillance of AMR in the non-
EU countries of Europe
• by providing technical support in the field of laboratory
methods,
• surveillance methodology
• Collaboration:
– RIVM (National Institute for Public Health and the Environment, The Netherlands)
– ESCMID (European Society of Clinical Microbiology and Infectious Disease)
– WHO Europe (World Health Organization Regional Office for Europe)

10. Public Health Institution of Turkey
Ministry of Health
CAESAR
• Albania
• Armenia
• Azerbaijan
• Belarus
• Bosnia Herzegovina
• Georgia
• Israel
• Kosovo*
• Kyrgyzstan
• FYR Macedonia
• Moldova
• Montenegro
• Russia
• Serbia
• Switzerland
• Tajikistan
• Turkey
• Turkmenistan
• Ukraine
• Uzbekistan
in accordance with the United Nations Security Council Resolution 1244 (1999)
Figure is taken from presentation of Zsuzsanna Jakab, The Global Action Plan to combat AMR, Challenges of AMR on a global and regional level

11. Public Health Institution of Turkey
Ministry of Health
Methodology
Clinical samples
• Blood
• CSF
Pathogens
• Escherichia coli
• Klebsiella pneumoniae
• Pseudomonas aeruginosa
• Streptococcus pneumoniae
• Staphylococcus aureus
• Enterococcus faecium/faecalis
• Acinetobacter spp. (Added in 2014)
Antibiotics

12. Public Health Institution of Turkey
Ministry of Health
Turkey’ Cities in CAESAR
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*2013-2014 Participating Cities
*2015 Participating Cities

13. Public Health Institution of Turkey
Ministry of Health
Participating Laboratories
Years
The
Number of
Cities
Participating
Laboratories
State
Hospital
University
Hospital
Private
Hospital
2013-
2014
45 77 42 35 0
New in
2015
14 28 15 10 3
Total 59 105 57 45 3

14. Public Health Institution of Turkey
Ministry of Health
Legislation
• Scientific committee working procedures and
principles
• Inclusion criteria for the surveillance network
• The duties and responsibilities of National AMR
Laboratory
• Selection criteria for surveillance system
• Surveillance objectives and content
• Data collection criteria

15. Public Health Institution of Turkey
Ministry of Health
Scientific commission
• Select participating laboratory
• Prepare Standard Operating Procedure
• Prepare annual report
• Choose isolates for National External Quality
Assessment
• Training of participating laboratory (the
courses…)

16. Public Health Institution of Turkey
Ministry of Health
Selecting participating laboratory
First stage: evaluating
laboratory capacity
Tool: Questionnaire
• Test capacity
• Staff capacity
• Equipment capacity
Second stage: evaluating
laboratory performance
Tool: EQA
• Identification methods
• AST methods

17. Public Health Institution of Turkey
Ministry of Health
National EQA System
• Since 2011
• On-line system
• One cycle per year (4 isolates)
• Each isolate is scored: 100 point
– Identification:30 points
– AST: 70 points
• Max 400 points, min 280 points
• Report

18. Public Health Institution of Turkey
Ministry of Health
NEQAS-CAESAR
• In 2013
– 73 participating laboratories
• In 2014
– 77 participating laboratories

19. Public Health Institution of Turkey
Ministry of Health
Data
• Collecting data (Excel)
– Electronic system
• Pre-assessment
• Backlink-WHONET
• Data analysis
• Draft report
• Annual report (on-line)

20. Public Health Institution of Turkey
Ministry of Health
Training / Meeting
• Laboratory network meeting twice a year
- introduction of the participating laboratories
- annual report (analysis, comments…)
• Implementation of EUCAST standards in 2015

21. Public Health Institution of Turkey
Ministry of Health
www.uamdss.thsk.gov.tr
• Announcement
• SOP
• EUCAST in Turkish
• EQA Results
• Annual report
• Training documentation

22. Public Health Institution of Turkey
Ministry of Health
Summary
• Surveillance system is important
• WHY ?
– shows the current status
– allows the determination of target
– determine the roadmap
– allows comparisons
• National and international

23. Public Health Institution of Turkey
Ministry of Health
Thank you…