Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015

2. AMR surveillance in Europe:
Historical background and future
outlook
Hajo Grundmann,
University Medical Centre Groningen,
The Netherlands

3. Sources of funding and COI
Staphylococcus aureus Reference Laboratory (SRL)
Network: ECDC framework service contract
09/033
UK MRSA INVESTIGATION NETWORK: UK CRC
MRC/Wellcome Trust
European Survey on Carbapenemase-Producing
Enterobacteriaceae (EuSCAPE): ECDC framework
service contract 12/055
COI none to declare

4. Overview
• Surveillance of antibiotic resistance
• Historical context
• Ingredients for success
• How to address the challenges of the future?

5. Surveillance of antibiotic resistance

6. Definition: Surveillance
‘ The ongoing systematic collection, analysis of health data
essential to the planning, implementation, and evaluation, of
public health practice, …
Alexander Langmuir 1963

7. The ecological landscapes of AMR surveillance
Patients Antibiotic
Exposure
Microbiota

8. The Nemesis of good surveillance in
Antibiotic resistance
Ambition
Perfection
Conflicting demands

9. Historical context

10. The Golden age of AMR surveillance
Year Name Country
1986 NNIS USA
1989 ISS IS
1990 CDSC/PHLS Eng & Wales
1994 STRAMA SE
1995 DANMAP DK
1996 ICARE USA
MITRA/MENSUR ES
ENARE EU
Alexander Project 5 countries
1997 CARB FR
SENTRY USA/8 countries
MYSTIC How many countries ?
ARM/WHO-NET WHO
1998 WHO-NET Greece GR
ISGAR IT
EARSS EU

11. The Golden age of AMR surveillance
Year Name Country
1986 NNIS USA
1989 ISS IS
1990 CDSC/PHLS Eng & Wales
1994 STRAMA SE
1995 DANMAP DK
1996 ICARE USA
MITRA/MENSUR ES
ENARE EU
Alexander Project 5 countries
1997 CARB FR
SENTRY USA/8 countries
MYSTIC How many countries ?
ARM/WHO-NET WHO
1998 WHO-NET Greece GR
ISGAR IT
EARSS EU

12. Philosophy of EARSS
“Simplicity is the name of the game”

14. Heterogeneity between laboratories and regions
 Health care system
 Hospital mix
 Disease patterns
 Diagnostic habits
 Susceptibility testing
Sceptic view:

15. “…it is doubtful if national rates of resistance have any comparative
value at all.”
Surveillance of antimicrobial resistance – what, how and
whither ?
R. Bax, R. Bywater, G. Cornaglia, H. Goossens, et al
Clin Microbiol Infect Dis 2001, 7: 316-325
Resumeé:

16. Ingredients for success

17. The six conditions for successful AMR
surveillance
legal support
economic viability
partnership
acceptability
validity & comparability
representativeness

18. The six conditions for successful AMR
surveillance (1)
Legal support
EARSS = European Antimicrobial Resistance
Surveillance System
Recommended by the Visby declaration 1998
endorsed by European Parliament and the Council
Legislation 2119/98/EC and Commission Decision
2000/96/EC

23. The six conditions for successful AMR
surveillance (2)
Economic viability
EARSS funding by ECDC and the Dutch Ministry of
Welfare and Sports
at an annual cost of EURO 668.458

24. The six conditions for successful AMR
surveillance (3)
Partnership = Devolution
network of network approach
clear data ownership
support network development
support data management
support microbiological protocols

25. Datamanagers workshop 2003

26. WHO – NET support

27. The six conditions for successful AMR
surveillance (4)
Acceptability = Restriction
routine data
indicator pathogens
invasive isolates
indicator antibiotics (class resistance)
reporting proportions

28. The six conditions for successful AMR
surveillance (5)
Validity & Comparability
standard protocols
defined endpoints (S,I,R, EUCAST, CLSI)
routine internal quality control
regular external quality assurance exercises

29. EARSS - EUCAST added value

30. and lost of good wine and dine…..

31. EARSS 2008
917 Laboratories
1587 Hospitals
>100 million citizens
33 countries

32. EARSS-
database

33. EARSS-
database

34. EARSS-
database

35. How to address the challenges of the
future ?

36. European structured surveys
Staphylococcal Reference Laboratory Working Group
Structured survey 1 (2006)
Structured survey 2 (2011, supported through ECDC tender)
European Survey on Carbapenemase-producing
Enterobacteriaceae (EuSCAPE, 2013 – 2014, supported through
ECDC tender)

37. Conclusions
• Population level surveillance of Antibiotic resistance in Europe was
successful for many good reasons
• EARS-net continues to provide ever more meaningful data about
the spread of clinically relevant antibiotic resistance through
Europe
• ECDC is well prepared to take on novel challenges by embracing
advanced approaches that will increasingly help understand
contain the dissemination of antibiotic resistant bacteria through
communities and patient populations.

38. Thanks
University Medical Center Groningen
Tjibbe Donker
Corinna Glasner
Alex Friedrich
Sanger Centre
Matt Holden
Sandra Reuters
Julian Parkhill
University of Bath
Ed Feil
Santiago Castillo-Ramirez
Imperial College London
David Aanesen
Brian Spratt
European Centers for Disease Prevention
and Control (ECDC)
Ole Heuer, Lotta Diaz Högberg
Marc Struelens
Barbara Albiger, Dominique Monnet
The EARSS management team
Paul Schrijnemakers
Nienke van der Sande Bruinsma
Edine Timmermans
Carola Schinkel
WHO-Net
John Stelling
Tom O’Brian
UK NEQAS
Christine Walton
Vivienne James
EUCAST
Gunnar Kahlmeter
Derek Brown
All national representatives & data mangers