COMBACTE EPI-Net Showcase · (Israel National Center for Infection Control), Nandini Shetty (PHE) 14 Outbreaks Number of outbreaks: 528 ... o Characterization of AMR genes in livestock

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


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

9

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


AMR surveillance studies

Number of studies: 22


National HAI surveillance systems Number of systems: 22


International HAI surveillance systems Number of systems: 1


HAI surveillance studies Number of studies: 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


12

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


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


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.


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

[email protected]

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


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


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

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


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


36

EPI-Net goes global

International collaboration to share experiences and compare data on AMR from surveillance systems in different settings


• 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!

[email protected]

[email protected]

mailto:[email protected]




Documents

COMBACTE EPI-Net Showcase · (Israel National Center for Infection Control), Nandini Shetty (PHE) 14 Outbreaks Number of outbreaks: 528 ... o Characterization of AMR genes in livestock