Capacity Building and Strengthening of Hospital Infection Control to detect and prevent antimicrobial resistance in India AIIMS-ICMR-CDC EQAS Recommendations to take it forward!
Top regional diagnostic microbiology laboratories of the country are in AMR EQAS IAMM EQAS Skill Identification & DD Antibiotic panel given MIC not expected Skill AMR EQAS Identification & DD Antibiotic panel not given Expected MIC determination Knowledge Appropriate testing methodology like DD, MBD, E test, cast Appropriate reporting Difference exits between routing IAMM EQAS and the proposed AMR EQAS
To enhance EQAS performance bridging the gap Not following the recommended testing methodologies Not reporting the syndrome specific drug-bug combinations Not sticking to the interpretative breakpoints Validation & quality control issues of commercial AST conventional Versus cast - challenging Restricted reporting of reserve drugs for XDR pathogens
Not following the recommended testing methodologies
Susceptibility testing thumb rule.. Colistin MIC Broth Micro Dilution Fosfomycin Agar dilution (25 µg Glucose 6 phosphate) E test (need not use Glucose 6 phosphate) *BMD not to be used * Ignore colonies in the zone of inhibition Vancomycin MIC E test Broth Micro Dilution Commercial AST Tigecycline MIC Broth Micro Dilution (Freshly prepared CAMHB)
Not reporting the syndrome specific drug-bug combinations
Syndrome Vs Drug-Bug panel Blood CSF Respiratory Urine GNB Cefotaxime Ceftazidime Cefoperazone/Sulbactum Piperacillin/Tazo Ciprofloxacin Gentamicin Tigecycline Chloro Tetra Cefpodoxime Chloramphenicol Cefoperazone/sulbactam Piperacillin/tazobactam Ciprofloxacin Cefpodoxime (Cpd) Cefuroxime Amox/Clavulanate Pip/Tazo CFP /Sulbactam Levofloxacin Tigecycline Tobramycin Cotrimoxazole Cefpodoxime Amoxicillin/sulbactam Cefoperazone/sulbactam Piperacillin/tazobactam Ertapenem Ciprofloxacin Gentamicin Co-Trimoxazole Nitrofurantoin NFGNB Ceftazidime Cefepime Piperacillin/tazo CFP / Sulbactum Aztreonam Levofloxacin Tobramycin Tetracycline Cotrimoxazole TIgecycline Ceftazidime Cefepime Aztreonam Cefoperazone/sulbactam Piperacillin/tazobactam Levofloxacin Ceftazidime Cefepime Piperacillin/tazo CFP / Sulbactam Aztreonam Levofloxacin Tobramycin Ceftazidime Cefepime Cefoperazone/sulbactam Piperacillin/tazobactam Aztreonam Levofloxacin Tobramycin
Cycle 1 Cycle 2 Cycle 3 Proposed AMR EQAS plan Testing scheme Smear, Culture, Identification, Antimicrobial Susceptibility Testing Smear, Culture, Identification, Antimicrobial Susceptibility Testing Smear, Culture, Identification, Antimicrobial Susceptibility Testing, Antimicrobial Resistance Phenotypic tests Test performance source Lyophilized cultures Lyophilized cultures Lyophilized cultures In the subsequent cycles, simulated specimens will be commenced Molecular tests for antimicrobial resistance characterization will be assessed for the selected sites in the third cycle Not taken through!
Recommendations to continue Inadequacies still does exits in the IAMM EQAS, hence the need for AMR EQAS Need to strengthen laboratories in detecting antimicrobial resistance Phenotypic and molecular techniques to be started only for selected sites Need for continuation - for a minimum of two years, as to strengthen the regional labs Regional labs can further train the smaller laboratories In the past three cycles, participants have stabilized in the basic antimicrobial susceptibility testing in terms of methodology, interpretation and drug-bug combinations Determination of MIC, AMR screening techniques and essential molecular techniques would be the next step to take forward!!!
Thank you