Monitoring of AMR in Russia Surveillance studies conducted by Institute of Antimicrobial Chemotherapy (IAC) Centre for Monitoring of Antimicrobial Resistance (CMAR)
Prospective surveillance studies on AMR in Russia Ø Collection of microbial isolates and patient s data (in CRFs) matching the defined study criteria and patients population Ø Repeated cross-sectional studies conducted at intervals of 1-3 years or continuous studies Ø Main focuses: Nosocomial infections Community-acquired UTIs Community-acquired LRTI Ø Consecutive non-duplicate isolates (one per patient / case of infection) Ø Various types of specimens (representative for infection type) Ø AST in central laboratory of IAC Ø Storage of all isolates (regardless of AMR profile)
Participants of IAC / IACMAC surveillance studies on AMR 1994-95: 4 hospitals in 2 cities; 400 isolates 2013-15: 62 hospitals in 50 cities of Russia; ~4000 isolates/year Anadyr Murmansk Petrozavodsk St.-Petersburg Archangelsk Cherepovets Vologda Smolensk Moscow Yaroslavl Rostov Kaluga Nizh.Novgorod Orel Nab. Chelny Kazan Ryazan Izhevsk Noyabrsk Voronezh Lipetsk Perm Surgut Tolyatti Ufa Nizhni Tagil Nizhnevartovsk Rostov-on-Don Samara Yekaterinburg Khanty-Mansiysk Volgograd Penza Tyumen Seversk Krasnodar Chelyabinsk Тomsk Stavropol Omsk Kemerovo Krasnoyarsk Kislovodsk Novosibirsk Barnaul Novokuznetsk Irkutsk Ulan-Ude Yakutsk Khabarovsk Vladivostok + collaborating sites in 9 cities of Belarus, Kazakhstan, Ukraine and Moldova
National surveys of AMR in nosocomial pathogens in Russia 1994-95 Nosocomial Gram-negative Pathogens Prevalence and Resistance Survey in ICUs (NPRS I) 4 hospitals in 2 cities 1998-99 NPRS II 30 hospitals in 14 cities 2002-04 Antimicrobial resistance in nosocomial bacterial pathogens in Russian ISUs (RESORT) 33 hospitals in 20 cities 2006-08 Antimicrobial resistance in nosocomial bacterial pathogens in wards with intensive use of antibiotics (REVANSH) 36 hospitals in 26 cities 2011-12 Monitoring of prevalence and antimicrobial resistance of nosocomial pathogens and use of antimicrobial agents in tertiary hospitals (MARATHON) 23 hospitals in 19 cities
New design of AMR surveillance studies in hospitals in Russia Ø Transition from repeated cross-sectional to continuous study design Ø Any infections in hospitalised patients: nosocomial or communityacquired (distinguished based on formal 48-hour criterion and recorded in CRF) MARATHON-2013: 23 hospitals in 19 cities MARATHON-2014: 33 hospitals in 22 cities MARATHON-2015: 23 hospitals in 16 cities (isolates and data submitted by Dec. 2015) + APEx (since 2013): carbapenemase-producing Acinetobacter spp., Pseudomonas aeruginosa and Enterobacteriaceae
Species distribution of bacterial nosocomial pathogens in Russia Gram(-)... 72,1% % Escherichia coli 7,8 Klebsiella pneumoniae 17,0 Klebsiella oxytoca 0,4 Enterobacter cloacae 2,6 Enterobacter aerogenes 0,7 Enterobacter asburiae 0,2 Serratia marcescens 1,9 Serratia ureilytica 0,1 Proteus mirabilis 1,7 Proteus vulgaris 0,5 Proteus penneri 0,1 Citrobacter freundii 0,4 Morganella morganii 0,4 Raoultella ornithinolytica 0,1 Pseudomonas aeruginosa 19,9 Pseudomonas mendocina 0,1 Pseudomonas mosselii 0,1 Pseudomonas stutzeri 0,1 Acinetobacter baumannii 14,0 Acinetobacter pittii 0,4 Acinetobacter calcoaceticus 0,2 Acinetobacter genomosp. 13 0,1 Acinetobacter haemolyticus 0,1 Stenotrophomonas maltophilia 2,8 Alcaligenes faecalis 0,5 Alcaligenes xylosoxidans 0,1 Achromobacter xylosoxidans 0,1 Myroides odoratimimus 0,1 Gram(+)... 27,9% % Staphylococcus aureus 16,9 Staphylococcus epidermidis 2,0 Staphylococcus haemolyticus 1,4 Staphylococcus hominis 0,5 Staphylococcus albus 0,1 Staphylococcus saprophyticus 0,1 Staphylococcus simulans 0,1 Staphylococcus warneri 0,1 Enterococcus faecalis 4,2 Enterococcus faecium 2,1 Enterococcus gallinarum 0,1 Enterococcus avium 0,1 Enterococcus raffinosus 0,1 Streptococcus agalactiae 0,1 Streptococcus pneumoniae 0,1 Streptococcus pyogenes 0,1 MARATHON Study
Carbapenem resistance (%I+R) and production of carbapenemases in nosocomial Enterobacteriaceae in Russia 2006-07: CPE 1 isolate (0.1%) 2011-12: CPE 19 isolates (3.4%), 3 cities 2012-15 (all studies): CPE >100 isolates, 11 cities Rostov-on-Don Krasnodar St.-Petersburg Smolensk Orel Kaluga Voronezh Stavropol Moscow Lipetsk Volgograd VIM-4 (single) Yaroslavl Ryazan Tolyatti Samara OXA-48 (dominant) NDM-1 (sporadic) KPC-2 (local) Nizh.Novgorod Kazan Ufa Chelyabinsk Perm Yekaterinburg Noyabrsk Tyumen Omsk Nizhnevartovsk Seversk Тomsk Kemerovo Novosibirsk Krasnoyarsk Barnaul Novokuznetsk Irkutsk 3.2 3.6 6.7 Yakutsk MER IPM ETP Ca-se.-pos. 2.1 9.8 Н 0.1 0.3 Н 0.0 0.0 0.1 1997-99 2002-04 2006-07 (n=1598) (n=1374) (n=1039) Khabarovsk Vladivostok 2.8 8.4 14.0 3.3 2011-12 (n=572)
Carbapenem resistance (%I+R) and production of MBLs in nosocomial Pseudomonas aeruginosa in Russia 2002-04: MBL(+) 47 isolates (4.5%), 3 cities 2006-07: MBL(+) 160 isolates (20.1%), 12 cities 2011-12: MBL(+) 97 изолятов (28.0%), 13 cities 2006-15 (all studies): MBL(+) >800 isolates, 24 cities Rostov-on-Don Krasnodar St.-Petersburg Smolensk Orel Kaluga Voronezh Stavropol Moscow Lipetsk Volgograd Yaroslavl Ryazan Tolyatti Samara Nizh.Novgorod Kazan Ufa VIM-2 (dominant) IMP-30 (local) Chelyabinsk Perm Yekaterinburg Noyabrsk Tyumen Omsk Novosibirsk Nizhnevartovsk Seversk Тomsk Novokuznetsk Kemerovo Krasnoyarsk 19.0 Irkutsk 39.0 Yakutsk IPM MER MBL-pos. 55.4 0.0 Н 4.5 1997-99 (n=821) 2002-04 (n=1053) 55.9 79.3 Khabarovsk Vladivostok 20.1 58.5 66.8 28.3 2006-07 (n=787) 2011-12 (n=347)
Epidemic spread of P. aeruginosa ST235 VIM-2 in Belarus, Kazakhstan and Russia Ø Rise of MBL prevalence in nosocomial P. aeruginosa in Russia from 4.5% to 28.7% between 2002 and 2010 Ø 96.5% of MBL producers belong to the epidemic clone ST235 VIM-2
251 MBL-pos. isolates, 2003-2012 ST111 (VIM, IMP): 29.9% ST235 (VIM, IMP): 20.7% ST357 (VIM): 12.0% ST233 (VIM): 10.4% ST654 (VIM, IMP, NDM): 7.6% ST773 (VIM): 5.2% Other (VIM, IMP, NDM): 14.3%
Carbapenem resistance (%I+R) and production of carbapenemases in nosocomial Acinetobacter spp. in Russia 1997-99: Ca-se.(+) 1 isolate (0.5%) 2002-04: Ca-se.(+) 11 isolates (2.4%), 3 cities 2006-07: Ca-se.(+) 9 isolates (2.7%), 3 cities 2011-12: Ca-se.(+) 111 isolates (44.0%), 13 cities 2011-15 (all studies): Ca-se.(+) >700 isolates, 20 cities St.-Petersburg Murmansk Smolensk Moscow Nizh.Novgorod Orel Kaluga Kazan Ryazan Ижевск Noyabrsk Voronezh Lipetsk Perm Rostov-on-Don Tolyatti Ufa Yekaterinburg Сургут Samara Seversk Volgograd Tyumen Krasnodar Chelyabinsk ТOmsk Stavropol Omsk Kemerovo OXA-58-like OXA-23-like Yaroslavl OXA-24/40-like (dominant) NDM-1 Novosibirsk Novokuznetsk Krasnoyarsk Irkutsk Yakutsk IPM MER Ca-se.-pos. 38.6 Khabarovsk Vladivostok 3.0 11.8 6.0 5.1 0.5 Н 2.4 2.7 1997-99 2002-04 2006-07 (n=202) (n=466) (n=332) 48.0 67.5 44.0 2011-12 (n=252)
Dominance of international high-risk clones among Russian nosocomial A. baumannii and allodemic pattern of carbapenemase-producing strains SNP typing and MLST of 103 isolates from 54 hospitals, 32 cities
Nosocomial infections due to carbapenemaseproducing Gram-negative pathogens in Russia MARATHON Study (2011-12), 26 hospitals, 19 cities ~13% Ca-se.-positive, (most XDR) ~1% PDR E. coli 7,8% K. pneumoniae 17,0% OXA-48, NDM-1: 1,1% P. aeruginosa 19,9% VIM-2: 5,6% Другие бактерии 24,4% A. baumannii 14.0% S. aureus 16,9% OXA-40/-23/-58: 6,2%
Prospective surveillance studies: Pros and Cons + Standardised AST in central lab (MIC data) + Storage of collected isolates but Low coverage of hospitals and patient population Long time to results!
Future development of AMR surveillance in Russia Ø Establishing a network of laboratories to collect reliable AST data as part of the CAESAR (Central Asian and Eastern European Surveillance of Antimicrobial Resistance) project Ø Collecting AST data in real time Ø Development of a web-based resource Map of Antimicrobial Resistance (supported by the Ministry of Health of Russian Federation Distributed access system for coordinating centre, participating centres, and general users Interactive trends, charts, geographic maps Basic and advanced statistics and BI tools Comparison of local and national AMR data: my hospital vs. city / region / country