Antimicrobial Resistance Surveillance in Bangladesh

AMR Surveillance Data Visualization

Antimicrobial resistance (AMR) is a global public health problem. In May 2015, the 68thWorld Health Assembly adopted the Global Action Plan on Antimicrobial Resistance. One of the five strategic objectives of the Global Plan (GAP) is to strengthen the evidence base through surveillance and research. All countries are required to develop their own national action plan based on the GAP, and start implementing it at local level. Accordingly National Action plan for containment of Antimicrobial Resistance in Bangladesh 2017-2022 has been prepared. Surveillance of Antimicrobial resistance is an important issue in this plan.

Institute of Epidemiology, Disease Control and Research (IEDCR) has been conducting AMR surveillance since 2017 with technical support initiallyfrom US-CDC and then also from WHO to find out the status of Antimicrobial Resistance of ten selected bacteria from six types of specimens
  1. Urine
  2. Stool
  3. Wound swab
  4. Sputum
  5. Blood
  6. Endotracheal aspirate.

Case selection:

5 different cases of infectious diseases are enrolled by case definition and the samples are collected from these patients after being diagnosed by the physicians
  1. UTI
  2. Diarrhoeal diseases
  3. Wound infection
  4. Pneumonia
  5. Septicaemia

4Wound Swab / pusWound infection5Endotracheal aspirateSepticaemia

Sl. No Specimen Case
1 Blood Septicaemia
2 Urine UTI
3 Stool Diarrhoea

Ten priority pathogens has been selected considering the GLASS (Global Antimicrobial Resistance Surveillance System) protocol by WHO as well as the country perspective. These are:
  1. Escherichia coli
  2. Klebsiellapneumoniae
  3. Enterococcus species
  4. Vibrio cholerae
  5. Shigella species
  6. Streptococcus pneumoniae
  7. Staphylococcus aureus
  8. Salmonella spp.
  9. Pseudomonas aeruginosa
  10. Acinetobacter spp.

In 2016 and surveillance protocol, Standard Operating procedure (SOP), training of the relevant personnel and other necessary preliminary works had been done. A project facilitator has been appointed to organize the whole work in each sentinel sites.

In 2017, sample collection and laboratory testing started in 5 sentinel sites mentioned below:

  1. Mymensingh Medical College & Hospital (MMCH), Mymensingh
  2. Rajshahi Medical College & Hospital (RMCH), Rajshahi
  3. Rangpur Medical College Hospital (RpMCH),Rangpur
  4. UttaraAdhunik Medical College & Hospital (UAMCH) Uttara, Dhaka
  5. Bangladesh Institute of Tropical and Infectious Diseases (BITID), Chattogram

To strengthen selected Microbiology laboratories important equipments and logistics are being provided. For ensuring the quality of laboratory worksStandard Operating Procedure (SOP) for lab has been prepared and provided to the labs hands on training has been provided to the lab personnel.Internal and external quality control measures are included in the SOP’s and emphasized inrefresher’s trainings. Repeated monitoring visits are being conducted to ensure the smooth running of all activities at the sentinel sites.

Samples are cultured and isolates are being tested at these sites to determine the antibiotic sensitivity pattern. All the relevant epidemiological as well as laboratory data is being compiled in hard copy as well as uploaded in the IEDCR IT team designed software. At IEDCR data is cleaned and analyzed using WHONET.

In 2018 further revisions and update of laboratory SOP was done by ASM (American Society for Microbiology) consultant.
In 2018 in addition to the previous five sentinel sites three new sites started their activity.
They are:
  1. Dhaka Medical College and Hospital, Dhaka
  2. Khulna Medical College and Hospital, Khulna
  3. Sylhet MAG Osmani Medical College, Sylhet

Total 8332 samples has been tested in the sentinel sites till 31st January,2019 and positive samples has been preserved in ultra low -800 C temperature freezer at IEDCR for further analysis.

Dissemination of the findings was done in SMEE (Clinical lab Subject Matter Expert Exchange program) program at Dhaka Cantonment in 7th August,2018 and in CDC DGHS in the antimicrobial resistance week.

The analysis of the surveillance data will soon be disseminated to all the stakeholders centrally as well as at the sentinel sites.

The graphical representation of this data is updated real time from the surveillance sites. This may change after checking by IEDCR reference laboratory. Data collection has been started from March,2017

Link for dashboard:AMR Surveillance Dashboard