Northern Dimension Antibiotic Resistance Study

NoDARS

Prof Jaana Vuopio, M.D., Ph.D., PAC 11 side-event, 19 November 2015, Berlin, Germany

NoDARS project •  Collaboration between 7 countries in Northern Europe

Finland, Norway, Sweden, Latvia, Poland, Germany and Russia

•  Focus on antibiotic resistance in society

•  Led by the NDPHS secretariat

•  Co-funded by the European commission (Contract reference 2014/344-660,

in total 430,000 EUR)

Project lead and partners •  Lead partner: NDPHS secretariat, Sweden

•  Sweden: The Public Health Agency of Sweden (Work package leader) •  Finland: University of Turku •  Russia: Smolensk State Medical Academy •  Latvia: Pauls Stradins Clinical University Hospital •  Norway: Norwegian Institute of Public Health •  Poland: Institute of Occupational Medicine and Environmental Health •  Germany: Robert Koch Institute

Timeline •  Three year project (2014-2017)

Year one: Agreement and Setting-up of common study protocols (2015) - 2 workshops in Stockholm with all partners Year two: Recruitment of study subjects and collection of samples (2016) Year three: Analysis and publication of results (2017)

Background Traditionally AMR-surveillance is based on data on isolates from clinical infections Ø  Risk of bias in resistance levels Ø  Do we use too powerful antibiotics to treat common infections

such as uncomplicated UTIs?

Burden of antibiotic resistance in society/on population-level? Ø  Need for international cooperation and surveillance initiatives

Is there a link between AMR levels and national strategies towards containing AMR?

First study on AMR situation in the Northern Dimension Partnership

Purpose To investigate antibiotic resistance levels in society of each participating country by: Ø  studying antimicrobial susceptibility of bacteria causing uncomplicated UTIs

in women Ø  studying asymptomatic stool carriage of ESBL-producing bacteria in

healthy individuals

To evaluate: Ø  current national guidelines for treatment of uncomplicated UTI’s Ø  AMR strategies in each participating country Results will be used by health-care professionals, authorities and policy makers to improve and facilitate their work on AMR

Investigation of resistance level in uncomplicated urinary tract infections in women

One of the most common reasons for antibiotic prescription and consumption, but bacterial cultures are not taken as routine in many countries •  Focus on E. coli (ca 80 % of infections) •  Recruit study subjects from primary care •  Test susceptibility against panel of antibiotics •  Compare levels between countries

Estimate: Identify antibiotics that have <20% resistance and compare to national treatment recommendations

Investigation of stool carriage rates of ESBL, AmpC and carbapenemase-producing E. coli and K. pneumoniae

Recruitment of study subjects from three different groups of individuals: •  Students/Job seekers •  Primary-care patients •  Elective surgery patients

Same laboratory methods are used by each partner in the project

Estimate: Incidence of specific resistance determinants in the healthy population

Sample collection 500 bacterial cultures from uncomplicated UTIs from each partner country (in total 3500 samples):

§  Antimicrobial susceptibility testing §  Questionnaire on risks factors known to connect to infections caused by

MDR strains §  Each country recruits and selects the study subjects based on their own

health care practices

250 fecal samples from each partner country (in total 1750 samples): §  Screen for ESBL-carriage §  Questionnaire on risk factors known to link to becoming a ESBL carrier

Outcome Ø  Better international cooperation: sharing of methods

and expertise Ø  Better understanding on antibiotic resistance in

society: indication if treatment guidelines overestimate resistance levels

Ø New information on AMR to health-care professionals, authorities and policy makers with comparable methods

Ø  Synergy with other ongoing global and regional AMR surveillance initiatives

Expected impact of the actions Ø lower the selective pressure on resistance as exerted

by antibiotic use and increase the appropriateness of the treatment and actions taken

Ø a favourable effect on the development and spread of

antibiotic resistance

Thank you!

•  http://www.ndphs.org/?database,view,project,1468

http://www.ndphs.org/enewsletter/NDPHS_e-Newsletter_2015_1.pdf