Project goals

Antibiotic resistance in clinically important bacteria is an emerging and worldwide problem. It severely affects the usefulness of antibiotics in treatment of bacterial infections. One important step in the control of this problem is to apply standardized methodologies and interpretation criteria and to introduce regular surveillance programs of antibiotic resistant bacteria. Surveillance programs based on routine susceptibility data should involve clinical bacteriology laboratories serving defined areas of the country. To initiate a surveillance program the following parts should be attended to: (i) collecting relevant clinical isolates for susceptibility testing, (ii) registering quantitative data, (iii) analysing computerized data, and (iv) modifying and improving methodology and interpretative criteria, if necessary. Regular external quality assurance of methods should be implemented. As a complement to the surveillance system it is necessary to introduce modern DNA-based methods for detection of resistance. These methods could be introduced during an applied training program and need funding in terms of equipment. At the national level, these advanced methods should preferably be centralized to a reference/referral laboratory.

Target Group: Primary target group is the participating laboratories, secondary patients in hospitals and communities in the Baltic Sea States

Output Indicators:

• International acknowledged standardized methodology should be used for identification and suscept…
  Output: Quality assured data on antimicrobial resistance should be available and reported
  Means of Verification: Standard Operational Procedures (SOPs) should be available for evaluation
  Criteria for Success: SOPs implemented
• Participation in a external quality assurance programme
  Output: Quality assured data on antimicrobial resistance should be available and reported
  Means of Verification: Data on identification as well as susceptibility testing from the quality assurence programme should be published in a report and available for external assesment
  Criteria for Success: Satisfactory report within two years
  Comments: In 2003 Estonia and Lithuania took part in the quality assurance programme of antibiotic resistance organised by the European network for surveillance of antibiotic resistance, EARSS. In 2004 Latvia will also be included in this programme.

• Establisment of national and local networks for coordinating the strategy for containment of anti...
  Purpose: To reduce the transmission of resistant microorganisms and to increase the prudent use of antimicrobials
  
  Means of Verification: National as well as more local meetings for responsable parties using human resourses from twinning institutions and MOH
  
  Success Criteria: Establishment of a national committee and networks for coordinating the strategy to contain antimicrobial resistance and improve the prudent use of antimicrobials
  
  Important Assumptions:
  
  Comments: In collaboration with project AB24 and by means of a steering committee with representatives from Estonia, Latvia, Lithuania, Russia and Sweden, a joint seminar has been planned for March 2004 in Riga, Latvia. It will focus on antibiotic resistance and infection control. The outcome will be an educational package on recent knowledge in this area.
• Standard methodology for susceptibility testing and quality assurance (QA) established
  Purpose: To reduce the transmission of resistant microorganisms and to increase the prudent use of antimicrobials
  
  Means of Verification: Adherence to national or international QA programmes
  
  Success Criteria: Participating labs enroled in QA programmes using standerdized methods
  
  Comments: During the seminar which will be held in March 2004 in Riga, standard methodology for susceptibility testing, detection of antibiotic resistance, and quality assurance will be agreed upon.

Results

Antibiotic resistance in clinically important bacteria is an emerging and worldwide problem. It severely affects the usefulness of antibiotics in treatment of bacterial infections. One important step in the control of this problem is to apply standardized methodologies and interpretation criteria and to introduce regular surveillance programs of antibiotic resistant bacteria. Surveillance programs based on routine susceptibility data should involve clinical bacteriology laboratories serving defined areas of the country. To initiate a surveillance program the following parts should be attended to: (i) collecting relevant clinical isolates for susceptibility testing, (ii) registering quantitative data, (iii) analysing computerized data, and (iv) modifying and improving methodology and interpretative criteria, if necessary. Regular external quality assurance of methods should be implemented. As a complement to the surveillance system it is necessary to introduce modern DNA-based methods for detection of resistance. These methods could be introduced during an applied training program and need funding in terms of equipment. At the national level, these advanced methods should preferably be centralized to a reference/referral laboratory.

Target Group: Primary target group is the participating laboratories, secondary patients in hospitals and communities in the Baltic Sea States

Output Indicators:

• International acknowledged standardized methodology should be used for identification and suscept…
  Output: Quality assured data on antimicrobial resistance should be available and reported
  Means of Verification: Standard Operational Procedures (SOPs) should be available for evaluation
  Criteria for Success: SOPs implemented
• Participation in a external quality assurance programme
  Output: Quality assured data on antimicrobial resistance should be available and reported
  Means of Verification: Data on identification as well as susceptibility testing from the quality assurence programme should be published in a report and available for external assesment
  Criteria for Success: Satisfactory report within two years
  Comments: In 2003 Estonia and Lithuania took part in the quality assurance programme of antibiotic resistance organised by the European network for surveillance of antibiotic resistance, EARSS. In 2004 Latvia will also be included in this programme.

• Establisment of national and local networks for coordinating the strategy for containment of anti...
  Purpose: To reduce the transmission of resistant microorganisms and to increase the prudent use of antimicrobials
  
  Means of Verification: National as well as more local meetings for responsable parties using human resourses from twinning institutions and MOH
  
  Success Criteria: Establishment of a national committee and networks for coordinating the strategy to contain antimicrobial resistance and improve the prudent use of antimicrobials
  
  Important Assumptions:
  
  Comments: In collaboration with project AB24 and by means of a steering committee with representatives from Estonia, Latvia, Lithuania, Russia and Sweden, a joint seminar has been planned for March 2004 in Riga, Latvia. It will focus on antibiotic resistance and infection control. The outcome will be an educational package on recent knowledge in this area.
• Standard methodology for susceptibility testing and quality assurance (QA) established
  Purpose: To reduce the transmission of resistant microorganisms and to increase the prudent use of antimicrobials
  
  Means of Verification: Adherence to national or international QA programmes
  
  Success Criteria: Participating labs enroled in QA programmes using standerdized methods
  
  Comments: During the seminar which will be held in March 2004 in Riga, standard methodology for susceptibility testing, detection of antibiotic resistance, and quality assurance will be agreed upon.

Location

Project Budget

111 000 Euro.

Personnel

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