Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR)
The Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR) network is a joint initiative of the WHO Regional Office for Europe, the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the Dutch National Institute for Public Health and the Environment (RIVM). CAESAR is a network of national AMR surveillance systems and includes all countries of the WHO European Region that are not part of the European Antimicrobial Resistance Surveillance Network (EARS-Net), which is coordinated by the European Centre for Disease Prevention and Control in the European Union (EU).
Steps towards CAESAR participation
The first step towards the implementation of the European strategic action plan on antibiotic resistance in general, and participation in CAESAR in particular, is the appointment of an AMR focal point in each country, territory or area outside the EU, who should play a leading role in the formation of an intersectoral coordinating committee for the containment of AMR. The committee should identify key areas where action must be taken, and develop or update the strategic national action plan on AMR. One of these key areas is AMR surveillance.
The Regional Office offers a country situation analysis, in collaboration with ESCMID and RIVM, to determine the country status regarding prevention and control of AMR through surveillance, prudent use of antimicrobials and infection control, specifically focusing on promoting national coordination and strengthening surveillance of antimicrobial consumption and resistance. An assessment report is provided to the WHO Country Office and the Ministry of Health containing observations, recommendations and specific further actions. These include, for example, technical workshops to support setting up or strengthening a national AMR surveillance system. A pool of experts supports WHO in providing technical support to Member States.
The first CAESAR annual report
The first annual CAESAR report was published in October 2015. Currently, 19 countries are participating in CAESAR. These countries are: Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Georgia, Kazakhstan, Kyrgyzstan, Montenegro, the Republic of Moldova, the Russian Federation, Serbia, Switzerland, Tajikistan, the former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Ukraine and Uzbekistan, as well as Kosovo (in accordance with United Nations Security Council resolution 1244 (1999)).
To date, six countries (Belarus, Russia, Serbia, Switzerland, the former Yugoslav Republic of Macedonia and Turkey) and Kosovo (in accordance with United Nations Security Council resolution 1244 (1999)) have submitted national surveillance data to the CAESAR database. The vast majority of CAESAR countries have participated in the annual External Quality Assessment (EQA) exercise for Antimicrobial Susceptibility Testing (AST) and Species Identification in September 2015 (250 laboratories from 15 countries). Results from the first EQA in 2013 are presented in the first CAESAR annual report.
An updated version of the CAESAR manual was published in 2015, describing the objectives, methodology and organization of CAESAR, the steps that have to be taken by a country for participation, the steps for routine data collection and the protocols and AMR case definitions used.
CAESAR is part of the Global initiative GLASS, the Global Antimicrobial Resistance Surveillance System.