Reliable surveillance helps combat antimicrobial resistance: CAESAR report shows progress

As the international community calls for more and better information to add to the ever-growing body of evidence on the effects of antimicrobial resistance (AMR) on humans, animals, the environment and the economy, policy-makers need access to reliable surveillance data. This data is crucial for monitoring the status of key antimicrobial classes (groups of antimicrobials that are related to each other) in the European Region, and to track how effective policies have been in addressing this public health challenge.

The Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR) network complements the surveillance data generated by the European Surveillance of Antimicrobial Resistance Network (EARS-Net) for countries of the European Union and European Economic Area, coordinated by the European Centre for Disease Prevention and Control (ECDC). The latest annual CAESAR report reveals steady progress towards forming a more complete picture of AMR in Europe. The report covers a growing and developing network of 19 countries to date.

Updates in this reporting period include:

  • Eleven countries and 1 area have an AMR reference laboratory in place.
  • Ten countries and 1 area provide data to the CAESAR network.
  • Participation in the external quality assessment (EQA) for laboratories has again expanded with 248 laboratories from 16 countries/areas, and overall results continue to improve.
  • Two central Asian countries are preparing to implement a proof-of-principle project, while 1 additional country concluded a project in October 2018.

The CAESAR network supports the establishment of AMR surveillance networks, which are the cornerstones of the fight to keep antibiotics working. The CAESAR network also helps to improve the quality of laboratory testing, manage data, and analyse and report data from other surveillance networks. The support is tailored to the specific needs of the surveillance system. For example, the report includes preliminary results from a proof-of-principle project in Armenia, providing an excellent example of how CAESAR supports diagnostic stewardship in the European Region by helping identify suspected cases of bloodstream infection and then fostering appropriate laboratory testing. Georgia concluded a proof-of-principle project last year and is now able to report AMR data to the CAESAR network.

Keeping tabs on labs

The report also provides a benchmark for the quality of reported data that is systematically collected and shared. Participation of laboratories in CAESAR EQA continues to increase and in the future the network will be concentrating even more on enabling participating laboratories to evolve, improve and maintain the good work that has been started. The importance of reference laboratories to support surveillance networks cannot be overstated and they require investments in staff, equipment and quality consumables to remain functional and useful.

The CAESAR network was started in 2012 by WHO/Europe, together with the Netherlands National Institute for Public Health and the Environment (RIVM) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), to assist countries and areas in setting up or strengthening national AMR surveillance following the adoption of the European strategic action plan. The establishment of the network showed recognition that surveillance is crucial to an effective response to AMR.

The rapid emergence and spread of AMR is one of the biggest threats to global health, with many common infections becoming resistant to the antimicrobial medicines previously used to treat them. AMR poses a fundamental threat to human and animal health and the achievement of the Sustainable Development Goals. As currently available antimicrobial agents lose their effectiveness and the new drug development pipeline runs dry, many types of infection are becoming life threatening again.