Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR)

The Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR) network is a network of national antimicrobial resistance (AMR) surveillance systems and includes all countries in 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.

CAESAR 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 part of the Global initiative GLASS, the Global Antimicrobial Resistance Surveillance System.

Currently, 19 countries participate in CAESAR – 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 does Kosovo (in accordance with United Nations Security Council resolution 1244 (1999)).

To date, seven countries (Belarus, Bosnia and Herzegovina, the Russian Federation, 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.

CAESAR Publications

The first annual CAESAR report was published in October 2015, together with an updated version of the CAESAR manual. This manual describes the objectives, methodology and organization of CAESAR, the steps a country must take in order to participate, the process for routine data collection and the protocols and AMR case definitions used.

The second CAESAR report was published in November 2016. This presents the trends of resistance observed among specific pathogens, and for the first time contains maps of the whole European Region, including data from both CAESAR and EARS-Net countries. Furthermore, the report includes a reader’s guide to common errors in AMR surveillance, as well as describing progress made in the CAESAR network in general.

Steps towards CAESAR participation

To become members of the CAESAR network, countries, territories or areas outside the European Union must start by appointing an AMR focal point, 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 WHO Regional Office for Europe offers a country situation analysis, in collaboration with ESCMID and RIVM, to determine the national status of 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.

All laboratories participating in a national AMR surveillance network should follow standard operating procedures for specimen processing, species identification and sensitivity testing. CAESAR recommends that countries use European Committee on Antimicrobial Susceptibility Testing (EUCAST) or Clinical and Laboratory Standards Institute (CLSI) guidelines. CAESAR provides training in EUCAST methods because it is the most widely used methodology in the European Region and because all EUCAST documents are freely downloadable in various languages.