The indicator is measured based on the isolate-level antimicrobial resistance (AMR) data collected annually through the enhanced surveillance initiative launched in the Region. The initiative, coordinated through the national AMR focal points, has enabled countries to report carbapenem-resistant pathogens isolated from blood cultures. Since its launch in 2019, seven countries—Argentina, Colombia, Costa Rica, Ecuador, Panama, Paraguay, and Peru—have enrolled in the initiative. At the end of each reporting year, countries are invited to submit two sets of data to PASB: one related to AMR bloodstream infection and another on hospital capacity performance metrics. Collaboration with the Latin American and Caribbean Network for Antimicrobial Resistance Surveillance (ReLAVRA+) has been essential to enhance surveillance capacities.
As of 2023, five of the seven countries (Argentina, Colombia, Costa Rica, Panama, and Paraguay) have submitted isolate-level AMR data to PASB. A total of 202 809 positive strains have been reported. There has been a significant increase in the number of strains received, from 12 059 in 2019 to 85 481 in 2022. The latest review of data for 2023 will begin in last quarter of 2024 as scheduled.
Colombia contributed the majority of these strains, totaling 130 768, from an average of 246 sentinel sites. Argentina submitted 50 953 strains from an average of 100 sentinel hospitals over four years (2019 to 2022). During this period, the number of strains reported annually in Argentina increased from 10 014 in 2019 to 12 854 in 2022. Additionally, the number of sentinel sites in Argentina expanded from 86 (73 network members and 13 additional peripheral laboratories) in 2019 to 109 (82 network members and 27 additional peripheral laboratories) in 2022. Costa Rica submitted 2 045 isolates from 4 sentinel sites in 2019, while Panama submitted 1 908 isolates from 2 sentinel hospitals in 2020. Between 2020 and 2022, Paraguay submitted data for a total of 17 135 strains, averaging 5 711 annually. The number of reporting sentinel sites in Paraguay increased from 9 in 2020 to 27 in 2022. Ecuador and Peru are in the process of submitting data to PASB. This indicator has not been updated on an annual basis.
In 2024, PASB incorporated an electronic data capture (EDC) system to facilitate data collection from sentinel hospitals, addressing obstacles in collecting denominators for the indicator. The EDC system was developed in alignment with requirements of the Global Antimicrobial Resistance and Use Surveillance System (GLASS), which also facilitates data reporting at the global level. The pilot in Colombia has shown improvement in the quality and efficiency of data collection.
As of 2023, 20 countries have submitted aggregated AMR data to PASB. However, not all countries have the capacity to monitor AMR in bloodstream infections at the national level. Consequently, there is limited capacity to report on this indicator at the regional level.
Recommendation
• Continue efforts to build capacity to monitor bloodstream infections across countries, in order to gain valuable insights into the impact of AMR on human health.
• Expand the use of EDC systems to more countries to mitigate barriers in data collection. This will position countries to enroll in the enhanced surveillance initiative and improve the overall quality of AMR surveillance, as well as enabling measurement of this indicator.
• Develop a better understanding of the burden of AMR, which can inform policies and the allocation of resources toward infection control, antimicrobial stewardship, and the development of new antimicrobial agents.
• Develop and strengthen the analysis of the indicator from the perspective of health care quality. Since blood steam infections are commonly acquired in health care settings, they serve as a good indicator of the effectiveness of infection control measures and the prevalence of AMR in hospitals.