| What is cefoxitin used as a surrogate marker for? | methicillin resistant S. aureus (MRSA) | Higher rates of resistance are seen in ICU settings for most of the antibiotics. Sixty-six percent resistance is seen for cefoxitin, surrogate marker for methicillin resistant S. aureus (MRSA). 1% resistance is seen in S. aureus and 5% in Enterococcus spp. to linezolid and 13% resistance to vancomycin in Enterococcus spp. Resistance to these last resort drugs for treating Gram-positive cocci is a matter of concern. Among gram negative bacteria (E. coli, Klebsiella spp.) reported under NARS-Net, 80% and 60% of the blood isolates were resistant to 3rd and 4th generation cephalosporins respectively. High level resistance to carbapenems is seen in Klebsiella spp. and E. coli. Five percent of Klebsiella spp. isolated from blood of ICU patients are colistin resistant. | 154 | definition | 1.000 | https://ncdc.mohfw.gov.in/uploads/pdf/amr37.pdf | Sixty-six percent resistance is seen for cefoxitin, surrogate marker for methicillin resistant S. aureus (MRSA). | 11 | page=11,block=2 | 0.700 | valid |
| What does the acronym GLASS stand for? | Global Antimicrobial Resistance Surveillance System | a A. Acronyms AMR Antimicrobial Resistance Surveillance AST Antimicrobial Susceptibility Testing BMD Broth Microdilution EQAS External Quality Assessment Scheme GLASS Global Antimicrobial Resistance Surveillance System IPD In-patient ICU Intensive care unit IQC Internal Quality Control LIMS Laboratory Information Management System MRSA Methicillin Resistant S. aureus NARS-Net National AMR Surveillance Network NFGNB Non-fermenting Gram-negative bacilli NRL National Reference Laboratory OPD Outpatient OSBF Other Sterile Body Fluids PA Pus aspirate R Resistant R I S Resistant Intermediate Sensitive SOP Standard Operating Procedure WHO World Health Organization | 167 | definition | 0.980 | https://ncdc.mohfw.gov.in/uploads/pdf/amr37.pdf | Acronyms AMR Antimicrobial Resistance Surveillance AST Antimicrobial Susceptibility Testing BMD Broth Microdilution EQAS External Quality Assessment Scheme GLASS Global Antimicrobial Resistance Surveillance System IPD In-patient ICU Intensive care unit IQC Internal Quality Control LIMS Laboratory Information Management System MRSA Methicillin Resistant S. | 7 | page=7,block=0 |
| What happens when E. coli is found in both a blood culture and a urinary culture from the same patient? | both specimen types are analyzed and reported | If there is growth of E. coli in one blood culture and in one urinary culture from the same patient, both specimen types are analyzed and reported. V. Priority Pathogens under surveillance in NARS -Net Under the programme, the AMR data for the year 2019 has been submitted by 21 sentinel laboratories from Government Medical colleges/ tertiary healthcare settings in 19 states (S.no. 1 to 21 at Annexure 1). AMR surveillance data of a total of 78,860 isolates submitted under NARS-Net has been de-duplicated & analyzed and is summarized below: Table 1 Pathogens and specimens included under surveillance 2 WHO Global Antimicrobial Surveillance System Manual for Early Implementation (2015)]. Specimen S. aureus Enterococc us spp. Klebsiella spp. E. coli Acinetobacter spp. Pseudomo nas spp. | 101 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr37.pdf | coli in one blood culture and in one urinary culture from the same patient, both specimen types are analyzed and reported. | 15 | page=15,block=2 | 0.700 |
| What is done if two blood cultures from the same patient show growth of different pathogens? | both results are analyzed and reported | IV. Data Deduplication During analysis, data de-duplication has been done for data from each site at NCDC. In situations where several clinical specimens of same type have been reported for a unique patient by the reporting facility, de-duplication has been done to achieve one isolate per patient. Only one AST result has been considered for data analysis even though there might be different AST patterns observed during repeated isolation of same species from same specimen type i.e. AST result of the first isolate of a priority pathogen reported from the same specimen type of the patient during the hospital stay has been considered. if two blood cultures from the same patient yield growth of E. coli, only the first result is included in the data analysis; if growth of E. coli is detected in one culture and of K. pneumoniae in the other, both results are analyzed and reported. | 848 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr37.pdf | pneumoniae in the other, both results are analyzed and reported. | 15 | page=15,block=2 | 0.700 |
| What is one issue impacting the quality of AMR surveillance data under NARS-Net? | absence of strict SOP compliance by some sites regarding rigorous quality checks for antibiotic discs | VII. Discussion The NARS-Net is collating National AMR surveillance data and sharing resistance profile of commonly used antibiotics to stakeholders at the National and state level. This data is also submitted at the global level to WHO-GLASS. Various efforts are being made to strengthen quality of lab testing so as to generate good quality data, namely external quality assessment, development of internal quality control and data management SOPs, provision of trainings, regular feedback on data quality etc. certain limitations which could affect this data are absence of strict SOP compliance by some sites regarding rigorous quality checks for antibiotic discs, e.g. imipenem discs deteriorate frequently and if IQC is not rigorous, may give rise to falsely high resistance rates. | 566 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr37.pdf | certain limitations which could affect this data are absence of strict SOP compliance by some sites regarding rigorous quality checks for antibiotic discs, e.g. | 42 | page=42,block=4 |
| What is used for data analysis when multiple AST patterns are observed for the same species during a hospital stay? | AST result of the first isolate of a priority pathogen reported from the same specimen type of the patient during the hospital stay | IV. Data Deduplication During analysis, data de-duplication has been done for data from each site at NCDC. In situations where several clinical specimens of same type have been reported for a unique patient by the reporting facility, de-duplication has been done to achieve one isolate per patient. Only one AST result has been considered for data analysis even though there might be different AST patterns observed during repeated isolation of same species from same specimen type i.e. AST result of the first isolate of a priority pathogen reported from the same specimen type of the patient during the hospital stay has been considered. if two blood cultures from the same patient yield growth of E. coli, only the first result is included in the data analysis; if growth of E. coli is detected in one culture and of K. pneumoniae in the other, both results are analyzed and reported. | 487 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr37.pdf | Only one AST result has been considered for data analysis even though there might be different AST patterns observed during repeated isolation of same species from same specimen type i.e. AST result of the first isolate of a priority pathogen reported from the same specimen type of the patient during the hospital stay has been considered. |
| What issue can occur with imipenem discs if internal quality control is not thorough? | imipenem discs deteriorate frequently and if IQC is not rigorous, may give rise to falsely high resistance rates | VII. Discussion The NARS-Net is collating National AMR surveillance data and sharing resistance profile of commonly used antibiotics to stakeholders at the National and state level. This data is also submitted at the global level to WHO-GLASS. Various efforts are being made to strengthen quality of lab testing so as to generate good quality data, namely external quality assessment, development of internal quality control and data management SOPs, provision of trainings, regular feedback on data quality etc. certain limitations which could affect this data are absence of strict SOP compliance by some sites regarding rigorous quality checks for antibiotic discs, e.g. imipenem discs deteriorate frequently and if IQC is not rigorous, may give rise to falsely high resistance rates. | 674 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr37.pdf | certain limitations which could affect this data are absence of strict SOP compliance by some sites regarding rigorous quality checks for antibiotic discs, e.g. imipenem discs deteriorate frequently and if IQC is not rigorous, may give rise to falsely high resistance rates. |
| What kind of support is provided to sentinel surveillance sites to enhance specimen collection and antimicrobial susceptibility testing? | provision of regular hands on training and onsite support for streamlining AMR data management. | The sentinel surveillance laboratories under NARS-Net follow a standardized approach for AMR data collection, analysis, and reporting of AMR surveillance data using WHONET data management software. Standard operating procedures (SOPs) and guidance documents have been developed for sentinel surveillance sites for AMR surveillance and the sites are trained to use these effectively in their day to day work. training is also provided on AMR data management using the WHONET software. Continuous support is provided to sites to improve the quality of specimen collection, bacterial culture, identification of pathogens & their antimicrobial susceptibility testing (AST) which includes provision of regular hands on training and onsite support for streamlining AMR data management. Regular feedback is provided using a standardized data management tool to improve the AMR data quality. | 684 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr37.pdf | Continuous support is provided to sites to improve the quality of specimen collection, bacterial culture, identification of pathogens & their antimicrobial susceptibility testing (AST) which includes provision of regular hands on training and onsite support for streamlining AMR data management. Regular feedback is provided using a standardized data management tool to improve the AMR data quality. |
| What problem can occur if internal quality control for antibiotic discs is inadequate? | may give rise to falsely high resistance rates | VII. Discussion The NARS-Net is collating National AMR surveillance data and sharing resistance profile of commonly used antibiotics to stakeholders at the National and state level. This data is also submitted at the global level to WHO-GLASS. Various efforts are being made to strengthen quality of lab testing so as to generate good quality data, namely external quality assessment, development of internal quality control and data management SOPs, provision of trainings, regular feedback on data quality etc. certain limitations which could affect this data are absence of strict SOP compliance by some sites regarding rigorous quality checks for antibiotic discs, e.g. imipenem discs deteriorate frequently and if IQC is not rigorous, may give rise to falsely high resistance rates. | 740 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr37.pdf | imipenem discs deteriorate frequently and if IQC is not rigorous, may give rise to falsely high resistance rates. | 42 | page=42,block=4 | 0.700 | valid |
| What role was assigned to NCDC by the Ministry of Health and Family Welfare in July 2017? | National coordinating center for AMR surveillance in the country and for submission of country data onto WHO-Global Antimicrobial Resistance Surveillance System (GLASS). | In July 2017, NCDC has been designated by Ministry of Health and Family Welfare as National coordinating center for AMR surveillance in the country and for submission of country data onto WHO-Global Antimicrobial Resistance Surveillance System (GLASS). The AMR surveillance data submitted under the National programme on AMR Containment is validated by NCDC and the AMR trends are published in the form of annual report. The annual report for the AMR surveillance data of 2017 and 2018 is available on NCDC website. | 83 | relationship | 0.970 | https://ncdc.mohfw.gov.in/uploads/pdf/amr37.pdf | In July 2017, NCDC has been designated by Ministry of Health and Family Welfare as National coordinating center for AMR surveillance in the country and for submission of country data onto WHO-Global Antimicrobial Resistance Surveillance System (GLASS). The AMR surveillance data submitted under the National programme on AMR Containment is validated by NCDC and the AMR trends are published in the form of annual report. |