রোগতত্ত্ব, রোগ নিয়ন্ত্রণ ও গবেষণা ইনস্টিটিউট

National Antimicrobial Resistance (AMR) Surveillance Report Bangladesh

According to Global Action Plan of the World Health Organization, Surveillance is on one of the main strategies for AMR containment. National Antimicrobial Resistance (AMR) Surveillance in Bangladesh is initiated by the Institute of Epidemiology, Disease Control and Research (IEDCR) under the Ministry of Health and Family Welfare since 2016.

The main objective of the surveillance is to establish a surveillance system to monitor the status of Antimicrobial Resistance (AMR) among selected microbial pathogens of public health importance in Bangladesh and support improving the capacity of the sentinel site laboratories so that they can act as regional laboratories.

The surveillance activities are carried out in accordance with the Global Antimicrobial Resistance and Use Surveillance System (GLASS) protocol, wherein the CDC, DGHS serves as the National Coordination Center (NCC), and IEDCR functions as the Sectoral Coordination Center for Human Health as well as the National Reference Laboratory (NRL) for AMR surveillance. The national surveillance data are submitted annually to the WHO GLASS IT platform by CDC, DGHS.

The surveillance system includes two components:

Case-based surveillance: At present, thirteen sentinel sites are functioning, where clinically diagnosed cases are identified, and comprehensive clinical, epidemiological, and microbiological data are collected from patients with suspected infections.

The quality of participating laboratories is strictly maintained through internal and external quality control measures, complemented by regular monitoring and supervision.

Laboratory-based surveillance: Following a comprehensive evaluation process, twenty-two private and two public microbiology laboratories have been included in the surveillance network. Only laboratory data are taken in this passive surveillance.

Data Management:

The data management is done through the locally designed Comprehensive AMR Data Management System (CAMS), ensuring timely and centralized data collection and management.

Data Visualization and Dissemination:

There is a designated online Dashboard for visualization of the AMR related data analyzed by CAMS on the IEDCR website. The dashboard link is- https://dashboard.iedcr.gov.bd/amr/

Surveillance findings are disseminated annually both centrally at IEDCR and individually at each sentinel site to the clinicians and other stakeholders. Details surveillance findings are included in ‘Annual AMR Report’, the softcopy is available at IEDCR website.

Moreover, data is being regularly uploaded in WHO platform - Global Antimicrobial Resistance and Use Surveillance System (GLASS) since 2019.

AMR surveillance co-ordination Committee is the administrative authority of AMR surveillance centrally. AMR surveillance coordination subcommittee consists of Epidemiologists, Laboratory personnel, AMR Surveillance Consultant, representative from CDC, DGHS and representatives from donor agency lead by Director IEDCR. This team is supported by IT experts, data management assistant and medical technologists and AMR surveillance lab consultant. The team meeting of this committee is held when required.

Activities of Central Surveillance Team

The central team at IEDCR provides guidance and coordinates all the activities of the sentinel sites. They collaborate and communicate with national and international agencies. They arrange training and refresher training for the sentinel site physicians, nurses, microbiologists, and technologists. They conduct monitoring and evaluation visits to the sites to assess their activities and progress. They give technical support to the sentinel site laboratories and maintain the logistic supply chain. They perform data cleaning, analysis, review, and feedback.

Surveillance team at sentinel sites has Surveillance physicians and nurses, microbiologists and medical technologists, lab attendants and cleaner from the respective medical college, and an IEDCR appointed coordinator, designated as Project Facilitator (PF). The PF regularly communicates, coordinates and collects the data and sends it to the central hub for analysis. This team is headed by Head of Microbiology department.

NRL at IEDCR is equipped with automated identification system (VITEK-2, VITEK MS). Laboratory activities in the sites are done following the SOPs of NRL including IQC.
Bacterial isolates from the sentinel sites are regularly sent to the central repository at NRL, IEDCR.
Quarterly 5-10% of isolates are retested at NRL, root cause analysis is done and discussed with the sites. NRL and sometimes the sentinel site laboratories participate in international EQA program provided by CAP (College of American Pathologists), WHO collaborating center at Thailand. Recently NRL has participated in consecutive Eleven EQA program of EQAsia of Fleming fund. For the improvement of the laboratory quality of the sentinel site NRL has started piloting EQA of the sites.

The future vision of this surveillance is to include improving molecular diagnostic capacity and genome sequencing and more engagement and support in AMR research is the future commitment of the NRL.

The National AMR Surveillance System receives support from various entities, including the WHO, US-CDC and the Fleming Fund at different times and in various capacities.