Evidence-based Decision-making on Antimicrobial Resistance

By March 17, 2019 Solution


Antimicrobial resistance (AMR) affects all countries and endangers the effectiveness of prevention and treatment of infections by viruses, bacteria, fungi and parasites. Antimicrobial resistance occurs when microorganisms (e.g. bacteria, fungi, viruses and parasites) change when they are exposed to antimicrobial drugs (e.g. antibiotics, antifungals, antivirals, antimalarials and anthelmintics). Microorganisms that develop antimicrobial resistance are sometimes referred to as“superbugs”. Asaresult, the medicines become ineffective and infections persist in the body, increasing the risk of spread to others. AMR is an increasingly serious threat to global public health that requires action across all government sectors and society. It is estimated that 10 per cent of all patients who receive hospital care develop a healthcare-associated infection. In recent years, the Latin America and the Caribbean region experienced a series of outbreaks caused by multi-drug resistant bacteria, impacting lives and hospital costs.

Towards a Solution

Since the 1990s, Pan American Health Organization/World Health Organization (PAHO/ WHO) has recognized the importance of laboratory capacity for AMR surveillance and created the Latin American Antimicrobial Resistance Surveillance Network (ReLAVRA) in 1996 to obtain reliable microbiological data and timely and repeatable information to improve patient care and strengthen surveillance through sustainable quality assurance programmes.

This Network, which was built by Argentina, the Plurinational State of Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, and the Bolivarian Republic of Venezuela, established the Latin American Quality Control Programme in Bacteriology and Antimicrobial Drug Resistance (LA-EQAS), implemented by the Antimicrobial Department of the Instituto Nacional de Enfermedades Infecciosas (INEI) in Argentina. The latter has a dual function: to ensure the quality of surveillance data and to strengthen the countries’ reference laboratories.

LA-EQAS is fundamental in terms of achieving reliable laboratory data, which are the basis of AMR surveillance. Through this initiative, data quality is ensured by standardizing techniques so that the entire region “speaks the same language” and the countries can compare and share solutions. AMR data contributes to reducing infant and maternal mortality, improving population health, and fighting curable and preventable diseases through the use of safe and affordable antimicrobials for all.

LA-EQAS has strengthened the laboratories of the countries of the Network through training courses, generating reference strains, defining resistance mechanisms, issuing publications and holding online sessions with the countries of the Network.

The success of this horizontal cooperation among countries and in triangulation with PAHO/WHO is based on continuity over time, commitment of the health authorities, financial support from seed and resources from PAHO/WHO and the laboratories of the countries, as well as the great leadership and solidary of the INEI of ANLIS-Argentina.


Country and Subregional Coordination Office, PAHO, csc@paho.org

Project name: Evidence-based decision making on Antimicrobial Resistance – Latin American Quality Control Programme in Bacteriology and Antimicrobial drug Resistance (LA-EQAS)

Countries/Regions: Argentina, the Plurinational State of Bolivia, Chile, Colombia, Costa Rica, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Uruguay, the Bolivarian Republic of Venezuela

Nominated by: PAHO/WHO

Sustainable Development Goal targets: 3.1, 3.2, 3.3, 3.8

Supported by: PAHO/WHO

Implementing entities: Servicio de Antimicrobianos del Instituto Nacional de Enfermedades Infecciosas (I NEI) – Argentina; PAHO/WHO; National reference laboratories of 17 countries in the Americas

Project status: Ongoing

Project period: 2000- Present

URL of the practice: goo.gl/SyLKTwThe annual reports provide the results of laboratory surveillance (www.paho.org: Relavra). However, the Programme’s success is evidenced by the gradual increase in the number of countries that have joined it regularly over time, ensuring that the capacity of the National Reference Laboratories to detect resistance mechanisms continues to improve:

Eight countries: the Plurinational State of Bolivia, Ecuador, El Salvador, Guatemala, Paraguay, and Peru


Four countries: Costa Rica, the Dominican Republic, Honduras, and Panama


Three countries: Chile, Uruguay, and Venezuela


One country: Mexico


One country: Colombia


Incorporation of Belize, Cuba, and Suriname, and the English-speaking countries of the Caribbean is ongoing

This programme is an innovative experience that has managed to standardize processes over 18 years, despite the internal regulations of each country. Horizontal technical cooperation among countries and exchange of technologies applicable to LMIC were key to gradually increasing AMR surveillance capacity. Participating countries were able to replicate the Programme nationally with a positive impact in the quality of laboratory results. Quality and reliability of laboratory results are the cornerstone of adequate antibiotic treatment. The project illustrates networking with clear results that are replicable and adaptable to other public health events, such as arboviral diseases, tuberculosis and mycotic diseases. In the context of the AMR National Action Plans, capacity was strengthened to monitor and evaluate the impact of these plans. The triangulation with PAHO/WHO has helped to ensure sustainability, supported by Member States’ mandates and resolutions.