Description: ReLAVRA Data Visualization Dashboards
The AMR dashboards are a series of interactive visualizations developed by the PAHO Antimicrobial Resistance (AMR) Special Program, using aggregate level passive surveillance data, from 19 Latin American countries. The data used in the synthesis of the dashboards are collected through the Latin American Network for Antimicrobial Resistance Surveillance (Spanish acronym ReLAVRA), for selected priority pathogen-drug combinations.
The dashboards are aimed at improving and disseminating the knowledge around AMR in the region. They display regional and national trends for a number of selected pathogens and antibiotics, presented in an interactive and user-friendly fashion. By using outputs that allow for better interaction with the data, we seek to promote a better understanding and use of these historic data. The end goal is to increase the awareness around AMR in the region and provide baseline data to technical and non-technical users, and decision makers in the region and beyond.
All data outputs included in the dashboards, can be customized by selecting the year, country, patient age, gender and for some pathogens the origin of infection i.e. community or hospital-acquired. The dashboards allow for display of more detailed information by hovering over the data point(s) in the view.
The dashboard also includes filters with drop-down menus that allow for selection of the country, antibiotic and when available the origin of infection. Additionally, a filter under the maps allows for displaying results on the map for a specific year. This filter could also provide a play-by-play visualization of the evolution of non-susceptibility on the map.
In addition, all the visual outputs from the dashboard views can be exported and/or shared as pdf format file. The data behind the outputs are also accessible in various downloadable formats, such as excels tables, basic images, cross tabulations, and maps.
The AMR dashboards are NOT INTENDED TO GUIDE ANTIMICROBIAL THERAPY. Selection of antimicrobial therapy must follow local and national guidelines in each country. In the absence of such guidelines, evidence-based global guidelines should be followed.
DATA SOURCES AND DESCRIPTION, ABOUT ReLAVRA:
The Latin American Network for Antimicrobial Resistance Surveillance (ReLAVRA by its Spanish acronym) was formally established in 1996 by the WHO/PAHO regional office and partnering member states. The goal was to inform AMR prevention and control policies and interventions in the region, through the ongoing collection of reliable, comparable, and reproducible AMR data . Initially, the network was constituted of 8 designated national reference laboratories (NRLs), in 8 member states. The surveillance scope was limited to reporting AMR data for a few targeted foodborne pathogens (Salmonella, Shigella and V. cholerae). Each NRL, reported antimicrobial susceptibility testing information (mainly for stool specimens isolates) from sentinel laboratories in each of the participating countries in addition to isolates analyzed in theses NRLs. During the following years, the network and scope of surveillance continued to expand. By 2000, 15 NRLs, in 15 member states were reporting on an additional 7 healthcare-associated pathogens (E. coli, Staphylococcus aureus, Acinetobacter baumannii, Klebsiella spp., Pseudomonas aeruginosa, Enterobacteriaceae, Enterococci spp.); and 5 community-acquired pathogens (Salmonella, Shigella, S. pneumoniae, N. meningitidis, Haemophilus influenzae). Note that not all parameters are collected systematically for all pathogens i.e. demographic, epidemiological variables and some antimicrobial susceptibility testing methods. In these cases, data not available are shown as NA.
The ReLAVRA network is one of the oldest, and largest regional AMR surveillance networks in the world. It includes 20 countries, namely Argentina, Belize, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, the Dominican Republic, Uruguay, and Venezuela. Each country is represented by a NRL, officially designated by national authorities. Aggregate-level data on antibiotic resistance are collected and reported annually, on a number of priority pathogen-drug combination. At the moment, information on 7 priority pathogens and 5 antibiotics is displayed on the AMR dashboard, however as the AMR epidemiological situation evolves and countries share more data, other pathogens and drug-pathogen combinations may be added. It is also worth noting that countries may have shared with PAHO more information than is displayed on the public dashboard, for instance historic data on community-acquired infections reported prior to 2013 are currently undergoing validation.
The number of participating microbiology laboratories varies between countries, as well as within a country from year to year. PAHO estimates that during 2000-2014, over 750 laboratories in the region reported AST data on a total of ~2,633,000 isolates, to the ReLAVRA network through their corresponding NRLs. Compiled AST data are reported to the PAHO regional office through the PAHO country offices in each of the 19 countries of the network.
The pathogen-drug combinations are reported to PAHO in accordance with the ReLAVRA surveillance protocol. These combinations are selected based on evidence and expert consultations in ReLAVRA countries, and in coordination with NRL focal points. The development of these pathogen-drug combinations takes into account regional epidemiology, country needs, and current and future capacities. The protocol is reviewed and updated periodically (last reviewed in 2015).
A reporting template was designed to ensure standardized and accurate reporting. Guidelines for species identification and antimicrobial susceptibility (AST) such as Clinical & Laboratory Standards Institute (CLSI), are used across countries in the region, to enable comparisons between countries.
- This dashboard is based on nationally aggregated AST data reported by NRLs in the region, to PAHO, through the ReLAVRA network.
- The data are reported using a series of standardized data reporting templates designed to streamline the aggregated reporting of information by each NRLs in the network.
- Each of the templates is designated for one pathogen and contains the list of the recommended drugs to be tested against that pathogen, per the ReLAVRA protocol.
- Once reported the aggregated data are reviewed by the PAHO AMR technical team. Erroneous values and unusual results are returned for further review and final validation by the reporting NRL(s) in the network (since 2014). When needed, unverifiable erroneous results were excluded from further analyses.
- Results for pathogen-drug combinations with less than 30 isolates reported per calendar year and country are excluded from the trends analyses.
- Results for pathogens with natural resistance to a specific antibiotic were omitted.
- For each pathogen, countries report aggregated data on the number of isolates intermediate resistant (I); and resistant (R) to a selection of drugs per year.
- To determine non-susceptible (NS) isolates to a drug per year, the I and R isolates are added for each pathogen.
- Maps reflect the mean percentage NS (I+R) for the different pathogen drug combinations reported by the countries
- Results for pathogen-drug combinations, with less than 30 isolates reported per calendar year by country are not shown. This is indicated by a grey color of the country on the map
- Overall, the frequency of reporting of tested isolates varied between countries and by year for different pathogen drug combinations. The total number of isolates reported for each of the pathogen drug combinations is provided in a text box when you select a country on the map. When no data was reported by a country for a given year this was also color indicated (light grey color) on the displayed map.
- The results displayed on the dashboard are based on analyses of historic aggregated surveillance data reported by countries through the ReLAVRA network during each specific year of reporting. Typically, data have a one-year delay before being integrated into the dashboard given the time needed to collate, validate and analyze.
- The data compiled are essentially based on routine clinical laboratory reporting, therefore underreporting may occur due to the passive nature of this surveillance. Regional analyses are restricted to samples for which information was shared through the ReLAVRA network.
- The frequency of reporting of tested isolates varies between countries, with most countries reporting annually and a few countries reporting irregularly. There are currently notable differences in the volume of specimens collected/tested and isolates reported. Differences in the scope of data collection and testing methods may also exist. Thus, comparing non-susceptibility findings between countries should be undertaken with caution.
- With regards to the completeness of the variables under study, different countries may have stronger surveillance for some of the pathogen-drug combinations under ReLAVRA surveillance or may collect information differently for some pathogens for example, reporting on age groups that are most relevant for the disease caused, or on the most relevant types of infection, types of sample etc.
- With regards to representativeness, both the geographic and population representativeness may vary between and within countries depending on their location, level of care of the participating facilities, the representation of the private sector in ReLAVRA surveillance, etc. Indeed, some of the pathogens isolated and analyzed by the NRLs might be biased towards clinical samples from severe cases (a proportion of isolates form severe or treatment-failure cases), which might be associated with multidrug resistant strains, resulting in an overestimated overall proportion of resistance.
- The population stratification is typically limited to broad age groups and may vary between countries and per pathogen-drug combinations. No information on underlying conditions is reported. It is worth noting that no information about age or gender was reported prior to 2014 nor on the origin of infection. Since 2018, data have included the sample type and origin of infection. Given these limitations, more detailed epidemiological analyses of the population distribution of AMR examining certain age groups or high-risk groups are not possible.
- With regards to data quality, the regional team monitors predefined routine quality indicators, and the validation process conducted very closely with the countries allows to rapidly detect and resolve inconsistencies in data. Key indicators from lab external quality assessments are also included in the dashboard.
- The susceptibility results (values of I & R) reported are based on CLSI breakpoints corresponding to the year that data were reported. Hence, the data should be interpreted carefully in relation to changes or updates to CLSI breakpoints or surveillance guidelines to detect surveillance artefacts.
STATEMENT OF PRIVACY AND DATA OWNERSHIP:
The dashboards and corresponding data are made publicly available through PAHO’s Antimicrobial Resistance (AMR) Special Program and the ReLAVRA network. The dashboards reflect a selection of the historic AMR data reported through the ReLAVRA network. To obtain data use authorization, unpublished results and/or more details on specific pathogen-drug combinations in a specific country, kindly contact any of the following:
- ReLAVRA national focal point or coordinator in the country,
- PAHO AMR focal points at the country office or