National Programme on AMR Containment

National Programme on AMR Containment

Antimicrobial resistance is a growing public health problem. Resistance has emerged even to newer & more potent antimicrobial agents like Carbapenems. The rapid spread of multi-drug resistant bacteria and the lack of new antibiotics to treat infections caused by these organisms pose a rapidly increasing threat to human health which urgently needs to be tackled if we are to contain the problem and prevent untreatable illness from becoming a reality.

India has given due cognizance to the problem of Antimicrobial resistance (AMR) and to tackle this issue, Government of India launched a “National Programme on AMR Containment” during the 12^th five-year plan (2012-2017) which is being coordinated by NCDC. The network of labs is being expanded in a phased manner and currently includes 35 state medical college labs in 26 States/UTs.

The main objectives of this programme are: 

1. Establish a laboratory-based AMR surveillance system in the country to generate quality data on antimicrobial resistance
2. Carry out surveillance of antimicrobial usage in different health care settings
3. Strengthen infection control practices and promote rational use of antimicrobials through Antimicrobial stewardship activities
4. Generate awareness amongst health care providers and community on antimicrobial resistance and rational use of antimicrobials.

 Activities carried out under the programme:

1. AMR Surveillance:

Under the programme, National Antimicrobial Surveillance network (NARS-Net) has been established to determine the magnitude and trends of AMR in different geographical regions of the country. The network labs under NARS-Net are required to submit AMR surveillance data of seven priority bacterial pathogens of public health importance:  Klebsiella spp., Escherichia coli, Staphylococcus aureus, and Enterococcus spp., Pseudomonas spp, Acinetobacter spp., Salmonella enterica serotypes Typhi and Paratyphi. The list of 35 labs in 26 states/UTs currently included in the network is as below:

1. BJMC Pune, Maharashtra
2. BJMC Ahmedabad, Gujarat
3. GSVM Medical college Kanpur, UP
4. GMCH Chandigarh
5. SMS Medical College Jaipur, Rajasthan
6. LHMC, Delhi
7. VMMC and Safdarjung Hospital, Delhi
8. MMC & RI Mysore, Karnataka
9. KAPV Government Medical College, Trichy, Tamil Nadu
10. Government Medical College, Thiruvanathapuram, Kerala
11. Guwahati Medical college, Guwahati, Assam
12. Mahatma Gandhi Memorial Medical college, Indore, MP
13. NEIGRIHMs, Shillong, Meghalaya
14. IGMC, Shimla, HP
15. Medical College, Jammu
16. Medical College, Aurangabad, Maharashtra
17. Osmania General Hospital & Osmania Medical College, Hyderabad, Telangana
18. SCB Medical College Hospital, Cuttack, Odisha
19. Agartala Govt. Medical College & GBP Hospital
20. Guntur Medical College & Govt. General Hospital, Andhra Pradesh
21. Jawaharlal Nehru Memorial Medical College, Raipur, Chattisgarh
22. Rajendra Institute of Medical Sciences, Ranchi, Jharkhand
23. B D Sharma PGIMS Rohtak, Haryana
24. Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar
25. Medical College, Haldwani, Uttarakhand
26. Gandhi Medical College, Bhopal, Madhya Pradesh
27. Calcutta School of Tropical Medicine, Kolkata, West Bengal
28. LLRM Govt. Medical College, Merrut, Uttar Pradesh
29. GMERS Medical College, Valsad, Gujarat
30. Coimbatore Medical College & Hospital (CMCH), Coimbatore, Tamil Nadu
31. Maulana Azad Medical College & Associated Hospitals, Delhi
32. Sardar Patel Medical College, Bikaner, Rajasthan
33. Karnataka Institute of Medical Sciences, Hubbali, Karnataka
34. Indira Gandhi Medical College & Research Institute, Puducherry
35. NAMO Medical College & Research Institute, Silvassa, UT of Dadra & Nagar Haveli and Daman & Diu

Under the programme AMR surveillance data is submitted by the network labs to NCDC using the WHONET software on a quarterly basis and feedback is provided to the labs by NCDC regarding completeness of data etc. The corrected data once received is analysed at NCDC and compiled in the form of an annual report. The annual report of 2017, 2018 and 2019 are available on NCDC website at: https://ncdc.gov.in/index1.php?lang=1&level=2&sublinkid=393&lid=349. The National AMR surveillance data is also uploaded annually onto GLASS (Global AMR Surveillance system).

The quality of data submitted under the National AMR surveillance network is ensured through External Quality Assessment Scheme (EQAS) conducted by NCDC, under which all network sites submit isolates every quarter (as per programme guidelines) to the National Reference Laboratory established at NCDC. NCDC has also developed various SOPs, which are updated on regular basis, and all the sentinel site laboratories are provided training on the use of these SOPs. In addition, training is also provided on AMR data management using the WHONET software. Capacity building on standardisation of basic procedures in Bacteriology across the network has also been initiated using the virtual platform in collaboration with CDC, ASM and ECHO-India. Other activities carried out for quality improvement include onsite support visits, trainings and review meetings conducted on regular basis. The AMR surveillance network sites are also mandated to submit AMR alert strains for confirmation to NRL at NCDC. NRL at NCDC also conducts molecular characterisation of the AMR strains.    

2. National Treatment Guidelines:

A common unified National Treatment Guidelines for antimicrobial use in infectious diseases has been released and uploaded on the website at: https://ncdc.gov.in/WriteReadData/l892s/File622.pdf. It can serve as a guide to all the hospitals to formulate their own guidelines on basis of which physicians will be trained. 

3. Infection Prevention & Control guidelines and surveillance of Healthcare associated infections :

“National Guidelines for Infection Prevention and Control in Healthcare facilities” have been developed with support from WHO and have been disseminated to various stakeholders and also unloaded on NCDC website at https://ncdc.gov.in/showfile.php?lid=431.

For surveillance of Healthcare associated infections, sentinel sites under the National Programme on AMR Containment are joining the ICMR-AIIMS Healthcare Associated Infections (HAI) surveillance network in a phased manner. For more details on ICMR-AIIMS HAI surveillance network may refer to https://www.haisindia.com

4. IEC Activities:

Material for IEC has been developed and its dissemination is under process. In addition, various IEC activities are conducted/supported round the year including quiz competition in schools, public lectures in academic Institutions and radio programmes, participation in Health fairs etc.   

5. Review meetings, trainings and workshops

The network labs are provided training on WHONET software and onsite support through site visits. All the labs are trained for Micro broth dilution testing for colistin and vancomycin. Annual meetings are conducted to review the working of the network labs under the programme. 

6. Strengthening Laboratory capacity for AMR detection

During onsite visits, the lab capacity is assessed and hand holding is done for strengthening Internal Quality Control and Proficiency testing in these labs. 1% resistant strains are to be submitted every quarter by the sites for confirmation to NCDC. Most labs under the programme are enrolled onto the IAMM EQAS programme.