11 NOVIEMBRE 2021 RESULTADOS DE LA ENCUESTA TRIPARTITA DE AUTOEVALUACIÓN DE LOS PAÍSES SOBRE LA RAM (TRACSS) 2021 PARA LOS INDICADORES DE SALUD HUMANA
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Resultados de la encuesta tripartita de
autoevaluación de los países sobre la RAM
(TrACSS) 2021 para los indicadores de salud
humana
11 noviembre 2021
Dra. Pilar Ramon-Pardo
Coordinadora
Programa Especial de Resistencia a los Antimicrobianos
OPS/OMS
2
LÍNEAS ESTRATÉGICAS PLAN DE ACCIÓN GLOBAL
1. Mejorar la concientización y la comprensión;
2. Reforzar los conocimientos a través de la vigilancia y la
investigación;
3. Reducir la incidencia de las infecciones;
4. Utilizar de forma óptima losantimicrobianos; y
5. Asegurar una inversión sostenible.
WHO, 2015. Global Action Plan on Antimicrobial Resistance.
http://apps.who.int/iris/bitstream/10665/193736/1/9789241509763_eng.pdf?ua=1
3
Participación de la OMS Tasas de respuesta TrACSS
2021, N (%)
Global (N=194) 163 (84%)
AFR, 41 41 (87%)
AMER, 35 23 (66%)
Tasas de EMR, 21 21 (100%)
participación
EUR, 53 50 (94%)
SEAR, 11 11 (100%)
en TrACSS 2021
WPR, 27 17 (63%)
Tasas de respuesta de TrACSS en los
últimos 5 años
79% 82% 84%
100% 78%
(n=154) (n=159) 70% (n=163)
(n=151)
80% (n=136)
60%
40%
20%
0%
2017 2018 2019 2020 2021
COVID-1 9 y RAM
Aumento de vulnerabilidad 4
en los pacientes:
enfermedades subyacentes y
factores de riesgo
9 Nov 2021
-Inicialmente, sobreinfecciones bacterianas en el 50% de
las muertes por COVID-19.
-Uso de antibióticos (94% -100%) más alto que la
incidencia informada de infección secundaria (7 - 10% ).
- Durante la pandemia de COVID-19, los hospitales están
sobrecargados.
-Impacto en las infecciones asociadas a la atención de la salud.
-Ensayos clínicos con azitromicina e hidroxicloroquina
Fuente foto: https://www.nbcnews.com/news/latino/chile-hospital-gives-
covid-19-patients-families-rare-chance-say-n1231870
Impacto de la COVID-1 9 en los PNA de RAM 5
% of countries responding ‘YES’
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
93%
Covid impact AMR NAPs
100%
Governance and administrative 82%
impacts 91%
79%
Operational impacts
78%
Global (n=163) AMER (n=23)Planes de Acción Nacionales sobre la RAM 6
Progreso de los PAN
50%
39%
40% (39%) ¡Trabajo en progreso!
Responding countries at each level % (N)
30% (7)
28%
30% 26%
(45)
(6)
22% 22%
(5) 20% (5)
(32)
20%
A No national AMR action plan.
11%
(18) B National AMR action plan under development.
10% C National AMR action plan developed.
3% D National AMR action plan being implemented.
(5)
E National AMR action plan being implemented and actively
0%
0% monitored through a monitoring and evaluation
framework.
A B C D E
Global (n=163) AMER (n=23)PNA RAM: vínculos con sectores y otros temas de salud
7
PNA vinculados a estrategias/planes de acción de
Sectores que participan otros temas de salud
AMER (n=23) Global (n=163)
AMER (YES) Global (YES)
AMR NAP linked with other… 70%
61%
Human 100%
Health 100%
National Food Safety/Food… 65%
Animal 40%
96%
Health 96% TB 52%
38%
HIV 52%
87% 33%
Food Safety
79% 35%
Health Security 31%
Environmen 65% WASH 39%
28%
t 64%
Sexually Transmitted Infections 52%
26%
Food 65% 26%
61%
Immunization 26%
Production
Malaria 30%
23%
74%
Plant Health 22%
50% National Environmental plans 21%
NTD- Neglected Tropical Diseases 26%
0% 20% 40% 60% 80% 100% 9%
Percentage of countries responding ‘YES’ 0% 20% 40% 60% 80%
Percentage of countries responding ‘YES’8
Grupos de Trabajo Multisectoriales
80%
70%
¡Trabajo en progreso!
Responding countries at each level %
61%
60%
50%
42%
40%
30% 26% A No formal multi-sectoral governance or coordination
mechanism on AMR exists.
22%
B Multi-sectoral working group(s) or coordination committee on
20%
15% AMR established with Government leadership.
13%
C Multi-sectoral working group(s) is (are) functional, with clear
8% 9%
10% terms of reference, regular meetings, and funding for working
4% group(s) with activities and reporting/accountability
0% arrangements defined.
0%
D Joint working on issues including agreement on common
A B C D E
objectives.
E Integrated approaches used to implement the national AMR
Global (n=163) AMER (n=23) action plan with relevant data and lessons learned from all
sectors used to adapt implementation of the action plan.9
Objetivo 1 – Aumentar la concientizacion frente a la RAM
AMR awareness raising campaigns
80%
70%
Responding countries at each level %
60%
52%
50% 47%
40%
29%
30% 26%
A No significant awareness-raising activities on relevant aspects of risks of
antimicrobial resistance.
20%
B Some activities in parts of the country to raise awareness about risks of
10% antimicrobial resistance and actions that can be taken to address it.
9% 9% 9%
10% C Limited or small-scale antimicrobial resistance awareness campaign
4% 4%
targeting some but not all relevant stakeholders.
0% D Nationwide, government-supported antimicrobial resistance awareness
A B C D E campaign targeting all or the majority of priority stakeholder groups,
based on stakeholder analysis, utilizing targeted messaging accordingly
Global (n=163) AMER (n=23) within sectors.
E Targeted, nationwide government-supported activities regularly
implemented to change behavior of key stakeholders within sectors,
with monitoring undertaken over the last 2-5 years.10
Objetivo 1 : Formación y educación sobre RAM
Training and education on AMR in human helath sector
80%
70%
70%
Responding countries at each level %
60%
53%
50%
40%
A No training for AMR.
30% Ad hoc AMR training courses.
B
AMR is covered in curricula of some pre-service training and in 2)
19% some in-service training or other continuing professional
20% 17%
C development (CPD) for human health workers.
13%
9% 9% 9%
10%
AMR is covered in pre-service training for all relevant cadres. In-
1% service training or other CPD covering AMR is available for all types of
0% D human health workers nationwide.
0%
A B C D E
AMR is systematically and formally incorporated in pre-service
training curricula for all relevant human health cadres. In-service
Global (n=161) AMER (n=23) training or other CPD on AMR is taken up by relevant groups for
E
human health nationwide, in public and private sectors.Objetivo 2 – Monitoreo del uso/venta de antimicrobianos 11
National monitoring system for antimicrobial use
in human health
60%
50%
Responding countries at each level %
40%
30%
30%
26% A No national plan or system for monitoring use of antimicrobials.
23% 23% System designed for surveillance of antimicrobial use, that includes
22% 22%
20%
20%
B monitoring national level sales or consumption of
antibiotics in health services.
13% Total sales of antimicrobials are monitored at national level and/or some
12%
C monitoring of antibiotic use at sub-national
10% 9% level.
Prescribing practices and appropriate antibiotic use are monitored in a
D national sample of healthcare settings.
0% On a regular basis (every year/two years) data is collected and reported
A B C D E on:
a) Antimicrobial sales or consumption at national level for human use;
E
Global (n=163) AMER (n=23) and
b) Antibiotic prescribing and appropriate/rational use, in a
representative sample of health facilities, public and private.12
Objetivo 2 – Vigilancia de la RAM en la salud humana
National AMR surveillance systems
in human health
80%
70%
Responding countries at each level %
60%
50% 48%
43%
40%
35% No capacity for generating data (antibiotic susceptibility testing and
A accompanying clinical and epidemiological data) and reporting on
30% antibiotic resistance.
AMR data is collated locally for common bacterial infections in
23% hospitalized and community patients, but data collection may not
19% B
20% , use a standardized approach and lacks national coordination and/or
13% quality management.
11% AMR data are collated nationally for common bacterial infections in
10% C hospitalized and community patients, but national coordination and
3% 4% standardization are lacking.
0% There is a standardized national AMR surveillance system collecting
0% data on common bacterial infections in hospitalized and community
A B C D E D patients, with established network of surveillance sites, designated
national reference laboratory for AMR,, and a national coordinating
Global (n=159) AMER (n=23) centre producing reports on AMR.
The national AMR surveillance system links AMR
E surveillance with antimicrobial consumption and/or use
data for human health.Objetivo 2 – Red de laboratorios de RAM en salud humana 13
(nueva pregunta en 2021 TrACSS) -
National AMR lab network
80%
National lab structure
Responding countries at each level %
70% 0% 20% 40% 60% 80% 100%
60%
48%
50% Majority of bacteriology laboratories in the public
health sector part of a National Laboratory network 78% 22% 0%
40% (n=23)
33%
30% 25%
18%
20% 14% 13%
13% 13% 13%
10%
10% Regulatory authority exists to certify/accredit
70% 30% 0%
bacteriology laboratories (n=23)
0%
A B C D E
Global (n=158) AMER (n=23)
Regulatory authority exists to provide accreditation
A Information not available. based on International Standards for Bacteriology 56% 31% 13%
The National Reference Laboratory (NRL) and/or the National Regulatory Authority Laboratories (n=16)
B (NRA) has not agreed and approved national guidelines for AST (e.g CLSI or EUCAST),
bacterial isolation and identification protocols
The NRL and/or NRA have issued national guidelines, based on international standards
C for AST (e.g CLSI or EUCAST), bacterial isolation and identification for use within the
bacteriology laboratory network.
Yes No Don't Know
The NRL and/or NRA have issued national guidelines for AST (e.g CLSI or EUCAST),
bacterial isolation and identification for use within the bacteriology laboratory network
D and National Reference Laboratory participates in an international external quality
assurance.
The National Reference Laboratory supports the bacteriology laboratory network in
identification of pathogens and AMR through a systematic approach to cascade training
E and supportive supervision and it has established a National External Quality Assurance
program provided to the national bacteriology laboratory network.14
Utilización de datos pertinentes sobre el consumo/uso de
antimicrobianos y/o la RAM para modificar la estrategia nacional
en los siguientes sectores
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
67%
Human Health 73%
50%
Animal Health 55%
12%
Plant Health 16%
26%
Food Production 33%
38%
Food Safety 47%
7%
Environment 0%
Global (Yes) AMER (Yes)15
Objetivo 3- Reducir la RAM en la salud humana
Programa nacional de la PCIP
80%
70%
¡Trabajo en progreso!
Responding countries at each level %
60%
52%
50%
40%
32% A No national IPC programme or operational plan is available.
30% 26% A national IPC programme or operational plan is available.
National IPC and water, sanitation and hygiene (WASH) and
22% B
19% environmental health standards exist but are not fully
20% implemented.
15%
13% A national IPC programme and operational plan are available and
11% national guidelines for health care IPC are available and
10% C
disseminated. Selected health facilities are implementing the
4% 4% guidelines, with monitoring and feedback in place.
National IPC programme available according to the WHO IPC core
0% components guidelines and IPC plans and guidelines implemented
A B C D E D nationwide. All health care facilities have a functional built
environment (including water and sanitation), and necessary
materials and equipment to perform IPC, per national standards.
Global (n=162) AMER (n=23) IPC programmes are in place and functioning at national and
health facility levels according to the WHO IPC core components
E guidelines. Compliance and effectiveness are regularly evaluated
and published. Plans and guidance are updated in response to
monitoring.16
Objetivo 4 – Optimizar el uso de antimicrobianos en
la salud humana
Políticas para optimizar el uso de antimicrobianos en la salud humana
80%
70%
Responding countries at each level %
61%
60%
50%
39%
40%
30% 27% 26% A No/weak national policies for appropriate use.
National policies for antimicrobial governance
B developed for the community and health care
20%
16% settings.
13% Practices to assure appropriate antimicrobial use
10% being implemented in some healthcare facilities and
6% C
4% 4% 4% guidelines for appropriate use of antimicrobials
available.
0% Guidelines and other practices to enable appropriate
A B C D E use are implemented in most health facilities
D nationwide. Monitoring and surveillance results are
used to inform action and to update treatment
Global (n=161) AMER (n=23) guidelines and essential medicines lists.
Guidelines on optimizing antibiotic use are
E implemented for all major syndromes and data on
use is systematically fed back to prescribers.17
Objetivo 4 – AWaRe en la lista nacional de
medicamentos esenciales
¡Trabajo en progreso!
Adopción de AWaRe en LME nacional
80%
70%
60%
Responding countries at each level %
53%
50%
43%
40%
30%
22%
20%
20% 17% Country has no knowledge or information about the AWaRe
A
classification of antibiotics.
11% 10% Country has knowledge about the AWaRe classification of
10% 9% 9% B antibiotics and country has intention to adopt it in the next
6%
few years.
Country has adopted the AWaRe classification of antibiotics
C
in their National Essential Medicines List.
0%
Country is monitoring its antibiotic consumption based on
A B C D E D
the AWaRe classification of antibiotics.
Country has incorporated AWaRe classification of antibiotics
Global (n=161) AMER (n=23) E
into its antibiotic stewardship strategies.18
Regulaciones en el uso de antimicrobianos (ventas y uso)
Yes No Don't Know
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Laws/regulations on prescription and sale of antimicrobials for human use. 91% 9% 0%
Laws/regulations on prescription and sale of antimicrobials for animal use. 74% 22% 4%
Prohibit antimicrobials for growth promotion 39% 57% 4%
Legislation on marketing of pesticides, including antimicrobial pesticides, in plant
74% 9% 17%
production
Source: TrACSS 2021 data n=2319
PAHO/WHO
Reflexiones hacia TraCSS 2023
Datos confiables para el uso Oportunidades de mejora
• Herramienta para la abogacia - Mejorar la tasa de respuesta
• Datos para el desarrollo de políticas y - Mejorar la calidad de las respuestas,
líneas de cooperación técnica que reflejen la situacion real de los
• Oportunidad de discusión sobre los paises (Una Salud, multisectorial,
avances y desafíos del país metodología)
- Estandarizar la comprensión de las
preguntas y respuestas (intra e inter)
- Apoyo de los colegas de FAO y OIE20
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