Developing a national surveillance system for antimicrobial resistance

An interview with Nilay Çöplü

Antibiotic use in Turkey

People need a prescription to buy antibiotics in Turkey, but in practice they are easy to obtain from pharmacies, and so misuse is possible. Antibiotics are also sold freely and used extensively as a growth promoter, together with vitamins, in many agricultural industries, including fish farming.

The prevalence of hospital-acquired infection with methicillin-resistant Staphylococcus aureus has reached 40% in hospitals in Turkey.

A surveillance system for antimicrobial resistance in Turkey

“In my daily work at the Agency, I undertake research and training on antibiotic resistance and vaccine preventable diseases. In 2008, I became Turkey’s focal point on antibiotic resistance for the European Centre for Disease Prevention and Control and managed awareness-raising activities to mark European Antibiotic Awareness Day, celebrated annually on 18 November.”

“More recently, I have been instrumental in setting up Turkey’s National Antimicrobial Resistance Surveillance System. The main aims of this surveillance system are to assess the current situation on antimicrobial resistance in Turkey, and based on the best scientific knowledge available, to provide guidance on policies for antibiotic use and to measure the long-term effectiveness of such policies.”

“This process began in 2009, with the first meeting of the scientific advisory board, bringing together professors and senior scientists from 19 universities and training hospitals. We have since had a further three meetings and have developed standard operating procedures for identifying and testing bacteria, including quality control.”

“We sent a questionnaire to 354 laboratories across the country, and based on that, have selected 79 laboratories from the 12 regions to be part of the surveillance network. This means that at least six laboratories in each region (two university laboratories, two training institutions and two government hospitals) will submit data on eight types of bacteria.”

The first set of data is due in April

“These laboratories will submit their data using WHONET, a software system developed by John Stelling of the WHO Collaborating Centre for Surveillance of Antimicrobial Resistance in Boston, Massachusetts. More than 1000 laboratories in 80 countries use WHONET, which is available in 17 languages.”

“One additional task of the advisory board is to ensure quality control and check the performance of the 79 laboratories selected.”

“We are due to receive the first data from the network in April 2011, and these findings will be a great step forward in mapping antimicrobial resistance in Turkey.”

What needs to change

“Awareness campaigns such as European Antibiotic Awareness Day and this year’s World Health Day are good examples of how the issues surrounding antibiotic use can be explained to primary health care professionals and the public. But I would like to see the scope of these initiatives widened and extended to all countries.”

“Legislation across the board should be strict about not allowing the purchase of antibiotics without a prescription. Equally important is addressing antibiotic use in the farming industry. These issues must be tackled, both in Turkey and abroad.”

About Nilay Çöplü

Nilay Çöplü is Associate Professor at the Communicable Disease Research Department of the Refik Saydam National Public Health Agency in Ankara, Turkey. Before joining the Agency in 1989, Nilay Çöplü spent four years working as a general practitioner and then began specializing in microbiology.