National Antimicrobial Susceptibilty Testing Committees (NACs)
EUCAST recommends that countries institute a “National Antimicrobial Susceptibility Testing Committee” (or a committee corresponding to this description). Countries in the process of adopting EUCAST antimicrobial susceptibility testing guidelines will find this particularly useful during the implementation process. The chairperson, or another committee officer, should represent the country on the EUCAST General Committee.
This document presents EUCAST suggestions on How to organise and form a NAC.
NACs are invited to provide a link to their website for EUCAST to post here.
List of and brief information on National breakpoint committees and NACs:
The National AST Committee was established in mid-2011 under the auspices of the Australian Society for Antimicrobials to provide expert advice and further the cause of skill development in the area of antimicrobial susceptibility testing. Until now, there has been no entity undertaking this task, although matters have often been referred to the Executive of the Australian Group on Antimicrobial Resistance (AGAR), a federally funded resistance surveillance group ran through the financial auspices of ASA.
Membership: the inaugural membership comprises medical microbiologists and clinical laboratory scientists, currently under the chairmanship of John Turnidge, Adelaide.
Terms of reference include:
• Provide expert advice to laboratories and other stakeholders Australia-wide on all aspects of susceptibility testing (principally for but not necessarily restricted to antibacterial and antifungals)
• Provide advice to device manufacturers on preferred testing ranges and other aspects of devices and supplies as requested or required for the Australian environment
• Assist laboratories in transitioning from CLSI to EUCAST methods and breakpoints (where available)
• Provide advice to resistance surveillance groups on laboratory methods, testing concentrations, and interpretation of data relevant to the type of resistance surveillance being undertaken
• Run educational workshops on basic and advanced aspects of susceptibility testing
• Liaise with international standards setting bodies such as EUCAST and CLSI
Meetings: Initially, the NAC will meet face-to-face twice yearly in conjunction with the biannual ASA/AGAR, with work being undertaken in between meeting via email and teleconference.
Four societies in Brazil (Brazilian Society for Clinical Analysis, Brazilian Society for Clinical Pathology and Laboratory Medicine, Brazilian Society for Infectious Diseases and Brazilian Society for Microbiology) signed a Technical Cooperation Agreement in August 2013, creating the Brazilian Committee on Antimicrobial Susceptibility Testing (BrCAST). This committee aims at providing scientific expertise and generating data that could support decisions from ANVISA, the Brazilian regulatory health agency. It also aims at leading and promoting the development and standardization of antimicrobial susceptibility tests in Brazil according to EUCAST guidelines. Click here to access the website of BrCAST.
CANCAST (Canadian Antimicrobial Susceptibility Testing Committee) was established in early 2016 in association with the Canadian Standards Association (CSA) to provide expert advice in the area of antimicrobial susceptibility testing to Canadian clinical laboratories. Until this time a variety of standards and guidelines had been used in Canadian laboratories.
CANCAST is composed at present of an Executive Committee with medical and clinical microbiology and infectious diseases experts and ex officio involvement of the Therapeutics Products Directorate (TPD) of Health Canada. Advisors, representing medical microbiology and infectious diseases experts, national organizations (e.g. AMMI-CACMID) provincial jurisdictions, the Public Health Agency of Canada, National Microbiology Laboratory, external quality assurance agencies, provincial laboratory accreditation bodies, and susceptibility test manufacturers are being recruited to provide encompassing support for CANCAST. The current Chair of CANCAST is Dr. Bob Rennie, from Edmonton, Alberta.
- The goals of CANCAST are to:
Provide standardized antimicrobial susceptibility testing methods and breakpoints for Canadian laboratories (primarily for anti-bacterial and anti-fungal testing) that are consistent with global standards (EUCAST) where available.
- Provide advice to groups conducting resistance surveillance, on laboratory methods, testing concentrations, and on interpretation of data relevant to the type of resistance surveillance being undertaken.
- Provide educational workshops on basic and advanced aspects of susceptibility testing.
- Interact with TPD and other antimicrobial standards groups (EUCAST, CLSI) to ensure that methodologies and breakpoints are harmonized internationally.
The Danish National AST committee was established in 1996 as a subcommittee under the auspice of the Danish Society of Clinical Microbiology. The first Chairman was Knud Siboni. In 2007 the Committee was restructured into Danres with responsibility for surveillance and political issues and a subcommittee on methodology and and quality assurance DanresM. In Danres the members are representatives from all departments of Clinical Microbiology and Statens Serum Institut,
in DanresM the number of members has varied but today has a similar structure. Danres meets twice a year and DanresM 4 times a year. DanresM has 3 members in NordicAST, the committee for Norway, Sweden and Denmark.
CA-SFM was founded in 1980. It is composed of twenty members (clinical microbiology, pharmacology, and infectious diseases) and has three meetings annually. Special working parties have dealt with particular issues. The primary role of CA-SFM has been to propose breakpoints but also to establish rules of interpretation of the “antibiogramme”, taking into account an in-depth knowledge of the accepted mechanisms of resistance and of the technical procedures for their detection. These rules have been discussed and developed under French leadership in the EUCAST expert rules subcommittee.
CA-SFM is linked to the Medicines French Agency (AFSSAPS) for establishment of the spectrum of activity of antibiotics. The recommendations of CA-SFM have been published in a “Communiqué” annually revised and updated.
CA-SFM belongs to the Steering Committee and the General Committees of EUCAST and actively participates to their work.
The German NAC was founded the 14th of June, 2012. Major objectives are I) to establish EUCAST breakpoints and technical aspects of in vitro antimicrobial susceptibility testing in German laboratories, II) to adapt EUCAST breakpoint to local requirements, and (III) to evaluate breakpoints for antimicrobial agents that have not yet been considered by EUCAST.
The organizational structure largely follows that of EUCAST. The General Committee comprising representatives of national scientific societies and organizations in the fields of infectious diseases and patient safety decides on recommendations proposed by the Steering Committee. The Steering Committee currently consists of 14 experts having a background in clinical microbiology, infectious diseases or regulatory affairs. Both boards will meet at least once a year. Industry has an observational status only.
DIN. During the period 2001 - 2011 Germany was represented by DIN and provided strong support in the work to establish EUCAST and the process through which harmonisation of breakpoints in Europe was achieved.
The Moroccan Society of Medical Microbiology (www.smamm.ma) in 2014 set up a National Committee on Antimicrobial Susceptibility Testing (CA-SMAMM).
The objectives of the CA-SMAMM is to promote the standardization of antimicrobial susceptibility testing in the public and private sectors by promoting and developing EUCAST guidelines (www.eucast.org) in the daily laboratory practice.
The achievement of these objectives will be done by establishing annual work program including seminars and workshops led by national and international experts and by participation with EUCAST in various studies and surveys.
The members were appointed mainly on the basis of their expertise in the field of microbiology and regional and national representation has been respected. The Committee consists of eleven members and includes microbiologists, representatives of the administration, private and public laboratories and a veterinary. The President is Professor Amina Benaouda.
The Norwegian Working Group on Antibiotics (NWGA; in Norwegian Arbeidsgruppen for antibiotikaspørsmål - AFA), was formed in 1978 and consisted of four specialists in clinical microbiology and two specialists in infectious diseases, appointed by the respective specialist committees in the Norwegian Medical Association. In 2005 NWGA became an official advisory expert group for the Norwegian Directorate of Health and the group was expanded to nine members and the Institute of Veterinary Medicine and the Norwegian Medicines Agency appointed observers. NWGA establish national guidelines for antimicrobial susceptibility testing (bacteria and fungi). This work is performed in close collaboration with other Scandinavian countries and follows EUCAST recommendations. NWGA also arrange national bi-annual courses (practical and theoretical) in antimicrobial susceptibility testing.
The Slovak "National Antimicrobial Susceptibility Testing Committee (The Slovak NAC)" was established in the Slovak Republic in 2014, it has 3 members and it works as subcommittee of the Central commission for anti-infective treatment and antibiotics policy of the Ministry of Health of the Slovak Republic (UKALAP).
Members of the Slovak NAC are:
Eva Schreterova, MD, PhD, Pavol Jozef Safsrik University in KoSice
Dusan Krkoska, MD, PhD, MBA, University Hospital of Martin
Milan NikS, MD, CSc., Public Health Authority of the Slovak Republic, Bratislava
Nominee to EUCAST General Committee for the Slovak Republic is:
Milan Niks, MD, CSc., Public Health Authority of the Slovak Republic, Bratislava
South African Society of Clinical Microbiology (SASCM) has established a National Antimicrobial Committee (NAC) on 20 February 2014. The subcommittee will serve the interest of the public and private sectors in the field of antimicrobial susceptibility testing. The committee has eight members and the chair is Professor Olga Perovic. Members were nominated primarily on their expertise in the field of microbiology.
In 2012, the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC, http://www.seimc.org/) created the National Antibiogram Committee, COESANT, in accordance with recommendations by EUCAST. The objective of COESANT is to implement EUCAST criteria in clinical practice and to collaborate with EUCAST. Among other activities, COESANT organizes training in the use of EUCAST breakpoints, and promotes studies on antimicrobial susceptibility and the rational use of antibiotics. COESANT is a multidisciplinary group that includes clinical microbiologists, experts in infectious diseases, clinical pharmacologists, and members from official institutions. It is financed by the SEIMC, although it may also receive support from official institutions. The members of COESANT are obliged to make a yearly declaration of conflict of interests.
The Swedish Reference Group of Antibiotics (SRGA; in Swedish Referensgruppen för Antibiotikafrågor, RAF), was formed in 1976 as a breakpoint committee. In 1986 a subcommittee on methodology and quality assurance was formed (SRGA-M), and SRGA took on more antibiotic policy issues. The first chairman of SRGA was Lars-Olof Kallings and of SRGA-M Gunnar Kahlmeter. The number of committee members in the respective groups varied but was typically 10 in each group. SRGA consisted of specialists in clinical microbiology, infectious diseases, pediatrics, clinical pharmacology, otorhinolaryngology and later also primary care medicine. Both groups are still active. They share a website.
The Dutch Committee on Susceptibility testing (CRG, Commissie Richtlijnen Gevoeligheidsbepalingen, formerly WRG) was established in 1971 to develop methodology in antimicrobial susceptibility testing and define clinical breakpoints and critical zone diameters. The first chairman was R. Peter Mouton and the secretary B. van Klingeren. He was succeeded by J. Degener and Johan W. Mouton, who is the current chair. As of 2010, the CRG is a subcomittee of the SWAB, the Dutch Working Party on Antibiotic Policy. The number of committee members in the group varied but was typically 10 and consisted of specialists in clinical microbiology, infectious diseases, pediatrics and clinical pharmacology. Breakpoints and critical zone diameters were originally published as reports and in later years in the Journal of the Dutch Society of Medical Microbiology.
The United Kingdom
The British Society for Antimicrobial Chemotherapy (BSAC) was established on 26 August 1971 "to facilitate the acquisition and dissemination of knowledge in the field of antimicrobial chemotherapy". Antimicrobial susceptibility testing has been a major interest from the first meeting and a specialist Antimicrobial Susceptibility Testing Working Party was formed in 1985. The first chairman of the BSAC was William Brumfitt, and the first chairman of the Antimicrobial Susceptibility Testing working party was Ian Phillips. The working party meets 3-4 times per year and comprises 10-15 members, currently including medical microbiologists, clinical scientists and veterinary scientists.
The Turkish Working Group on Standardization of Antimicrobial Susceptibility Tests (ADTS) was established in 1994 under the auspices of Turkish Society of Microbiology (TMC). It is composed of ten members, including clinical microbiology and infectious diseases specialists. ADTS aims to facilitate the nationwide standardization of AST methods. It organizes meetings under the name "Antimicrobial Chemotherapy Days" once every two years. Starting from 2013, ADTS has been organizing workshops to introduce the EUCAST methodology to Turkish microbiologists. All EUCAST documents have been translated to Turkish by ADTS since 2014 which are published on the TMC website. By the end of 2015, more than half of the Turkish laboratories have already implemented the EUCAST methodology.
The website of the Turkish NAC is Turkish Working Group on Standardization of Antimicrobial.
Ukrainian NAC (UCAST)
The National AST Committee for the Ukraine (UCAST) was established in late 2015 by experts in antimicrobial susceptibility testing and new drug research under the auspices of the Ukrainian Association of Infection Control and Antimicrobial Resistance (UAICAR) for Antimicrobials to provide expert advice and further the cause of skill development in the area of antimicrobial susceptibility testing. This effort was supported initially by several professional societies (The Zarifa Aliyeva International Center of Medical Science, Ukrainian Society of Epidemiology, Ukrainian Infectious Disease Society) and a broad base of scientists across the disciplines of infectious disease (adult and children), laboratory medicine (pathology and clinical microbiology), pharmacology and pharmacodynamics, antimicrobial discovery and development, resistance surveillance and monitoring, antimicrobial drug stewardship, and the epidemiology of infections. Currently the Ukrainian Group on Antimicrobial Resistance (UGAR) is working on the development and implementation of new regulations that will be approved by the Ministry of Health Care and used in Ukraine as a mandatory protocol. As a basis for this protocol the EUCAST standards will be taken.
Membership: The committee has 10 members (including a five member Executive Committee) that include experienced members in all key specialties (including medical microbiologists, epidemiologists, clinical laboratory and clinical scientists) and society representatives (including professional organisations/societies, antibiotic use, resistance surveillance committees and quality assurance agencies). The Chairman is Prof. Aidyn Salmanov. Current members of the Executive Committee are Ada Rudenko, MD Prof., Nina Vrunchanu, MD Prof., Mykhaylo Andreychin, MD Prof., Tetiana Glushkevych, MD.
Positions (committee or working group [WG] members and advisors) with the UCAST will be selected/confirmed after EC screening of resumés documenting qualifications and experience in the area of antimicrobial susceptibility testing methods, research and development and/or infectious disease therapy (efficacy and safety)/clinical research/education and/or regulatory processes.
- Provide a venue (electronic and "face-to-face" meetings) for Ukraine individual practitioners/scientists, governmental agencies, and medical societies to interact with the EUCAST/EMA process of antimicrobial testing and development of interpretive criteria per EUCAST.
- Provide expert advice to laboratories and other stakeholders Ukraine-wide on all aspects of susceptibility testing.
- Provide advice to device manufacturers on preferred testing ranges and other aspects of devices.
- Provide advice to resistance surveillance groups on laboratory methods, testing concentrations, and interpretation of data relevant to the type of resistance surveillance being undertaken.
- Assist laboratories in transitioning from other methods (USSR and CLSI) to EUCAST methods and breakpoints (where available).
- Review and endorse the "best use choice" of established reference and standardized antimicrobial susceptibility testing methods currently found in public domain documents for dilution and agar disk diffusion procedures.
- EUCAST published guidelines, review all clinical breakpoints and provide best, consensus published breakpoints recommendations to the agency and for use in Ukraine medical practice.
- Review new agent development data regarding those items impacting the selection of antimicrobial susceptibility testing breakpoint criteria for clinical practice. New agents will be promptly reviewed.
- Provide an efficient process respecting potentially sensitive, confidential information, but remaining open via full disclosures of conflicts of interest and by seeking public comment via electronic mechanisms on proposed published documents (breakpoints or test-result-based guidelines).
- Provide readily accessible breakpoints and other guidelines for antimicrobial chemotherapy related to tested available agents, on an electronic format (online/website) to minimize cost and maximize widespread clinical/laboratory utility. Rapid application of breakpoints would be facilitated by collaborations with commercial susceptibility testing systems manufacturers and regulatory agencies.
- Provide good practice in quality assurance in accord with EUCAST guidelines in Ukraine.
- Provide education including organizing meetings and practical workshops.
- Seek continued support and/or participations from established investigators in the disciplines important to antimicrobial breakpoint determinations.
Meetings: The UCAST began face-to-face meetings in December 2015 and will meet every 6 months. Additional meetings will be scheduled during national and international meetings (CAESAR, ECCMID, etc) and via teleconference, as needed by the WGs.
Contact Information: firstname.lastname@example.org
The National AST Committee for the USA (USCAST) was founded in early 2013 by experts in antimicrobial susceptibility testing and new drug research. This effort is supported by several professional societies (International Society of Anti-Infective Pharmacology, Pediatric Infectious Disease Society and others) and a broad base of scientists across the disciplines of infectious disease (adult and children), laboratory medicine (pathology and clinical microbiology), pharmacology and pharmacodynamics, toxicology, in vitro and in vivo modeling, antimicrobial discovery and development, resistance surveillance and monitoring, antimicrobial drug stewardship, and the epidemiology of infections.
The committee has 18 members (including a five-member Executive Committee) that includes experienced expert members in all key specialties and society representatives. The Chairman is Paul G. Ambrose, PharmD (Albany, New York) and the Scientific Secretary is Ronald N. Jones, MD (Silverton, Oregon). Current additional members of the Executive Committee are John S. Bradley, MD (San Diego, California), David R. Andes, MD (Madison, Wisconsin) and Robert K. Flamm, PhD (North Liberty, Iowa).
NAC member William A. Craig, MD (Madison, Wisconsin) died on the 11th of March 2015.
Read more about USCAST (uscast.org)