Cutting-edge Fleming Fund data surveillance equipment to target AMR in Bhutan

In partnership with the Fleming Fund, the Royal Government of Bhutan’s Ministry of Health (MoH) has renovated three antimicrobial resistance (AMR) surveillance sites with advanced laboratory equipment to support the country’s health system.

The laboratory equipment is part of the country’s AMR surveillance system, installed at the Jigme Dorji Wangchuk National Referral Hospital (JDWNRH) in Bhutan, its National Reference Laboratory (NRL) - the surveillance lynchpin.

The National Coordinating Center (NCC) for AMR at the Royal Center for Disease Control has also been equipped to monitor antimicrobial use (AMU) across the country to help improve prescribing practices in hospitals. We have also supported these centres and the National Veterinary Laboratory by installing rapid automated machines to analyse AMR.

In the face of the global AMR challenge, Bhutan first developed a One Health strategy centred around tackling AMR. This has informed the country’s National Action Plan (NAP) which adopts a One Health approach, recognising that resistant pathogens are transmitted between humans, animals, and the environment.

High-performance testing

The new, high-performance VITEK MS and VITEK 2 compact laboratory platforms are used for bacterial identification and Antimicrobial Susceptibility Testing (AST) – a process used to detect types of bacteria and fungi. With significantly more accurate and timely AMR testing, this will greatly benefit prescribing practices across the country and ultimately improve patient care.

Demonstration of new equipment in Bhutan from Fleming Fund supplier BioMérieux.

The VITEK 2 Compact is designed to identify microbial and AST results in as little as 5 to 8 hours, with conventional manual methods taking 48 hours. These AST test results help clinicians to prescribe an appropriate treatment and analyse AST patterns to categorise antimicrobial agents which inform health policy guidelines.

The VITEK MS uses Matrix-Assisted Laser Desorption Ionization Time-of-Flight (MALDI-TOF) technology which can identify resistant pathogens in just 60 minutes compared to existing methods requiring 24 hours.

Dr Manish Pathak, Microbiologist and Laboratory Specialist at Mott MacDonald for Fleming Fund in South Asia, said:

Installing this sophisticated, highly-efficient equipment in our referral laboratories will help expedite the accurate identification of bacteria and AMR analysis, reducing the overall turnaround time and improved diagnosis and treatment.

Training participants eager to use the cutting-edge platforms in their own laboratory - helping boost their confidence in performing AMR tasks and their enthusiasm in contributing to the global cause. Overwhelmingly satisfied with the content and the training modality, we were pleased to receive such positive participant feedback.

Biomedical training

In line with the Fleming Fund One Health principle, laboratory technical staff from human and animal health laboratories were trained to identify microorganisms using AST testing. Our industry partner BioMerieux trained technicians to use the new laboratory equipment, and biomedical engineers on platform maintenance and troubleshooting.

Initial training for laboratory technicians conducted by Fleming Fund supplier BioMérieux.

The AMR laboratory capacity in human and animal health will also be developed to improve biosafety and biosecurity. This involves developing guidelines and conducting bio-risk management training to handle and monitor sample processes appropriately across the referral surveillance sites.

As well as leading to better functioning referral laboratories, the guidelines can be used in other laboratories across the network to ensure an active, coordinated national surveillance system.

Dr Manish added:

The training by BioMeriuex allows the technicians to use the equipment to its best ability and streamline the AMR testing process with much more efficient results. Improving AMR capacity in the referral laboratories will lead to more robust Quality Assurance Assessments (QAs) for the network laboratories and provide equipment training for the latter in the future.

This will build the overall capacity of Bhutan’s data surveillance systems and strengthen our response to AMR.

The new laboratory equipment will also help in the Royal Government of Bhutan’s efforts to enhance the diagnostic capacities and contribute to achieving the NAP.

Dr. Sonam Wangda, Deputy Chief Programme Officer, Health Care and Diagnostic Division, MoH, Bhutan said:

Without these automated machines, our capacity in the area of detection of microorganisms and reporting of susceptibility testing has been limited. The introduction of the equipment will greatly help clinical studies and strengthen medical research, fortifying AMR data management and reporting at all levels – further highlighting the importance of the Fleming Fund support in laboratory capacity building and its potential impact on patient diagnosis.

Surveillance sustainability

The Royal Government of Bhutan has incorporated tackling AMR into its national budget to sustain the national surveillance system. This will include the upkeep of the grant-procured laboratory equipment by on-site trained biomedical engineers; replacement of consumables and reagents; and staff recruitment from the Fleming Fund’s Fellowship Scheme, developing in-country expertise.

With human resource being the biggest challenge in Bhutan’s healthcare sector due to national budgetary constraints, the Fleming Fund also supports health staff recruitment and retention for the referral hospitals, while building laboratory facilities to enhance and extend improved AMR containment.

Training conducted on culture, identification and AST by animal health fellow Puspa Sharma at the National Centre for Animal Health, Serbithang, Thimphu-Bhuta.

Dr Vikas Aggarwal, Regional Health Lead at Mott MacDonald for the Fleming fund in South Asia, said:

By working with Bhutan’s MoH, the Fleming Fund is helping to build laboratory capacity to provide an overall AMR national baseline report. The in-country surveillance system establishes effective monitoring, evaluation, and feedback to capture AMR resistance and antibiotics consumption data pattern trends, which will influence integral governmental healthcare decisions and policies.

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A plaque on the side of the Saint Mary’s Hospital in Paddington, London, UK, commemorates the discovery of penicillin, the first antibiotic, in 1928. Fungal spores, blown by the wind, landed on Sir Alexander Fleming's Petri dishes killing the bacteria he was growing leading to a revolution in medicine.

Since 2019, Fleming Fund grantee, International Vaccine Institute (IVI), has led the CAPTURA consortium to expand the volume of historical data for antimicrobial resistance (AMR), consumption (AMC), and use (AMU) across 12 countries in South and Southeast Asia.