1. National Reference Laboratory “Control and Monitoring of Antimicrobial Resistance” is the national reference laboratory responsible for the detection and investigation of antibiotic resistance. NRL “CMAR” studies and investigates all aspects of antibiotic resistance, in particular confirmation, interpretation and recently also molecular investigation of new or unusual resistance. The laboratory collects and tests referred isolates, principally those thought by the senders to have unusual resistances. NRL “CMAR” performs Disk Diffusion Method for Antimicrobial susceptibility testing and if it is necessary also Minimum inhibitory concentrations (MICs) of relevant antibiotics are determined for these isolates, and NRL “CMAR” advises on which agents may be appropriate therapy, and on any public health risk.

2. External Quality Assessment Scheme
National Reference Laboratory “Control and Monitoring of Antimicrobial Resistance”, together with the Bulgarian Association of Microbiologists (BAM), conducts the External Quality Assessment Scheme for microbiology laboratories in Bulgaria.

3. NRL “CMAR” also administrates Bulgarian Surveillance Tracking of Antimicrobial Resistance (BulSTAR).
The Department of Microbiology in NCIPD, in coordination and cooperation with the Bulgarian Association of Microbiologists (BAM) collects and analyzes annual routine susceptibility test data reports from almost all state microbiology laboratories of the public health facilities, and a significant number of private microbiology laboratories throughout the country. The reports include all clinically significant microorganisms, isolated in the collaborating centers, and their sensitivity to more than 50 antimicrobial agents, tested routinely in the participating laboratories using a nationally adopted standardized method and an element of a rule-based result checking, applied before the data have been accepted and proceeded for analysis. Currently BulSTAR is a national network of 165 microbiology laboratories - 20 public laboratories, 82 hospital ones, and 63 private laboratories, covering practically in 2007 the whole population in all the regions and counties of Bulgaria. A small working group in NRL “CMAR” organizes and conducts the surveillance process. Each year “CMAR” laboratory summarizes the results in annual reports, the latter being sent back to the collaborating centers and made available to the public on the Internet site of BAM (www.bam-bg.net).

4. Educational courses
NRL “CMAR” conducts a specialized educational course for graduated medical doctors, biologists and laboratory technicians on the issues of mechanisms and surveillance of antimicrobial resistance.

5. Specialized studies
NRL “CMAR” also undertakes commissioned studies to evaluate the in-vitro activity of novel antibacterial agents against tailored panels of bacteria, consisting of characterised strains with defined resistance mechanisms, and recent multi-resistant clinical isolates. As an ISO 17025 certified laboratory NRL “CMAR” participates and offers collaboration upon national and international projects and programs in the field of medical microbiology, surveillance of antimicrobial resistance and antibiotic consumption.

6. Microbiological testing with determination of antimicrobial susceptibility (antibiogram)
NRL “CMAR” has proven authority in Bulgaria and worldwide. We offer the possibility for microbiological testing with determination of antimicrobial susceptibility (antibiogram) of the most important human pathogens. The laboratory is equipped with the latest appliances and apparatuses for modern diagnostics and antimicrobial susceptibility testing, including rapid-diagnostic equipment: VITEK “bioMerieux”, Micronaut “Merlin” etc. Among the diagnosed materials and samples are: uroculture (urine samples), vaginal and cervical swabs, prostate secretes, urethral swabs, throat, nasal, eye and ear secretes, sputum, wound secretes, etc.