RATIONALE FOR SURVEILLANCE

Antimicrobial resistance has increased dramatically in the last decade, adversely affecting control of many important diseases such as Shigella dysentery, pneumonia, tuberculosis, and malaria. Antimicrobial resistance leads to prolonged morbidity, increases case-fatality and lengthens the duration of epidemics.

Surveillance is necessary for local control and for national and international coordination and collaboration in issues relating to antimicrobial use and resistance and drug development.

RECOMMENDED DEFINITION

Microbial isolate that is resistant to one or more antimicrobial agents on standard susceptibility tests (e.g., disk diffusion, minimal inhibitory concentration determination).

RECOMMENDED TYPES OF SURVEILLANCE

Peripheral level

Every hospital should have a surveillance system for antimicrobial resistance (e.g., routine weekly laboratory-based reporting). This must involve collaboration between microbiologists, clinicians, pharmacists, and infection control personnel.

Intermediate/Central level

 

• At minimum, reporting from sentinel sites

• Routine laboratory-based reporting (this may include comprehensive reporting of aggregate statistics as well as case-based reporting from sentinel sites)

• Reporting should be at least once a year

 

Note 1: Surveillance should be geographically and demographically representative.

Note 2: Reference authorities must perform collection and confirmation of new or unusual resistance phenotypes.

RECOMMENDED MINIMUM DATA ELEMENTS

Case-based data at peripheral level and sentinel sites

 

• Unique identifier, age, sex
• Hospitalized (Y/N)
• Specimen type, specimen date, organism, microbial susceptibility test results

Aggregated data for reporting

 

• Distribution by type (resistant intermediate, susceptible)

• Number of samples tested for each organism by antibiotic

• Data for important pathogens must be reported separately for hospitalized and non-hospitalized cases, as well as by age group

Aggregate statistics should address important local and national antimicrobial resistance problems.

RECOMMENDED DATA ANALYSES, PRESENTATION, REPORTS

At peripheral level

Daily review for unusual or important results.

Weekly-to-monthly review of organism frequencies and resistance profiles for outbreaks.

Quarterly review of data for monitoring resistance trends and review of hospital usage policy.

At intermediate and central level

Aggregated data

 

• Quarterly review of data for monitoring of resistance trends by organism, antibiotic, geographic, and demographic parameters

• Quarterly review of resistance results for possible errors in laboratory performance

Case-based data

Same analyses as for aggregate statistics, as well as more detailed analyses on test performance, mechanisms of resistance, and strain epidemiology.

PRINCIPAL USES OF DATA FOR DECISION-MAKING

 

• Monitor the changing trends and issues in antimicrobial resistance
• Aid the development of antimicrobial usage and infection control policies
• Monitor the impact of antimicrobial usage and infection control policies
• Guide the establishment of priorities for the development of new antimicrobial agents
• Aid research activities in the development of new antimicrobial agents
• Monitor outcome of treatment

SPECIAL ASPECTS

National Quality Assurance Programmes improve test performance by laboratories in the provision of reliable results to clinicians.

Local and national uses of antimicrobial resistance data can be greatly enhanced by the use of specialized software (WHONET), available free of charge from WHO.

CONTACT

Regional Offices:

See Regional Communicable Disease contacts on section "Communicable disease contacts in Regional Offices".

Headquarters: 20 Avenue Appia, CH-1211 Geneva 27, Switzerland

Communicable Diseases Surveillance and Response (CSR)

 

E-mail: amr@who.ch / outbreak@who.ch
Tel: (41 22) 791 2303/2111
Fax: (41 22) 791 4878/0746 attn CSR