30/11/20

Linking antimicrobial resistance surveillance to antibiotic policy in healthcare settings: the COMBACTE-Magnet EPI-Net COACH project

Pezzani MD, Mazzaferri F, Compri M, Galia L, Mutters NT, Kahlmeter G,  Zaoutis TE, Schwaber MJ, Rodríguez-Baño J, Harbarth S, Tacconelli E;  COACH working group..

J Antimicrob Chemother. 2020 Dec 6;75(Supplement_2):ii2-ii19. doi: 10.1093/jac/dkaa425., 12/2020.

Objectives: To systematically summarize the evidence  on how to collect, analyse and report antimicrobial resistance (AMR)  surveillance data to inform antimicrobial stewardship (AMS) teams  providing guidance on empirical antibiotic treatment in healthcare  settings.


Methods: The research group identified  10 key questions about the link between AMR surveillance and AMS using a  checklist of 9 elements for good practice in health research priority  settings and a modified 3D combined approach matrix, and conducted a  systematic review of published original studies and guidelines on the  link between AMR surveillance and AMS.


Results: The  questions identified focused on AMS team composition; minimum  infrastructure requirements for AMR surveillance; organisms, samples and  susceptibility patterns to report; data stratification strategies;  reporting frequency; resistance thresholds to drive empirical therapy;  surveillance in high-risk hospital units, long-term care, outpatient and  veterinary settings; and surveillance data from other countries. Twenty  guidelines and seven original studies on the implementation of AMR  surveillance as part of an AMS programme were included in the literature  review.


Conclusions: The evidence summarized in  this review provides a useful basis for a more integrated process of  developing procedures to report AMR surveillance data to drive AMS  interventions. These procedures should be extended to settings outside  the acute-care institutions, such as long-term care, outpatient and  veterinary. Without proper AMR surveillance, implementation of AMS  policies cannot contribute effectively to the fight against MDR  pathogens and may even worsen the burden of adverse events from such  interventions.