28/2/18

Surveillance for control of antimicrobial resistance

Evelina Tacconelli, Frangiscos Sifakis, Stephan Harbarth, Remco  Schrijver, Maaike van Mourik, Andreas Voss, Mike Sharland, Nithya Babu  Rajendran, Jesús Rodríguez-Baño, EPI-Net COMBACTE-MAGNET Group.

Lancet Infect Dis. 2018 Mar;18(3):e99-e106. doi: 10.1016/S1473-3099(17)30485-1., 03/2018.

Abstract: Antimicrobial resistance poses a growing threat to public health and the  provision of health care. Its surveillance should provide up-to-date  and relevant information to monitor the appropriateness of therapy  guidelines, antibiotic formulary, antibiotic stewardship programmes,  public health interventions, infection control policies, and  antimicrobial development. In Europe, although the European  Antimicrobial Resistance Surveillance Network provides annual reports on  monitored resistant bacteria, national surveillance efforts are still  fragmented and heterogeneous, and have substantial structural problems  and issues with laboratory data. Most incidence and prevalence data  cannot be linked with relevant epidemiological, clinical, or outcome  data. Genetic typing, to establish whether trends of antimicrobial  resistance are caused by spread of resistant strains or by transfer of  resistance determinants among different strains and species, is not  routinely done. Furthermore, laboratory-based surveillance using only  clinical samples is not likely to be useful as an early warning system  for emerging pathogens and resistance mechanisms. Insufficient  coordination of surveillance systems of human antimicrobial resistance  with animal surveillance systems is even more concerning. Because  results from food surveillance are considered commercially sensitive,  they are rarely released publicly by regulators. Inaccurate or  incomplete surveillance data delay a translational approach to the  threat of antimicrobial resistance and inhibit the identification of  relevant target microorganisms and populations for research and the  revitalisation of dormant drug-discovery programmes. High-quality,  comprehensive, and real-time surveillance data are essential to reduce  the burden of antimicrobial resistance. Improvement of national  antimicrobial resistance surveillance systems and better alignment  between human and veterinary surveillance systems in Europe must become a  scientific and political priority, coordinated with international  stakeholders within a global approach to reduce the burden of  antimicrobial resistance.