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White Paper: Bridging the gap between human and animal surveillance data, antibiotic policy and stewardship in the hospital sector-practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks

Pezzani MD, Carrara E, Sibani M, Presterl E, Gastmeier P, Renk H, Kanj SS, Velavan TP, Song LH, Leibovici L, Torumkuney D, Kostyanev T, Mendelson M, Tacconelli E; ARCH working group.

Background: Antimicrobial surveillance and  antimicrobial stewardship (AMS) are essential pillars in the fight  against antimicrobial resistance (AMR), but practical guidance on how  surveillance data should be linked to AMS activities is lacking. This  issue is particularly complex in the hospital setting due to structural  heterogeneity of hospital facilities and services. The JPIAMR ARCH and  COMBACTE-MAGNET EPI-Net networks have joined efforts to formulate a set  of target actions for linking surveillance data with AMS activities.

Methods: A scoping review of the literature was carried out addressing research questions on three areas: (i) AMS leadership and accountability; (ii) antimicrobial usage and AMS; (iii) AMR and AMS. Consensus on the target actions was reached through a RAND-modified Delphi process involving over 40 experts in different fields from 18 countries.

Results: Evidence was retrieved from 51 documents. Initially 38 targets were proposed, differentiated as essential or desirable according to clinical relevance, feasibility and applicability to settings and resources. In the first consultation round, preliminary agreement was reached for 32 targets. Following a second consultation, 27 targets were approved, 11 were deleted and 4 were suggested for rephrasing, leading to a final approved list of 34 target actions in the form of a practical checklist.

Conclusions: This White Paper provides a pragmatic and flexible tool to guide the development of calibrated hospital-surveillance-based AMS interventions. The strength of this tool is that it is a comprehensive perspective that takes into account the hospital patient case-mix and the related epidemiology, which ultimately drives antimicrobial usage, and the feasibility in low-resource settings.

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