Surveillance of resistance

Surveillance of antimicrobial resistance

Surveillance of antimicrobial resistance tracks changes in microbial populations, permits the early detection of resistant strains of public health importance, and supports the prompt notification and investigation of outbreaks. Surveillance findings are needed to inform clinical therapy decisions, to guide policy recommendations, and to assess the impact of resistance containment interventions.

Types of surveillance

Appropriate strategies for surveillance of antimicrobial resistance should reflect identified scientific or public health objectives, resources and available technical capacity for testing, and sustainability. A combination of complementary approaches is often desirable.

Alert organism tracking

the identification, confirmation, and communication of specific organisms of great public health importance, such as vancomycin-resistant Staphylococcus aureus or extensively drug-resistant Mycobacterium tuberculosis

Enhanced routine surveillance

the active review, interpretation, confirmation, and investigation of results generated in the course of routine clinical care

Targeted surveys

one-time or periodic study protocols to address specific scientific or public policy needs not adequately addressed by routine diagnostic test results.

The role of the microbiology laboratory

A key partner is the microbiology laboratory. Healthcare workers and public health authorities rely on the work and expertise of laboratory staff to determine:

what organism is causing a patient infection
what antimicrobials would be effective treatment options

The WHO Global strategy for containment of antimicrobial resistance identifies the establishment and support of microbiology laboratories as a fundamental priority in guiding and assessing intervention efforts. This requires trained and motivated laboratory professionals, materials and equipment, mechanisms for assuring the quality of test performance, and communication with clinicians and public health authorities.

Detection of antimicrobial resistance and laboratory quality assurance

Software for surveillance of antimicrobial resistance

WHONET
Software for the management and analysis of microbiology laboratory test results with a focus on antimicrobial susceptibility test results
SDRTB4
Surveillance of Drug Resistance in Tuberculosis Version 4.0

Surveillance of antimicrobial use and antimicrobial resistance

Antimicrobial resistance surveillance is enhanced when linked to monitoring of antimicrobial use practices. The collaborative efforts of the European Antimicrobial Resistance Surveillance System and the European Surveillance of Antimicrobial Consumption program have demonstrated that the integrated monitoring of resistance, use, and costs can prove the crucial factor driving political commitment to successful resistance containment campaigns.

Guidelines

Surveillance reports

2nd Technical Consultation on Global Surveillance of Antibacterial Resistance (ABR) in Humans
Strategies for global surveillance of antimicrobial resistance
Report of a technical consultation, 8-9 December 2012

Community-based surveillance of antimicrobial use and resistance in resource-constrained settings: report on Five Pilot Projects

10 FACTS ON ANTIMICROBIAL RESISTANCE

Many of the medical breakthroughs of the last century could be lost through the spread of antimicrobial resistance. Previously curable infectious diseases may become untreatable and spread throughout the world. This has already started to happen.

The report “Antimicrobial resistance: global report on surveillance 2014” showed that antimicrobial resistance is everywhere and has the potential to affect anyone, of any age, in any country.

In April 2015, WHO published a “Worldwide country situation analysis: Response to antimicrobial resistance”. It revealed that while much activity is underway and many governments are committed to addressing the problem, there are major gaps in actions needed across all 6 WHO regions.

This fact file describes the threat of drug resistance, some of its main causes, and how WHO is helping to lead the global response

What is antimicrobial resistance?

Antimicrobial resistance is the ability of a microorganism (like bacteria, viruses, and some parasites) to stop an antimicrobial (such as antibiotics, antivirals and antimalarials) from working against it. As a result, standard treatments become ineffective, infections persist and may spread to others.

Drug resistance is a global problem

Over the past years, the use and misuse of antimicrobials has increased the number and types of resistant organisms. Consequently many infectious diseases may one day become uncontrollable. With the growth of global trade and travel, resistant microorganisms can spread promptly to any part of the world.

What causes drug resistance?

Drug resistance is a natural evolutionary phenomenon. When microorganisms are exposed to an antimicrobial, the more susceptible organisms succumb, leaving behind those resistant to the antimicrobial. They can then pass on their resistance to their offspring.

Inappropriate use of medicines worsens drug resistance

Inappropriate use of antimicrobials drives the development of drug resistance. Both overuse, underuse and misuse of medicines contribute to the problem Ensuring that patients are informed about the need to take the right dosage of the right antimicrobial requires action from prescribers, pharmacists and dispensers, pharmaceutical industry, the public and patients, as well as the policy makers.

Lack of quality medicines contributes to drug resistance

Most drug quality assurance systems are weak. This can lead to poor quality medicines, exposing patients to sub-optimal concentrations of antimicrobials, thus creating the conditions for drug resistance to develop. In some countries poor access to antimicrobials forces patients to take incomplete courses of treatment or to seek alternatives that could include substandard medicines.

Animal husbandry is a source of resistance to antibiotics

Sub-therapeutic doses of antibiotics are used in animal-rearing for promoting growth or preventing diseases. This can result in resistant microorganisms, which can spread to humans.

Poor infection prevention and control amplifies drug resistance

Poor infection prevention and control can increase the spread of drug-resistant infections. Hospitalized patients are one of the main reservoirs of resistant microorganisms. Patients who are carriers of resistant microorganisms can act as a source of infection for others.

Weak surveillance systems contribute to the spread of drug resistance

While surveillance for the emergence of drug resistant TB and HIV infection is improving, currently there are few well-established networks that regularly collect and report relevant data on drug resistance. Some countries lack laboratory facilities that can accurately identify resistant microorganisms. This impairs the ability to detect emergence of resistance and take prompt actions.

The pipeline for new tools to combat drug resistance is almost dry

Existing antibiotics and anti-parasitic drugs, and, to a lesser extent, antiviral drugs, are losing their effect. At the same time there is insufficient investment in developing new antimicrobials. Similarly, there is insufficient new research into new diagnostics to detect resistant microorganisms; and new vaccines for preventing and controlling infections. If this trend continues, the arsenal of tools to combat resistant microorganism will soon be depleted.

WHO calls on stakeholders to combat drug resistance

The threat from drug resistance is increasing. There is a need for urgent action; everyone must play a part. The complex problem of drug resistance requires collective action. WHO has developed a draft global action plan to combat antimicrobial resistance which has been submitted to the sixty-eighth World Health Assembly, taking place in May 2015. Governments was asked to approve the plan and, in doing so, declare their commitment to address this global health threat.