Abstract
Background: Antimicrobial resistance (AMR) / drug resistant infections (DRIs) are a major global health priority. Surveillance data is critical to inform infection treatment guidelines, monitor trends, and to assess interventions. However, most existing AMR / DRI surveillance systems are passive and pathogen-based with many potential biases. Addition of clinical and patient outcome data would provide considerable added value to pathogen-based surveillance. Methods: The aim of the ACORN project is to develop an efficient clinically-oriented AMR surveillance system, implemented alongside routine clinical care in hospitals in low- and middle-income country settings. In an initial pilot phase, clinical and microbiology data will be collected from patients presenting with clinically suspected meningitis, pneumonia, or sepsis. Community-acquired infections will be identified by daily review of new admissions, and hospital-acquired infections will be enrolled during weekly point prevalence surveys, on surveillance wards. Clinical variables will be collected at enrolment, hospital discharge, and at day 28 post-enrolment using an electronic questionnaire on a mobile device. These data will be merged with laboratory data onsite using a flexible automated computer script. Specific target pathogens will be Streptococcus pneumoniae, Staphylococcus aureus, Salmonella spp ., Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii. A bespoke browser-based app will provide sites with fully interactive data visualisation, analysis, and reporting tools. Discussion: ACORN will generate data on the burden of DRI which can be used to inform local treatment guidelines / national policy and serve as indicators to measure the impact of interventions. Following development, testing and iteration of the surveillance tools during an initial six-month pilot phase, a wider rollout is planned.
Highlights
Antimicrobial resistance (AMR) surveillance serves three main purposes: to provide local evidence for empiric treatment guidelines and clinical decision making, to characterise trends in space and time, and to serve as benchmark to measure the impact of interventions
The effectiveness and cost-effectiveness of the diagnostic stewardship activities will be monitored as the proportion of cases with linked diagnostic specimens
Very pragmatic definitions have been employed in the pilot phase of ACORN, with capture of simple severity markers to enable patient stratification within a syndrome
Summary
Antimicrobial resistance (AMR) surveillance serves three main purposes: to provide local evidence for empiric treatment guidelines and clinical decision making, to characterise trends in space and time, and to serve as benchmark to measure the impact of interventions. Pilot implementation is occurring in three locations, focusing on a narrow range of syndromes whilst the methodology is established, and will be followed by review and refinement of the surveillance procedures, tools and results Surveillance design This protocol describes collection of clinical and laboratory data of hospitalised patients with clinically suspected meningitis, pneumonia or sepsis, for surveillance purposes. Clinical notes and electronic hospital information systems will be reviewed to capture ICD10 code for infection episode (if routinely generated by the hospital), final classification of the surveillance diagnosis (confirmed or rejected, plus likely source in sepsis cases), hospitalisation outcome and date, and the total number of days admitted to an intensive care unit during the hospitalisation (Extended data[13]). Study status Enrolment commenced in Cambodia on 18th November 2019, in Laos on 12th December 2019, and will start in Vietnam in early 2020
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