AMR Surveillance in low and middle-income settings - A roadmap for participation in the Global Antimicrobial Surveillance System (GLASS).

Anna C Seale,Sharon J Peacock,Jasmin Islam,J Anthony G Scott,N Claire Gordon

doi:10.12688/wellcomeopenres.12527.1

Abstract

Drug-resistant infections caused by bacteria with increasing antimicrobial resistance (AMR) threaten our ability to treat life-threatening conditions. Tackling AMR requires international collaboration and partnership. An early and leading priority to do this is to strengthen AMR surveillance, particularly in low-income countries where the burden of infectious diseases is highest and where data are most limited. The World Health Organization (WHO) has developed the Global AMR Surveillance System (GLASS) as one of a number of measures designed to tackle the problem of AMR, and WHO member states have been encouraged to produce National Action Plans for AMR by 2017. However, low-income countries are unlikely to have the resources or capacity to implement all the components in the GLASS manual. To facilitate their efforts, we developed a guideline that is aligned to the GLASS procedures, but written specifically for implementation in low-income countries. The guideline allows for flexibility across different systems, but has sufficient standardisation of core protocols to ensure that, if followed, data will be valid and comparable. This will ensure that the surveillance programme can provide health intelligence data to inform evidence-based interventions at local, national and international levels.

Highlights

Antimicrobial resistance (AMR) develops when strains of micro-organisms evolve to survive exposure to antimicrobial agents
Reporting the characteristics of resistant pathogens rarely represents a threat to patient confidentiality, but the inclusion of simple clinical data such as age, sex, collection date, specimen type and syndromic diagnosis adds considerable value to the information obtained from the laboratory, and there are clear benefits from antimicrobial resistance (AMR) surveillance at patient, pathogen and population levels[6]
Development of AMR surveillance is essential to address the global challenge of drug-resistant infections (DRIs)

Summary

Introduction

Antimicrobial resistance (AMR) develops when strains of micro-organisms evolve to survive exposure to antimicrobial agents. The subsequent transmission and spread of resistant pathogenic bacteria sets the scene for development of drug-resistant infections (DRIs). The increasing use of antimicrobials worldwide has been associated with a global increase in DRIs, which threatens to return clinical therapies to the pre-antibiotic era. DRIs are estimated to account for 50,000 deaths each year in Europe and the USA alone[1], but by 2050 it is estimated that DRIs will account for 10 million deaths per year worldwide, posing an economic and biosecurity threat[2]. Countries with the highest burdens of communicable diseases usually have the least resources and, in these settings, data on AMR and DRIs are most limited[3,4]. While large regional AMR surveillance networks have been established in Europe (EARSNet), Latin America (Red Latinoamericana de Vigilancia de la Resistencia a los Antimicrobianos, ReLAVRA) and Central Asia and Eastern Europe (CAESAR), capacity for AMR surveillance in low-income countries is relatively limited and fragmented, despite evidence that, as with the rest of the world, AMR in low-income regions is increasing[3]

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