An inventory of supranational antimicrobial resistance surveillance networks involving low- and middle-income countries since 2000.

Elizabeth A Ashley,David Dance,Nicholas P Day,Nicholas J White,Paul Turner,Judith Recht,Philippe J Guerin,Nigel V Thomas,Nisha Ranganathan,Mehul Dhorda,Arlene Chua

doi:10.1093/jac/dky026

Abstract

Low- and middle-income countries (LMICs) shoulder the bulk of the global burden of infectious diseases and drug resistance. We searched for supranational networks performing antimicrobial resistance (AMR) surveillance in LMICs and assessed their organization, methodology, impacts and challenges. Since 2000, 72 supranational networks for AMR surveillance in bacteria, fungi, HIV, TB and malaria have been created that have involved LMICs, of which 34 are ongoing. The median (range) duration of the networks was 6 years (1–70) and the number of LMICs included was 8 (1–67). Networks were categorized as WHO/governmental (n = 26), academic (n = 24) or pharma initiated (n = 22). Funding sources varied, with 30 networks receiving public or WHO funding, 25 corporate, 13 trust or foundation, and 4 funded from more than one source. The leading global programmes for drug resistance surveillance in TB, malaria and HIV gather data in LMICs through periodic active surveillance efforts or combined active and passive approaches. The biggest challenges faced by these networks has been achieving high coverage across LMICs and complying with the recommended frequency of reporting. Obtaining high quality, representative surveillance data in LMICs is challenging. Antibiotic resistance surveillance requires a level of laboratory infrastructure and training that is not widely available in LMICs. The nascent Global Antimicrobial Resistance Surveillance System (GLASS) aims to build up passive surveillance in all member states. Past experience suggests complementary active approaches may be needed in many LMICs if representative, clinically relevant, meaningful data are to be obtained. Maintaining an up-to-date registry of networks would promote a more coordinated approach to surveillance.

Highlights

The burden of drug-resistant infections is increasing year on year
We identified 72 supranational networks concerned with antimicrobial resistance (AMR) surveillance since 2000, of which 26 were World Health Organization (WHO)/governmental, 24 academic and 22 pharma initiated (Figure 1)
In terms of the pathogens under surveillance, 45 networks were for AMR in bacteria or fungi (Table 1), 18 in malaria, 2 in TB, 6 in HIV and 1 for influenza (Table 2)

Summary

Introduction

It has been predicted that the largest numbers of lives that will be lost as a result of these infections will be in low- and middleincome countries (LMICs).[1]. A global action plan on antimicrobial resistance (AMR) was endorsed in May 2015 by the World Health Assembly and calls upon countries to strengthen AMR surveillance. It is generally accepted that we need good AMR surveillance data to be able to assess the scale of the problem accurately and to guide interventions. Attempts to kick-start global surveillance for resistance to commonly used antibacterial drugs have been made in the past but generally without success. The Global Antimicrobial Resistance Surveillance System (GLASS) was launched in 2015 with the goal of collecting comparable AMR data at country level for key bacterial pathogens.[2]. The interaction between different drivers in humans, animals and the environment argues for adopting a ‘One Health’ approach to surveillance for both AMR and emerging diseases

Methods

Results

Conclusion