Abstract
Despite a high use of antibiotics and a significant burden of infectious disease, ongoing monitoring and reporting of antimicrobial resistant pathogens in rural and regional Australia is insufficient. Many geographically isolated regions of Australia have limited infrastructure, resources and fall outside of surveillance reach, limiting health services’ ability to provide an early warning signal and appropriate response. To monitor trends in the development of antimicrobial resistance (AMR), identify high-risk populations and to evaluate effectiveness of control and prevention in rural and regional Australia, a subnational surveillance system termed HOTspots was developed. To promote the best use of public health resources through the development of effective and efficient surveillance systems, we evaluated HOTspots and its prototype surveillance platform for data quality, acceptability, representativeness, and timeliness. We used the Centers for Disease Prevention and Control (CDC) guidelines for evaluating public health surveillance systems and assessed the four attributes using a descriptive analysis of quantitative data and a thematic analysis of qualitative data. We report that the HOTspots surveillance system and its prototype platform effectively captures and represents AMR data across Northern Australia. The descriptive analysis of HOTspots data demonstrated some variation in data completeness but that data validity and representativeness were high. Thematic analysis of interview transcripts found that the system was acceptable, with almost all study participants identifying timeliness, online accessibility, and community representativeness as drivers for adoption of the system, and that the system provided timely data. The evaluation also identified areas for improvement and made recommendations to the HOTspots surveillance system and its associated prototype platform.
Highlights
Surveillance of antimicrobial resistance (AMR) is fundamental to contain the spread of AMR by generating evidence for local, national global guidance and actions [1]
The Centers for Disease Prevention and Control (CDC) guidelines for evaluating public health surveillance systems were used as a framework to assess the performance of HOTspots [12]
We described the representativeness of the population by setting and by pathology service provider coverage across three jurisdictions that are captured by HOTspots
Summary
Surveillance of antimicrobial resistance (AMR) is fundamental to contain the spread of AMR by generating evidence for local, national global guidance and actions [1]. The purpose of AMR surveillance includes (a) gathering and disseminating local evidence for empiric treatment and clinical decision making; (b) to assess the effect of antimicrobial stewardship program and infection control strategies; (c) to determine the burden of disease; and (d) to track temporal and geographic trends for outbreak detection [1, 2]. Surveillance can be comprehensive for the entire population at risk, or sentinel reaching a limited catchment area. Passive AMR surveillance using routine pathology data of clinical isolates from sentinel sites is the most commonly used approach [4]. A key assumption is that sentinel surveillance is representative of the population at risk as closely as possible
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