Feasibility, Challenges, and Benefits of Global Antimicrobial Resistance Surveillance System Implementation: Results from a Multicenter Quasi-Experimental Study.

Rujipas Sirijatuphat,Visanu Thamlikitkul,Darat Ruangkriengsin,Jintana Srisompong,Pinyo Rattanaumpawan,Surapee Tiengrim,Sunee Chayangsu,Pornpan Koomanachai,Walaiporn Wangchinda

doi:10.3390/antibiotics11030348

Abstract

The Global Antimicrobial Resistance Surveillance System (GLASS) is one of the pillars of the global action plan on antimicrobial resistance launched by the World Health Organization in 2015. This study was conducted to determine the feasibility and benefits of GLASS as a component of antimicrobial stewardship strategies in three provincial hospitals in Thailand. Data on the types of bacteria isolated and their antibiotic susceptibility during January–December 2019 and January–April 2020 were retrieved from the microbiology laboratory of each participating hospital. Laboratory-based antibiograms from 2019 and GLASS-based antibiograms from 2020 were created and compared. A total of 14,877 and 3580 bacterial isolates were obtained during January–December 2019 and January–April 2020, respectively. The common bacteria isolated in both periods were Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus. Hospital-acquired infection (HAI)-related bacteria were observed in 59.0%, whereas community-acquired infection (CAI)-related bacteria were observed in 41.0% of isolates. Antibiotic resistance in CAIs was high and may have been related to the misclassification of colonized bacteria as true pathogens and HAIs as CAIs. The results of this study on AMR surveillance using GLASS methodology may not be valid owing to several inadequate data collections and the problem of specimen contamination. Given these considerations, related personnel should receive additional training on the best practices in specimen collection and the management of AMR surveillance data using the GLASS approach.

Highlights

The burden of antimicrobial resistance (AMR) has been increasing worldwide, including in Thailand [1–3]
Global Antimicrobial Resistance Surveillance System (GLASS) is used for priority clinical specimens that are sent routinely for microbiological examinations for priority pathogens to test their susceptibility to particular antibiotics
A total of 14,877 bacterial isolates were recovered from all clinical specimens in the three participating hospitals

Summary

Introduction

The burden of antimicrobial resistance (AMR) has been increasing worldwide, including in Thailand [1–3]. AMR surveillance is one of the pillars of the global action plan on AMR launched by the World Health Organization (WHO) in 2015. AMR surveillance (i) is an effective strategy to gather vital information to target the interventions for prevention and control of AMR; (ii) permits measurement of the outcomes of such interventions;. In 2015, the WHO recommended an innovative surveillance system for AMR: the Global Antimicrobial Resistance Surveillance System (GLASS) [5,6]. GLASS is used for priority clinical specimens (i.e., blood, urine, feces, and genital samples) that are sent routinely for microbiological examinations for priority pathogens to test their susceptibility to particular antibiotics. GLASS is a case-based surveillance system that combines microbiological data with clinical and epidemiological data, such as the demographic features of patients, community-acquired infection (CAI), and hospital-acquired infection (HAI)

Objectives

Methods

Results

Discussion

Conclusion