Targeted enlargement of surveillance activities.

Abstract

Surveillance of nosocomial infections is one of the most important activities of infection control programs in hospitals. Over the course of the last 25 years, a lot of progress has been made in the application of surveillance methods as well as in the stratification of patient risks.Traditionally, surveillance of nosocomial infections has focused on measurements of outcomes, such as incidence or prevalence rates of surgical site infections, respiratory tract infections, bloodstream infections, urinary tract infections and others. More recently, the American National Nosocomial Infections Surveillance (NNIS) System has added some process indicators, such as device utilization rates (i.e. number of central venous catheter days per 1,000 patient days) to its surveillance methodology. Many countries have later followed this lead and have integrated these parameters into their respective surveillance protocols. The increased awareness of the importance of antibiotic resistance for the management of nosocomial infections has prompted many hospital epidemiologists to increase their activities in the area of antibiotic resistance and antibiotic utilization.While some efforts to standardize the methodology of surveillance of antibiotic use and resistance are being made – WHO provides definitions for daily cumulative doses of antibiotics; defined daily doses (DDD) – there still exist considerable differences between countries, networks and individual hospitals regarding this particular type of surveillance. The study by Meyer et al. in this issue of INFECTION is very welcome and timely, as it describes a practical approach to the surveillance of antibiotic utilization and resistance in the ICU setting [1].The study demonstrates the feasibility of such a surveillance system on a national level. It also shows that it is very advantageous for a country to have a surveillance system in place, making it much easier to add-on a new surveillance component.This system, called SARI by its developers, does have some limitations, such as the problem of using two separate breakpoint systems to determine susceptibility (NCCLS and DIN), but has the advantage of flexibility. It seems highly possible that the number of participating units could rapidly be enlarged. If this enlargement takes place, SARI will be a very useful surveillance system for the analysis of the relationship between antibiotic use and resistance. It might be tempting for other national systems to adopt the SARI design as well.