Linking antimicrobial resistance surveillance to antibiotic policy in healthcare settings: the COMBACTE-Magnet EPI-Net COACH project

Abstract

Objectives To systematically summarize the evidence on how to collect, analyse and report antimicrobial resistance (AMR) surveillance data to inform antimicrobial stewardship (AMS) teams providing guidance on empirical antibiotic treatment in healthcare settings. Methods The research group identified 10 key questions about the link between AMR surveillance and AMS using a checklist of 9 elements for good practice in health research priority settings and a modified 3D combined approach matrix, and conducted a systematic review of published original studies and guidelines on the link between AMR surveillance and AMS. Results The questions identified focused on AMS team composition; minimum infrastructure requirements for AMR surveillance; organisms, samples and susceptibility patterns to report; data stratification strategies; reporting frequency; resistance thresholds to drive empirical therapy; surveillance in high-risk hospital units, long-term care, outpatient and veterinary settings; and surveillance data from other countries. Twenty guidelines and seven original studies on the implementation of AMR surveillance as part of an AMS programme were included in the literature review. Conclusions The evidence summarized in this review provides a useful basis for a more integrated process of developing procedures to report AMR surveillance data to drive AMS interventions. These procedures should be extended to settings outside the acute-care institutions, such as long-term care, outpatient and veterinary. Without proper AMR surveillance, implementation of AMS policies cannot contribute effectively to the fight against MDR pathogens and may even worsen the burden of adverse events from such interventions.

Determination of the Enablers and Challenges in the Implementation of Pharmacy-based Antimicrobial Stewardship (AMS) Program in a Level 3 Hospital in Manila

“…A number of clinical and dispensing pharmacists perceive the hospital’s utilization of the antibiogram to be lacking, while only a number of clinical pharmacists are mostly not satisfied with the current systems on surveillance-related activities, such as monitoring of resistance rates of pathogens, tracking of susceptibility patterns, and usage of facility-specific antibiograms. 7 Respondents generally have a good perception towards implementation of AMS to target resistance rates and utilization of antibiograms.…”

“…Working on improving AMU and AMR surveillance will generally play a crucial role in ensuring appropriate empirical antimicrobial prescribing and in implementing a successful AMS program. 7 …”

Evaluation of Hospital Antimicrobial Stewardship Programs: Implementation, Process, Impact, and Outcomes, Review of Systematic Reviews

“…Additionally, there is a paucity of studies that report accurate microbiological results linked to ASPs, which is the hallmark for monitoring AMR [ 19 ]. To bridge such gaps, it is advocated to conduct proper AMR surveillance methods in all healthcare facilities that should guide the ASP implementation process, and not vice versa [ 14 , 85 ].…”

EPI-Net One Health reporting guideline for antimicrobial consumption and resistance surveillance data: a Delphi approach

“…To identify potential experts for the panel, we reviewed: 1) recent publications on One Health surveillance; 2) ongoing European One Health consortia or projects website; 3) experts from the COACH project. 11 A preliminary list of experts was created and an invitation for participation in the EPI-Net One Health consensus project was sent to 95, 58% of whom (55 experts) responded positively. These experts received a preliminary project protocol for perusal; a response with a feedback was considered as a further confirmation for participation in the initiative.…”

“…The COMBACTE-MAGNET EPI-Net network, a European public-private partnership project, has been working towards harmonising AMR surveillance strategies and developing tools for improving surveillance since 2015. 10 In 2018, the COACH (Consensus group on antimicrobial surveillance to drive stewardship) project 11 was launched with the aim to systematically summarise evidence on how to report AMR surveillance data to inform antimicrobial stewardship (AMS) teams in healthcare settings. The review did not identify any document providing indications on if and how AMR data from the animal sector from regional/national surveillance systems should be included to inform AMS in the human sector.…”