White Paper: Bridging the gap between surveillance data and antimicrobial stewardship in long-term care facilities—practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks

Abstract

Background In long-term care facilities (LTCFs) residents often receive inappropriate antibiotic treatment and infection prevention and control practices are frequently inadequate, thus favouring acquisition of MDR organisms. There is increasing evidence in the literature describing antimicrobial stewardship (AMS) activities in LTCFs, but practical guidance on how surveillance data should be linked with AMS activities in this setting is lacking. To bridge this gap, the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks joined their efforts to provide practical guidance for linking surveillance data with AMS activities. Materials and methods Considering the three main topics [AMS leadership and accountability, antimicrobial usage (AMU) and AMS, and antimicrobial resistance (AMR) and AMS], a literature review was performed and a list of target actions was developed. Consensus on target actions was reached through a RAND-modified Delphi process involving 40 experts from 18 countries and different professional backgrounds adopting a One Health approach. Results From the 25 documents identified, 25 target actions were retrieved and proposed for expert evaluation. The consensus process produced a practical checklist including 23 target actions, differentiating between essential and desirable targets according to clinical relevance and feasibility. Flexible proposals for AMS team composition and leadership were provided, with a strong emphasis on the need for well-defined and adequately supported roles and responsibilities. Specific antimicrobial classes, AMU metrics, pathogens and resistance patterns to be monitored are addressed. Effective reporting strategies are described. Conclusions The proposed checklist represents a practical tool to support local AMS teams across a wide range of care delivery organization and availability of resources.

Antimicrobial Resistance in the Global Health Network: Known Unknowns and Challenges for Efficient Responses in the 21st Century

“…Traditionally, populations are analyzed at tertiary and secondary healthcare centers (hospitals and long-term care facilities), where the concentration of the high-risk groups of people and online diagnostic and life-sustaining equipment (such as ventilators), indwelling catheterization, and frequent use of drugs facilitate the emergence and local evolution of AMR. Within hospitals, some wards concentrate on groups and factors at higher risk than others [130,131]. Primary healthcare is greatly influenced by structural, governance, and management networks [105,106,132].…”

“…AMC/AMU data are primarily relevant in combination with local AMR trends and the preparation of antibiotic stewardship guidelines. Protocols and tools to properly collect AMC/AMU information are currently being debated [130][131][132]. Nonetheless, AMU data are still unavailable in most countries and hospitals, and antimicrobial exposure is generally reflected as AMC [94].…”

“…More specifically, the SRIA defines priority topics through which coordinated research activities are translated into new and/or improved strategies to address AMR (development of new therapies, stewardship of new and existing antimicrobials, and strategies to monitor and prevent the selection and spread of AMR between humans, animals, and the environment). Gaps and challenges of specific AMR topics have been highlighted in various workshops supported by the JPIAMR in the last years [38,[130][131][132]204,205], as well as in reports by other policymakers, such as UNEP [38,97,206].…”

“…Develop composite indexes [171,175]. Combine AMR and AMC/AMU trends in categorized patient populations [122,[130][131][132]209,210]. Understand microbial transmission (plasmid, clones, and microbial consortiums).…”

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

“…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. A subsequent updated literature review and consensus exercise carried out in collaboration with the JPIAMR ARCH Network 12 , 13 , 14 , 15 further highlighted the need for recommendations that are inclusive of the environmental sector and antimicrobial residues surveillance.…”