Intended for healthcare professionals

Education And Debate

Surveillance of antimicrobial resistancean international perspective

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7159.651 (Published 05 September 1998) Cite this as: BMJ 1998;317:651
  1. R J Williams, technical officer, bacterial diseases,
  2. M J Ryan, medical officer, epidemiological surveillance/epidemic response
  1. Division of Emerging and other Communicable Diseases Surveillance and Control, World Health Organisation, CH-1211 Geneva, Switzerland
  1. Correspondence to: Dr Williams

    Surveillance is essential for containing antimicrobial resistance.1 Information on resistance is needed at local, national, and international levels to guide decision making and responses. Local information should be used in clinical management and to update treatment guidelines, educate prescribers, and guide infection control policies. At national level, information is required to guide policy, update lists of essential drugs and national guidelines for treatment, and evaluate the effect of intervention strategies. There is an added value to gathering surveillance data internationally for sharing of information on the emergence of resistance in key pathogens, analysis of the impact of resistance and of policies for control, stimulating dialogue and engaging policy makers, developing advocacy and educational programmes, and stimulating research.

    Surveillance of antimicrobial resistance requires laboratory facilities organised in a network within which data on patterns of resistance can be shared for analysis and interpretation. The information generated should guide public health actions. Because of uncertainty about the correlation between in vitro tests and in vivo results in some infections (notably, respiratory tract infections), linking surveillance of resistance to monitoring of clinical outcomes would help in evaluations of the true impact of resistance on morbidity and mortality and the value of such surveillance activities.

    In many developing countries and in countries whose economies are in transition, laboratory facilities and information networks will require considerable strengthening before reliable surveillance of resistance is a reality. Indeed with the promotion of syndromic management of infections (clinical management of patient by presenting syndrome without laboratory confirmation — for example, of sexually transmitted infections) there has been the tendency to downgrade laboratory facilities because they are seen as unnecessary. Syndromic management can be kept relevant only if it is updated on the basis of surveillance information. A recent survey of national lists of essential drugs in 120 countries found that 66 had not been updated within the past five years.2

    Summary points

    • The problem of antimicrobial resistance worldwide requires urgent action

    • Surveillance is an essential tool for the containment of antimicrobial resistance

    • Global surveillance depends on strong national surveillance systems

    • The role of international organisations is to achieve international consensus standards for surveillance of antimicrobial resistance, strengthen national surveillance systems, and create a respository of information about resistance in key pathogens worldwide

    Many countries are currently grappling with these challenges. As an international organisation with a mandate in this area, WHO is working with its partners to:

    • Achieve international consensus for standards for surveillance of antimicrobial resistance (for example, priority pathogens,surveillance methodologies, minimum data, data sharing and exchange, and data analysis and interpretation). This will provide a clear vision of what minimum surveillance standards should be in place and will create an environment for sharing of experiences internationally.

    • Strengthen national surveillance systems. International surveillance of antimicrobial resistance depends on strong national surveillance systems, and the WHO is assisting member states to strengthen their surveillance capacity through support in training and education and through quality assurance.

    • Create a repository of information about resistance in key pathogens worldwide. This will be a valuable resource for prescribers to guide empirical treatment of imported infections, and it could provide an official mechanism for international alert when new phenotypes are identified (vancomycin resistant Staphylococcusaureus, for example).

    The adoption of a resolution on antimicrobial resistance in the recent World Health Assembly underlines the need for urgent action.

    Many countries are currently grappling with these challenges. There is no internationally agreed consensus on standards for surveillance of antimicrobial resistance (for example, priority pathogens, surveillance methodologies, minimum data, data sharing or exchange, and data analysis or interpretation). A clear vision of the minimum surveillance standards that should be in place is critical, and much could be learned from sharing experiences between countries.

    International surveillance of antimicrobial resistance depends on strong national surveillance systems. There is currently no official mechanism for international alert when new phenotypes are identified (vancomycin resistant Staphylococcus aureus, for example), nor are there any international regulations that deal specifically with antimicrobial resistance. A repository of information about resistance in key pathogens worldwide would be a valuable resource for prescribers to guide empirical treatment of imported infections. The adoption of a resolution on antimicrobial resistance in the World Health Assembly in May this year underlines the need for urgent action.

    Acknowledgments

    Conflict of interest: None.

    References

    View Abstract