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Skip to 0 minutes and 4 seconds I will be discussing surveillance resistance. What is surveillance resistance? What does it involve, and how to do it? As you’ve learned before, with the widespread use and misuse of antibiotics across the globe, antimicrobial resistance has developed, and it is now a threat to public health worldwide, not only for its effect on population health, but also for the significant associated economic burden. Several governments and organisations, including the World Health Organisation, the WHO, have emphasised the need to control this problem and called for the development and implementation of national policies and strategies to limit its spread. To better understand and respond to antimicrobial resistance patterns and key drivers, information about antimicrobial resistance incidence, prevalence, and trends must be gathered.

Skip to 1 minute and 3 seconds And therefore, resistance surveillance is a key and a must. There is evidence that the wiser use of antimicrobials may diminish the rate at resistance emerges. Thus, information about surveillance of antimicrobial resistance in conjunction with data on the use of antimicrobial provides a powerful tool for the containment of resistance. Ideally, surveillance of antimicrobial resistance should involve the collection of both clinical and microbiological data. Surveillance of antimicrobial resistance tracks changes in microbial populations, permits the early detection of resistant strains of public health importance, and supports the prompt notification and investigation of outbreaks. Surveillance findings are needed to inform clinical therapy decisions, to guide policy recommendations, and to assess the impact of resistance containment interventions.

Skip to 2 minutes and 0 seconds Governments, intergovernmental organisations, agencies, professional organisations, industry, and academic should all pursue research on the causes and impacts of antimicrobial resistance to inform policies and actions to address the growing health security challenges of anti-microbial resistance. The different types of surveillance, for example the most common and the ones advocated by the WHO, are a combination of complementary approaches to provide or to give the desirable results. One type of surveillance is the alert organism tracking. That includes identification, confirmation, and communication of specific organisms of great public health concern, such as multidrug resistance acinetobacter and XDR TB, resistant staph aureus, et cetera.

Skip to 3 minutes and 0 seconds Another type of surveillance is enhanced routine surveillance, whereby there is an active review and interpretation, confirmation, and investigation of results generated in the course of routine clinical care. A third type of surveillance is the targeted survey, where it’s a one-time, periodic study of a certain specific scientific or public health policy need to study a particular question. In surveillance resistance, there is a very important role for the microbiology lab. And in addition to developed softwares that will survey antimicrobial resistance, there is also a very important tool for surveillance of antimicrobial use, and this will be explained by other colleagues.

Skip to 3 minutes and 51 seconds The WHO developed the Global Antimicrobial Resistance Surveillance System, or GLASS, to facilitate and encourage a standardised approach to AMR surveillance globally, and in turn, support the implementation of the global action plan on antimicrobial resistance.

Skip to 4 minutes and 8 seconds The five objectives of GLASS are as follows: number one - to improve awareness and understanding of antimicrobial resistance through effective communication, education, and training. Number two is to strengthen the knowledge and evidence base through surveillance and research. Number three is to reduce the incidence of infection through effective sanitation, hygiene, infection prevention methods. Number four is to optimise the use of antimicrobial medicines in human and animal health. The last point, number five, is to develop the economic case for sustainable investment that takes account of the needs of all countries and to increase investment in new medicines, diagnostic tools, vaccines, and other interventions.

Resistance surveillance

Dr Nesrine Rizk discusses what resistance surveillance is, what it involves, and how it is carried out.

To better understand and respond to antimicrobial resistance patterns and key drivers, information about AMR incidence, prevalence and trends must be gathered. Therefore, resistance surveillance is key.

Surveillance includes the collection of both clinical and microbiological data. The tracking of microbiological populations permits the early detection of resistant strains. Findings inform clinical therapy decisions, drive policy recommendations and provide the ability to assess the impact of resistance containment interventions.

There are several different types of surveillance, such as:

  1. Alert organism tracking – identification, confirmation and communication of a specific organism of concern

  2. Enhanced routine surveillance – active review, interpretation, confirmation and investigation of results generated from routine clinical care

  3. Targeted survey – a one-time, periodic study of certain scientific/public health policy to study a specific question

The following are very important for surveillance:

• Role of microbiology lab

• Developed software’s that will survey AMR

• Surveillance of antimicrobial use (see step X)

The WHO developed the Global Antimicrobial resistance Surveillance Systems (GLASS) to facilitate and encourage a standardised approach to AMR surveillance globally and also to support the implementation of the global action plan on AMR. The main objectives of GLASS are:

  1. Improve awareness and understanding of AMR

  2. Strengthen knowledge and evidence base

  3. Reduce the incidence of infection

  4. Optimise use of antimicrobials in humans and animals

  5. Develop economic tools for sustainable investment

We have now seen the importance of resistance surveillance in practice, so next we will discuss the methodology for measuring antibiotic consumption.

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Antimicrobial Stewardship for the Gulf, Middle East and North Africa

BSAC