Table 8 Distribution of resistance phenotypes among US inpatient and outpatient methicillin-resistant Staphylococcus aureus, from 2002 to March 2005 Table 9 Numbers and types of publications arising from Australian Group on Antimicrobial Resistance studies Table 10 Formative enablers and barriers relevant to ‘enhance’ and ‘construct’ options Table 11 A high-level overview of the proposed program, comprising five elements developed over three stages Table 12 Element 1 – Surveillance of antimicrobial resistance Table 13 Element 2 – Surveillance of antibiotic usage Table 14 Element 3 – Disease burden and outcomes Table 15 Element 4 – Analysis and action Table 16 Element 5 – Planning Table 17 Overview of the current status of key elements of the proposed program
Clostridium difficile 3 Y Y Y Y Bacillus anthracis 1 Y Clostridium tetani 1 Y Acid-fast bacilli Mycobacterium tuberculosis 3 Y Y Y Mycobacterium ulcerans 1 Y Mycobacterium leprae 1 Y Other groupings Sexually transmitted infections 1 Y Protozoa and parasites 1 Y Viruses 1 Y diseases 1 Y ABCs = Active Bacterial Core Surveillance; AGAR = Australian Group on Antimicrobial Resistance; ANSORP = Asian Network for Surveillance of Resistant Pathogens; BulSTAR = Bulgarian Surveillance Tracking Antimicrobial Resistance; CARTIPS = Community-Acquired Respiratory Tract Infection Pathogen Surveillance; CDC = Centers for Disease Control and Prevention;
Program Program has an organism focus (e.g. MRSA or Neisseria gonorrhoeae). Program focuses on one or more disease entities (e.g. respiratory tract infections or enteric pathogens). The program focus will be influenced by decisions regarding the numbers and types of organisms, antimicrobials and specimens to be monitored. Geographic range of surveillance Program covers a county or state. Program covers a nation. Program covers a group of nations in a region. The Australian system should be national, with involvement of all states and territories that are responsible for data collection from public healthcare facilities. Australia’s current and potential contribution to multinational systems should be evaluated. Number of bacteria Program gathers data on one pathogenic organism (e.g. Mycobacterium The most effective way to initiate a program may
Program gathers data on a group of pathogenic organisms related to a disease entity (e.g. Salmonella, Vibrio cholerae, Campylobacter jejuni and other food poisoning organisms). Program gathers data on all pathogens isolated from clinical specimens. AMR data are collected for sentinel organisms. be to focus initially on a defined set of organism and specimen types, and later expand the scope. Bacterial characteristics Program gathers data on antibiotic resistance from laboratory breakpoint or minimum inhibitory concentration testing using a variety of methods. Program gathers data from molecular testing of bacterial genes. data on AMR testing are essential. Laboratories need to be evaluated to determine their capacity to undertake molecular genetic testing of isolates beyond that currently performed. It may be appropriate to bring existing molecular testing data contributed to surveillance programs
as well as contributing to policy and planning deliberations. Mandatory reporting All AMR reporting is voluntary. The reporting of AMR data for certain organism/antibiotic combinations is mandated by government. The reporting of AMR data for certain organism/specimen type combinations is mandated by government. The desirability of a of mandatory reporting needs to be determined. If some level of mandatory reporting is desired, potential mechanisms at a jurisdictional or national level need to be explored. Population monitored AMR data are collected to reflect community-acquired infections only. AMR data are collected to reflect healthcare-acquired infections only. AMR data are collected to reflect a subset of hospital data only (e.g. intensive care units). AMR data are collected to reflect community and settings. An Australian national system should collect data from community and settings. associated associated
Scientific Clinical aspects Data Shown to work with existing laboratory processes, networks and datasets with existing standards Has the confidence of existing users Has a public profile; is known Ability to work with data from networks not currently participating can only be inferred Can be designed to accommodate known issues with the incorporation of laboratory data and processes Practicalities of data submission and handling will not be known until during proof of concept and rollout No existing proof of concept in Australian environment
Operational Operating Governance Might be undertaken via expansion in situ, or by transfer to a new operating and development environment System demands and requirements are known Transfer to new governance arrangements and/or operating environment requires satisfactory negotiation and capacity Can take advantage of the latest programming and operating platforms, potentially adding to efficiency and flexibility of the solution System requirements and demands can be estimated, but cannot be tested until proof of concept stage Inherent risks regarding suitability and capacity of untested operating environment
Financial Funding Current costs of development and operation can be ascertained Costs of further development and operation can be reasonably estimated Likely cost than the ‘construct’ option Opportunity for Agreement is needed to fund Limited fiscal resources to support unplanned cost imposts Opportunity for Potential for significant variance between cost estimates and delivery cost Limited fiscal resources to support unpredictable cost scenario
Governance and policy influence Stakeholder interests and Opportunity for tangible interaction and evaluation by all stakeholders and decision Broad support at a national level for a national approach Visibility of existing systems Potential for non-user ‘not invented here’ bias Perception that existing and owners will be advantaged compared to new adopters New adopters can perceive loss of the advantages of their legacy Can seek to address the concerns and interests of all Broad support at a national level for a national approach Key stakeholders can find it difficult to commit to an intangible concept Periods of negotiation and design can be extended in trying to appease all parties and reach agreement to proceed system
Background JETACAR EAGAR JETACAR and EAGAR reports accepted by previous governments contain references to the evolution of existing Australian systems as a suitable solution for AMR surveillance Of the existing some remain valid and other not valid Previous reviews and committees recommend a national approach No reference to new construction in of previous and committees Other considerations that are equally relevant to either approach include:
participants and data sources Element 2 Surveillance of antibiotic Leverage existing systems Expand capacity and include additional participants and data sources Build new capacity Link to nonhuman data Complete comprehensive system capturing human, animal and food data Element 3 Disease burden and outcomes Strengthen hospital and community programs Set up new initiatives for specific disease entities Improve existing initiatives Set up new initiatives for specific disease entities Improve existing initiatives Element 4 Analysis and action Establish definitions and standards Scope analytic and reporting requirements Improve analytic and reporting capability Reinforce standards and guidelines Identify research priorities Demonstrate progress Leverage emerging science and technology Increase capacity and authority for action Set research priorities Demonstrate progress Element 5 Planning Map complete program Evaluate Stage 1 Evaluate Stage 2
Plan for Stage 2 Confirm program direction Plan for Stage 3 Plan international participation Be a One Health leader Table 12: Element 1 – Surveillance of antimicrobial resistance Rationale It is essential to measure the extent and trends in antimicrobial resistance in the community and hospitals if effective interventions are to be developed, and outcomes from interventions demonstrated. Proposed approach Review available and potential data sources Develop and promulgate standard approaches Develop existing systems and mechanisms that are operating or have the potential to operate at a national level Stage 1 Stage 2 Stage 3 Passive surveillance – real-time public and private laboratory data Targeted surveillance Alert – emerging pathogens New initiatives – explicit aim is to receive data from external entities. The Australian Commission on Safety and Quality in Health Care will not assume authority for animals and food, but may lever funding from existing government departments for animal, food and nonbacterial microorganisms (fungi and viruses) Improve existing initiatives – extend targeted and alert surveillance systems Comprehensive passive, targeted and alert systems for: humans animals food and Table 13: Element 2 – Surveillance of antibiotic usage
Rationale Understanding and to what extent antibiotics are used is key to developing strategies to address a range of issues, from appropriateness of prescribing to demonstrating links between use and emerging resistance. Proposed approach Review available and potential data sources Develop and promulgate standard approaches Build on existing systems that operate or have the potential to operate nationally Stage 1 Stage 2 Stage 3 NAUSP: report at local level in real-time increase national of all hospitals, including paediatric. Community data from Pharmaceutical and Repatriation Subsidy Schemes, BEACH, Medicine Insight and others. New initiatives: secure human data animal usage data data for hospital and animal. Improve existing initiatives: NAUSP is inclusive Comprehensive indication data systems for: humans animals food and Integrated human and community usage systems for: humans animals.
antimicrobial stewardship data targeted surveillance of specific infections. Community level: targeted surveillance of specific infections and disease. continue existing work. continue existing work. Table 15: Element 4 – Analysis and action Rationale Once data sources have been developed and systems implemented, the improvement of health outcomes is dependent on high-quality analysis of the datasets, and action plans being developed and implemented. Proposed approach Resource the national coordinating centre for antimicrobial resistance strategy to undertake appropriate analysis and planning
Develop guidelines, advice, standards, particularly education Recommend research priorities Identify the burden of disease and disease outcomes Examine scope and opportunity of the National Antibiotic Utilisation Surveillance Program to include hospital and community within one entity Make recommendations to regulatory authorities Develop guidelines, advice and standards, particularly education Influence and set research priorities Develop guidelines, advice and standards, particularly education Influence and set research priorities Table 16: Element 5 – Planning Rationale Effective planning is essential to coordinate strategies and implementation, identify and apply resources, ensure outcomes are measured and deliver improvement Proposed approach Resource the national coordinating centre for antimicrobial resistance strategy
to undertake appropriate planning Stage 1 Stage 2 3 Plan for Stage 2 Map ultimate program Scope and determine ultimate comprehensive program Evaluate Plan for Stage 3 Plan for full system Evaluate Set up international participation Be a One Health leader 5.2 Overview of the status of program components Table 17 provides an overview of the perceived current status of key elements of the proposed program. It presents a subjective viewpoint, and represents a consensus view of the members of AMRSC. 17: Overview of the current status of key elements of the proposed program Element Attribute Example system or organisation Status 1 – Surveillance of antimicrobial resistance Passive surveillance, public CHRISP OrgTRx 4 Passive surveillance, private sector CHRISP OrgTRx 2 Targeted surveillance, public sector AGAR 6 Targeted surveillance, private sector AGAR 6
Multiresistant organism surveillance, public sector CHRISP OrgTRx 4 Multiresistant organism surveillance, private sector CHRISP OrgTRx 2 Links to animal and food data 2 2 – Surveillance of antibiotic use Surveillance, public hospital sector 6 Surveillance, community sector PBAC, DUSC, BEACH, Medicine Insight 2 Links to primary industries data 2 3 – Disease burden and outcomes Hand hygiene audit ACSQHC 5 infection surveillance ACSQHC 5 Patient and disease outcome data AGAR/ASA, AESOP, ANZCOSS 4 4 – Analysis and action Establish data definitions ACSQHC 2
Appendix 2: Global program and activity analysis International or supranational Program Country or Region Program status Type of activity Funding model Program focus Population Data collection type Data Notifiable organism Report WHO Regional Offices EURO 20, 184 (EARS-Net, ESAC-Net, HAI-Net)11, 185, 186 27 EU member countries, Iceland and Norway (900 public health laboratories serving over 1400 hospitals) Current AMR surveillance and antimicrobial Publicly funded (coordinated and funded by ECDC since 2010) Organism Community and hospital Data uploaded to central database (TESSy) S. pneumoniae, S. aureus, E. faecalis, E. faecium E. coli K. pneumoniae P. aeruginosa n/a ECDC website; annual reports; publications AFRO (AFRO IDSR20, 43 countries Current 2002) AMR surveillance Coordinated by WHO Disease n/a n/a 8 pathogens20; malaria, tuberculosis, S. dysenteriae, chancroid, gonorrhoea and pneumonia (S. H. influenzae)187 n/a n/a
PAHO 188) 21 countries (519 laboratories) Current (since 1996) AMR surveillance and antimicrobial Coordinated by WHO n/a n/a n/a 16 pathogens (all sample types) n/a n/a EMRO (EMRO Regional Program for surveillance of formerly ARMed29, n/a AMR surveillance Funded by ECDC n/a n/a n/a 28 species (all sample proposed (formerly 7 pathogens, blood and CSF) n/a n/a WPRO (WPRO Regional Program for of 189) 13 countries (14 Current AMR surveillance Coordinated by WHO n/a n/a n/a 26 bacteria of ‘public health importance’ n/a Drug resistance data reported annually to regional office (4–15 antibiotics); annual reports 2005)
HAI-Net 186 As above Current HAI and surgical site infection surveillance (various surveillance activities and projects) Publicly funded (coordinated by ECDC since 2008 (formerly IPSE network) Acute care hospitals and long-term care facilities Point prevalence survey of HAI and antimicrobial use in acute care hospitals; surveillance of surgical site infection (7 surgical categories), HAI (ICUs and care facilities) and C. difficile; maintains ARHAI EPIS HAI and antimicrobial use in care hospitals and long-term care facilities; HAI in ICUs; surgical site infections n/a ECDC website; annual reports 192 15 countries within 4 EU national public health institutes (Brussels, Barcelona, Berlin and London) Inactive HAI and surgical site infection surveillance Previously coordinated by IPSE and now under HAI-Net Infection n/a Antimicrobial susceptibility of pathogens isolated from patients with HAI n/a n/a n/a
ABS 137, 138 antibiotic strategies for appropriate use of antibiotics in hospitals in member states of the European Hospitals in 9 European member states Inactive n/a – n/a n/a n/a n/a n/a 28 participating countries in 5 regions (Asia-Pacific, Latin America, Middle North America and Europe) Current AMR surveillance Commercially funded by Sharp & Dohme Corp. (subsidiary of Merck & Co. Inc.) Organism Hospital In vitro susceptibility tests and longitudinal susceptibility patterns of Gram-negative bacilli isolated from infections Aerobic and facultative Gram-negative bacilli n/a publications 2008)
Euro-GASP 197, 198 (lab) component of ESSTI) 17 European Economic Area member states Current AMR surveillance (N. Coordinated by ECDC from 2009 Disease Laboratory N. gonorrhoeae antimicrobial susceptibility Representative sample of N. gonorrhoeae strains tested against a range of antimicrobials (e.g. penicillin, ciprofloxacin, tetracycline, azithromycin, cephalosporin) n/a Reports, publications Military and host-nation populations (Egypt, Jordan, etc.) Current AMR and HAI surveillance Funded by the US Department of Defense Organism Military and host nations (Peru, Jordan, Egypt) Susceptibility testing of pathogens isolated from hospitalised service personnel Pathogens of military importance: MRSA, Acinetobacter spp., producing etc. n/a Website; annual reports; publications 200 (project conducted by four study groups of ESCMID) Network of European Hospitals Inactive AMR surveillance and antimicrobial Funded by DG research, European Commission Organism n/a AST, AMR prevalence, typing methods, antimicrobial consumption, infection control policies and antibiotic prescribing policies n/a n/a Website; consensus conference (co-hosted by ESCMID and SWAB); publications 2004)
35 ICUs from 8 European counties (participating national ICU networks and individual ICUs) Inactive project) AMR surveillance and antimicrobial n/a Infection European ICUs Susceptibility testing of ICU pathogens to common antimicrobial agents E. coli K. pneumoniae S. aureus A. baumannii P. aeruginosa n/a DDD/1000 occupied bed-days; website ESAR202, 203 5 laboratories in Western and Eastern Europe Inactive AMR surveillance Funded by ESBIC Organism European microbiological laboratories Incidence and mechanisms of resistance using sentinel laboratories and standardised methodology Alert and target organisms n/a Website; regular through ESBIC meetings and bimonthly publications 204 at CDC) 135 hospitals in 35 countries Inactive AMR surveillance Consortium of clinical infectious disease specialists, experts in AMR, public health agencies and national reference laboratories Organism Hospital patients Identification and susceptibility testing of isolates warning for emerging AMR pathogens; facilitate rapid distribution of information to hospitals/public health authorities n/a publications
GLOBAL surveillance 206 15 countries Current AMR surveillance Commercially funded Organism ICU, long-term care facilities and outpatient settings Susceptibility testing of key respiratory tract pathogens against commonly prescribed antimicrobial agents S. pneumoniae H. influenzae M. catarrhalis n/a publications 203, 204, 207 Principally US, but also Canada, Europe, Australia and New Zealand. Operated in Australia from however, was not considered viable and data was purchased by the Australian Society for Current AMR surveillance (passive surveillance of resistance patterns) Commercially funded by Eurofins Organism Hospital centres/ laboratories Internet-based data resource of in vitro antimicrobial susceptibility data All clinically encountered bacterial pathogens (597 taxa) and antimicrobial agents (119). Primary source of antimicrobial susceptibility data for the US FDA n/a Website; conferences and publications; data not publicly available
SDLN208 Worldwide Current AMR surveillance Commercially funded by IHMA Organism Hospital Internet-based data resource of in vitro antimicrobial susceptibility data More than 200 bacterial species, 100 antimicrobials n/a Website; reports 52, 130, 203, 204, 207, (part of GAARD) 30 countries (reference laboratories and outpatient facilities; including Australian sites) Current AMR surveillance Commercially funded by BristolMyers Squibb Organism, infection Hospital and community populations AMR trends of common pathogens causing HAI and infections Bloodstream infection, respiratory tract infections (S. H. influenzae, M. catarrhalis), pneumonias, skin/soft tissue infections and urinary tract isolates; gastroenteritis pathogens and (since 2001) streptococcal isolates n/a Website, provides mainly point prevalence information; annual reports, publications
TEST203, 215 130 centres from participating countries (US, Latin America, Europe and Asia) Current AMR surveillance Commercially funded by Pfizer Inc. Organism Hospital centres/ laboratories In antimicrobial susceptibility of defined isolates collected from patients with a documented infection to glycylcycline, tigecycline, and comparator antimicrobials Various and Gram-negative strains n/a Website, publications MYSTIC46, 130, 203, 204, 207, 213, 216 (part of GAARD) Worldwide medical centres actively prescribing meropenem Inactive Longitudinal AMR surveillance study (AMR trends among meropenem and common pathogens; antimicrobial usage patterns) Commercially funded by AstraZeneca International Organism Hospital centres (e.g. cystic fibrosis, neutropaenic and ICUs, and general wards) In vitro antimicrobial susceptibility of meropenem and comparator antimicrobials against various Gram-positive and strains Gram-positive and strains n/a Website, publications
PROTEKT (and PROTEKT US)42–45, 130, 39 countries (including Australia) Inactive Longitudinal AMR surveillance study (AMR mechanisms and trends over time and geographic region) Commercially funded by Sanofi-Aventis Organism Hospital Susceptibility data of common respiratory pathogens from patients with respiratory infections to telithromycin Telithromycin and comparator antimicrobial susceptibility data n/a publications The Alexander Project48, 130, 204, 207, 222, 223 (part of GAARD) 27 countries Inactive Longitudinal AMR surveillance study Commercially funded by Organism Hospital Antimicrobial susceptibility data for adults with respiratory infections to a range of compounds S. pneumoniae H. influenzae M. catarrhalis n/a publications LIBRA surveillance study (program or n/a Inactive n/a Commercially funded by Bayer n/a n/a Community and nosocomial infections n/a n/a publications
AR InfoBank (WHO)204 Worldwide Inactive Aggregated data from national or subnational AMR surveillance networks WHO Organism Community and hospital settings Susceptibility data (including low- and countries) n/a n/a n/a (formerly Salm-Net) EU member countries Inactive and laboratory surveillance of pathogens Coordinated and funded by ECDC n/a Gastrointestinal pathogens Shiga toxigenic E. coli verocytotoxin producing E. coli Campylobacter n/a n/a Euro TB204 (formerly hosted by the Institut de Veille Sanitaire, France 53 countries of the WHO European Region Inactive Surveillance of M. tuberculosis Now coordinated by European Tuberculosis Surveillance Network (ECDC/WHO Euro) Disease n/a n/a M. tuberculosis n/a n/a ENARE204 n/a Inactive n/a Combined with SENTRY 1997 Organism n/a n/a n/a n/a n/a 225 14 countries (37 laboratories) Inactive AMR surveillance n/a Organism n/a Antimicrobial susceptibility data Consecutively collected blood and urine culture isolates n/a publications
European ICU Study Group226 n/a Inactive AMR surveillance n/a Organism n/a Isolates from intensive care patients n/a n/a publications WARN204, 227 n/a Inactive AMR information system (server) n/a Organism n/a n/a Pneumococci, staphylococci, glycopeptides, n/a publications European GAS Study Group204 n/a Inactive AMR surveillance n/a Organism n/a n/a Streptococcus pyogenes n/a n/a (developed as part of the Detecting and Eliminating Bacteria Information Technology [DebugIT] project) 39 countries (127 Current AMR surveillance system (framework for information sharing across multinational clinical networks) Funded by the European Seventh Framework Programme n/a n/a n/a E. faecalis E. faecium E. coli K. pneumoniae P. aeruginosa S. aureus S. pneumoniae against and publications aminoglycoside
BSAC Resistance Project229 (European centre for ESAC-Net) England, Wales, Scotland, Northern Ireland and Ireland Current AMR surveillance infection program and lower respiratory tract infection program Funded by several commercial sponsors (2012: Basilea Cempra, Cubist Pfizer) Bacteraemia program: HAI and infections. Respiratory program: CAP, AECB, etc. detection of bacteraemias and respiratory isolates Identification and susceptibility testing of pathogens isolated from bloodstream infections and lower respiratory tract infections against a range of antimicrobial agents n/a Website, publications European Country Specific Program Country or Region Program status Type of activity Funding model Program focus Population Data collection type Data Notifiable organism Report
HPS S. aureus bacteraemia surveillance programme230 Scotland n/a HAI Publicly funded Infection Acute and non-acute hospitals, primary care and community n/a S. aureus, bacteraemias (including MRSA and MSSA bacteraemias) n/a Quarterly and annual reports. Includes Scotland data form EARS-Net; ECDC 163, 164, 204, 231–233 Denmark AMR and Publicly funded (Danish Ministry of Health and the Danish Ministry of Food, Agriculture and Fisheries) Organism Hospital and community (healthy and outpatient) Susceptibility testing of selected bacterial organisms and monitoring of antibiotic consumption from human, animal and food sources E. faecium, E. faecalis, E. coli (community); Salmonella, S. aureus, MRSA, S. pneumoniae, staphylococci, S. pyogenes (community and hospital patients) n/a DDD/1000 bed days; monthly use data; annual negative
NETHMap65, 66 Netherlands AMR and antibiotic Coordinated by SWAB from funding by CIb (National Institute for Public Health and the Organism Patients in community (GPs, nursing outpatient and hospitals Susceptibility testing of isolates from patient samples (blood, lower respiratory tract infection, CSF, urine and wound) E. coli, Klebsiella spp., Enterobacter spp., Proteus mirabilis, P. aeruginosa, staphylococci, enterococci and respiratory pathogens *SWAB resistance surveillance data derived from ISIS-AR dataset and studies n/a reported DDD/1000 inhabitant days; annual reports
STRAMA (including 62 Sweden AMR and antibiotic Public funding (Swedish Organism Hospital and infection Antimicrobial usage, incidence and susceptibility testing of bacterial isolates against antibiotics MRSA infection; pneumococci infection; VRE infection; (links to interactive database – ResNet) n/a DDD/1000 patient days; ICU reported separately; annual reports publications SWEDRES167 (Report of STRAMA and the Swedish Institute for Infectious Disease Control [SMI]; contributes data to Ears-Net [ECDC]) Sweden AMR and antibiotic Public funding (Swedish n/a Hospitals and community Antimicrobial usage, incidence and susceptibility testing of bacterial isolates against antibiotics S. pneumoniae S. pyogenes H. influenzae E. coli K. pneumoniae S. aureus P. aeruginosa C. difficile producing Entero- MRSA, S. pneumoniae and VRE Public reports; consumption DDD per 1000 inhabitants and per day
SARI67, 69–71, 73, 75, 130, 234–236 (commenced collecting prospective data from ICUs participating in the German System (KISS); similar to ICARE [US]) Germany (40 German ICUs) AMR and antibiotic Public funding (German Organism Hospital ICUs Antimicrobial usage, incidence and susceptibility testing of bacterial isolates against antibiotics S. aureus staphylococci E. faecalis E. faecium P. aeruginosa E. cloacae Citrobacter spp. S. marcescens A. baumannii S. maltophilia S. pneumoniae E. coli K. pneumoniae n/a reported as DDD/1000 patient days; publications MABUSE network9, 237 Germany and AMR Public funding (German n/a Ambulatory and hospital data n/a n/a n/a WHO DDDs are used in addition to prescribed daily doses; publications
ARS System234 (within the framework of DART [German Antibiotic Resistance strategy]) Germany AMR Voluntary Organism Ambulatory and hospital data n/a Clinically relevant bacterial pathogens in inpatient and outpatient facilities (hospital and ambulatory care). Linked to EARS-Net via TESSy Statutory notification of MRSA (in and cerebrospinal fluid) Annual report KISS234 (supplemented with module; MRSAKISS; based on NNIS [US]) Germany AMR Public funding (German Ministry of Health). Coordinated by the National Reference Centre for the Surveillance of Nosocomial Infections and the Robert Koch Institute Infection Nosocomial infections 4 surveillance components: ICUs, neonatal ICUs and patients undergoing surgery and bone blood stem cell transplants n/a n/a Infection incidence rates considered a national reference database for German ICUs
GENARS238 (within the framework of DART [German Antibiotic Resistance strategy]) Germany labs in 6 university hospitals) AMR project n/a Organism labs in university hospitals Susceptibility testing of isolates against 25 antibiotic classes E. coli E. cloacae P. mirabilis P. aeruginosa S. aureus n/a publications BulSTAR76 Bulgaria (28 public, 45 hospital and 6 private AMR and antibiotic Public funding (Bulgarian Ministry of Health) Organism Hospitals Isolation and susceptibility testing All clinically significant isolated from blood, cerebrospinal fluid, upper and lower respiratory tract, urine and wound samples n/a reported as WHO DDD/100 bed days; website, publications AURES77 (contributes data to [ECDC]) Austria AMR and antibiotic Publicly funded (Federal Ministry of Health, Family and Youth) Hospitals and primary care sector (reported separately) Susceptibility testing of isolates from blood cultures and cerebrospinal fluid S. pyogenes S. pneumoniae H. influenzae E. coli P. mirabilis S. aureus n/a Public reports; publications NORM61, 239 (contributes data to [ECDC]) Norway AMR resistance n/a n/a n/a n/a n/a n/a Annual public reports, publications
Antimicrobial Resistance Information from Czech Republic240, 241 Czech Republic n/a AMR resistance n/a n/a n/a n/a n/a n/a n/a FiRe64, 241 Finland (28 n/a AMR n/a Organism Hospital and community Identification and antibiotic susceptibility testing or routine clinical isolates S. pneumoniae H. influenzae N. gonorrhoeae Salmonella spp., E. faecium MRSA, M. tuberculosis n/a n/a The National Institute for Public Health Surveillance Saint-Maurice National Observatory of the Epidemiology of Bacterial Resistance to France n/a n/a n/a n/a n/a n/a n/a n/a n/a
WHONET Greece241, 242 (Greek System for the Surveillance of antimicrobial resistance; (participates in EARS-Net) Greece AMR Publicly funded (Ministry of Health and Social Solidarity) Organism Hospital Identification and antibiotic susceptibility testing of routine clinical isolates n/a n/a n/a Margherita2243 (previously GiViTi) Italy (125 ICUs) n/a AMR (continuous infection software) n/a Infection n/a n/a n/a n/a n/a AR-ISS241 Italy (70 hospital clinical AMR n/a Organism Hospitals Identification and antibiotic susceptibility testing of routine clinical isolates S. aureus S. pneumoniae E. faecalis E. faecium K. pneumoniae K. oxytoca E. coli n/a Results sent to laboratories via newsletter; website
United States and Canada Program Country or Region Program status Type of activity Funding model Program focus Population Data collection type Data Notifiable organism Report Centers for Disease Control and Prevention (CDC) NHSN69 (formerly NNIS136, 158) United States AMR surveillance (HAI; secure, surveillance system) Managed by DHQP, CDC Hospitals (acute and long-term care facilities, psych and rehab); outpatient dialysis and ambulatory surgery centres and long-term care facilities) Incidence of HAI; trends in AMR pathogens; epidemiology of specific pathogens; risk factors for infection Capacity for timely information exchange between healthcare facilities and other entities (i.e. public health agencies) Website; national reporting; annual NARMS:EB70, 80–82 United States AMR surveillance between health departments and CDC Organism n/a Susceptibility testing of clinical isolates; trend analysis Non-S. typhi Salmonella Salmonella typhi Shigella isolate E. coli O157 Website; annual reports; publications ABCs102 United States AMR surveillance (invasive bacterial disease) n/a (42 million) Identification and susceptibility testing of clinical isolates H. influenzae N. meningitidis Group A and B S. MRSA Website; annual reports; publications report
TRUST130, 213, 245 United States (~434 healthcare institutions; centralised AMR surveillance funded Hospitals Susceptibility data for respiratory tract infections; resistance trends over time and geographic region S. pneumoniae H. influenzae M. catarrhalis publications AWARE surveillance program246 United States (9 US census regions; 71 medical centres) AMR resistance funded Organism Hospitals Susceptibility testing of respiratory or bloodstream isolates against ceftaroline and comparators S. pneumoniae H. influenzae M. catarrhalis publications ARMOR247 United States (34 institutions) Surveillance study funded (Bausch & Lomb, Eurofins Medinet) Infection/ organism Healthcare institutions Susceptibility profile of isolates from ocular infections against relevant antibacterials S. aureus staphylococci, S. pneumoniae H. influenzae P. aeruginosa publications PHAC (Public Health Agency of Canada)
CIPARS248, 249 Canada AMR surveillance and antimicrobial consumption Publicly funded (PHAC) Infection/ organism Hospital and community Includes susceptibility testing of human clinical isolates Selected bacterial organisms (E. coli 0157:H7, Salmonella spp., spp.) isolated from human, animal and food sources Website; quarterly summaries and annual reports; DDD/1000 patient CNISP248, 249 Canada (54 sentinel hospitals in 10 provinces) (since 1994) HAI surveillance Publicly funded (PHAC) Infection/ organism Hospital Rates and trends of HAI Nosocomial pathogens (MRSA, VRE, ESBL C. difficile, resistant Website; regional and national web-based data entry Canadian National Centre for Network of Canadian reference laboratories AMR surveillance Publicly funded (PHAC) Organism Hospital/ community Susceptibility testing of Streptococcus and Enterococcus isolates Streptococcus and Enterococcus Website; annual reports; publications
Canadian Tuberculosis Laboratory Surveillance System248 laboratories in Canadian provinces AMR surveillance Publicly funded (PHAC) Hospital/ community Susceptibility testing of M. tuberculosis isolates against drugs M. tuberculosis (and other species: M. africanum M. canetti M. caprae M. microti M. pinnipedii M. bovis) Website; annual reports; publications CBSN248 15 networks of Centres for Excellence AMR surveillance funded Organism Microbiology laboratories Susceptibility testing of clinical isolates of S. pneumonia, H. influenzae S. pneumoniae H. influenzae Website; newsletters; publications CARA248 (contributes to national AMR studies such as CANWARD, CAN-ICU, NAUTICA and CARS) Canadian hospitals AMR surveillance and antibiotic consumption studies funded Organism Hospital/ community Susceptibility testing of clinical isolates S. pneumoniae H. influenzae Miscellaneous Website; publications Asia
Program Country or Region Program status Type of activity Funding model Program focus Population Data collection type Data Notifiable organism Report ANSORP250 Asia Current AMR resistance studies on community pneumococcal infections n/a Organism/infection Community/hospital Susceptibility testing of pneumococcal isolates MRSA S. pneumoniae n/a publications CARTIPS88 Current AMR resistance study of respiratory tract infections n/a Organism/ infection Community/hospital Susceptibility testing of clinical isolates against antimicrobial agents S. pneumoniae H. influenzae M. catarrhalis K. pneumoniae MSSA Streptococcus spp. n/a publications MOHNARIN251 China (129 tertiary hospitals) Current AMR surveillance studies n/a Organism Hospital (ICUs) Susceptibility testing of clinical isolates n/a n/a journal, annual reports CHINET251 China (21 tertiary hospitals) Current AMR surveillance studies n/a Organism Hospital Susceptibility testing of clinical isolates n/a n/a publications; surveillance data does not account for AMR in primary care or community settings
The Network for Antimicrobial Resistance Surveillance (Singapore)255 Singapore (public acute and secondary care hospitals) Current AMR surveillance (HAI) n/a Organism Acute-care hospitals Susceptibility testing of clinical isolates S. aureus E. coli Enterococcus spp. K. pneumoniae P. aeruginosa Acinetobacter spp. n/a journal Australia Program Country or Region Program status Type of activity Funding model Program focus Population Data collection type Data Notifiable organism Report
AGAR174, 256 Australia (national laboratories; 30 public institutions and 4 private laboratories representing all Australian states and territories) AMR surveillance Funded by DoHA; some supportive funding (e.g. Eli Lilly (1985–2002) Organism Susceptibility testing of clinical isolates; surveys of AMR patterns; applicability of typing methods S. aureus E. coli Klebsiella spp. Enterobacter spp. (annually) S. pneumoniae Enterococcus spp. H. influenzae (periodically) n/a Website; annual and periodic surveys; publications; conference ability to monitor AMR in private facilities and primary care 115, 152 Australia (national; 70 hospitals including 41 tertiary referral or large private representing all states and territories) use monitoring Funded by DoHA; coordinated by Australian Infection Control Service, Disease Control Branch – Hospital Total hospital and ICU usage rates for 6 antimicrobial classes 3rd/4th generation cephalosporins, glycopeptides, and penicillin with beta-lactamase inhibitor combinations n/a Website; aggregate data reported to DoHA and ACSQHC; bimonthly and annual reports; consumption reported as WHO defined DDD/1000 OBD
AGSP257, 258 National (reference laboratories of all Australian and New Zealand) AMR surveillance Funded by DoHA Susceptibility testing of N. against single-dose regimens of penicillins, ceftriaxone, ciprofloxacin and high-level resistance to tetracyclines and intermittent surveys of azithromycin N. gonorrhoeae n/a Website; quarterly and annual reports to Diseases Intelligence; also reports annually on WPR and SEAR Gonococcal Antimicrobial Surveillance Programme 2007/08) HISWA116 Western Australia (public hospitals and private healthcare facilities) HAI surveillance Funded by WA government and PathWest; managed by HAIU at the Disease Control Directorate Hospital Susceptibility testing and molecular typing Surgical site infections, central line, haemodialysis infections; S. aureus (MRSA/MSSA), bloodstream infections, MRSA and C. difficile infections MRSA, VRE and C. Website; individual hospital reports and aggregate reports; rates stratified by specimen site and patient location
South Australian AUSP153, 259 Australia (7 public and 6 private hospitals) utilisation Funded by DoHA; coordinated by South Australian Infection Control Service, Disease Control Branch – Hospital Total hospital and ICU usage rates for 6 antimicrobial classes 3rd/4th generation cephalosporins, glycopeptides, and penicillin with beta-lactamase inhibitor combinations n/a Website; individual patient data and aggregated statewide data; bimonthly reports; consumption reported using DDD/1000 occupied bed-days CHRISP Queensland (25 public hospitals) HAI surveillance HSCID, Queensland Health Hospital Identification and trends in infection AMR and nosocomial pathogens n/a n/a Website; individual patient data and aggregated statewide nosocomial data (to QLD Health) for facilities; provide data for national database
Victoria HAI surveillance VICNISS coordinating centre, Victorian Government Department of Health Hospital Rates of HAI and antibiotic prophylaxis data Surgical site infections, nosocomial infections, S. aureus, C. difficile n/a Website; individual patient data and aggregated statewide data; bimonthly and annual reporting TIPCU120 Tasmania (acute public hospitals) HAI surveillance Funded by Tasmanian Department of Health and Human Services Hospital n/a S. aureus, C. difficile, VRE S. aureus isolated from blood, VRE Website; quarterly reports; future reports to monitor antibiotic use in acute care hospitals SA HAI program South Australia (includes public and private acute care hospitals) HAI surveillance SA Health Infections/ specific organisms Hospital Patient level data on healthcare infections Rates and trends over time All BSI incl. SAB MRSA & VRE infection and colonisation Selected MRGNs (ESBL, AMP C, C. difficile none Monthly KPI reports to LHNs Annual detailed reports for BSI (incl. SAB) and MRO infections