Global initiatives for surveillance of antimicrobial resistance
Global surveillance of antimicrobial resistance is a cornerstone in the work to contain further spread of resistant organisms and contributes to the understanding of the global impact of antimicrobial resistance (AMR) on public health, economy and entire societies. Efforts are urgently needed for implementing activities to ensure that collected data is used for local and global action. The Public Health Agency is a key player in this work and is collaborating with national and international partners.
The government of Sweden and the Public Health Agency are actively supporting WHO in the implementation of the Global Action Plan on Antimicrobial Resistance, including the Global Antimicrobial Resistance and Use Surveillance System (GLASS) launched by WHO in 2015 to promote “a standardized approach to the collection, analysis and sharing of AMR data at a global level”. Recently, global surveillance on antimicrobial consumption and use has been incorporated into GLASS.
Sweden is also an active member of the Global Health Security Agenda, an initiative for a multilateral and multi-sectorial approach to strengthen both the global capacity and nations' capacity to prevent, detect, and respond to infectious diseases threats. Nearly 50 nations, international organizations, and non-governmental stakeholders are involved, and the Public Health Agency is active in the work within the AMR Action Package, one of eleven packages and all with five-year targets.
WHO Collaboration Centre for antimicrobial resistance containment
The Unit for Antibiotics and Infection Control at the Public Health Agency is a designated WHO Collaborating Centre since 2016 and a member of the WHO Antimicrobial Resistance Surveillance and Quality Assessment Collaborating Centre Network. The Centre supports WHO in the development of strategies to contain AMR globally, promotes Member State commitment to local, national and global surveillance, and contributes to building technical and human capacity.
Specifically, the Centre supports WHO in:
- Implementation of surveillance systems for AMR and antimicrobial consumption/use at country level through capacity building activities, including assessment of country capacity, technical advice and trainings.
- Continued development of GLASS through technical inputs to the periodic revision of the GLASS system, and development of supporting documents, reports, training materials, and data repositories. Together with the Swedish government, the Centre has hosted several high-level WHO meetings on GLASS, and will be co-hosting the 3rd High Level Technical Consultation and Meeting on Surveillance of Antimicrobial Resistance and Use for Concerted Actions taking place during 2020 and 2021 (www.glass2020.org)
- Providing technical support towards the implementation of antimicrobial stewardship programs in healthcare facilities, using an integrated, multidisciplinary approach.
A webinar series for technical support to WHO Member States
Limited availability of supporting material and training has been raised by Member States as a challenge for further implementation of national AMR surveillance and GLASS. In response to these needs, the WHO Antimicrobial Resistance Surveillance and Quality Assessment Collaborating Centre Network provides a webinar series as a flexible and interactive way to provide training and support to Member States. Each session is recorded and published below.
The Proof-of-Principle AMR routine diagnostics (PoP) project: successes and challenges
In many countries, underuse of bacteriology diagnostics in routine clinical practice is a barrier to implementing AMR surveillance. This webinar discusses how the Proof-of-Principle AMR routine diagnostics (PoP) project promotes the use of blood cultures and AMR susceptibility testing in clinical practice, thereby aiming to provide a starting point for a national AMR surveillance system. We provide an overview of the PoP project methodology. Furthermore, we discuss the experience gained with PoP project implementation in the WHO European region and address commonly faced challenges. The PoP protocol is available at the WHO Regional Office for Europe website.
Detection and Reporting of Colistin Resistance
Detection of colistin resistance has proven difficult in the past due to interactions of the antimicrobial with diverse laboratory materials and reagents. Moreover, there are doubts regarding the adequacy of current cut-offs for classification of isolates from different species as wild-type or non-wild-type, and clinically susceptible or clinically resistant to the antimicrobial. These issues will be addressed, accompanied by discussion of the advantages and pitfalls of current phenotypic and genotypic methods for detection of colistin resistance.
Data Entry Using WHONET
The first webinar in this series discusses how WHONET can be used to capture relevant patient, location, specimen, and microbiology results, either by manual data entry or by downloading data from existing information systems. We also cover how WHONET can be utilized to export national data for upload to the GLASS IT platform.
AMR surveillance requires the right clinical specimens to be collected and in the right way, which is the practice of proper diagnostic stewardship. The webinar sessions on Diagnostic Stewardship provide an overall definition, explaining how it involves the diagnostic pathway for infections and the way to properly organized it, as set out in the WHO GLASS Guide to Implementation. Practical protocols for the proper collection of the four groups of specimens, namely blood, urine, faeces and urethral/cervical swabs needed for GLASS participation are provided, with precise guidance on good practice.
Interpretation of AMR Surveillance Data
When interpreting results, one should always assess whether the results reflect reality. The validity and representativeness of AMR surveillance results may be negatively affected at different points in the data generation process. Different sources or error and bias, and how they influence the representativeness of the results, are addressed.