Linking antimicrobial resistance surveillance to antibiotic policy in healthcare settings: the COMBACTE-Magnet EPI-Net COACH project
Maria Diletta Pezzani, Fulvia Mazzaferri, Monica Compri, Liliana Galia, Nico T. Mutters, Gunnar Kahlmeter, Theoklis E. Zaoutis, Mitchell J. Schwaber, Jesús Rodríguez‐Baño, Stéphan Harbarth, Evelina Tacconelli, the COACH working group, Blanca Anaya, Fabiana Arieti, Nithya Rajendran, Zaira R. Palacios‐Baena, Jesús Rodríguez‐Baño, Silvio Brusaferro, Elena Carrara, Dario Cattaneo, Esmita Charani, Monica Compri, Sergey Eremin, Liliana Galia, Daniele Roberto Giacobbe, Aina Gomila‐Grange, Stephan Harbarth, Ramanan Laxminarayan, Giuliana Lo Cascio, Fulvia Mazzaferri, Elena Mazzolini, Michael McCarthy, Rafael Cantón, Nico T Mutters, Olaf Neth, Abdelhak Oualim, Maria Diletta Pezzani, Adelina Prioteasa, Katia Saris, Mitchell J. Schwaber, Remco Schrijver, AstraZeneca LP, Evelina Tacconelli, Cuong Vuong, Martin Wolkewitz, Theoklis E. Zaoutis
Abstract
OBJECTIVES: To systematically summarize the evidence on how to collect, analyse and report antimicrobial resistance (AMR) surveillance data to inform antimicrobial stewardship (AMS) teams providing guidance on empirical antibiotic treatment in healthcare settings. METHODS: The research group identified 10 key questions about the link between AMR surveillance and AMS using a checklist of 9 elements for good practice in health research priority settings and a modified 3D combined approach matrix, and conducted a systematic review of published original studies and guidelines on the link between AMR surveillance and AMS. RESULTS: The questions identified focused on AMS team composition; minimum infrastructure requirements for AMR surveillance; organisms, samples and susceptibility patterns to report; data stratification strategies; reporting frequency; resistance thresholds to drive empirical therapy; surveillance in high-risk hospital units, long-term care, outpatient and veterinary settings; and surveillance data from other countries. Twenty guidelines and seven original studies on the implementation of AMR surveillance as part of an AMS programme were included in the literature review. CONCLUSIONS: The evidence summarized in this review provides a useful basis for a more integrated process of developing procedures to report AMR surveillance data to drive AMS interventions. These procedures should be extended to settings outside the acute-care institutions, such as long-term care, outpatient and veterinary. Without proper AMR surveillance, implementation of AMS policies cannot contribute effectively to the fight against MDR pathogens and may even worsen the burden of adverse events from such interventions.