ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network): a pilot protocol for case based antimicrobial resistance surveillance
Paul Turner, Elizabeth A. Ashley, O. Celhay, Anousone Douangnouvong, Raph L Hamers, Clare Ling, Yoel Lubell, Thyl Miliya, Tamalee Roberts, Chansovannara Soputhy, Phạm Ngọc Thạch, Manivanh Vongsouvath, Naomi Waithira, Prapass Wannapinij, H. Rogier van Doorn
Abstract
<ns4:p> <ns4:bold>Background</ns4:bold> : Antimicrobial resistance (AMR) / drug resistant infections (DRIs) are a major global health priority. Surveillance data is critical to inform infection treatment guidelines, monitor trends, and to assess interventions. However, most existing AMR / DRI surveillance systems are passive and pathogen-based with many potential biases. Addition of clinical and patient outcome data would provide considerable added value to pathogen-based surveillance. </ns4:p> <ns4:p> <ns4:bold>Methods</ns4:bold> : The aim of the ACORN project is to develop an efficient clinically-oriented AMR surveillance system, implemented alongside routine clinical care in hospitals in low- and middle-income country settings. In an initial pilot phase, clinical and microbiology data will be collected from patients presenting with clinically suspected meningitis, pneumonia, or sepsis. Community-acquired infections will be identified by daily review of new admissions, and hospital-acquired infections will be enrolled during weekly point prevalence surveys, on surveillance wards. Clinical variables will be collected at enrolment, hospital discharge, and at day 28 post-enrolment using an electronic questionnaire on a mobile device. These data will be merged with laboratory data onsite using a flexible automated computer script. Specific target pathogens will be <ns4:italic>Streptococcus pneumoniae, Staphylococcus aureus, Salmonella</ns4:italic> spp <ns4:italic>., Klebsiella pneumoniae, Escherichia coli,</ns4:italic> and <ns4:italic>Acinetobacter baumannii</ns4:italic> . A bespoke browser-based app will provide sites with fully interactive data visualisation, analysis, and reporting tools. </ns4:p> <ns4:p> <ns4:bold>Discussion</ns4:bold> : ACORN will generate data on the burden of DRI which can be used to inform local treatment guidelines / national policy and serve as indicators to measure the impact of interventions. Following development, testing and iteration of the surveillance tools during an initial six-month pilot phase, a wider rollout is planned. </ns4:p>