ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network): a pilot protocol for case based antimicrobial resistance surveillance

Abstract

Background: 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. Methods: 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 Streptococcus pneumoniae, Staphylococcus aureus, Salmonella spp., Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii. A bespoke browser-based app will provide sites with fully interactive data visualisation, analysis, and reporting tools. Discussion: 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.

How covid-19 is accelerating the threat of antimicrobial resistance

“…Wellcome is currently backing the ACORN project—organised by Oxford University in the UK and Mahidol University in Thailand—to establish an active surveillance network for AMR across low and middle income countries 9. The idea is to collect data in a way that better integrates clinical information about each patient’s health condition with the microbiology laboratory results.…”

Electronic information systems for One Health surveillance of antimicrobial resistance: a systematic scoping review

“…In this study, the 21 EIS that identified a specific country of implementation, were mostly located in HICs (n=17), with a smaller number implemented in LMICs (n=4). Additionally, two of the six EIS which included a range of countries were found to involve predominantly LMICs (such as Southeast Asian countries), 43 44 demonstrating a slight overall increase in the presence of EIS in LMICs over the past 5 years since a previous review in 2017 17 of a similar scope. The growing number of EIS being deployed in LMICs in recent years may be due to the heightened awareness at national and global levels about AMR, increased access to digital health technologies in LMICs, availability of international funding initiatives for implementing EIS as components of AMR surveillance or increased demand for AMR data in recent years.…”

Coverage gaps in empiric antibiotic regimens used to treat serious bacterial infections in neonates and children in Southeast Asia and the Pacific

“… 16 By improving the standardised reporting of routine microbiological and clinical surveillance data and ensuring open access to underlying data sources, these inherent challenges to antibiogram and WISCA methodology (and their subsequent clinical and policy-guiding utility) could be substantially improved. 48 …”