Rethinking Antimicrobial Resistance Surveillance: A Role for Lot Quality Assurance Sampling

Ginting, Franciscus; Sugianli, Adhi Kristianto; Bijl, Gidion; Saragih, Restuti Hidayani; Kusumawati, R. Lia; Parwati, Ida; Jong, Menno D. de; Schultsz, Constance; Leth, Frank van

doi:10.1093/aje/kwy276

Cited by 14 publications

(9 citation statements)

References 24 publications

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“…These limitations propagate into our prevalence estimates, and they should thus be interpreted as an approximation of the true prevalence in a country. Future unbiased surveillance will likely require novel approaches, e.g., population-based surveillance ( 33 , 34 ), for which the necessary resources and infrastructure are not yet in place. Our predictive framework provides a means to support the prioritization of investments required for this.…”

Section: Discussionmentioning

confidence: 99%

Filling the gaps in the global prevalence map of clinical antimicrobial resistance

Oldenkamp

Schultsz

Mancini

et al. 2021

Proc. Natl. Acad. Sci. U.S.A.

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Surveillance is critical in containing globally increasing antimicrobial resistance (AMR). Affordable methodologies to prioritize AMR surveillance efforts are urgently needed, especially in low- and middle-income countries (LMICs), where resources are limited. While socioeconomic characteristics correlate with clinical AMR prevalence, this correlation has not yet been used to estimate AMR prevalence in countries lacking surveillance. We captured the statistical relationship between AMR prevalence and socioeconomic characteristics in a suite of beta-binomial principal component regression models for nine pathogens resistant to 19 (classes of) antibiotics. Prevalence data from ResistanceMap were combined with socioeconomic profiles constructed from 5,595 World Bank indicators. Cross-validated models were used to estimate clinical AMR prevalence and temporal trends for countries lacking data. Our approach provides robust estimates of clinical AMR prevalence in LMICs for most priority pathogens (cross-validated q2 > 0.78 for six out of nine pathogens). By supplementing surveillance data, 87% of all countries worldwide, which represent 99% of the global population, are now informed. Depending on priority pathogen, our estimates benefit 2.1 to 4.9 billion people living in countries with currently insufficient diagnostic capacity. By estimating AMR prevalence worldwide, our approach allows for a data-driven prioritization of surveillance efforts. For carbapenem-resistant Acinetobacter baumannii and third-generation cephalosporin-resistant Escherichia coli, specific countries of interest are located in the Middle East, based on the magnitude of estimates; sub-Saharan Africa, based on the relative prevalence increase over 1998 to 2017; and the Pacific Islands, based on improving overall model coverage and performance.

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Section: Discussionmentioning

confidence: 99%

Filling the gaps in the global prevalence map of clinical antimicrobial resistance

Oldenkamp

Schultsz

Mancini

et al. 2021

Proc. Natl. Acad. Sci. U.S.A.

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“…Instead of assessment of a prevalence estimate with corresponding confidence intervals, a LQAS-based surveillance approach classifies the prevalence to be above a pre-defined threshold determined on the basis of clinical criteria and guidelines [15]. The study showed that LQAS-based surveillance of the prevalence of AMR provided the opportunity to obtain locally relevant estimation in a timely and affordable manner that can be repeated for monitoring purposes [16]. Other surveillance approaches that provide unbiased population-based AMR prevalence estimates may provide similar solutions and need to be explored.…”

Section: Plos Onementioning

confidence: 99%

Laboratory-based versus population-based surveillance of antimicrobial resistance to inform empirical treatment for suspected urinary tract infection in Indonesia

et al. 2020

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Surveillance of antimicrobial resistance (AMR) enables monitoring of trends in AMR prevalence. WHO recommends laboratory-based surveillance to obtain actionable AMR data at local or national level. However, laboratory-based surveillance may lead to overestimation of the prevalence of AMR due to bias. The objective of this study is to assess the difference in resistance prevalence between laboratory-based and population-based surveillance (PBS) among uropathogens in Indonesia. We included all urine samples submitted to the laboratory growing Escherichia coli and Klebsiella pneumoniae in the laboratory-based surveillance. Population-based surveillance data were collected in a cross-sectional survey of AMR in E. coli and K. pneumoniae isolated from urine samples among consecutive patients with symptoms of UTI, attending outpatient clinics and hospital wards. Data were collected between 1 April 2014 until 31 May 2015. The difference in percentage resistance (95% confidence intervals) between laboratory-and population-based surveillance was calculated for relevant antibiotics. A difference larger than +/-5 percent points was defined as a biased result, precluding laboratory-based surveillance for guiding empirical treatment. We observed high prevalence of AMR ranging between 63.1% (piperacillin-tazobactam) and 85% (ceftriaxone) in laboratory-based surveillance and 41.3% (piperacillin-tazobactam) and 74.2% (ceftriaxone) in population-based surveillance, except for amikacin and meropenem (5.7%/9.8%; 10.8%/5.9%; [laboratory-/population-based surveillance], respectively). Laboratory-based surveillance yielded significantly higher AMR prevalence estimates than population-based surveillance. This difference was much larger when comparing surveillance data from outpatients than from inpatients. All point estimates of the difference between the two surveillance systems were larger than 5 percent points, except for amikacin and a1111111111 a1111111111 a1111111111 a1111111111 a1111111111

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“…This also holds for Indonesia where information on AMR is infrequently derived from a limited number of university laboratories [13]. We know from our earlier work that AMR prevalence is high in Indonesia, and can differ markedly between settings and even hospital wards [14,15].…”

Section: Discussionmentioning

confidence: 92%

“…There is a clear need for strategies that can provide rapid and locally relevant information on AMR to guide empirical antibiotic treatment choices in a variety of settings. We showed earlier that this is possible by assessing whether the prevalence of AMR is above a clinically relevant level that precludes the use of an antibiotic, rather than attempting to assess a precise AMR prevalence [15].…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of diagnosis and antibiotic use in sepsis patients admitted to a tertiary hospital in Indonesia

Ginting

Sugianli

Barimbing

et al. 2020

Postgraduate Medicine

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Objective: To evaluate the diagnostic and antibiotic treatment strategies for patients suspected of sepsis, in a tertiary hospital in Indonesia. This can identify areas for improvement in care provided, and inform diagnostic and antimicrobial stewardship activities within the hospital. Methods: Retrospective review of medical records with regards to the diagnosis and management of adult patients with sepsis admitted to a tertiary hospital in Indonesia. We assessed the diagnostic process, and whether or not the antibiotic treatment provided was appropriate for the diagnosis. Appropriateness of antibiotic treatment was classified as being definite appropriate, probable appropriate, inappropriate, or unknown. Results: The study included 535 adult patients, of whom 295 (55%) were diagnosed with a communityacquired sepsis, and 240 (45%) with a hospital-acquired sepsis. A specimen for culture and antimicrobial susceptibility testing was collected from three out of four patients (392/535). All but 10 patients had information on antibiotic treatment at the time of sepsis diagnosis. Of those, nearly 50% (257/525) of the patients received antibiotic treatment with unknown appropriateness because no cultures were taken (n = 141) or all cultures were negative (n = 116). Just 3.4% and 9.1% of the patients received definite or probable appropriate antibiotic treatment, respectively. Conclusions: There is a clear need in encouraging attending physicians to obtain the much-required blood cultures, or cultures from the suspected source of infection before empirical antibiotic treatment is started. This will improve the use of appropriate antibiotic treatment strategies, and contribute to antimicrobial stewardship.

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Rethinking Antimicrobial Resistance Surveillance: A Role for Lot Quality Assurance Sampling

Cited by 14 publications

References 24 publications

Filling the gaps in the global prevalence map of clinical antimicrobial resistance

Filling the gaps in the global prevalence map of clinical antimicrobial resistance

Laboratory-based versus population-based surveillance of antimicrobial resistance to inform empirical treatment for suspected urinary tract infection in Indonesia

Appropriateness of diagnosis and antibiotic use in sepsis patients admitted to a tertiary hospital in Indonesia

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