White Paper: Bridging the gap between human and animal surveillance data, antibiotic policy and stewardship in the hospital sector—practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks

Abstract

Background Antimicrobial surveillance and antimicrobial stewardship (AMS) are essential pillars in the fight against antimicrobial resistance (AMR), but practical guidance on how surveillance data should be linked to AMS activities is lacking. This issue is particularly complex in the hospital setting due to structural heterogeneity of hospital facilities and services. The JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks have joined efforts to formulate a set of target actions for linking surveillance data with AMS activities. Methods A scoping review of the literature was carried out addressing research questions on three areas: (i) AMS leadership and accountability; (ii) antimicrobial usage and AMS; (iii) AMR and AMS. Consensus on the target actions was reached through a RAND-modified Delphi process involving over 40 experts in different fields from 18 countries. Results Evidence was retrieved from 51 documents. Initially 38 targets were proposed, differentiated as essential or desirable according to clinical relevance, feasibility and applicability to settings and resources. In the first consultation round, preliminary agreement was reached for 32 targets. Following a second consultation, 27 targets were approved, 11 were deleted and 4 were suggested for rephrasing, leading to a final approved list of 34 target actions in the form of a practical checklist. Conclusions This White Paper provides a pragmatic and flexible tool to guide the development of calibrated hospital-surveillance-based AMS interventions. The strength of this tool is that it is a comprehensive perspective that takes into account the hospital patient case-mix and the related epidemiology, which ultimately drives antimicrobial usage, and the feasibility in low-resource settings.

The omission of children from the UK’s antimicrobial strategy must be tackled

“…Routine reporting of antimicrobial prescribing must use metrics that are appropriate for all ages, including children. We suggest the use of days of therapy per 1000 patient days (or a similar denominator), in line with current evidence based recommendations 101112. Primary care data on antibiotic use are already reported by age group, including children, but a similar approach is required in secondary care.…”

Antimicrobial Resistance in the Global Health Network: Known Unknowns and Challenges for Efficient Responses in the 21st Century

“…Traditionally, populations are analyzed at tertiary and secondary healthcare centers (hospitals and long-term care facilities), where the concentration of the high-risk groups of people and online diagnostic and life-sustaining equipment (such as ventilators), indwelling catheterization, and frequent use of drugs facilitate the emergence and local evolution of AMR. Within hospitals, some wards concentrate on groups and factors at higher risk than others [130,131]. Primary healthcare is greatly influenced by structural, governance, and management networks [105,106,132].…”

“…AMC/AMU data are primarily relevant in combination with local AMR trends and the preparation of antibiotic stewardship guidelines. Protocols and tools to properly collect AMC/AMU information are currently being debated [130][131][132]. Nonetheless, AMU data are still unavailable in most countries and hospitals, and antimicrobial exposure is generally reflected as AMC [94].…”

“…Surprisingly, only a few guidelines clearly state which antibiotics should be routinely monitored. A consensus list based on the antibiotics most used or included in the "Watch" and "Reserve" categories of the WHO's Essential Medicines List AWARE index has been suggested to harmonize information [131,132].…”

EPI-Net One Health reporting guideline for antimicrobial consumption and resistance surveillance data: a Delphi approach

“…The review did not identify any document providing indications on if and how AMR data from the animal sector from regional/national surveillance systems should be included to inform AMS in the human sector. A subsequent updated literature review and consensus exercise carried out in collaboration with the JPIAMR ARCH Network 12 , 13 , 14 , 15 further highlighted the need for recommendations that are inclusive of the environmental sector and antimicrobial residues surveillance.…”