Antimicrobial resistance (AMR) is a global threat to health, livelihoods, food security and the achievement of many of the Sustainable Development Goals. Antibiotics, antivirals, antiparasitic agents and antifungals are increasingly ineffective owing to resistance developed through their excessive or inappropriate use, with serious consequences for human and animal health (terrestrial and aquatic), and plant health, and negative impacts on food production, the environment and the global economy. Rationale for selecting the types of AMR organisms: (i) E. coli and S. aureus are among the most common human fast-growing bacteria causing acute human infections; (ii) E. coli is highly prevalent in both humans, animals and environment, being an ideal indicator for monitoring AMR across the sectors in line with the One Health approach. It recognizes that the health of humans, animals and ecosystems are interconnected and therefore requires a coordinated, collaborative, multidisciplinary and cross-sectoral approach to address potential or existing risks that originate at the animal-human-ecosystems interface; (iii) both MRSA and E. coli resistant to third-generation cephalosporins are largely disseminated and found in high frequency in human infections observed in hospital settings all over the world and increasingly very frequent in the community. Infections with these types of AMR lead to increase in use of the last resort drugs (e.g., vancomycin for MRSA infections, and carbapenems for E. coli resistant to third-generation cephalosporins) against which new types of AMR are emerging. Effective control of these two types of AMR will ultimately help preserve the capacity to treat infections with available antimicrobials while new prevention and treatment solutions can be developed. WHO has well defined global infection prevention and control standards and strategies.

Proportion of bloodstream infection due to methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli resistant to third-generation cephalosporins (e.g., ESBL- E. coli) among patients seeking care and whose blood sample is taken and tested. Presumptive methicillin-resistant S. aureus (MRSA) isolates as defined by oxacillin minimum inhibitory concentration (MIC) and cefoxitin disc diffusion tests according to current internationally recognized clinical breakpoints (e.g., EUCAST or CLSI). E. coli resistant to third-generation cephalosporins: E. coli isolates that are resistant as defined by current internationally recognized clinical breakpoints for third-generation cephalosporins (e.g., EUCAST or CLSI), specifically ceftriaxone or cefotaxime or ceftazidime.

The WHO Global AMR Surveillance System (GLASS) supports countries to implement an AMR standardized surveillance system. Cases of AMR infection are found among patients from whom routine clinical samples have been collected for blood culture at surveillance sites (health care facility) according to local clinical practices, and antimicrobial susceptibility tests (AST) are performed for the isolated blood pathogens as per international standards. The microbiological results (bacteria identification and AST) are de-duplicated and combined with the patient data and related to population data from the surveillance sites. GLASS does collect information on the origin of the infection, either community origin (less than 2 calendar days in hospital) or hospital origin (patients hospitalized for more than 2 calendar days). Data are collated and validated at national level and reported to GLASS where epidemiological statistics and metrics are generated. GLASS has published guidelines on the set up of national AMR surveillance systems and the GLASS methodology implementation manual is available to countries. Although national representativeness of generated AMR rates is not a strict requirement, GLASS encourages countries to derive representative national data.

Formulation of the proposed new indicator: Proportion of patients with bloodstream infections due to selected antimicrobial resistant organisms. This is derived from the following and multiplied by 100: Numerator: Number of patients with growth of methicillin-resistant S. aureus or E. coli resistant to third-generation cephalosporins in tested blood samples. Denominator: Total number of patients with growth of S. aureus or E. coli in tested blood samples. From 2020 onwards, the proportion of patients with bloodstream infections due to selected antimicrobial resistant organisms is only shown for countries, territories and areas reporting at least 10 bacteriologically confirmed bloodstream infections with antimicrobial susceptibility test results in one calendar year. Global estimates for each calendar year, are represented by the median of these proportions.

Annual

All references to Kosovo should be understood to be in the context of the United Nations Security Council resolution 1244 (1999).

stolba@who.int

Sara Tolba

5751

AMR is an emerging global threat and risk to public health worldwide. In its early implementation phase of the global antimicrobial resistance surveillance system (GLASS), WHO recognizes various constraints in obtaining unbiased, representative AMR data: number and distribution of surveillance sites and representativeness of surveillance data, sampling bias, poor diagnostic capacity, measurements errors, issues with data management. It is imperative that countries should have a functioning national system to support AMR surveillance and report to GLASS. More detailed GLASS methodology and limitations of data currently submitted by countries can be found in the GLASS report (6). AMR surveillance, country preparedness and response are now high priority for WHO and its Member States. In the next five years, WHO aims to provide intensified technical assistance. Experience gained and lessons learnt from the further implementation of the national AMR surveillance systems will increase effectiveness, address limitations, and the make the data more robust. (6) Global antimicrobial resistance and use surveillance system (‎GLASS)‎ report: 2022 https://apps.who.int/iris/bitstream/handle/10665/364996/9789240062702-eng.pdf