WHO AMR Surveillance and Quality Assessment Collaborating Centres Network

The CC supports AMR surveillance and GLASS activities,, by strengthening their capacity for data collection management, especially in Latin-American and Caribbean (Lat-C) countries, through strengthening their capacity for data collection, data management, and data quality control related to antimicrobial consumption (AMC). The CC contributes to training for health staff in the identification of AMC sources of information, registration and analysis at country and hospital levels. The CC supports countries in the selection of national strategies and the decision-making aimed at controlling the irrational use and abuse of antimicrobials belonging to "Watch" and "Reserve" groups of the AWaRe classification. The CC also supports the development of studies on the use of medicine and other health technologies that hold interventions concerning antimicrobial consumption. The CC supports WHO in developing/implementing GLASS tools consumption registration as well as AMR surveillance in regional countries.

The CC supports AMR surveillance and GLASS in Latin-American and Caribbean countries through capacity building activities on data management, data quality control, data analysis and interpretation. It organises training and support for reference level diagnostic services, laboratory Standard Operating Procedures (SOPs), control strains and coordinates laboratory surveillance networks and External Quality Programmes in AMR. The CC contributes to the Network through the provision technical guidance for the detection and reporting of colistin resistance or the use of Whole Genome Sequencing (WGS) for AMR surveillance.

This CC is the current coordinator of the WHO AMR Surveillance CC Network. The CC supports AMR surveillance and GLASS by providing technical training and support for reference level diagnostic services, coordination of laboratory surveillance networks and quality programmes. The CC contributes towards Network activities relating to molecular methods and Whole Genome Sequencing (WGS) to support AMR surveillance, provides updates to the WHO on N. gonorrhoeae reference strains for quality control of diagnostic testing and typing, and External Quality Assessment (EQA) programmes for AMR.

The CC provides technical expertise and training for the detection and monitoring of AMR pathogens through support for laboratory diagnostics and surveillance, and genomics and bioinformatics. The CC also supports the prevention and response to AMR through provision of technical expertise and training for the implementation of antimicrobial stewardship activities and infection prevention and control practices. The WHO CC will contribute to the revision of the GLASS manual, as well as development of any additional supporting documents as needed.

The CC provides support for policy analysis and research on multisectoral governance instruments, and accountability and financing mechanisms towards addressing antimicrobial resistance (AMR) through a multi-sectoral One Health approach. The CC also provides support for conducting targeted research, evidence reviews, data analysis, and policy analysis to support the implementation of the People-centered core package of AMR interventions in the human health sector, and on integration of the package of interventions into primary health care / universal health coverage strategies and plans, and pandemic preparedness and response plans and initiatives. Finally, the CC provides support for delivering technical assistance for the development, governance, financing, effective implementation, and evaluation of multisectoral AMR national action plans (NAPs) at the country level, with a focus on multisectoral governance and human health sector activities.

The CC focuses on strengthening regional and global capacity and response for infection prevention and control; strengthening AMR capacity, including training and surveillance, and contributing to the implementation of the Global Action Plan; and strengthening regional capacity for evidence-based public health prevention and responses to emerging and re-emerging infectious diseases.

The CC provides technical support and training for the detection and characterization of AMR pathogens through assist laboratory diagnosis and surveillance, genomics and bioinformatics. The CC also supports vaccine-preventable and foodborne diseases through the provision of technical expertise and training. The WHO CC contributes to the improvement in the surveillance of clinically important bacteria and their AMR surveillance by sending reference material and supplies to the National Reference Laboratories of the countries of Central America and the Caribbean. The CC also collaborates with the review of different manuals and protocols at the request of PAHO/WHO.

The CC supports with capacity building of global surveillance of antimicrobial resistance and response systems for foodborne diseases (FBD), including with next generation sequencing for diagnostics. It supports with improving laboratory capacity, strengthening knowledge and the implementation of AMR guidance in FBD. The CC co-leads activities to develop technical guidance for the detection and reporting of colistin resistance and leads on creating a network of supranational laboratories that provide reference testing of unusual AMR. The CC also facilitates global surveillance of antimicrobial resistance through a metagenomics approach and through chairing WG4 of WHO Tricycle.

This WHO Collaborating Centre (CC) is currently responsible for the overall coordination of the WHO AMR Surveillance and Quality Assessment CC Network. The CC supports WHO and the Network in its mission to develop GLASS and jointly build the capacity of countries to implement AMR surveillance. The CC also contributes to the Network with its technical expertise in the area of AMR, AMC and HAI surveillance, diagnostic stewardship and infection prevention and control (IPC) through training, education and operational research.

The CC provides training, technical support and capacity building for the implementation of AMR surveillance models in countries, in line with the GLASS system. It has a particular focus on One Health surveillance systems. The CC supports in guideline, manual and methodology development with a special emphasis on epidemiology, and supports with the implementation of WHO programmes and activities at country level.

The CC carries out epidemiological studies in outbreaks, provides diagnostic support, carries out identification and anti-fungal susceptibility testing of medically important fungi, performs molecular studies, maintains culture collection of medically important fungi, provides leadership in diagnostic mycology laboratory development, promotes research and imparts training for workforce development in the field of fungal diseases.

The CC supports WHO Member States in assessing progress with the implementation of national action plans on antimicrobial resistance (NAP on AMR) through developing policy briefs that support the work of AMR coordination committees. The CC develops AMR and One Health situational analyses to support countries with subsequent iterations of the NAP on AMR. The CC will work on using local data to build an economic rationale for AMR.

The CC provides support to healthcare facilities entering, cleaning and reporting data to GLASS through the use of WHONET and ASIARS-Net, and providing reports generated from the data. The CC also supports implementing tricycle surveillance projects, processing and analyzing specimens of AMR pathogens with the use of WGS upon the request of WHO. The CC supports WHO in developing/implementing GLASS and in developing AMR surveillance guidance paper.

The CC provides support to developing and conducting training and mentoring activities for planning, development, and implementation of antimicrobial stewardship and infection prevention and control activities. The CC also supports WHO in development of AMR advocacy, awareness strategies, to preparedness for outbreak due to AMR pathogens, including technical assistance for IPC, AMS, diagnostic stewardship, and clinical management, antimicrobial consumption monitoring.

The CC assists PAHO/WHO in the regional implementation of whole genome sequencing (WGS) protocols and bioinformatics analysis as tools for the characterization of antimicrobial resistance (AMR) genes and other genomic elements. It also contributes to the work of PAHO/WHO in the development of a database and data visualization tool for WGS-derived antimicrobial resistance genes from bacteria isolated from food animals. And finally, CC supports and contributes to the work of PAHO/WHO at the global and regional level in the development of public health programs and policies for capacity building in detection and response to foodborne diseases including those associated with antimicrobial resistance (AMR).

The CC supports the WHO and its member states by providing technical guidance and capacity building in microbial food and water safety and antimicrobial resistance (AMR). Technical guidance includes technical inputs to support WHO in developing international standards, guidelines and guidance materials and dissemination thereof to protect from water- and foodborne illness and AMR and to support WHO’s activities with capacity building, awareness raising, and technical support. The CC is working on the fate and spread of AMR from humans and animals through food and the environment (water, soil, animal manure and air) in a One Health approach. Besides AMR in water as a transmission route, extensive knowledge within our WHO CC also exists on the use of sewage and surface water as a complementary human surveillance tool for antibiotic resistant bacteria and resistance genes with a focus on global priority pathogens such as carbapenem-resistant or ESBL-producing Enterobacterales. We support good practice on integration of wastewater surveillance for AMR with SARS-CoV-2, and poliovirus as a multipathogen approach. Our WHO CC contributed to the protocol for integrated global surveillance on ESBL-producing E. coli using a “One Health” approach (the Tricycle protocol) and supports its implementation in countries. The WHO CC establishes exposure assessment of resistant bacteria in water. Furthermore, the WHO CC contributes to technical support to development of standard setting for industrial emissions of antibiotics. The WHO CC has been an active member of the WHO AMR Surveillance and Quality Assessment Collaborating Centres Network (AMR Surveillance CC Network) in supporting WHO in capacity building activities in countries.

The CC supports with efforts to develop One Health AMR surveillance systems and has a particular focus on AMR in Campylobacter. It also supports with training on laboratory techniques and the development and implementation of prevention and intervention strategies. The CC develops new techniques and improved tools for Campylobacter isolation, identification and typing, and AMR. It also provides reference services for Member States for isolation, identification, typing and susceptibility testing of Campylobacter.

The CC supports strengthening AMR surveillance networks at the national level, by supporting capacity building activities on data management, data quality control, data analysis and interpretation. It supports WHO’s programmes, projects and collaboration platforms relating to antimicrobial resistance surveillance, as appropriate. It also supports WHO with the collection, collation and dissemination of information on national and regional AMR trends and threats, and provides technical expertise to WHO on standardisation of methods and development of best practices for national, regional and global surveillance of AMR.

The CC develops and maintains the Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) methodology in collaboration with WHO. This methodology serves as a tool for drug utilisation monitoring and research in order to improve quality of drug use. One component of this is the presentation and comparison of drug consumption statistics at international and other levels. The CC provides technical support to countries and provides capacity building of global surveillance. Specifically, it also supports the surveillance of antimicrobial consumption data and will be working with the Network in this area.

The CC supports WHO in strengthening AMR surveillance by providing laboratory training and Russian-speaking facilitators or consultants to support the implementation of global AMR surveillance as well EUCAST standards, laboratory Standard Operating Procedures (SOPs) and quality assurance. The CC supports the Network with technical assistance on guidance on the use of molecular methods and development of informatics tools to foster AMR surveillance implementation.

The CC provides technical support and training to countries to strengthen laboratory capacity for AMR surveillance. It provides technical assistance to implement EQA programmes on AMR pathogens to laboratories in GLASS participating countries. The CC also supports WHO to address AMR issues through the multi-sectoral approaches with the One Health concept, and to support technically for development and implementation of GLASS and AMR research.

The CC promotes infection prevention and control (IPC) awareness through the collaboration of international workshops, training Infection Preventionists from hospitals in the WHO Eastern Mediterranean Region (WHO EMRO). It supports WHO in the development of GLASS through various activities, including the development of guidelines, methodologies and manuals. The CC carries out collaboration research on Infection Prevention and Control (IPC) and AMR.

The CC supports with strengthening surveillance, addressing One Health responses, using available tools for assessing infection prevention and control in healthcare facilities and providing professional education. The CC supports the Network by leading work on the provision of technical assistance for developing functional and integrated laboratory quality systems and providing training in AMR detection and surveillance for GLASS organisms. The CC supports WHO in development of guidelines, manuals, and other tools for GLASS-related activities.

The CC supports the development and implementation of global and regional AMR and AMU surveillance and promote a One Health approach by providing technical input and support to WHO. The CC assists WHO in the implementation of integrated work on AMR and AMU with a focus on healthcare-associated infections (HCAI), including use and feedback of data for action by providing technical knowledge and human resources. The CC contributes to the work for responsible use of antibiotics and improved Infection Prevention and Control (IPC). An additional area of work is on ensuring access to existing and novel antibiotics, by support to WHO`s technical work with Member States. The CC assists WHO in the support to Member States towards the operationalization of the global AMR action plan (2015) and the regional AMR roadmap (2023 – 2030) in countries.

The CC supports with enhancing AMR surveillance in Neisseria gonorrhoeae in the WHO global Gonococcal Antimicrobial Surveillance Programme (GASP); provides expertise on sexually transmitted infections (STIs), assists in laboratory and management issues, training and research; and provides updates on the WHO N. gonorrhoeae reference strains for quality assurance of diagnostics and typing, including phenotypic and genomic AMR testing. The CC contributes this technical assistance to the Network and promotes the development of GLASS, including the implementation of GASP in the GLASS module.

The CC supports WHO AMR Surveillance networks in promoting and disseminating EUCAST antimicrobial susceptibility testing standard, and in building best practice cases for EUCAST standard uptake and implementation. The CC also supports WHO in strengthening Member States’ AMR surveillance capacity by improving laboratory capacity for antimicrobial susceptibility testing, resistance screening, and implementation of internal laboratory quality control systems.

The CC contributes its expertise on the development of control and prevention of healthcare-related infections and AMR programmes. It supports WHO in determining evidence-based elements for antibiotic stewardship and control of antimicrobial resistance, with a particular focus on multi-resistant Gram-negative bacteria. The CC provides its support to the Network by leading the work on developing protocols for the assessment of the health-economic impact of AMR for application in sentinel sites in all regions.

The CC works with WHO to support Member States with the development and implementation of national action plans on AMR. The CC provides AMR-related domestic and international training including surveillance of AMR, antimicrobial use (AMU), antimicrobial consumption (AMC), and antimicrobial stewardship (AMS). The CC also conducts research for the development of AMR/AMU/AMC surveillance and interventions to prevent and contain AMR.

The CC assists WHO in providing technical support in the development and operation of national reference laboratories through tutoring and the implementation of international External Quality Assessment (EQA) programmes and quality management. It supports the Network in capacity building/technical support on microbiology laboratory through training on performing AMR laboratory testing, as well as reporting and interpretation of AMR data.

The CC supports WHO in laboratory strengthening and capacity building in countries through technical guidance for detection and reporting of colistin resistance and the use of molecular and genomic methods to enhance surveillance. It provides expertise for the development and review of WHO guidance documents. It delivers training and mentoring to Low- and Middle- Income Countries, supports the development and delivery of AMR curricula, and promotes diagnostic stewardship and use of data for policymaking.

The CC provides technical expertise and support for the implementation, integration and interpretation of genomics and allied data for the genomic epidemiology, surveillance and monitoring of AMR. The CC will also contribute to the improvement of the GLASS system, for the incorporation of genomic data into GLASS, and develop technical specifications for the production and validation of genomic catalogues for signatures and diagnostics of AMR together with associated epidemiological, outcome, phenotypic and other metadata. The CC will also develop supporting documents and training with tangible use cases on the fundamentals of genomics for AMR surveillance.

The CC provides technical expertise in pharmaceutical policy analysis and evaluation. The CC also supports training in monitoring and evaluation of pharmaceutical policies. A particular focus of the CC has been the pharmaceutical pricing policies, generic medicines policies and promoting the appropriate use of medicines including the monitoring of AMU in countries in the Americas and around the globe.

The CC supports GLASS by developing a framework to address antifungal resistance on a global scale. It is doing this through reviewing current methods for detection of antifungal resistance in invasive fungal disease; assessing the landscape of fungal disease surveillance around the world; and mapping public and university laboratories with capacity to assist and support antifungal susceptibility testing.

The CC focuses on the detection, characterisation, analytics, and surveillance of antimicrobial resistance in animals and their environments. Its mission is to reduce the burden of AMR and preserve future antimicrobial efficacy. The CC particularly leads within the Network on the development of integrated One Health surveillance systems. It also focuses on implementing and strengthening the integrated surveillance of antimicrobial resistance in foodborne bacteria.

The CC provides technical support and training to countries and healthcare facilities developing and advancing antimicrobial stewardship initiatives upon request from WHO as part of the response to AMR problem. It also supports WHO in developing online educational content to support antimicrobial stewardship efforts, targeting the spectrum of actors, from policy makers to frontline clinicians, such as pharmacists and physicians. The CC is also contributing to the new WHO Academy course: Antimicrobial Resistance and Antimicrobial Use Surveillance by developing a module aimed at antimicrobial and diagnostic stewardship.

The CC supports and strengthens both technical and programmatic AMR capacities. It provides technical advice to WHO and identifies and works with laboratories to improve their capabilities to detect and report data on AMR both domestically and internationally, including continued assistance to countries to strengthen national and regional reference laboratory capacity and participation in GLASS. The CC provides technical advice and support on establishing comprehensive AMR surveillance, appropriate response to identified AMR threats, and focused implementation of infection control activities in countries, as needed.

The CC provides strategic and technical guidance to local, national, and international surveillance with a particular focus on the management, interpretation, and sharing of microbiology laboratory data. The team developed the free WHONET software, which is used to support surveillance activities worldwide. Areas of expertise include clinical and molecular aspects of infectious diseases and antimicrobial resistance, biostatistical methods, and software development.