5.2 Multinational surveillance systems

Now that you have looked at two systems which operate at national level, let’s consider two examples of multinational systems which operate across several nations. You will then look at the WHO’s GLASS programme, a standardised international programme for collecting AMR data and provides guidance on how to set up a national surveillance system which can submit data to its international platform.

EARS-NET

The European Antimicrobial Resistance Surveillance Network (EARS-NET) is an European Centre for Disease Prevention and Control (ECDC)-funded platform which operates at a pan-national level in European countries and collects routine clinical antimicrobial susceptibility data from national clinical laboratories. EARS-NET [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)] has been running since 2010 and was preceded by the European Antimicrobial Resistance Surveillance System (EARSS) established in 1998, providing useful comparisons over place and time.

EARS-NET relies on individual countries submitting data in a standard format to an intermediary system: The European Surveillance System (TESSy). Data on TESSy are then collated centrally by EARS-NET to produce comparable data on AMR across member countries, including trends in AMR which guide timely decision-making at national level.

EARS-NET requires member countries to submit information on antimicrobial susceptibility results for the following bacterial pathogens commonly causing infections in humans:

  • Escherichia coli
  • Klebsiella pneumoniae
  • Pseudomonas aeruginosa
  • Acinetobacter species
  • Streptococcus pneumoniae
  • Staphylococcus aureus
  • Enterococcus faecalis
  • Enterococcus faecium.

It should be noted that these are certainly not the only bacteria that cause infections – there are many others – however, these were chosen by the people setting up the EARS-NET system as being particularly relevant for the problem of AMR in Europe at this time. No AMR surveillance system can monitor all forms of resistance in all different bacteria – there are simply too many possibilities, so strategic choices must be made.

ReLAVRA

The Latin American Network for Antimicrobial Resistance Surveillance (ReLAVRA), is an example of a WHO/Pan American Health Organization (PAHO) network which operates at a multinational level across countries in Latin America, established in 1996.

Like EARS-NET, ReLAVRA’s aim is to inform national policies via the systematic and reliable collection of AMR data. When it was established its initial scope was limited to reporting AMR data for just three pathogens (Salmonella spp., Shigella spp. and V. cholerae). By 2000 its scope had expanded to include several predominantly hospital-associated pathogens (Escherichia coli, Staphylococcus aureus, Acinetobacter baumannii, Klebsiella spp., Pseudomonas aeruginosa, Enterobacteriales and Enterococcus spp.) and three further community-acquired pathogens (S. pneumoniae, N. meningitidis and Haemophilus influenzae) in addition to Salmonella spp. and Shigella spp.

ReLAVRA is the world’s oldest AMR surveillance network, constituting 19 countries reporting AMR data via 750 laboratories.

  • Which pathogens are included in the ReLAVRA AMR surveillance network but are not included in the EARS-NET surveillance network? Why do you think there are these differences?

  • Examples of pathogens included in ReLAVRA but not in EARS-NET are as follows:

    • V. cholerae, as there are virtually no cases in Europe, so no need to include in the surveillance programme.
    • Shigella spp., which does occur in Europe but does not often cause severe illness, so is less of a priority for surveillance, as resistance patterns are probably very similar to E. coli, to which it is very closely related.
    • Both pathogens N. meningitidis and H.influenzae are rare in Europe as there have been successful vaccination programs against major strains.

    In some countries these organiams are covered under other surveillance systems (e.g. looking at vaccine coverage and efficacy).

5.1 National surveillance systems

5.3 Setting up national surveillance systems – the WHO’s GLASS