An overview of national AMR surveillance

Introduction

You should be familiar with the concept of antimicrobial resistance (AMR) from previous modules. As a reminder, it defines a situation where microbes (e.g. bacteria, fungi, parasites or viruses) causing infection in humans, plants or animals develop the ability to remain unaffected by the drugs designed to kill them, making such antimicrobial-resistant infections difficult to treat (CDC, 2020). In this module, as in previous modules, we use the term AMR to refer mainly to bacterial antimicrobial resistance, but many of the same principles apply to resistance in other types of organisms.

The emergence of resistance in bacteria is a natural evolutionary process. It becomes a problem when there is acceleration of this natural process as a consequence of the widespread, often inappropriate, use of antimicrobials. This leads to the emergence of new strains of resistant bacteria, which are able to spread rapidly, nationally and globally, threatening the effectiveness of current treatments against infectious diseases. The inability to effectively treat infections caused by resistant organisms leads to increased morbidity and mortality. In addition, since bacteria are found across human, animal and environmental sectors, and antimicrobials are used in all of these sectors, the animal-human ecosystem interface allows for resistant organisms and/or resistance genes to be transferred from animals to humans, and vice versa. Strong interactions between humans and animals, through food production and shared environments, for example, means that countries need to take a One Health approach in building effective national AMR surveillance systems that will allow for:

• assessment of the scale of the AMR problem, across human and animal sectors
• measurement of patterns of AMR over time in a particular place(s) and species
• development of appropriate public health policies and strategies to mitigate AMR across sectors
• planning and implementation of strategies, and assessment of their ongoing effectiveness in tackling AMR across and within sectors.

We touched on examples of national AMR surveillance systems and the components of such systems, as per the WHO GLASS framework, in the module Introducing AMR surveillance systems.

In this module, the focus will be on national AMR surveillance relevant to human health. The module AMR surveillance in animals will focus on AMR surveillance in the animal sector.

After completing this module, you will be able to:

• describe the structure, functions and characteristics of AMR surveillance systems in the context of the WHO GLASS approach
• know the components of national surveillance systems and how they contribute to AMR surveillance
• understand the governance structures needed for a functioning surveillance system, such as antimicrobial resistance coordinating committees, technical working groups and equivalent bodies
• understand the key stakeholders needed to establish, support and maintain such a system
• know how your role fits within local and national AMR surveillance systems.