3.4 National systems in action

Let us look at two examples of a national AMR surveillance system incorporating these components, in alignment with the WHO GLASS framework. We will consider two examples of German national AMR surveillance systems: one gathering data on bacterial antimicrobial susceptibility and one gathering data on antimicrobial consumption.

1. The Antibiotic Resistance Surveillance monitoring system (or ARS, in German) was established in 2007 by the Robert Koch Institute, the national public health institute of Germany. It gathers data centrally and evaluates resistance trends in the outpatient and inpatient settings. The surveillance system covers all clinically indicated samples submitted, the bacterial pathogens isolated and the antimicrobial susceptibility test results. The ARS invites submissions from medical laboratories that process samples from patients in medical facilities. Resistance statistics based on this data are then made accessible via an interactive dashboard. The platform is supported by multiple agencies including the National Antibiotics Committee and National Reference Centres. The National Reference Centres have an advisory function and deal with:
   • developing and improving diagnostic methods for pathogens
   • examining trends in resistance development
   • publishing frequent reports on the epidemiology of AMR.
   As of 2017, the ARS gathered data from medical laboratories that serve 483 general hospitals and 18,129 general practices (community-based care providers) in Germany. Via ARS, Germany participates in the European Antimicrobial Resistance Surveillance Network (EARS-Net) and WHO GLASS.
2. Alongside Antibiotic Resistance Surveillance Monitoring System (ARS), the Robert Koch Institute set up the Antimicrobial Consumption Surveillance (AVS, in German) to support hospitals carrying out AMC surveillance. It gathers AMC data from 397 hospitals and rehabilitation facilities.

Germany is currently trialling a system called ARVIA, an integrated antimicrobial resistance and consumption monitoring project, which aims to combine AMR and AMC surveillance data at national level from ARS and AVS, respectively.