4.4 Standardisation of antibiotic susceptibility testing (AST) data reporting

WHO GLASS recommends that pathogen data should include sampling type and bacterial species details, in line with guidance laid out in the GLASS manual (WHO, 2023). Susceptibility data are derived from antimicrobial susceptibility testing (AST). AST should be performed in accordance with one of two internationally recognised microbiology standards: either that of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) or the Clinical and Laboratory Standards Institute (CLSI). This is discussed further in the Antimicrobial susceptibility testing and Quality assurance and AMR surveillance courses. We will briefly discuss quality standards that laboratories and national AMR surveillance systems must ensure in Section 5.4 Quality assurance.

Activity 4: Designing a surveillance system

Timing: Allow about 30 minutes

In Section 3, we examined examples of national AMR surveillance systems in Germany, namely the ARS and AVS. We also discussed ARVIA, the system being trialled with the aim of combining AMR and AMC data from ARS and AVS, respectively.

Taking into account what you have learnt in Section 4, what considerations would you apply when designing a system such as ARVIA?

Hint – if you were designing such a system, would ‘representativeness’ be a valid consideration? How about ensuring ‘standardisation of AST reporting’? If so, why? Write down which considerations would apply and a few points explaining why you think so.

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Answer

Representativeness – should be addressed by ensuring that AMR and AMC data are gathered from a variety of surveillance sites, and that both are collected in most sites to enable further interpretation (e.g. explore the association between consumption and resistance data).

Standardisation of AST – reporting should be addressed by ensuring surveillance sites report susceptibility data in a consistent manner, according to EUCAST or CLSI methodology, and following similar SOPs.

Other considerations:

Population estimation – Information on population makeup, for example, demographics and geographic spread, needs to be considered to ensure accurate measurement of AMR and AMC.

Epidemiology and laboratory expertise – ARVIA would rely on the expertise of bodies designated as NRLs (in this example, Robert Koch Institute).

We have discussed areas that require work on the part of local surveillance sites. We will now discuss what samples are included in the national surveillance system using this framework. Note that this is also covered in the Sampling courses.

4.3 Epidemiology and laboratory expertise

4.5 Sample collection