Surveillance of AR is critical to providing early warning of emerging problems, monitoring changing patterns of resistance, and targeting and evaluating prevention and control measures (e). Timely surveillance information is also necessary for assisting researchers in developing new drugs and for providing good patient care. For example, clinicians should be informed of drug resistance problems in their communities that may influence their prescribing decisions in order to help them avoid treatment failures. In addition, monitoring patterns of antimicrobial drug use is needed to interpret trends and variations in rates of AR, improve understanding of the relationship between drug use and resistance, identify and anticipate gaps in availability of existing drugs, and help identify preventive interventions.
At present, the United States lacks a coordinated national plan for AR surveillance. Creating a national plan requires collaboration with partners in the public and private sectors. Improved AR surveillance depends on enhancing epidemiologic and laboratory capabilities at local, state, and national levels; using standardized and reliable laboratory testing methods; and enhancing use of informatics. |
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Issue: The United States lacks a coordinated national plan for surveillance of:
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AR emergence in organism-drug combinations of public health importance and |
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Antimicrobial drug use in human and nonhuman settings. |
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Goal: Collaborate with appropriate partners to develop procedures and methods for surveillance of AR emergence in organism-drug combinations of public health importance. |
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Action Items |
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Determine which organisms and susceptibility to specific antimicrobial drugs should be under surveillance and create a mechanism for periodic updating of this list.
Coordinators: CDC, FDA, USDA, EPA
Timeline: Initiated |
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TOP PRIORITY ACTION ITEM — With partners, design and implement a national AR surveillance plan: |
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Identify the components of a national AR surveillance plan and the roles of partners in its design and implementation.
Coordinator: CDC; Collaborators: DoD, DVA, FDA, USDA, HCFA |
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Determine which surveillance activities should be conducted routinely at national, regional, state, or local levels and which may require specialized projects.
Coordinators: CDC, FDA, USDA |
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Define the roles of clinical, reference, public health, and veterinary laboratories at federal, state, and local levels in AR surveillance.
Coordinator: CDC; Collaborators: DoD, DVA, FDA, USDA, HCFA |
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Improve coordination of AR surveillance systems at CDC, FDA, and USDA (e.g., identify components for integration).
Coordinators: CDC, FDA, USDA |
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Consider the role of non government-funded surveillance and other data collection systems to augment a national surveillance plan.
Coordinators: CDC, FDA, USDA |
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Ensure that the national AR surveillance plan is consistent with local and national surveillance methodology and infrastructure that currently exist or are being developed.
Coordinators: CDC, USDA, FDA |
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Identify and assess practical surveillance strategies for components of the national plan by conducting pilot studies and demonstration projects.
Coordinators: CDC, USDA, FDA
Timeline for entire action item 2: Begin within one to two years |
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Develop standards and methodologies. |
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Develop standards and methodologies for monitoring drug-resistant microbes in humans, animals, and plants as well as for monitoring drug-resistant microbes in food products and environmental samples.
Coordinators: CDC, UDSA, FDA, EPA |
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Develop standardized laboratory methodologies and data elements that allow susceptibility test results and AR surveillance data to be compared across geographic jurisdictions.
Coordinators: CDC, USDA, FDA, EPA |
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Explore the use of standardized definitions and methodology (Related Action Item: Surveillance #5) to create an electronic surveillance system health care institutions can use to compare AR data from other local facilities.
Coordinator: CDC; Collaborators: HCFA, DVA, DoD, HRSA |
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Encourage development of local, regional, and national data systems that allow linking of microbiology, clinical and pharmaceutical data that would support local decision making for prevention and control of antimicrobial resistance and facilitate surveillance for antimicrobial resistance at all levels.
Coordinator: CDC; Collaborators: HCFA, DVA, DoD, HRSA |
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Develop standards for reporting quantitative resistance data (e.g., minimal inhibitory concentrations or zone diameters) in ways that will detect decreased susceptibility. These standards are necessary because numerical AR test results reported nonquantitatively (e.g., as susceptible, intermediate, or resistant) as "susceptible" may mask an emerging AR problem, i.e., microbes with a small decrease in susceptibility may still be classified as susceptible.
Coordinators: CDC, USDA, FDA |
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Assess how current policies on maintaining the confidentiality of medical and veterinary data collected for other purposes relate to procedures for gathering data on antimicrobial resistance. If necessary, develop a comprehensive national confidentiality policy on human and agricultural AR surveillance that includes both patient and institutional confidentiality, is consistent with confidentiality policies applied to other forms of surveillance and research data, and recognizes the differences in human and animal medicine and food production surveillance programs.
Coordinator: CDC; Collaborators: DVA, HCFA, DoD, FDA, USDA
Timeline for entire action item 3: Initiated |
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Address additional surveillance issues unique to AR. |
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Conduct post-marketing surveillance for the development of resistance to critical antimicrobial drugs. Surveillance should be linked to information on drug use, and criteria should be developed to allow a prompt response to a finding of increased resistance associated with a specific pattern of use (e.g., consumer and professional alerts, enhanced education, labeling changes, or restrictions on use depending on the extent of and reasons for emergence of resistance).
Coordinators: FDA, CDC, USDA |
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Facilitate the collection of AR surveillance data on pathogens for which cultures are not routinely obtained, either because the infections are empirically treated without laboratory diagnosis or because they are diagnosed with nonculture tests.
Coordinator: CDC |
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Enhance availability of isolates of drug-resistant microbes to researchers (e.g., via a network of collections with an accessible databank).
Coordinator: CDC; Collaborator: NIH
Timeline for entire action item 4: Begin within one to two years |
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Goal: Collaborate with appropriate partners to develop procedures and methods for nationwide surveillance of antimicrobial drug use in human and nonhuman settings. |
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Action Items |
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TOP PRIORITY ACTION ITEM — Develop and implement procedures for monitoring antimicrobial use in human medicine, agriculture, veterinary medicine, and consumer products: |
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Link human drug-use data to clinical information (e.g., diagnosis, severity of illness, and outcome). |
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Link agricultural drug-use data to species and usage patterns. |
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Assess potential effects of geographic variations in drug use on the incidence and prevalence of antimicrobial resistance. |
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Incorporate appropriate confidentiality protections. |
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Identify and anticipate gaps in availability of existing drugs. (Related Action Item: Product Development #79).
Coordinators: CDC, FDA, USDA; Collaborators: EPA, DVA, DoD
Timeline for entire action item 5: Begin within one to two years |
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Identify and evaluate methods for collecting (e.g., optimal sampling methods) and disseminating the surveillance data on antimicrobial drug use: |
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Identify inexpensive sources of drug use data (e.g., the National Ambulatory Medical Care Survey [NAMCS], the National Hospital Ambulatory Medical Care Survey [NHAMCS], and databases in some health care delivery systems and pharmacies) and evaluate their usefulness for surveillance purposes
Coordinators: CDC, FDA |
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Consider ways that results of periodic drug use surveys could be made available to food animal producers and veterinarians to encourage participation in data collection
Coordinators: CDC, FDA, USDA
Timeline for entire action item 6: Begin within one to two years |
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Work with accrediting agencies to address antimicrobial drug-use monitoring as part of quality assurance in health care delivery systems. (Related Action Item: Prevention and Control #64)
Coordinators: CDC, HCFA
Timeline: Begin within one to two years |
