Readiness of national reference laboratories in the Eastern Mediterranean Region for antimicrobial resistance surveillance systems.

Abstract

Background: National reference laboratories are central to antimicrobial resistance surveillance, yet their capacities vary widely across the Eastern Mediterranean Region.

Aim: To assess the readiness of national reference laboratories in the Eastern Mediterranean Region for antimicrobial resistance surveillance.

Methods: From November 2019 to June 2020 and from December 2024 to February 2025 we collected and analysed data relating to antimicrobial resistance surveillance capacities of national reference laboratories from the 22 countries and territories in the WHO Eastern Mediterranean Region. We compared the paired binary indicators using the 2-sided exact McNemar test (P < 0.05) and analysed the secondary Global Antimicrobial Resistance and Use Surveillance System data for 2017-2023.

Results: Only 3 national reference laboratories had the full public health capacity. Limited confirmatory and reference testing, poor data integration and use, shortage of skilled workforce, and suboptimal quality assurance mechanisms were the major gaps identified. Fungal diagnostic capacity was a critical and largely neglected gap. There were no statistically significant within-country changes among the 9 countries included in the longitudinal comparison. The Global Antimicrobial Resistance and Use Surveillance System data suggest gradual strengthening of surveillance infrastructure.

Conclusion: There is an urgent need to strengthen the core functions of national reference laboratories in the Eastern Mediterranean Region to better support antimicrobial surveillance systems.