[Antimicrobial resistance surveillance: from the bottle plunged into the ocean to a critical evaluation of the methods].

Abstract

According to the resolution adopted by the Member States in the "Microbial threat" Conference, Copenhaga, 1988. antimicrobial resistance surveillance is one of the four pillars of the control strategy of this increasingly serious public health problem, coming together with the antimicrobial consumption surveillance, intersectoral actions and antibiotics prudent use promotion. Seventeen years ago, O'Brien and col. were describing the current degree of the antimicrobial resistance surveillance as follow: "There are no reliable data in this area--simply fragments of information and anecdotes that we use to draw an overall picture" (Diagnostic Microbiology and Infectious Diseases, 1992, 15.53S-60S). Ten years later, Morris and Masterton were showing that there were reports underlying the big volume of activity delivered in the field of antimicrobial resistance surveillance during that time, but there were no major changes in respect of the data quality (JAC,. 2002, 49, 7-10). According to the WHO definition, surveillance, as continuous and systematic process of data collection, data analysis and data reporting, is reaching it's scope only if it is able to provide information valuable for action. Though it is by excellence a type of surveillance based on the microbiology laboratory activity, antimicrobial resistance surveillance is not coming to be useful according to the WHO and EUCAST (European Committee for Antimicrobial Susceptibility Testing) acception without using the epidemiology methods in order to make possible the adoption of a clear strategy, starting from the definition of the type of information that we want to obtain. Pending on the scope and taking into account the preexisting premises for setting up a surveillance network, we need to select the appropriate surveillance methods, in respect of data and strains collection and storage, data reporting, appropriate denominators (population categories. admission days, patient days etc.), data stratifying etc. In Romania there are few data on antimicrobial resistance surveillance which could resist to a critical evaluation of representativity, reporting to adequate denominators, stratifying methodologies which would allow to follow trends, comparing data by wards, hospitals, counties, intercomparing data with other countries etc. Contacting the European Antimicrobial Resistance Surveillance System in 2001 was an initial modality to decrease the huge gap existing by that time, but could not remain the unique solution to develop in this direction. On the other hand, participating in the European Antimicrobial Resistance Surveillance System is enforcing the involvement of all implicated professional categories, improving logistic and interdisciplinary collaboration, in order to set up a systematic surveillance. We are supporting the initiative of a critical evaluation of the existing situation, as of setting up a surveillance strategy in accordance with the targetted goals, starting from the recent recommendations of WHO and ESCMID Antimicrobial Resistance Surveillance Study Group. This initiative could contribute, together with the participation in the European antimicrobial resistance surveillance program, to the efficient turning account of the resources and uncoordinated and sometimes redundant efforts of different working groups including prestigious microbiology, infectious diseases and epidemiology specialists.