Table 2. Sentinel site functions for antimicrobial resistance (AMR) Surveillance (core, extended, advanced).
AMR surveillance component | Requirements and standards for core level | Extended level activities | Advanced level activities | |
---|---|---|---|---|
Overall aim | Surveillance data inform individual care | Surveillance data drive local and national
policy (e.g. empiric treatment guidelines, drug procurement) and public health activities |
||
Clinical admission
assessment and investigation |
Clinical admission
assessment |
Clinical history and examination and
investigation based on physician (syndromic) diagnosis. |
Systematic clinical history and examination
according to clinical algorithms in all patients presenting with suspected infection. |
Standardised admission proforma
documenting clinical signs and symptoms used to guide diagnosis. |
Clinical data | Clinical data included in (paper) request
for laboratory investigation, with unique alphanumeric identifier |
Clinical data included in (electronic) request
for laboratory investigation, with unique alphanumeric identifier |
Linkage of extended clinical data (e.g.
vital signs, blood results, outcomes) with laboratory data |
|
Clinical
investigation |
Systematic investigation based on physician
syndromic diagnosis |
Systematic investigation based on clinical
findings. |
||
Training and
quality assurance |
Routine training for surveillance standard
operating procedures (SOPs), quality control and Internal Quality Assessment. |
External Quality Assessment | Functions as a regional training centre | |
Isolate identification
and susceptibility testing |
Sample transport | Samples transported according to local SOPs | Samples transported according to
international biosafety standards |
|
Sample
registration |
Local laboratory paper based data system | Electronic laboratory data system | ||
Culture and
identification |
Automated blood culture system and
capacity to identify the relevant priority pathogens according to SOPs |
Automated blood culture; CSF, urine, stool
and swab culture, identifying all isolates according to SOPs for all priority pathogens. |
Automated identification (e.g. MALDI-
TOF) |
|
Susceptibility
testing |
Use of disc diffusion for blood culture priority
pathogens according to SOPs |
Use of disc diffusion methods according to
SOPs for all species; may include e-tests or broth dilution methods. |
Automated identification (e.g. VITEK) | |
Training and
quality assurance (QA) |
Routine training for SOPs, quality control and
internal QA |
External quality assessment | Functions as a regional training centre | |
Isolate storage
(local) and referral to AMR laboratory |
Storage of
isolates |
Freezer storage (-20°C) of resistant isolates
with linkage to paper or electronic database |
Reliable (generator back-up) freezer storage
(-80°C) of resistant isolates with linkage to electronic database |
|
Transport to AMR
laboratory |
Invasive isolates are transferred to AMR
laboratory annually according to SOPs |
Invasive isolates are transferred to
AMR laboratory quarterly according to international standards for biosafety |
||
Training and QA | Routine training for isolate storage,
SOPs, quality control and internal quality assessment |
External quality assessment | ||
Data review | Data use | Anonymised individual data submitted to
national coordinating centre and shared regionally and internationally |
Automated real time submission of
data to national network |
|
Data linkage | Clinical and laboratory data linked by
recording them on the same lab request form |
Automated linkage between clinical request
data and laboratory data |
Automated linkage between clinical
and laboratory databases |
|
Data governance | Data sharing policy and agreements in place
in collaboration with the Ministry of Health and/or national public health institute |