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