Table 6.

Antimicrobial resistance surveillance and antimicrobial stewardship

Which resistant pathogens should be targeted?
3.1. Essential	Monitor methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, carbapenem-resistant Gram-negatives, ESBL-producing bacteria and colistin-resistant Gram-negative bacteria in all blood cultures and Clostridioides difficile.
3.2. Essential	In highly endemic settings for tuberculosis, check availability of local data on resistance in tuberculosis and consider having a section of the periodic report summarizing the most important information.
3.3. Essential	Before starting a surveillance programme, ensure minimum infrastructural requirements and alignment with quality control programmes to support AMR surveillance.
3.4. Essential	Monitor antibiotic resistance to new antibiotics in settings highly endemic for multidrug-resistant Gram negatives.
3.5. Desirable	Monitor resistance in Candida spp. if the stewardship intervention is targeting institutions/wards with high rates of invasive fungal infections (i.e. haematology, transplant centre, ward with high consumption of broad-spectrum antibiotics).
How should resistance be monitored?
3.6. Desirable	Monitor MICs (or inhibition zones) of resistant bacteria of primary clinical importance at the local/unit level.
3.7. Desirable	Where resources allow, monitor molecular mechanisms of resistance in clinically relevant strains according to the antimicrobial stewardship team.
Should non-clinical samples (screening and colonization status) be monitored?
3.8. Desirable	Monitor resistance in screening samples in settings with infection control measures applied to colonized patients (e.g. targeting screening and contact precautions, preventive isolation).
Which time interval should be used for reporting?
3.9. Essential	Provide an annual analysis of cumulative susceptibility data on the identified resistant bacteria target at your facility.
3.10. Desirable	Where resources allow provide antimicrobial resistance reporting more frequently than yearly in certain settings and/or for specific endemic resistant phenotypes (ICUs).
Which stratification criteria should be adopted?
3.11. Essential	Provide unit-specific resistance surveillance data.
3.12. Desirable	For settings where the number of infections per genus is limited (i.e. neonatal or paediatric intensive care units), check if regional data (for the same setting) are available and evaluate if generalizability of the data to your setting is applicable.
Report delivery
3.13. Essential	Deliver a report to prescribers with a commentary; consider highlighting specific data that might require re-evaluation of therapeutic guidelines.