Guide for Establishing Laboratory-based Surveillance for Antimicrobial Resistance
(2013; 32 pages)


Antimicrobial agents play a critical role in reducing morbidity and mortality due to communicable diseases the world over. However, the emergence and spread of resistance to many of these agents are negating their efficacy. Antimicrobial resistance (AMR) threatens the effectiveness of successful treatments for infections and is a public health issue with local, national and global dimensions. In low-income countries, AMR frequently occurs in microorganisms that are likely to be transmitted in the community such as those that cause pneumonia, diarrheal diseases, typhoid fever, tuberculosis, sexually transmitted diseases and malaria. Resistance to antimicrobial agents renders drugs for these illnesses ineffective, resulting in the need for wide-scale use of broad-spectrum agents, in the process creating a major global threat. Almost all studies on the outcomes of patients with bloodstream infections demonstrate high mortality in hospitals due to inappropriate use of antimicrobial agents.

Resistant organisms or their resistance genetic materials can be spread widely by travellers or through contaminated goods traded internationally. Antimicrobial resistance thus is a global challenge requiring multidisciplinary and multisectorial efforts at national, regional and global levels. It is possible to minimize the spread of antimicrobial resistance through adopting approaches such as combination therapy, rational prescription of medication, patient adherence to prescription regimen, strong regulatory mechanisms, and educational activities, along with creating an efficient surveillance system. This is feasible through strong national monitoring programmes that aim to detect the emergence and spread of resistant strains. A number of initiatives have been launched by the WHO Regional Office for Africa and other agencies to combat the growing threat of AMR.

Members States in the WHO African Region endorsed the Integrated Disease Surveillance and Response (IDSR) strategy in 1998 and recommended the implementation of the International Health Regulations (IHR 2005) in the framework of IDSR. Effective implementation of IDSR will strengthen networks of public health laboratories and thus contribute to effective monitoring of antimicrobial resistance.

Accurate, reliable and timely laboratory testing is an essential component of effective disease prevention and management. High quality AMR testing is essential for clinicians to make accurate diagnoses, formulate treatment plans and subsequently monitor the effects of treatment. It is also important to guide national policies and treatment guidelines according to the national AMR patterns. Improving laboratory-based surveillance of AMR is a key component of health system strengthening and is critical to the enhancement of health care delivery and disease prevention and control. In addition, the WHO Global Strategy for Containment of Antimicrobial Resistance recognized laboratory-based surveillance of antibiotic resistance as a fundamental priority for the development of strategies to contain antibiotic resistance and for assessment of the impact of interventions.

To contribute to the improvement of surveillance of antimicrobial resistance at the country level, the WHO Regional Office for Africa has developed this guide to facilitate establishing of laboratory-based surveillance for priority bacterial diseases in the WHO African Region.

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