Aura 2016: first Australian report on antimicrobial use and resistance in human health

1.6 Developing the Antimicrobial Use and Resistance in Australia Surveillance System

In 2013, the Australian Government Department of Health engaged the Commission to establish a national surveillance system for AU and AMR in human health. The Commission has undertaken wide-ranging consultation, planning and development activities to review current surveillance systems, identify the requirements of the national system, and negotiate with a range of stakeholders to build and improve surveillance infrastructure.

There have been a range of AU and AMR surveillance programs, activities, data sets and reports in Australia. AU and AMR surveillance activity occurs at the jurisdictional level in Queensland, South Australia, Tasmania, Victoria and Western Australia. These surveillance programs have considerable strengths, including in-depth subject matter expertise, high-quality information and data assets, and commitment from individuals and health organisations to sustain effective surveillance reporting for action. However, to date, there has been a lack of nationally coordinated surveillance activity.

The AURA Surveillance System will provide a comprehensive picture of patterns and trends in AU and AMR to inform clinicians; policy and program developers; health service managers and executives; and state, territory and Australian governments. These patterns and trends will guide improvements in infection control, antimicrobial stewardship and antimicrobial prescribing practices.

The planning phase for AURA has confirmed the key elements required for a comprehensive approach to surveillance in Australia. AURA will initiate data collection, where needed, to complement data and information from existing programs, and coordinate eight streams of data and information for AU and AMR. This data will cover both the community and acute sectors and, through the use of passive and targeted data collections, produce integrated surveillance reports about the current state of play, trends over time and, where feasible, the interrelationships between AMR and AU.

The AURA Surveillance System is being established by partnering and enhancing existing surveillance programs, and targeting specific action to improve data representativeness, accessibility and data analytics. This is complemented by the establishment of new systems where gaps in surveillance have been identified, such as an alert system for critical antimicrobial resistances. A number of publications have recently been released that report on the enhanced information from these programs on AU and AMR in the hospital, aged care and community sectors across Australia, and for public and private providers.^14,15

Box 1.3 Role of the Antimicrobial Use and Resistance in Australia Surveillance System

The Antimicrobial Use and Resistance in Australia Surveillance System:

improves quality, coverage and utility of existing high-quality data collections on antimicrobial use (AU) and antimicrobial resistance (AMR)

coordinates and enhances reporting for individual data collections

provides more detailed analyses across data collections, including analysing the relationships between AU and AMR at a system level

provides systematic, coordinated and centralised national reporting on AU and AMR

establishes new data collections, where needed, such as the systematic and timely identification of the emergence of critical AMRs.

The integrated approach used by AURA, combined with partnerships with existing programs, will improve understanding of AMR, and of the type, volume and nature of AU in Australia. This is being achieved through enhanced data collection, greater standardisation, and cooperation and coordination across all jurisdictions, public and private sector hospitals, and the primary and aged care sectors.

Data collections contributing to the Antimicrobial Use and Resistance in Australia Surveillance System

The AURA Surveillance System is an integrated approach to bringing together eight streams of surveillance activity through a coordinating hub in the Commission.

Currently, four core existing surveillance programs provide the foundation to AURA:

the Australian Group on Antimicrobial Resistance

the National Antimicrobial Prescribing Survey

the National Antimicrobial Utilisation Surveillance Program

the Queensland Health OrgTRx System.

In addition, data is gathered from:

the National Neisseria Network, on Neisseria gonorrhoeae and N. meningitidis

the National Notifiable Diseases Surveillance System, on Mycobacterium tuberculosis

the PBS and RPBS

NPS MedicineWise

Sullivan Nicolaides Pathology, on rates of AMR from the private sector.

Each of these programs provides valuable data on the breadth of AU and AMR surveillance. The data from these collections covers selected organisms or antimicrobials from the community and hospitals. The collections use a range of methods, sampling techniques and sources, and have largely been set up to provide data at the local or state level for specific purposes.

The coverage, capture and content of these collections have been variable. However, each of these programs is now positioned within the framework of AURA to provide an integrated and comprehensive picture of both AU and AMR in Australia over time.

1.7 AURA 2016 report

This AURA 2016 report provides a more complete picture of AU and AMR rates, and patterns and trends than has previously been available in Australia. The report provides core surveillance data, as well as describing the health impact of resistant organisms and AU. This information will support the development of action currently planned to implement the National Antimicrobial Resistance Strategy.

This report identifies key AMR issues for Australia, with information on the most frequently used antimicrobials and a designated group of priority organisms. Where available, it includes data and analyses on patterns and trends:

on antimicrobial prescribing and dispensing in hospitals, residential aged care facilities and the community

on the appropriateness of antimicrobial prescribing in acute care, general practice and residential aged care facilities

to provide evidence for AMR prevention and containment strategies by all jurisdictions

on resistance in priority organisms for key antimicrobials in acute care, residential aged care facilities and the community.

The report describes key emerging issues for AU and AMR in Australia, draws on comparisons with other countries undertaking similar surveillance, and provides commentary on the relationship between select organisms and antimicrobials.

Although the report is modelled on international reports of similar standing, it includes data on the appropriateness of AU, which has not been produced in similar overseas surveillance reports.

The 2016 report integrates data from AURA’s partner programs and organisations, and includes participation from all states and territories, and the private sector. New partnerships continue to be forged to strengthen the AURA Surveillance System. Details on the data sources and the methods for individual collections can be found in Chapter 2 and Appendix 1.

The integration of data from public and private facilities, and the community, as illustrated through the data from Queensland, has not previously been undertaken. It demonstrates the ability to bring this data together in a meaningful way, and provides an indicator of what is possible with the increasing breadth of surveillance currently under way.

Work has begun, through AURA, to examine the relationship between AU and AMR in Australian hospitals. This work is ongoing, and it is expected that the results will be presented in the next national report.

The Commission thanks each of the organisations and networks contributing to the report and to the AURA Surveillance System.