Saq065 amrau report Internal V11
Options and models for the Australian context
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- Bu səhifədəki naviqasiya:
- Key question
- 3.2 Case studies – existing programs of most relevance to the Australian context
- 3.2.1 European Centre for Disease Prevention and Control
- European Antimicrobial Resistance Surveillance Network
- Table 5: Case studies examined in this report
- Figure 6: Data flow chart from the European Antimicrobial Resistance Surveillance Network (EARS-Net)
3. Options and models for the Australian contextThis section examines the elements that drive international programs and their features that appear to be important for success, relevant to a national, coordinated surveillance system in Australia. Select programs and activities of greatest relevance are presented as case studies. Key questionWhat options or models for a nationally coordinated approach to the reporting and surveillance of antibiotic usage and antimicrobial resistance are most applicable to the Australian context? 3.1 Objectives of international antimicrobial resistance surveillance systemsThe objectives of an antimicrobial surveillance system for Australia need to be defined, as the methods used to gather data and decisions regarding data use will be driven by the objectives of the system.132 For example, if a system is to provide real-time detection of an emerging threat, it will not be satisfactory to design a system that requires annual data collection. The Centres for Disease Control and Prevention Updated Guidelines for Evaluating Public Health Surveillance Systems lists the following uses for data taken from a surveillance system and used for public health purposes:133
An overarching objective for antimicrobial surveillance might be given as: The ongoing generation, capture, assembly, and analysis of all information on the evolving nature, spread, and distribution of infecting microbes and their resistance to antimicrobial agents and its full use for actions to improve health.134 When considering appropriate objectives for an Australian system, it is informative to review those of established systems. The stated objectives of the European Antimicrobial Resistance Surveillance Network (EARS-Net) are to:
The Alliance for the Prudent Use of Antibiotics provides suggested objectives for coordinated AMR surveillance programs,135 which demonstrate significant concordance and overlap with both the generic Centers for Disease Control and Prevention (CDC) and EARS-Net objectives:
3.2 Case studies – existing programs of most relevance to the Australian contextThis section provides case studies of a number of systems that have relevance to the Australian environment – that is, they have dealt with cross-jurisdictional issues, supported surveillance in nations with well-developed healthcare systems and/or presented a model for broad surveillance across human, animal and food-related sources of AMR. In each case study, there are sections to describe the model for data collection and processing, and the ways in which data are made available to the public. Table 5 summarises the case studies. 3.2.1 European Centre for Disease Prevention and ControlThe European Centre for Disease Prevention and Control (ECDC) conducts surveillance for both AMR and antimicrobial consumption. The two programs are the European Antimicrobial Resistance Surveillance Network (EARS-Net) and European Surveillance of Antimicrobial Consumption Network (ESAC-Net). European Antimicrobial Resistance Surveillance NetworkEARS-Net is a Europe-wide network of national surveillance systems, providing European reference data on AMR for public health purposes. The network is coordinated and funded by ECDC. It is the largest publicly funded AMR surveillance system in the European region. ECDC was established in 2005 as a European Union (EU) agency, aiming to ‘… identify, assess and communicate current and emerging threats to human health posed by infectious diseases’.136 It works in partnership with existing national health protection bodies across Europe. European AMR surveillance data has been collected since 1998 by the European Antimicrobial Resistance Surveillance System (EARSS), which was coordinated by the Dutch National Institute for Public Health and the Environment (RIVM) between 1998 and 2009. Coordination of the network was transferred to the ECDC in January 2010, and the name of the network changed to EARS-Net. Historical EARSS data was transferred to The European Surveillance System (TESSy). TESSy is the single point of access for European Member States to enter and retrieve data. In 2009, EARSS was funded by ECDC and the Dutch Ministry of Welfare and Sport, at a cost of €668 458 (approximately AU$815 000), to support the external quality assurance program, organise an annual plenary meeting and more frequent scientific advisory board meetings, and undertake data management and report generation.137 This cost compares to an estimated 25 000 lives lost and around €900 000 (approximately AU$1.1 million) that is estimated to be spent each year on additional healthcare costs related to a limited number of resistant bacteria in the EU.138 In 2010, the first EARS-Net Reporting Protocol was published, which guided participating institutions on data collection, management, analysis and validation, and provided case definitions. The protocol provides detailed descriptions of data elements that are captured by the system, and was updated in 2012.139 ECDC and EARS-Net are both underpinned by Decisions and Regulations of the European Parliament.
On 30 October 2012, the World Health Organization’s European Region signed an agreement with RIVM (the original operators of the system that is now EARS-Net) and the European Society of Clinical Microbiology and Infectious Diseases to expand AMR surveillance to all countries in the WHO European Region. To date, EARS-Net has primarily covered countries that are EU Member States. The Central Asia and European Surveillance of Antimicrobial Resistance network, which will use EARS-Net methodology in collaboration with ECDC to permit comparison of data from across all of Europe, was established as a result of the EARS-Net expansion.140 Data collection and processing The national networks across Europe collect data from their own clinical laboratories. More than 900 laboratories report data from more than 1400 hospitals. In 2010, 19 of the 28 countries contributing data to EARS-Net used WHONET software.137 Each national network is responsible for uploading its data to TESSy, and then validating and approving the data before they are incorporated into the broader dataset. Bacterial isolate data are collected on the following seven organisms isolated from blood or cerebrospinal fluid according to 37 data variables described in the EARS-Net Reporting Protocol:
The flow of isolate-specific data is represented in the EARS-Net Reporting Protocol Version 2, 2012, and is represented in Figure 6. Denominator data are collected for laboratory and hospital activity, and population or patient characteristics. There are 19 data variables for denominator data, including country and laboratory location, population, and hospital or facility type, size, and activity levels. Examples of the denominator data variables captured for laboratories and hospitals are shown in Table 6. Table 5: Case studies examined in this report
AGAR = Australian Group on Antimicrobial Resistance; ANSORP = Asian Network for Surveillance of Resistant Pathogens; CHRISP = Centre for Healthcare Related Infection Surveillance and Prevention; DANMAP = Danish Integrated Antimicrobial Resistance Monitoring and Research Programme; ECDC = European Centre for Disease Prevention and Control; STRAMA = Swedish Strategic Programme for the Rational Use of Antibiotics Agents and Surveillance of Resistance; TSN = The Surveillance Network Figure 6: Data flow chart from the European Antimicrobial Resistance Surveillance Network (EARS-Net)Yüklə 0,85 Mb. Dostları ilə paylaş:
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