Community-Based Surveillance of Antimicrobial Use and ...

8. Lessons learnt and recommendationsproject members, of surveillance of AMR and ABM use in the community setting and itspublic health importance.8.5 RecommendationsCommunity surveillance of ABM use and AMR is possible in resource‐poor settings and cangenerate important information for public health planning. However, systems like these aredifficult to maintain even in well‐resourced settings. Although it is difficult to make onestandard recommendation that will be suitable for all sites, uniformity in methodology isessential to make the data collected comparable between sites.1. Community‐based surveillance of AMR and ABM use is possible in resource‐constrainedsettings, and the doing of it enables the development of multidisciplinary expertise forfuture AMR containment programmes. It is recommended that future surveillanceprojects be better integrated into existing routine systems, with sufficient long‐termtechnical support to ensure adherence to standard operating procedures.2. For ABM use, prescription data (especially that for calculating the percentage of ABMcontainingprescriptions) is probably the most reliable. However, since data on DDDprescribed per 100 patients help to provide insight into ABM use, efforts must be made tocollect these data and to improve their quality. Bulk use data may help in assessing ABMuse, but unless issues concerning quality and reliability are addressed, they are probablynot worth collecting.3. For AMR surveillance, E. coli is a suitable indicator bacterium. There are different optionsfor obtaining specimens which could yield E. coli isolates. Disc diffusion testing isprobably better than minimal inhibitory concentration (MIC) testing, at least in resourceconstrainedsettings.4. A multidisciplinary approach is required to set up and maintain the project and tointerpret data. Each site should have a qualified pharmacist/pharmacologist,microbiologist, community health personnel and a person competent in computerizeddata management. Training for data collectors, those collecting samples and managingdata is essential. A standardization workshop for the investigators dealing with differentaspects would be beneficial.5. Standard operating principles (SOPs) acceptable and practical at all sites are needed forall aspects of data collection, both for AMR and ABM use. Quality assurance schemesneed to be robust.6. Database entry programmes for ABM use and AMR need to be developed to allowuniformity in standards to assure quality of surveillance data. The design of suchdatabases should be done in consultation with experts in statistics, in order to enableappropriate analyses for time trends and measurement of impact. There should also bean in‐built mechanism for assuring quality of data collected and entered into thedatabase.103