Monitoring antimicrobial resistance for public health action

Antibiotics are used both to treat infections in individual patients and in public health interventions to control disease outbreaks. In both circumstances the outcome, as measured by morbidity and mortality, is compromised by antimicrobial resistance (AMR) in the causative organism. Of necessity, antibiotics are frequently given empirically and their selection is based on presumptions of efficacy and the susceptibility of the infecting agent. AMR surveillance provides reassurance with regard to efficacy and guides the formulation of standard treatment regimens. However, AMR surveillance is not always appropriately performed nor are the data generated necessarily used to best advantage. Optimal use of AMR surveillance data requires for each disease of importance: an understanding of the applications of AMR surveillance and a clear definition of the type of data required: the 'triggers for surveillance'; construction of AMR surveillance programs appropriate to differing requirements; and better linkages between AMR surveillance data and disease control functions so that the thresholds for initiating public health action are clearly defined. Examples which illustrate the application of these principles are provided from experience with surveillance of AMR in the pathogenic Neisseria (N. gonorrhoeae and N. meningitidis).