Obstacles to developing a multinational report card on antimicrobial resistance for Canada: an evidence-based review

Many countries want to compare the results of their antimicrobial resistance programs to those of others nations to help gauge the effectiveness of their prevention and control practices. In our attempt to compare Canada with other nations, we encountered several challenges that must be addressed before meaningful multinational comparisons can be made. The fundamental barriers to comparison were the lack of shared targets for performance and predictive measures of success. Unique problems and policies within countries resulted in variations in goals, methods, pathogens, drugs, and priorities within and between jurisdictions. Other obstacles included: (1) lack of information on potential biases associated with different microbiological testing and sampling methods; (2) lack of information with which to conclude whether or not different programs examined comparable spectra of patients or outcomes; (3) inadequate description of the epidemiological rationale for sampling strategies; (4) use of aggregated national data that can hide regional or local variations; (5) rarity of studies designed explicitly for multinational comparison; and (6) lack of international agreement on methods, continuing education, and quality control needed to ensure program comparability. Comparison based on a country's ability to meet its internal goals for antimicrobial resistance control may be a more informative basis for a report card than specific resistance or drug use rates.