Towards a global antibiotic resistance surveillance system: a primer for a roadmap

The need for global data about the scale of antibiotic resistance (ABR) in a geographical explicit and timely manner has been identified by many stakeholders, including the World Health Organization. This primer should help defining the objectives, scale, scope, and structure of possible future efforts. Stakeholders and their expected information demands were identified to generate an inventory of surveillance objectives. For simplification, an original approach was chosen to bundle sets of objectives that represent common demands and can be addressed by common subject areas, which fall into three areas. Subject area I addresses clinical demands and focuses on patients; subject area II addresses public health demands by focusing on meta-populations; subject area III addresses infection control demands and focuses on pathogens. A division into these areas leads to a separation of surveillance activities suggesting a modular approach which can provide complementary information. Moreover, the modules address the conundrum of ABR at the complementary levels of 1) patient, 2) population, and 3) pathogen, which-rather conventionally-follow the operational and professional fault-lines of the main disciplines involved, namely clinical medicine, public health, and biology. Essential features that define different surveillance systems have been listed and taken into consideration when suggesting templates for future efforts. Putting ABR on the global health map is a daunting task as it requires acceptance, agreements, and engagement but also concessions at many different levels. Given the existing gaps in the global diagnostic service landscape only a step-wise approach which defines achievable aims, objectives, and milestones will succeed to produce a sustainable system of international co-operative surveillance of ABR.