1

Objective 2: Strengthen the knowledge and evidence base through research and surveillance

Global

Advisory Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR)

The WHO Advisory Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR) was established in December 2008 to support WHO's effort to minimize the public health impact of antimicrobial resistance associated with the use of antimicrobials in food animals. In particular, the Advisory Group assists WHO on matters related to the integrated and coordinated surveillance of antimicrobial resistance across humans, animals and the environment and the containment of food-related antimicrobial resistance. AGISAR is working towards global standardization and harmonization of monitoring along the chain from food production to humans. http://www.who.int/foodborne_disease/resistance/agisar/en/ In 2013 AGISAR published guidance on integrated surveillance: http://apps.who.int/iris/bitstream/10665/91778/1/9789241506311_eng.pdf

Codex Alimentarius Commission

The Codex Alimentarius international food standards, guidelines and codes of practice contribute to the safety, quality and fairness of the international food trade. The Codex Committee on Residues of Veterinary Drugs in Foods (CCRVDF) was formed (a) to determine priorities for the consideration of residues of veterinary drugs in foods; (b) to recommend maximum levels of such substances; (c) to develop codes of practice as may be required; and, (d) to consider methods of sampling and analysis for the determination of veterinary drug residues in foods. http://www.codexalimentarius.org/committees-and-task-forces/en/?provide=committeeDetail&idList=6

Commonwealth AMR Laboratory Twinning Programme

Linking with the Commonwealth Secretariat, Public Health England is leading the development of a Commonwealth microbiology laboratory twinning initiative to combat AMR, in which high income Commonwealth countries can twin with low and middle income Commonwealth countries. This will support Commonwealth countries’ responses to AMR for their own populations and contribute to wider regional and international efforts. Twinning may be extended from laboratory capacity building to epidemiological partnering, strengthening disease surveillance and sharing wider expertise. http://thecommonwealth.org/media/news/commonwealth-and-public-health-england-strengthen-public-health-laboratories

Global Early Warning System (GLEWS)

The Global Early Warning System (GLEWS) is a joint system that builds on the added value of combining and coordinating the alert and disease intelligence mechanisms of OIE, FAO and WHO for the international community and stakeholders to assist in prediction, prevention and control of animal disease threats, including zoonoses, through sharing of information, epidemiological analysis and joint risk assessment. http://www.glews.net/

Global Point Prevalence Survey of Antimicrobial Consumption and

The GLOBAL-PPS is a project to expand the standardised surveillance method of data collection that can be used at a global level to monitor rates of antimicrobial prescribing in hospitalised patients. It establishes a global network for point prevalence surveys and aims to include as many hospitals from as many countries from all continents. The proposed network will create global awareness about antibiotic use and

2

Resistance (GLOBAL-PPS) resistance. http://app.globalpps.uantwerpen.be/globalpps_webpps

Gonococcal Antimicrobial Surveillance Programme (GASP)

The GASP is a worldwide laboratory network that is coordinated by focal points and regional coordinating centres. Each designated regional focal point, in partnership with its WHO regional office, collates data on patterns of antimicrobial susceptibility in gonorrhoea in participating countries. http://www.who.int/reproductivehealth/topics/rtis/gasp_network/en/

Joint Programming Initiative on Antimicrobial Resistance (JPIAMR)

The Joint Programming Initiative on AMR (JPIAMR) has been set up with support from the European Commission, bringing together 17 European countries, Israel and Canada to coordinate AMR research efforts, in order to allow greater impact and avoid duplication. JPIAMR’s Strategic Research Agenda (SRA) will provide guidance for future JPIAMR activities and has six priority topics:

Therapeutics: Development of novel antibiotics and alternatives for antibiotics – from basic research to the market.

Diagnostics: Design strategies to improve treatment and prevention of infections by developing new diagnostics.

Surveillance: Standardisation and extension of surveillance systems to establish a global surveillance programme on antibiotic resistance and antibiotic use.

Transmission: Transmission dynamics.

Environment: The role of the environment as a source for the selection for and spread of AMR.

Interventions: Designing and testing interventions to prevent acquisition, transmission and infection caused by AMR. http://www.jpiamr.eu/about/aims-objectivesexpected-outcomes/ http://www.jpiamr.eu/download/SRA1_JPIAMR.pdf

Study for Monitoring Antimicrobial Resistance Trends (SMART).

The purpose of SMART is to monitor the in vitro susceptibility of clinical bacterial isolates to antimicrobials in intra-abdominal infections worldwide. SMART monitors longitudinal susceptibility patterns (based on bacterial population MICs) among target organisms in the regions of Asia/Pacific, Latin America, Middle East/Africa, North America, and Europe. The study was initiated in 2002. http://www.globalsmartsite.com/login.aspx?ReturnUrl=%2fdefault.aspx http://www.inrud.org/icium/conferencematerials/1057-straus-_a.pdf

Tigecycline Evaluation and Surveillance Trial (T.E.S.T.)

T.E.S.T. (Tigecycline Evaluation and Surveillance Trial) is a global multi-center surveillance study designed to assess the in vitro activity of tigecycline and comparators against a range of important pathogens, from both the community and the hospital. T.E.S.T. began in 2004. http://www.testsurveillance.com/ http://www.testsurveillance.com/?view=site_description&template=blank

World Organisation for Animal Health (OIE)

With regards to the surveillance of the use of antimicrobial agents in a country:

The OIE Terrestrial Animal Health Code Chapter 6.8.: Monitoring of the quantities and usage patterns of antimicrobial agents used in food producing animals. http://www.oie.int/index.php?id=169&L=0&htmfile=chapitre_antibio_monitoring.htm

The OIE Aquatic Animal Health Code Chapter 6.3.: Monitoring of the quantities and usage patterns of antimicrobial agents used in aquatic animals. http://www.oie.int/index.php?id=171&L=0&htmfile=chapitre_antibio_quantities_usage_patterns.htm

OIE’s Terrestrial Animal Health Code also includes standards on: Harmonisation of national antimicrobial resistance surveillance and

3

monitoring programmes. http://www.oie.int/index.php?id=169&L=0&htmfile=chapitre_antibio_harmonisation.htm

The OIE has established a new ad hoc Group to develop an overall approach to collecting and reporting standardised data on antimicrobial agents used in animals and to build a global database on the use of antimicrobial agents in animals. http://www.ema.europa.eu/docs/en_GB/document_library/Presentation/2014/03/WC500162570.pdf

Guidelines on ‘Laboratory methodologies for bacterial antimicrobial susceptibility testing’ are published in the Manual of Diagnostic Tests and Vaccines for Terrestrial Animals. http://www.oie.int/fileadmin/Home/eng/Health_standards/tahm/GUIDE_3.1_ANTIMICROBIAL.pdf

The OIE has also developed a Tool for the Evaluation of Performance of Veterinary Services (OIE PVS Tool). http://www.oie.int/support-to-oie-members/pvs-evaluations/oie-pvs-tool/

Regional

Africa

WHO Regional Office for Africa

In order to contribute to the improvement of surveillance of antimicrobial resistance at the country level, WHO/AFRO has developed a guide for establishing laboratory-based surveillance of antimicrobial resistance. http://www.afro.who.int/en/media-centre/afro-feature/item/6768-towards-enhanced-surveillance-of-antimicrobial-resistance-in-the-who-african-region.html

Americas

Latin American Network for Antimicrobial Resistance Surveillance (Red Latinoamericana de Vigilancia de la Resistencia a los Antibióticos) (ReLAVRA)

In the mid-1990s, the Pan American Health Organization (PAHO), designed and implemented ReLAVRA, a programme aimed at strengthening microbiology laboratories in the Americas, to improve their ability to identify bacteria and test their susceptibility to antimicrobial drugs. The program had two main objectives:

To improve surveillance of antimicrobial resistance

To improve the national capacity of countries in the Americas to address antimicrobial resistance. The Network started with eight countries in 1996 and had grown to 21 countries by 2011, with the 6 Caribbean countries being the latest group of countries to join. http://new.paho.org/sscoop/?p=177&id=4 http://new.paho.org/sscoop/wp-content/plugins/form/download.php?file=sscoop/wp-content/plugins/form/files/19143052Drug_Resistance.pdf&PHPSESSID=1f0457c7479e41e9bb1535f90fa52cd2

Asia

Asia Pacific Foundation for The Asia Pacific Foundation for Infectious Diseases (APFID) was founded in 1999 as Asia’s first international foundation for research, control

4

Infectious Diseases (APFID)

and prevention of infectious diseases including AMR. APFID serves as a core infrastructure for control and prevention of infectious diseases and AMR in the Asian region through collaborative research, technical development, exchange of ideas and information, and strategic planning. APFID has been operating four major international programmes:

Asian Network for Surveillance of Resistant Pathogens (ANSORP)

Asian Bacterial Bank (ABB)

International Symposium on Antimicrobial Agents and Resistance (ISAAR)

Initiatives to Control Antimicrobial Resistance (I CARE). (Source: Antibiotic Resistance - a Threat to Global Health Security and the Case for Action, Written submissions (Asia) (2013). Link to document available through: http://www.who.int/drugresistance/activities/wha66_side_event/en/)

Europe

European Commission funded research

The European Commission has prioritised research to combat antimicrobial resistance over three successive Framework Programmes for Research starting from FP5 in 1999 through to FP7 and Horizon 2020 today. The EU has awarded nearly €950 million to transnational collaborative projects on antimicrobial resistance, mostly in the area of human health, but also in the areas of animal health, food and the environment. (This includes around €155 million for AMR research supported via the Innovative Medicines Initiative (see IMI entry).) The research priorities address all pathogens ( bacteria, virus, fungal and parasites) and takes a ‘One Health’ approach in addressing the following aspects:

Understanding the mechanisms and transmission dynamics of resistance

Development of diagnostics

Development of therapeutics and alternatives including vaccines

Improved surveillance systems

Understanding the role of the environment, animals and the food chain in the development and spread of AMR

Development of interventions to prevent acquisition and transmission of AMR pathogens. http://ec.europa.eu/health/files/committee/73meeting/pharm666_commission_s_reply_to_consultation.pdf

Joint Opinion on antimicrobial resistance (AMR) focused on zoonotic infections

Joint Opinion on antimicrobial resistance (AMR) focused on zoonotic infections: Scientific Opinion of the European Centre for Disease Prevention and Control; Scientific Opinion of the Panel on Biological Hazards; Opinion of the Committee for Medicinal Products for Veterinary Use; Scientific Opinion of the Scientific Committee on Emerging and Newly Identified Health Risks. The Joint Opinion includes a chapter on the areas where innovation and research should be encouraged in order to address existing problems caused by AMR. http://www.ema.europa.eu/docs/en_GB/document_library/Other/2009/11/WC500015452.pdf

Antimicrobial Resistance and Healthcare associated Infections Programme (ARHAI)

The European Centre for Disease Prevention and Control’s ARHAI programme focuses on four areas of public health: surveillance, response and scientific advice, training and communication to address the threat of antimicrobial resistance and healthcare-associated infections. Objectives:

To improve coordination, methods and capacities for surveillance of AMR, antimicrobial consumption and Healthcare-Associated Infections (HAI). (See entries for EARs-Net, ESAC-Net and HAI-Net)

5

To manage an Epidemic Intelligence Information System (EPIS): a web-based platform for rapid communication on AMR and HAI events between competent bodies and experts

To provide evidence-based guidance and systematic reviews on the prevention and control of AMR and HAI in healthcare settings and in the community

To contribute to training on surveillance, prevention and control of AMR and HAI

To support Member States activities in the field of AMR, antimicrobial consumption and HAI http://www.ecdc.europa.eu/en/activities/diseaseprogrammes/ARHAI/Pages/index.aspx

http://www.ecdc.europa.eu/en/activities/diseaseprogrammes/ARHAI/Pages/about_programme.aspx

European Antimicrobial Resistance Surveillance Network (EARS-net)

EARS-Net is a European wide network of national surveillance systems, providing European reference data on antimicrobial resistance for public health purposes. The network is coordinated and funded by the European Centre for Disease Prevention and Control. http://www.ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/index.aspx

Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR)

The CAESAR network is a joint initiative of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the Dutch National Institute for Public Health and the Environment (RIVM) and WHO Regional Office for Europe, to survey, contain and prevent emergence and spread of antibiotic resistance in the European Region. The aim of CAESAR is gradually to set up a network of national AMR surveillance systems in all countries of the Region that are not part of the AMR surveillance network EARS-Net of the European Commission. http://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/antimicrobial-resistance/central-asian-and-eastern-european-surveillance-on-antimicrobial-resistance-caesar

Annual summary reports on zoonoses and food-borne outbreaks from the European Food Safety Authority (EFSA) and European Centre for Disease Prevention and Control (ECDC)

EFSA monitors and analyses the situation on zoonoses, zoonotic micro-organisms, antimicrobial resistance, microbiological contaminants and food-borne outbreaks across Europe. The Authority is assisted by the Task Force on Zoonoses Data Collection: a pan-European network of national representatives of EU Member States, other reporting countries, as well as the World Health Organization (WHO) and World Organisation for Animal Health (OIE). Based on data collected by the EU Member States, EFSA produces in cooperation with ECDC the annual European Union Summary Reports on zoonotic infections and food-borne outbreaks. These illustrate the evolving situation in Europe regarding the presence of zoonotic micro-organisms in the food chain and the prevalence of animal and human infection as well as disease outbreaks caused by consuming contaminated food. http://www.efsa.europa.eu/en/topics/topic/monitoringandanalysisoffood-bornediseases.htm The European Union Summary Report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food in 2012. http://www.efsa.europa.eu/en/efsajournal/pub/3590.htm The European Union Summary Report on Trends and Sources of Zoonoses, Zoonotic Agents and Food-borne Outbreaks in 2012 http://www.ecdc.europa.eu/en/publications/Publications/EU-summary-report-zoonoses-food-borne-outbreaks-2012.pdf

AMR (EURL-AR) and National Reference Laboratories network

In the EU, an official network of laboratories for antimicrobial resistance has been created for the monitoring of AMR in the food chain. The network is composed of the European Reference Laboratory for AMR (EURL-AR) and the National Reference Laboratories appointed by each Member State. http://ec.europa.eu/health/files/committee/73meeting/pharm666_commission_s_reply_to_consultation.pdf

6

Harmonized monitoring and reporting of AMR in zoonotic and commensal bacteria

In order to improve and harmonize the surveillance systems in the veterinary and food sector, the European Commission has laid down, based on an EFSA opinion (http://www.efsa.europa.eu/en/topics/topic/amr.htm), the legal requirements for the harmonized monitoring and reporting of AMR in zoonotic and commensal bacteria. (http://ec.europa.eu/food/food/biosafety/antimicrobial_resistance/index_en.htm) http://ec.europa.eu/health/files/committee/73meeting/pharm666_commission_s_reply_to_consultation.pdf

European Surveillance of Antimicrobial Consumption Network (ESAC-Net)

ESAC-Net (formerly ESAC) is a Europe-wide network of national surveillance systems, providing European reference data on antimicrobial consumption. ESAC-Net collects and analyses data on antimicrobial consumption from EU and EEA/EFTA countries, both in the community and in the hospital sector. The collected data are used to provide timely information and feedback to EU and EEA/EFTA countries on indicators of antimicrobial consumption. These indicators provide a basis for monitoring the progress of EU and EEA/EFTA countries towards prudent use of antimicrobials. http://www.ecdc.europa.eu/en/activities/surveillance/ESAC-Net/Pages/index.aspx

European Surveillance of Veterinary Antimicrobial Consumption (ESVAC)

The ESVAC project collects information on the sales of antimicrobial medicines for use in animals across the European Union (EU). The European Medicines Agency started this project in April 2010 following a request from the European Commission for the Agency to develop a harmonised approach for the collection and reporting of data on the use of antimicrobial agents in animals from EU Member States. http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/document_listing/document_listing_000302.jsp

Joint Interagency Antimicrobial Consumption and Resistance (JIACRA)

JIACRA aims to promote smooth and effective cooperation between the European Centre for Disease Prevention and Control (ECDC), the European Food Safety Authority (EFSA) and the European Medicines Agency (EMA) on integrated use and reporting of data on usage of, and resistance to, antimicrobial agents in humans, animals and food in the European Union. http://www.ema.europa.eu/docs/en_GB/document_library/Presentation/2014/03/WC500162564.pdf

Healthcare-associated Infections Surveillance Network (HAI-Net)

HAI-Net is a European network for the surveillance of healthcare-associated infections (HAI). The network is coordinated by the European Centre for Disease Prevention and Control (ECDC). The main priorities of HAI-Net are the coordination of the European point prevalence survey of HAI and antimicrobial use in acute care hospitals, the European surveillance of surgical site infections, the European surveillance of HAI in intensive care units and the repeated prevalence surveys of HAI and antimicrobial use in European long-term care facilities. http://www.ecdc.europa.eu/en/activities/surveillance/HAI/Pages/default.aspx

Healthcare-associated infections in long-term care facilities (HALT2)

The HALT-2 project: between April and May 2013, 1,181 long-term care facilities (LTCFs) in 19 European countries (including three UK administrations) participated in the HALT-2 point prevalence survey (PPS) of healthcare-associated infections (HAIs) and antimicrobial use in European LTCFs. http://www.ecdc.europa.eu/en/publications/Publications/healthcare-associated-infections-point-prevalence-survey-long-term-care-facilities-2013.pdf https://halt.wiv-isp.be/default.aspx

Programme on Food- and Waterborne Diseases and Zoonoses (FWD)

The Programme on Food- and Waterborne Diseases and Zoonoses (FWD) was set up in 2006. Objectives are:

Improving and harmonizing surveillance of FWD

Improving knowledge of prevention and control of FWD

7

Strengthening capacity in the Member States

Improving early detection and coordinated response to EU-wide FWD outbreaks with an EU dimension

Facilitating collaboration between public health, veterinary and food sectors. http://www.ecdc.europa.eu/en/activities/diseaseprogrammes/fwd/Pages/about_the_programme.aspx

Appropriateness of prescribing antibiotics in primary healthcare in Europe with respect to antibiotic resistance (APRES)

The APRES project investigated the appropriateness of prescribing antibiotics in primary health care. It collected information on antibiotic resistance patterns in S. aureus in primary care with antibiotic prescription patterns retrieved from General Practitioners The multicountry collaboration started in October 2009 and ran for 4 years. http://www.nivel.nl/en/apres Key findings: http://www.nivel.nl/sites/default/files/APRES%20results%20-%20Schellevis.pdf

European collaborative project for studying the impact of Specific Antibiotic Therapies on the prevalence of hUman host ResistaNt bacteria (SATURN)

The SATURN project aimed to study the impact of antibiotic exposure on AMR with a multidisciplinary approach that bridged molecular, epidemiological, clinical and pharmacological research. http://www.saturn-project.eu/ http://www.saturn-project.eu/publications/scientific-publications/

Antimicrobial Advice ad hoc Expert Group (AMEG)

The AMEG is composed of representatives and experts from the European Medicines Agency’s (EMA) Committee for Medicinal Products for Veterinary Use (CVMP) and Committee for Medicinal Products for Human Use (CHMP) as well as the CVMP Antimicrobials Working Party and the CHMP Infectious Diseases Working Party, from the European Food Safety Authority (EFSA), the European Centre for Disease Prevention and Control (ECDC) and the Joint Interagency Antimicrobial Consumption and Resistance Analysis Report (JIACRA). It was set up to answer four questions posed by the European Commission in April 2013 when it requested scientific advice from the EMA on the impact of the use of antibiotics in animals on public health and animal health and measures to manage the possible risk to humans. http://www.ema.europa.eu/ema/index.jsp?curl=pages/regulation/document_listing/document_listing_000385.jsp&mid=WC0b01ac058080a585

Translational Research on Antimicrobial resistance and Community-acquired infections in Europe (TRACE)

TRACE (Translational Research on Antimicrobial resistance and Community-acquired infections in Europe) was launched in 2011, in Antwerp, supported by ESF (European Science Foundation), GRACE (Genomics to combat Resistance against Antibiotics in Community-acquired LRTI in Europe; www.grace-lrti.org) and 5 other partners. TRACE aims to consolidate the expertise integrated in several research programmes, in particular within the GRACE Network of Excellence, beyond EC funding, and to apply it to steer ongoing and to deploy new research activities, and to disseminate its results. (See also GRACE entry.) http://www.esf.org/index.php?id=9058

Europe and North America

ResistanceMap ResistanceMap is a collection of tools summarizing national and subnational data on antimicrobial use and resistance in North America and

8

Europe. It was established by the Center for Disease Dynamics, Economics and Policy (CDDEP) http://www.cddep.org/projects/resistance-map

National

Australia

Antimicrobial Resistance Standing Committee (of Australia)

National surveillance and reporting of antimicrobial resistance and antibiotic usage for human health in Australia, 2013, presents a review and analysis of national and international systems for the surveillance and reporting of AMR and antibiotic usage relative to the needs and characteristics of the Australian context. http://www.safetyandquality.gov.au/wp-content/uploads/2014/02/National-surveillance-and-reporting-of-antimicrobial-resistance-and-antibiotic-usage-for-human-health-in-Australia.pdf

Australian Group on Antimicrobial Resistance (AGAR)

AGAR is a collaboration of clinicians and scientists from major microbiology laboratories around Australia. AGAR tests and gathers information on the level of antibiotic resistance in bacteria causing important and life threatening infections around Australia. The group started in 1985 and has subsequently grown to involve 30 institutions including 4 private laboratories. The main focus of the group has been antimicrobial resistance in Staphylococcus aureus but has broadened to include studies on E. coli, Enterobacter spp., Klebsiella spp., Haemophilus influenzae, Streptococcus pneumoniae and Enterococcus spp. Survey reports are available to the public. http://www.agargroup.org/

Australian Government Department of Agriculture

The Department of Agriculture has commissioned a report on surveillance and reporting of antimicrobial resistance and antibiotic usage in animals in Australia that was due for completion in the latter part of 2014. The report will provide options for monitoring and surveillance in the animal/agriculture sector which could fit within a nationally coordinated One Health framework. http://www.agriculture.gov.au/animal-plant-health/animal/amr

Canada

The Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS)

CIPARS monitors trends in antimicrobial use and antimicrobial resistance in selected bacterial organisms from human, animal and food sources across Canada. The programme is based on several representative and methodologically unified surveillance components which can be linked to examine the relationship between antimicrobials used in food-animals and humans and the associated health impacts. (http://www.phac-aspc.gc.ca/cipars-picra/index-eng.php).

Canadian Nosocomial Infection Surveillance Program (CNISP)

Established in 1994, the objectives of CNISP are to provide rates and trends of healthcare-associated infections at Canadian healthcare facilities, thus enabling comparison of rates (benchmarks), and to provide data that can be used in the development of national guidelines on clinical issues related to healthcare-associated infections. At present, 54 sentinel hospitals from 10 provinces participate in the CNISP network. http://www.phac-aspc.gc.ca/nois-sinp/survprog-eng.php

9

China

Ministry of Health, China China has established the Ministry of Health Center for Antibacterial Surveillance; China Antimicrobial Resistance Surveillance System; and the Chinese Monitoring Network for Rational Use of Drug. http://www.carss.cn/

Denmark

Danish Integrated Antimicrobial Resistance Monitoring and Research Programme (DANMAP)

DANMAP is the Danish programme for surveillance of antimicrobial consumption and resistance in bacteria from animals, food and humans. It was established in 1995. The objectives are:

To monitor the consumption of antimicrobial agents for food animals and humans

To monitor the occurrence of antimicrobial resistance in bacteria isolated from food animals, food of animal origin and humans

To study associations between antimicrobial consumption and antimicrobial resistance

To identify routes of transmission and areas for further research studies. The monitoring of antimicrobial resistance is based on three categories of bacteria: Human and animal pathogens, zoonotic bacteria, and indicator bacteria. http://www.danmap.org/

Germany

GERMAP

GERMAP provides a summary of data on the consumption of antimicrobials and the extent of resistances against antimicrobials in human and veterinary medicine in Germany. http://www.bvl.bund.de/SharedDocs/Downloads/05_Tierarzneimittel/germap2012.pdf?__blob=publicationFile&v=4

MedVet-Staph The MedVet-Staph consortium was founded in 2010 to study the zoonotic impact of S. aureus/MRSA. In its first research period (2010-2013) the MedVet-Staph consortium has demonstrated that LA-MRSA causes a significant burden of human colonization and (healthcare-associated) infection in the German population and in animals. Since 2014, the consortium continues its work in a second research period. http://www.medvetstaph.net/EN/projectbackground.html

Resistance in Enterobacteriaceae (RESET)

The research group RESET deals with the study of antibiotic resistance in a group of bacteria, the Enterobacteriaceae. These include intestinal bacteria such as Escherichia (E.) coli and Salmonella (S.) enterica, which occur not only in humans but also in animals and the environment. RESET investigates: the incidence of antibiotic-resistant intestinal bacteria, their origin and the transmission paths, including via food. www.reset-verbund.de

India

Centre for Science and Environment

The Centre for Science and Environment is a public interest research and advocacy organisation based in New Delhi with a multi-year programme on the rational use of antibiotics in food-producing animals with an aim to contain the emergence and spread of AMR. The

10

programme includes laboratory studies (conducted in its in-house lab – Pollution Monitoring Laboratory http://cseindia.org/taxonomy/term/20166/menu), policy research, advocacy and awareness creation and media outreach). In July 2014 it released the finding of a study on antibiotic residues in chicken (Antibiotics in Chicken Meat http://cseindia.org/content/latest-study-cse%E2%80%99s-pollution-monitoring-lab-finds-antibiotic-residues-chicken). It has also published a report on antibiotic residues in honey http://cseindia.org/taxonomy/term/20166/menu. www.cseindia.org

Ireland

Point Prevalence Survey of Healthcare‐Associated Infections & Antimicrobial Use in Long‐Term Care Facilities (HALT):

The HALT survey in May 2013 was a national point prevalence survey of healthcare‐associated infections (HCAI) and antimicrobial use, covering 9,318 residents in 190 Irish long‐term care facilities. It is the national report for Ireland. http://www.hpsc.ie/A-Z/MicrobiologyAntimicrobialResistance/InfectionControlandHAI/Surveillance/HCAIinlongtermcarefacilities/HALTReports/2013Report/National2013HALTReport/File,14540,en.pdf

Japan

The Japanese Veterinary Antimicrobial Resistance Monitoring System (JVARM)

The objectives of JVARM, established in 1999, are to monitor the occurrence of antimicrobial resistance in bacteria in food-producing animals, and monitor the consumption of antimicrobials for animal use. Moreover, to identify the efficacy of antimicrobials in food-producing animals, to promote prudent use of such antimicrobials, and to ascertain the public health problem. JVARM is composed of three parts:

Monitoring the quantities of antimicrobials used in animals

Resistance monitoring in zoonotic and indicator bacteria isolated from healthy animals

Resistance monitoring in animal pathogens isolated from diseased animals. http://www.maff.go.jp/nval/tyosa_kenkyu/taiseiki/monitor/e_index.html

Lebanon

Lebanese University Research about antibiotics use in the country, including the dispensing policy of non-medical prescription antibiotics in community pharmacies, assessing the possible influence of the socio-economic level of the area over this practice. http://www.pubfacts.com/detail/25139454/Antibiotic-dispensation-by-Lebanese-pharmacists:-A-comparison-of-higher-and-lower-socio-economic-lev

Malawi

Malawi-Liverpool-Wellcome Trust Clinical Research Programme

Since 1999, the Programme's laboratories in Blantyre have been investigating health problems of local, regional and global significance such as malaria, HIV/AIDs, anaemia, tuberculosis and other bacterial and viral infections, including patterns of antibiotic resistance, and have collected a wealth of clinical and microbiological data on severe bacterial infection. Researchers are also studying the development of

11

insecticide resistance in mosquitoes. http://www.wellcome.ac.uk/Funding/International/Major-Overseas-Programmes/Malawi/WTDV027667.htm

Malaysia

National Surveillance of Antibiotic Resistance Report

The Malaysian Ministry of Health publishes annual surveillance reports on antibiotic resistance. For the year 2013, 38 hospitals participated in this surveillance data based on the antibiotic susceptibility testing of bacterial isolates. Antibiotic susceptibility data from 304,221 isolates were analysed. http://www.imr.gov.my/en/component/content/article/75-english-content/national-collabration/1469-nsar-main.html

Netherlands

Nethmap and MARAN Jointly, NethMap and MARAN provide a comprehensive overview of antibiotic usage and resistance trends in the Netherlands in humans and in animal husbandry and therefore offer insight into the ecological pressure associated with emerging resistance.

NethMap: Consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria in the Netherlands

MARAN: Monitoring of Antimicrobial Resistance and Antibiotic Usage in Animals in the Netherlands http://www.swab.nl/swab/cms3.nsf/uploads/05ABE3EF93A82F4BC1257D07001DE8BC/$FILE/Boek%20Nethmap-MARAN%202014%20TG.pdf

Norway

Norm/NormVet Report Surveillance of antibiotic resistance among pathogenic bacteria from humans occurs through NORM, coordinated by the Department of Microbiology at the University Hospital of North Norway.

The NORM-VET monitoring programme for antimicrobial resistance in the veterinary and food production sectors was established in 2000 and is coordinated by the Norwegian Zoonosis Centre at the Norwegian Veterinary Institute. Data from NORM-VET forms the basis for describing the relationship between the use of antimicrobials and occurrence of resistance.

http://www.vetinst.no/eng/Surveillance-programmes/Antimicrobial-resistance-NORM-VET NORM and NORM-VET collaborate and publish a joint Annual report on Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway in animals and humans. http://www.vetinst.no/eng/Publications/NORM-NORM-VET-Report

Sweden

SWEDRES/SVARM – Use of antimicrobials and occurrence of antimicrobial resistance in Sweden

An annual integrated report on Swedish Antibiotic Utilisation and Resistance in Human Medicine (SWEDRES) and Swedish Veterinary Antimicrobial Resistance Monitoring (SVARM), published by Public Health Agency of Sweden and National Veterinary Institute. The integrated report includes data from humans, animals and food, one of the products that is a result of the successful collaboration between the human and veterinary sector in Sweden. http://www.sva.se/en/Antibiotika/SVARM-reports/

12

Switzerland

anresis.ch – Swiss Centre for Antibiotic resistance

anresis.ch is a regional and national surveillance and research program for antibiotic resistance and antibiotic consumption in human medicine in Switzerland. It is based at the Institute for Infectious Diseases, University of Bern.

Antibiotic resistance: anresis.ch collects and analyses anonymous antibiotic resistance data provided by a selection of Swiss clinical microbiology laboratories. Resistance data are generated during routine medical care. The collected data represent at least 60% of annual hospitalisation days and at least 30% of Swiss practitioners.

Antibiotic consumption: A long-term project has been started to collect representative antibiotic consumption data directly from a selection of Swiss pharmacies and hospitals.

http://anresis.ch/index.php/about-anresisch.html

ARCH-Vet ARCH-Vet is the report on sales of antibiotics in veterinary medicine and antibiotic resistance monitoring of livestock in Switzerland http://www.blv.admin.ch/dokumentation/04506/04518/index.html?lang=en

Thailand

National Antimicrobial Resistance Surveillance Center (NARST)

NARST publishes annual reports and trend analyses of the percentage of susceptible bacteria for a range of pathogens collected in 36 hospitals. http://narst.dmsc.moph.go.th/

United Kingdom

Antimicrobial Resistance Funders’ Forum (AMRFF)

The AMRFF provides a framework for a more coordinated approach to tackling AMR research. Membership includes the Research Councils, Health Departments, Governmental bodies as well as charities with a direct or indirect interest in AMR and which provide significant R&D budgets in the area. http://www.mrc.ac.uk/research/initiatives/antimicrobial-resistance/antimicrobial-resistance-funders-forum/

British Society for Antimicrobial Chemotherapy (BSAC) Resistance Surveillance Project

The BSAC Resistance Surveillance Project monitors resistance to antibiotics (antimicrobials, antibacterials) in England, Wales, Scotland, Northern Ireland and Ireland. Isolates (bacteria) are collected by a network of laboratories. One survey covers bloodstream infection (bacteraemia, bacteremia, invasive infection, systemic infection); it includes both hospital-acquired infection (nosocomial, healthcare-associated infection, HAI) and community-acquired infections. The other surveillance project covers community-acquired lower respiratory tract infection (community-acquired pneumonia, CAP, acute exacerbation of chronic bronchitis, AECB, etc), monitoring their consumption. http://bsac.org.uk/surveillance/bsac-resistance-surveillance-programme/

National Institute for Health Research (NIHR) AMR Themed Call

The NIHR Public Health Research Programme AMR Themed Call will consider applications looking at the effectiveness and cost effectiveness of public health measures outside of healthcare settings to prevent the occurrence and transmission of antimicrobial resistance. http://www.themedcalls.nihr.ac.uk/amr/meet-the-programmes/phr-programme

Royal United Services Institute (RUSI)

Tackling Antimicrobial Resistance: Identifying Future Research Themes covers the proceedings of a Tackling Antimicrobial Resistance conference held at RUSI in 2013 to identify research topics that will help to enable and implement existing UK government policy on

13

antimicrobial resistance, which in turn will shape and inform future policy. https://www.rusi.org/publications/occasionalpapers/ref:O521C7E982D06B/ https://www.rusi.org/downloads/assets/201308_Tackling_AMR_web.pdf

Veterinary Medicines Directorate (VMD) surveillance

For the past 15 years the VMD has collected, collated and published figures on UK sales volumes of active antimicrobial ingredients in products authorised for use in animals. These reports were based on sales data provided voluntarily by the veterinary pharmaceutical companies from 1998-2004; data from 2005 onwards have been collected as a statutory requirement, as set out in the Veterinary Medicines Regulations. The VMD also conducts an ongoing surveillance programme to monitor resistance in bacteria of veterinary importance, in order to identify trends in patterns of resistance, and to ensure an 'early warning system' for any new types or patterns of resistance. The VMD’s programme of AMR surveillance in animals includes on-going monitoring of resistance in zoonotic organisms, commensal bacteria and veterinary pathogens. http://vmd.defra.gov.uk/public/antibiotic_salesdata.aspx http://vmd.defra.gov.uk/public/antibiotic_surveillance.aspx

Wellcome Trust and UK research councils

The Wellcome Trust and the seven UK research councils have announced a coordinated research effort to address AMR, led by the Medical Research Council. An initial £25 million will be spent. http://www.mrc.ac.uk/news-events/news/war-cabinet-to-tackle-amr/

United States

Advanced Molecular Detection (AMD)

CDC’s 5-year AMD initiative provides more precise and accurate means to:

Diagnose known and emerging infections

Find disease outbreaks we are missing now

Understand and control antibiotic resistance

Develop and target measures—like vaccines—to protect people’s health http://www.cdc.gov/amd/ http://www.cdc.gov/amd/basics/index.html

Drug Resistance Index The Drug Resistance Index (DRI) aggregates information about antibiotic resistance and antibiotic use into a single composite measure that quantifies the decay of antibiotic effectiveness over time. It is an epidemiological and communications tool to convey trends in drug resistance to non-experts: healthcare managers, policymakers, and media about the overall extent and evolution of antibiotic resistance of acute and non-acute patient settings. http://www.cddep.org/sites/default/files/2011.laxminarayan.drugresistanceindex_8.pdf http://www.who.int/medical_devices/global_forum/C06.pdf

Food and Drug Administration (FDA)

FDA collects and reports data on the sale of antimicrobial drugs intended for use in humans and food-producing animals

Estimates of Antibacterial Drug Sales in Human Medicine: FDA has assembled an estimate of human antibacterial drug sales based on IMS Health, IMS National Sales Perspectives™ data. http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm261160.htm

14

Section 105 of the Animal Drug User Fee Amendments of 2008 requires that animal drug companies annually report to FDA the amount of antimicrobial drugs they sell or distribute for use in food-producing animals, and that the FDA issues annual summary reports of the sales and distribution data. http://www.fda.gov/ForIndustry/UserFees/AnimalDrugUserFeeActADUFA/ucm236149.htm

HAI and Antibiotic Use Prevalence Survey of the Emerging Infections Programs (EIP);

CDC’s EIP network is a national resource for surveillance, prevention, and control of emerging infectious diseases. The Healthcare-associated infection (HAI) component of the EIP includes the HAI and Antibiotic Use Prevalence Survey, which will:

Make improved estimates of the burden of HAIs in the United States

Discover which pathogens are causing infections, and how many are resistant to antibiotics

Identify antibiotic use patterns that may be contributing to resistance. This prevalence survey is CDC’s largest in more than 30 years. Information from this project will inform national policies and recommendations that target HAI prevention and antibiotic preservation. http://www.cdc.gov/hai/eip/antibiotic-use.html

Modeling Antimicrobial Resistance (AMR) Intervention

The National Institute for Mathematical and Biological Synthesis’s (NIMBioS) Working Group on Modeling Antimicrobial Resistance (AMR) Intervention will identify specific analytical methods and quantitative data that are appropriate for associating population-level changes in antimicrobial use in livestock with population-level changes in antimicrobial resistance. http://www.nimbios.org/workinggroups/WG_amr

National and State Healthcare-Associated Infections Progress Report

The annual Progress Report consists of national and state-by-state summaries of healthcare-associated infections, using data from the CDC’s National Healthcare Safety Network (NHSN). http://www.cdc.gov/hai/progress-report/

National Antimicrobial Resistance Monitoring System (NARMS)

NARMS was established in 1996 as a partnership between the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and the U.S. Department of Agriculture (USDA). It tracks antibiotic resistance in foodborne bacteria from humans (CDC), retail meats (FDA), and food animals (USDA). NARMS also collaborates with similar programs in other countries to work towards international harmonization of testing and reporting. http://www.fda.gov/animalveterinary/safetyhealth/antimicrobialresistance/nationalantimicrobialresistancemonitoringsystem/default.htm

National Healthcare Safety Network’s (NHSN) Antibiotic Use and Resistance (AUR) module

NHSN is the US’s most widely used healthcare-associated infection tracking system. It provides facilities, states, regions, and the nation with data needed to identify problem areas, measure progress of prevention efforts, and ultimately eliminate healthcare-associated infections. Its Antibiotic Use and Resistance (AUR) module provides a mechanism for hospitals and healthcare facilities to report and analyse antimicrobial use and/or resistance as part of local or regional efforts to reduce antimicrobial resistant infections through antimicrobial stewardship efforts or interruption of transmission of resistant pathogens at their facility. http://www.cdc.gov/nhsn/ http://www.cdc.gov/nhsn/PDFs/pscManual/11pscAURcurrent.pdf

National Institute of Allergy and Infectious Diseases

NIAID, one of the National Institutes of Health (NIH), is funding and conducting research on many aspects of antimicrobial (drug) resistance, including basic research on how microbes develop resistance, new and faster diagnostics, and clinical trials designed to find new vaccines

15

(NIAID) and treatments effective against drug-resistant microbes. http://www.niaid.nih.gov/topics/antimicrobialresistance/Pages/default.aspx NIAID launched the Antibacterial Resistance Leadership Group (ARLG) in 2013, a major new clinical effort to address antibacterial resistance. The ARLG has developed a clinical research agenda identifying the priority areas for clinical studies relating to resistance. https://arlg.org/about-the-arlg/arlg-scientific-agenda

Threat Report 2013 The report, Antibiotic resistance threats in the United States, 2013 gives a first-ever snapshot of the burden and threats posed by the antibiotic-resistant germs having the most impact on human health. It was published by the US Centers for Disease Control and Prevention. http://www.cdc.gov/drugresistance/threat-report-2013/