52
utilizing this information should be considered in the designing of a surveillance system.
Surveillance is the keystone to address number of the global aspects of antimicrobial resistance. It provides a basis for assessing the resistance burden and for
providing the essential evidence for developing well organized and effective control
and prevention strategies. Co-development of programs for resistance surveillance
in humans and animals is indispensable, but there remain several key elements that
make it difficult to compare the data between human and animal antimicrobial resistance monitoring programs. Differences in antimicrobial resistance surveillance
programs between countries and region also generate challenges for data comparison. In Australia, implementation of national resistance surveillance in animals has
been developed by the World Health Organization Advisory Group on Integrated
Surveillance of Antimicrobial Resistance, the World Organization for Animal
Health, and the EFSA Working Group on Developing Harmonised Schemes for
antimicrobial\ resistance monitoring in Zoonotic Agents (Shaban et al. 2014).
Nowadays, whole genome sequencing based antimicrobial resistance analysis completes in one step, what was not feasible with ordinary PCR strategies namely, identifying new alleles responsible for resistance to the same drug class. In one study of
gentamicin resistant Campylobacter from retail meats and from human infections,
PCR failed to identify the presence of gene for aminoglycoside resistance in many
of the human isolates (Zhao et al. 2015). At present, resistance surveillance relies on
straightforward in vitro antimicrobial susceptibility methods. However, the lack of
synchronization across programs and the limited genetic information of antimicrobial resistance remain the foremost drawbacks of these phenotypic methods. The
way forward of antimicrobial resistance surveillance is to adopt the genotypic
detection, and molecular analysis methods for yielding a wealth of information.
However, it is expected that these molecular techniques will outshine the phenotypic susceptibility testing in routine diagnosis. Monitoring of resistance remains a
distant reality, and phenotypic testing remains necessary in the detection of new
resistance mechanisms, emerging resistant bacteria, and trends of antimicrobial
resistance.
2.12 Limitations of National Surveillance systems
Limitations have been categorised as
A. Structural problems
B. Laboratory based surveillance problem
C. Lack of coordination among animal and food surveillance systems
There exists wide range of structural problems. The efforts at national surveillance level are heterogeneous and fragmented. Data collection systems working on
antimicrobial resistance and health care related infections have different goals with
little or absence of coordination and sharing of information with international
S. Kumar et al.
utilizing this information should be considered in the designing of a surveillance system.
Surveillance is the keystone to address number of the global aspects of antimicrobial resistance. It provides a basis for assessing the resistance burden and for
providing the essential evidence for developing well organized and effective control
and prevention strategies. Co-development of programs for resistance surveillance
in humans and animals is indispensable, but there remain several key elements that
make it difficult to compare the data between human and animal antimicrobial resistance monitoring programs. Differences in antimicrobial resistance surveillance
programs between countries and region also generate challenges for data comparison. In Australia, implementation of national resistance surveillance in animals has
been developed by the World Health Organization Advisory Group on Integrated
Surveillance of Antimicrobial Resistance, the World Organization for Animal
Health, and the EFSA Working Group on Developing Harmonised Schemes for
antimicrobial\ resistance monitoring in Zoonotic Agents (Shaban et al. 2014).
Nowadays, whole genome sequencing based antimicrobial resistance analysis completes in one step, what was not feasible with ordinary PCR strategies namely, identifying new alleles responsible for resistance to the same drug class. In one study of
gentamicin resistant Campylobacter from retail meats and from human infections,
PCR failed to identify the presence of gene for aminoglycoside resistance in many
of the human isolates (Zhao et al. 2015). At present, resistance surveillance relies on
straightforward in vitro antimicrobial susceptibility methods. However, the lack of
synchronization across programs and the limited genetic information of antimicrobial resistance remain the foremost drawbacks of these phenotypic methods. The
way forward of antimicrobial resistance surveillance is to adopt the genotypic
detection, and molecular analysis methods for yielding a wealth of information.
However, it is expected that these molecular techniques will outshine the phenotypic susceptibility testing in routine diagnosis. Monitoring of resistance remains a
distant reality, and phenotypic testing remains necessary in the detection of new
resistance mechanisms, emerging resistant bacteria, and trends of antimicrobial
resistance.
2.12 Limitations of National Surveillance systems
Limitations have been categorised as
A. Structural problems
B. Laboratory based surveillance problem
C. Lack of coordination among animal and food surveillance systems
There exists wide range of structural problems. The efforts at national surveillance level are heterogeneous and fragmented. Data collection systems working on
antimicrobial resistance and health care related infections have different goals with
little or absence of coordination and sharing of information with international
S. Kumar et al.