bial Resistance Surveillance Program should be located within the National Center for Infectious Diseases at the CDC. This would allow integration with other surveillance activities for infectious diseases by experts in microbiology and epidemiology. Because of the CDC's track record and proven expertise, this is the logical location for a national surveillance system.

  1. If this program is successful in meeting the cited goals and objectives, cost savings to the national health care system could easily be in the hundreds of millions of dollars. A few areas of greatest impact are (i) the focusing of pharmaceutical research as early as possible on emerging drug resistance problems; (ii) the reduction of drug development costs by placing new compounds into the system to establish in vitro spectrums (cost rates would be less than the multiple individual grants to independent investigators); (iii) validation of current compound spectrums annually, reducing manufacturers' costs for independent vendor contracts (like item ii); (iv) availability of contemporary, localized data to federal and state agencies, enabling them to identify emerging resistances or pathogen frequencies and thus develop early interventions and selections of effective therapeutic regimens or prophylactic modalities; and (v) other interventions stimulated by the data derived from the surveillance, leading to greater cooperation among government, industry, and professional components of the health care system at large.

11. Immediate recommendations
  1. Convene an expert panel to develop surveillance protocol and establish an annual budget. The above outline could be used as a preliminary or tentative plan. Federal funding should be immediately identified for the national surveillance system, and several agencies (CDC, FDA, NIH, VA, USDA, etc.) as well as other sources should be involved in funding decisions.

  2. Seek appropriate expertise in statistical analysis for determination of organism sample sizes, population-based participant selection, and computer support for analyses.

  3. Initiate an extensive search for earlier surveillance databases on resistance generated from U.S. multicenter investigations performed with NCCLS or compatible methods. Also expand that literature search to worldwide surveillance data, if available.

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