and reference laboratories to accurately assess the susceptibility of a wide variety of bacterial and fungal pathogens via standardized methods. Medical informatics and computer technology are now available for accurate collection, efficient transmission, and timely analysis of surveillance data which will allow the information to be disseminated in a site-specific manner. Implementation of a surveillance system with necessary quality assurances and fiscal support will allow the generation of antimicrobial resistance data needed for decision-making regarding therapy and/or prophylaxis. Data will be forthcoming to predict emerging resistances among available therapeutic drugs, leading to effective interventions that could control the dissemination of resistance.

B. Considerations

1. National surveillance system should do the following
  1. Focus on the most prevalent bacterial and fungal pathogens (not viral) that concern human health. This will assess isolates from clinical disease cases and routine isolates so that no bias from one center testing only the "problem" isolate or more resistant isolates compromises the results. Attention will be given to the trend in upward "creep" of MICs [minimum inhibitory concentrations]. There is also a need to monitor food sources such as animal products at the supermarket level as well as imported fruits, vegetables, and other products that may carry colonizing, drug-resistant bacteria and colonizing fecal flora in some patient populations. Salmonella and Shigella both should be monitored. Salmonella gives the best window into the impact of uses of antibiotics in the animal world, and the fraction of Shigella that is imported gives us an excellent view of the impact of antibiotic uses in the developing world.* Monitoring of soil waste in farms should also be considered.

  2. Establish a baseline of antimicrobial in vitro efficacy to which the following can be compared: earlier data from similar surveillance studies found in medical literature reviews, especially if these studies utilized comparable methodologies and surveillance techniques; subsequent surveillance data resulting from the establishment of a national surveillance system analyzed in a longitudinal manner; non-U.S. data to assess the international risks of resistance.

*  

Ervik, A, et al. Impact of administering antibacterial agents on wild fish and blue mussels Mytilus edulis in the vicinity of fish farms. Diseases of Aquatic Organisms 13:45-51, 1994.



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