1. Introduction to Proposed Standards Global Surveillance of AMR in Humans Jean B. Patel, PhD, D(ABMM) WHO Collaborating Centre for International Monitoring of Bacterial Resistance to Antimicrobial Agents Centers for Disease Control and Prevention Atlanta, GA

2. The Objective Collect, analyze and report data with standardized definitions of infection and AMR Estimate the extent of AMR infections Detect new resistance Implement prevention measures

3. Disease Surveillance Bloodstream Infections: A serious infection with easily implemented definitions. Mostly healthcare- associated Urinary Tract Infections: A common infection and an opportunity to capture resistance not identified in BSI surveillance. Community and healthcare- associated infections Diarrhoea: Tracking human infections from potential animal/food sources Gonorrhoea: Expanding existing surveillance to new countries

4. Diagnostic Stewardship Use of microbiological diagnostics to identify pathogens and guide therapeutic decisions. Appropriate selection & collection of specimens Accurate and timely testing Accurate and timely reporting of results Laboratories should implement a quality management systems which includes quality control testing and participation in external proficiency testing programs.

5. Priority Pathogens & Resistance Enterobacteriaceae resistant to carbapenems, extended-spectrum β-lactamases and fluoroquinolones Neisseria gonorrhoeae resistant to aminoglycosides, extended-spectrum cephalosporins, fluoroquinolones and macrolides Staphylococcus aureus resistant to methicillin Streptococcus pneumoniae resistant to penicillin

6. Epidemiological Measures The goal: Standardized metrics for monitoring trends and measuring the impact of prevention programmes. Metric: % Resistant or % Non-susceptible Numerator: Number of patients with infection due to a resistant organisms Denominator: divided by the total number of patients with infection due to the same organism in the same period and region The easiest metric to implement May over estimate resistant if only the sickest patients are cultured Labs should report the number of cultures performed

7. Epidemiological Measures A Population-Based Measure Metric: The number of infection/population at risk A measure of incidence Denominator: 100 000 people in a catchment area or 1000 patient-days or 100 hospital admissions for hospitalized patients A more labor-intensive metric to implement, but it is useful for estimating the incidence in a populations Laboratories/hospitals should report the number of cultures performed & the number of hospital admissions (for BSI)

8. Minimal Data to be Collected Per Infection Pathogen identification Susceptibility data Patient unique identifier Patient gender Patient date of birth Date and site of specimen collection Date of hospitalization (if applicable)

9. A National Framework

10. A Global Framework

11. The Standards The current list of infections and pathogen/drug combinations should not interfere with more comprehensive surveillance programs at the local or national level: Examples of additional data needs: Local data needs – antibiogram data to guide empiric treatment decisions National data needs – surveillance for pathogen/drug combinations or infection types that is identified as a national priority

12. Acknowledgments Members of the WHO technical working group: Celia Alpuche Aranda Olov Aspevall Sigaugque Betuel Carolee Carson Tejinder Chowdhary Liselotte Diaz H ӧ gberg So Hyun Kim Sergey Eremin Hajo Grundmann Shashi Khare Roman S. Kozlov Tjalling Leenstra Ali Mafi Jorge Matheu Saskia Nahrgang Christopher Oxenford Olga Perovic Carmem Pessoa da Silva Pilar Ramon-Pardo John Baptiste Ronat Neinke van de Sande Nalini Singh John Stelling Johan Struwe Danilo Lo Fo Wong Yonghong Xiao

13. Thank You JPatel1@cdc.gov