Supranational surveillance of antimicrobial resistance: The legacy of the last decade and proposals for the future.

Antimicrobial resistance among clinically important bacteria is widely acknowledged as a major global public health threat. A decade ago, several supranational surveillance initiatives were introduced. Few of them are still ongoing, and only one features an interactive database in the public domain. No public surveillance system monitors resistance trends among non-invasive isolates on a supranational level. Although the relevance of measuring antimicrobial resistance in invasive isolates is undisputable and there is a large consensus on sampling techniques for these isolates, surveillance systems monitoring invasive infections will only have low sensitivity for early detection of emerging resistance trends, also missing an important opportunity for intervention. Surveillance of resistance patterns should ideally include characterization of important clones involved in the dissemination of resistance. This review also emphasizes important methodological issues to be considered whenever performing surveillance, and provides general recommendations applicable to surveillance at all levels.