Perovic Olga, Schultsz Constance
National Institute for Communicable Diseases, National Health Laboratory Service and Department of Clinical Microbiology, University of Witwatersrand, Johannesburg, South Africa.
Department of Global Health, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Afr J Lab Med. 2016 Oct 31;5(3):482. doi: 10.4102/ajlm.v5i3.482. eCollection 2016.
Antimicrobial resistance (AMR) has reached an end point, prompting a worldwide scare as no new antibiotics are in the pipeline, particularly for treatment of Gram-negative bacteria. To prevent further development and spread of AMR and to inform empirical treatment guidelines, surveillance of AMR is necessary.
We aim to provide a framework for a stepwise approach toward implementation of laboratory-based surveillance for AMR in African countries.
Building up a surveillance system is a robust process that begins with a gap analysis in each participating country. This framework provides practical guidance on how to set up surveillance, identify responsibilities and set timelines in sustainable manner for African countries. It addresses sampling strategies, human resources, procurement and maintenance issues for AMR testing at routine clinical and national reference and public health laboratories involved in AMR surveillance. Key issues such as laboratory capacity building, training and continuous education, quality and diagnostic stewardship are discussed in detail.
There are several priorities for AMR surveillance that need to be addressed in a comprehensive manner at regional and national levels, whilst keeping in line with current and proposed initiatives for laboratory capacity building, in order for African countries to achieve goals for combatting the real and current threat of AMR.
抗菌药物耐药性（AMR）已达到极限，引发了全球恐慌，因为目前没有新的抗生素正在研发中，尤其是用于治疗革兰氏阴性菌的抗生素。为防止AMR的进一步发展和传播，并为经验性治疗指南提供依据，有必要对抗菌药物耐药性进行监测。
我们旨在为非洲国家实施基于实验室的抗菌药物耐药性监测提供一个逐步推进的方法框架。
建立监测系统是一个稳健的过程，始于对每个参与国的差距分析。该框架为非洲国家如何建立监测、确定责任以及以可持续的方式设定时间表提供了实用指导。它涉及在参与抗菌药物耐药性监测的常规临床、国家参考和公共卫生实验室进行抗菌药物耐药性检测的抽样策略、人力资源、采购和维护问题。详细讨论了实验室能力建设、培训与持续教育、质量和诊断管理等关键问题。
抗菌药物耐药性监测有几个优先事项，需要在区域和国家层面全面解决，同时要与当前和提议的实验室能力建设举措保持一致，以便非洲国家实现应对抗菌药物耐药性这一现实和当前威胁的目标。
