Mesa Varona Octavio, Chaintarli Katerina, Muller-Pebody Berit, Anjum Muna F, Eckmanns Tim, Norström Madelaine, Boone Ides, Tenhagen Bernd-Alois
Department of Biological Safety, German Federal Institute for Risk Assessment (BfR), Berlin, Germany.
Department of Bacteriology, Animal and Plant Health Agency (APHA), Addlestone, Surrey, UK.
Infect Drug Resist. 2020 Apr 3;13:957-993. doi: 10.2147/IDR.S237038. eCollection 2020.
Antimicrobial resistance (AMR), associated with antimicrobial use (AMU), is a major public concern. Surveillance and monitoring systems are essential to assess and control the trends in AMU and AMR. However, differences in the surveillance and monitoring systems between countries and sectors make comparisons challenging. The purpose of this article is to describe all surveillance and monitoring systems for AMU and AMR in the human and livestock sectors, as well as national surveillance and monitoring systems for AMR in food, in six European countries (Spain, Germany, France, the Netherlands, the United Kingdom and Norway) as a baseline for developing suggestions to overcome current limitations in comparing AMU and AMR data.
A literature search in 2018 was performed to identify relevant peer-reviewed articles and national and European grey reports as well as AMU/AMR databases.
Comparison of AMU and AMR systems across the six countries showed a lack of standardization and harmonization with different AMU data sources (prescription vs sales data) and units of AMU and AMR being used. The AMR data varied by sample type (clinical/non-clinical), laboratory method (disk diffusion, microdilution, and VITEK, among others), data type, ie quantitative (minimum inhibition concentration (MIC) in mg/L/inhibition zone (IZ) in mm) vs qualitative data (susceptible-intermediate-resistant (SIR)), the standards used (EUCAST/CLSI among others), and/or the evaluation criteria adopted (epidemiological or clinical).
A One Health approach for AMU and AMR requires harmonization in various aspects between human, animal and food systems at national and international levels. Additionally, some overlap between systems of AMU and AMR has been encountered. Efforts should be made to improve standardization and harmonization and allow more meaningful analyses of AMR and AMU surveillance data under a One Health approach.
与抗菌药物使用（AMU）相关的抗菌药物耐药性（AMR）是一个重大的公共卫生问题。监测系统对于评估和控制AMU及AMR趋势至关重要。然而，不同国家和部门的监测系统存在差异，这使得比较具有挑战性。本文旨在描述六个欧洲国家（西班牙、德国、法国、荷兰、英国和挪威）人类和牲畜部门中AMU及AMR的所有监测系统，以及食品中AMR的国家监测系统，以此作为制定建议的基线，以克服当前在比较AMU和AMR数据方面的局限性。
2018年进行了文献检索，以识别相关的同行评审文章、国家和欧洲灰色报告以及AMU/AMR数据库。
六个国家的AMU和AMR系统比较显示，在不同的AMU数据源（处方数据与销售数据）以及所使用的AMU和AMR单位方面缺乏标准化和协调性。AMR数据因样本类型（临床/非临床）、实验室方法（纸片扩散法、微量稀释法和VITEK等）、数据类型（即定量数据（以mg/L为单位的最低抑菌浓度（MIC）/以mm为单位的抑菌圈（IZ））与定性数据（敏感-中介-耐药（SIR）））、所使用的标准（如EUCAST/CLSI等）和/或所采用的评估标准（流行病学或临床标准）而有所不同。
AMU和AMR的“同一个健康”方法要求在国家和国际层面上，人类、动物和食品系统在各个方面实现协调统一。此外，还发现AMU和AMR系统之间存在一些重叠。应努力提高标准化和协调性，并在“同一个健康”方法下，对AMR和AMU监测数据进行更有意义的分析。
