Malania Lile, Wagenaar Inge, Karatuna Onur, Tambic Andrasevic Arjana, Tsereteli David, Baidauri Marine, Imnadze Paata, Nahrgang Saskia, Ruesen Carolien
National Centre for Disease Control and Public Health, Tbilisi, Georgia.
Centre for Epidemiology and Surveillance of Infectious Diseases, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
Clin Microbiol Infect. 2021 Oct;27(10):1409-1413. doi: 10.1016/j.cmi.2021.05.027. Epub 2021 May 24.
Antimicrobial resistance (AMR) is a growing problem worldwide, with an estimated high burden in low- and middle-income countries (LMICs). In these settings, tackling the problem of AMR is often constrained by a lack of reliable surveillance data due to limited use of microbiological diagnostics in clinical practice.
The aim of this article is to present an overview of essential elements for setting up an AMR surveillance system in LMICs, to summarize the steps taken to develop such a system in the country of Georgia, and to describe its impact on microbiology laboratories.
A literature review of published papers using PubMed and experiences of experts involved in setting up AMR surveillance in Georgia.
Basic requirements for implementing a laboratory-based surveillance system in LMICs can be captured under four pillars: (a) governmental support, (b) laboratory capacity and quality management, (c) materials and supplies, and (d) sample collection, data management, analysis and reporting. In Georgia, the World Health Organization Proof-of-Principle project helped to start the collection of AMR surveillance data on a small scale by promoting the use of microbiological diagnostics in clinics, and by providing training and materials for laboratories. Thanks to governmental support and a strong lead by the national reference laboratory, the AMR surveillance network was sustained and expanded after the project ended.
This review describes the Georgian approach in building and expanding a functional AMR surveillance system, considering the elements identified from the literature. The introduction of quality management systems, standardization of guidelines and training paired with targeted capacity building led to improved laboratory standards and management of patients with bloodstream infections. Reliable AMR surveillance data may inform and facilitate policy-making on AMR control. The Georgian experience can guide other countries in the process of building up their national AMR surveillance system.
抗菌药物耐药性（AMR）在全球范围内是一个日益严重的问题，在低收入和中等收入国家（LMICs）估计负担沉重。在这些环境中，由于临床实践中微生物诊断的使用有限，缺乏可靠的监测数据常常限制了对抗菌药物耐药性问题的解决。
本文旨在概述在低收入和中等收入国家建立抗菌药物耐药性监测系统的基本要素，总结格鲁吉亚国建立这样一个系统所采取的步骤，并描述其对微生物实验室的影响。
使用PubMed对已发表论文进行文献综述以及参与格鲁吉亚国抗菌药物耐药性监测建立工作的专家经验。
在低收入和中等收入国家实施基于实验室的监测系统的基本要求可归纳为四个支柱：（a）政府支持；（b）实验室能力和质量管理；（c）材料和用品；（d）样本采集、数据管理、分析和报告。在格鲁吉亚国，世界卫生组织的原理验证项目通过促进临床微生物诊断的使用以及为实验室提供培训和材料，帮助小规模启动了抗菌药物耐药性监测数据的收集。由于政府支持以及国家参考实验室的有力引领，该项目结束后抗菌药物耐药性监测网络得以维持并扩大。
本综述考虑了文献中确定的要素，描述了格鲁吉亚国建立和扩大功能性抗菌药物耐药性监测系统的方法。质量管理体系的引入、指南的标准化和培训以及有针对性的能力建设，提高了实验室标准以及血流感染患者的管理水平。可靠的抗菌药物耐药性监测数据可为抗菌药物耐药性控制政策的制定提供信息并促进其制定。格鲁吉亚国的经验可指导其他国家建立其国家抗菌药物耐药性监测系统的过程。
