Integrated Multilevel Surveillance of the World's Infecting Microbes and Their Resistance to Antimicrobial Agents

Abstract

Microbial surveillance systems have varied in their source of support; type of laboratory reporting (patient care or reference); inclusiveness of reports filed; extent of microbial typing; whether single hospital, multihospital, or multicountry; proportion of total medical centers participating; and types, levels, integration across levels, and automation of analyses performed. These surveillance systems variably support the diagnosis and treatment of patients, local or regional infection control, local or national policies and guidelines, laboratory capacity building, sentinel surveillance, and patient safety. Overall, however, only a small fraction of available data are under any surveillance, and very few data are fully integrated and analyzed. Advancing informatics and genomics can make microbial surveillance far more efficient and effective at preventing infections and improving their outcomes. The world's microbiology laboratories should upload their reports each day to programs that detect events, trends, and epidemics in communities, hospitals, countries, and the world.

Fig. 1.

Descriptors of elements of microbial surveillance systems.

Fig. 2.

WHONET scatter plot of MICs of ceftriaxone (CRO) and of ceftazidime (CAZ) for all isolates of E. coli at one hospital during 1 year. The red circle encloses the 3,489 isolates that had MICs of 0.5 μg/ml for both agents. Scattered single or double digits falling on intercepts representing varied other MICs of the two agents indicate the numbers of isolates with each of those sets of MICs. The blue circle encloses the five isolates that had an MIC of 0.5 μg/ml for ceftazidime and an MIC of 64 μg/ml for ceftriaxone. All five isolates were from patient A, who, as shown in the inserted table, had a urine isolate and, a month later, urine and blood isolates with that unique-for-the-year combination of MICs. The patient had received a kidney transplant 3 months earlier on another continent, which illustrates how the systematic screening of phenotypes may detect the incursion of a foreign strain.

Fig. 3.

Transmission of microbiology laboratory reports into microbial surveillance systems along the world's gradient of available resources.