Antimicrobial Resistance (AMR) Surveillance

 

Antimicrobial resistance (AMR) surveillance is one of the most pressing global health priorities of the 21st century, as it provides the critical foundation for understanding how resistance emerges, spreads, and impacts both human and animal health. The modern era of antibiotics, which began with the discovery of penicillin, revolutionized medicine and made possible not only the treatment of bacterial infections but also the safe execution of surgeries, chemotherapy, organ transplantation, and many other lifesaving interventions. However, decades of overuse, misuse, and inappropriate prescribing of antibiotics in human medicine, veterinary practice, agriculture, and aquaculture have fueled the rise of resistant microorganisms that are Antimicrobial able to withstand even last-resort therapies. Surveillance systems have therefore been established as the central mechanism to detect emerging resistance patterns, monitor trends over time, and provide evidence-based data that can guide clinicians, policymakers, researchers, and public health officials in their efforts to design effective interventions. Without robust surveillance, the true magnitude of AMR remains hidden, and society risks sliding into a post-antibiotic era where common infections once again become untreatable and deadly.

The essence of AMR surveillance lies in the systematic collection, analysis, interpretation, and dissemination of data on Antimicrobial resistance across different populations and ecosystems. Surveillance is not a one-size-fits-all model, but rather a multi-layered and multi-sectoral framework that must integrate human health, veterinary health, food safety, and environmental monitoring, reflecting the principles of the One Health approach. At the clinical level, surveillance systems involve microbiology laboratories that isolate bacterial pathogens from patient samples, test Antimicrobial against panels of antibiotics, and report resistance rates that help physicians make evidence-based therapeutic decisions. At the population level, aggregated data provide insights into regional or national resistance trends, highlight outbreaks of multidrug-resistant organisms, and identify geographic hot spots where interventions are urgently needed. At the global level, international networks such as the World Health Organization’s Global Antimicrobial  Resistance Surveillance System (GLASS) compile standardized data from participating countries, creating a global picture of the resistance landscape that facilitates comparisons across regions and informs international strategies.

The success of AMR surveillance depends on several core pillars: the availability of reliable laboratory infrastructure, the adoption of standardized testing methods, the establishment of quality assurance systems, and the continuous training of healthcare professionals. Laboratories play a central role in AMR surveillance because they generate the data upon which all subsequent analysis relies. To ensure comparability of data across regions and countries, organizations such as the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) Antimicrobial developed harmonized protocols for Antimicrobial susceptibility testing (AST). These protocols define how bacterial isolates should be cultured, which antibiotics should be tested, and how results should be interpreted. Quality control measures, including the use of reference strains and external proficiency testing, are critical to avoid reporting errors that could distort surveillance findings. Without laboratory accuracy and consistency, surveillance data lose their reliability and credibility.

In addition to traditional phenotypic methods, molecular and genomic approaches are increasingly integrated into AMR surveillance to enhance sensitivity, specificity, and speed. Molecular methods, such as polymerase chain reaction (PCR), can detect resistance genes directly from clinical samples, even in cases where bacterial cultures are difficult or slow to grow. Whole genome sequencing (WGS) has emerged as a transformative technology that not only identifies resistance determinants but also provides insights into Antimicrobial evolution, clonal relatedness, and mechanisms of resistance transmission. Genomic data allow researchers to link specific resistance genes with mobile genetic elements such as plasmids and transposons, thereby unraveling how resistance traits spread within and between microbial populations. Moreover, genomic surveillance can Antimicrobial hidden outbreaks by showing that isolates collected from different hospitals or countries belong to the same lineage, indicating cross-border transmission. As sequencing costs continue to decline and bioinformatics capacity expands, genomic surveillance is poised to become an integral part of AMR monitoring at both national and global levels.

The scope of AMR surveillance extends beyond hospitals and clinics, encompassing communities, farms, food production systems, and natural ecosystems. In the community, surveillance tracks resistance in pathogens causing common infections such as urinary tract infections, respiratory infections, or diarrheal diseases. In Antimicrobial medicine, surveillance monitors the prevalence of resistance among zoonotic pathogens like Salmonella, Campylobacter, and Escherichia coli, which can be transmitted from animals to humans through direct contact, food consumption, or environmental pathways. The use of antibiotics as growth promoters in livestock farming has historically been a major driver of resistance, and surveillance provides the evidence base to justify regulatory bans and restrictions on non-therapeutic antibiotic use in agriculture. Environmental surveillance, on the other hand, examines how antibiotics and Antimicrobial bacteria disseminate into water systems, soil, and wildlife, often through pharmaceutical manufacturing waste, hospital effluents, and agricultural runoff. Together, these dimensions of surveillance create a comprehensive picture of AMR dynamics that reflects the interconnectedness of human, animal, and environmental health.

International collaboration is a cornerstone of AMR surveillance, since resistant pathogens do not respect national borders. The World Health Organization, the Food and Agriculture Organization (FAO), and the World Organisation for Animal Health (WOAH, formerly OIE) jointly promote the One Health approach through initiatives that encourage countries to establish integrated surveillance systems. Programs such as GLASS encourage standardized reporting, capacity-building, and data-sharing across member states, thereby creating a global repository of AMR data that can guide international interventions. The European Antimicrobial Resistance Surveillance Network (EARS-Net) is another example, providing high-quality data across EU/EEA countries that inform antibiotic stewardship policies. In the United States, the National Antimicrobial Resistance Monitoring System (NARMS) tracks resistance in enteric bacteria from humans, animals, and retail meats. These collaborative efforts are essential to detect emerging resistance threats early, coordinate policy responses, and prevent global health crises.

However, AMR surveillance faces numerous challenges, especially in low- and middle-income countries (LMICs), where laboratory infrastructure, Antimicrobial expertise, and financial resources may be limited. Many countries lack nationwide surveillance systems or have fragmented systems that do not cover all regions and sectors. In such contexts, resistance often remains underreported or undetected until outbreaks occur, limiting timely responses. The absence of standardized data collection and reporting practices further Antimicrobial comparisons across countries. Moreover, in resource-limited settings, many patients may not even have access to diagnostic tests, leading to empirical antibiotic use that fuels resistance while simultaneously depriving surveillance systems of critical data. Addressing these gaps requires sustained international investment in laboratory capacity, training programs, information systems, and governance frameworks that ensure data transparency and accountability.

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