PDF(Pubmed)
Abstract：
Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest.
摘要：
背景：抗菌素耐药性监测对于经验性抗生素处方至关重要，感染预防和控制政策，并推动新型抗生素的发现。然而,大多数现有的监测系统是基于隔离的，不支持基于患者的临床数据，特别是在低收入和中等收入国家（LMICs）没有广泛实施。方法：面向临床的抗菌素耐药性监测网络（ACORN）II是一个大规模的多中心方案，它建立在WHO全球抗菌素耐药性和使用监测系统的基础上，以估计综合征和病原体的结果以及相关的健康经济成本。ACORN-医疗保健相关感染（ACORN-HAI）是一项扩展研究，专注于医疗保健相关的血液感染和呼吸机相关性肺炎。我们的主要目标是实施一个有效的临床导向的抗菌素耐药性监测系统，它可以作为LMIC医院常规工作流程的一部分。这些监测系统包括任何年龄的住院患者，这些患者具有临床上兼容的急性社区获得性或医疗保健相关细菌感染综合征，以及开了肠胃外抗生素的人。将实施诊断管理活动，以优化微生物学培养标本收集实践。患者的基本特征,临床医生诊断，经验性治疗,在入组时和28天随访期间记录感染严重程度和HAI危险因素.RShiny应用程序可用于离线和在线合并临床和微生物学数据，并生成整理报告，以告知当地的抗生素管理和感染控制政策。讨论：ACORNII是一项全面的抗菌素耐药性监测活动，倡导务实的实施，并通过以患者为中心的数据收集优先改善当地的诊断和抗生素处方实践。这些数据可以快速传达给当地医生和感染预防和控制团队。相对容易的数据收集促进了可持续性，并最大限度地提高了参与度和可扩展性。以ACORN-HAI为例,ACORNII具有容纳扩展的能力，以调查更多感兴趣的具体问题。
