PDF(Pubmed)
Abstract：
BACKGROUND: Antibiotic resistance (ABR) has emerged as a major threat to health. Properly informed decisions to mitigate this threat require surveillance systems that integrate information on resistant bacteria and antibiotic use in humans, animals, and the environment, in line with the One Health concept. Despite a strong call for the implementation of such integrated surveillance systems, we still lack a comprehensive overview of existing organizational models for integrated surveillance of ABR. To address this gap, we conducted a scoping review to characterize existing integrated surveillance systems for ABR.
METHODS: The literature review was conducted using the PRISMA guidelines. The selected integrated surveillance systems were assessed according to 39 variables related to their organization and functioning, the socio-economic and political characteristics of their implementation context, and the levels of integration reached, together with their related outcomes. We conducted two distinct, complementary analyses on the data extracted: a descriptive analysis to summarize the characteristics of the integrated surveillance systems, and a multiple-correspondence analysis (MCA) followed by a hierarchical cluster analysis (HCA) to identify potential typology for surveillance systems.
RESULTS: The literature search identified a total of 1330 records. After the screening phase, 59 references were kept from which 14 integrated surveillance systems were identified. They all operate in high-income countries and vary in terms of integration, both at informational and structural levels. The different systems combine information from a wide range of populations and commodities -in the human, animal and environmental domains, collection points, drug-bacterium pairs, and rely on various diagnostic and surveillance strategies. A variable level of collaboration was found for the governance and/or operation of the surveillance activities. The outcomes of integration are poorly described and evidenced. The 14 surveillance systems can be grouped into four distinct clusters, characterized by integration level in the two dimensions. The level of resources and regulatory framework in place appeared to play a major role in the establishment and organization of integrated surveillance.
CONCLUSIONS: This study suggests that operationalization of integrated surveillance for ABR is still not well established at a global scale, especially in low and middle-income countries and that the surveillance scope is not broad enough to obtain a comprehensive understanding of the complex dynamics of ABR to appropriately inform mitigation measures. Further studies are needed to better characterize the various integration models for surveillance with regard to their implementation context and evaluate the outcome of these models.
METHODS: The literature review was conducted using the PRISMA guidelines. The selected integrated surveillance systems were assessed according to 39 variables related to their organization and functioning, the socio-economic and political characteristics of their implementation context, and the levels of integration reached, together with their related outcomes. We conducted two distinct, complementary analyses on the data extracted: a descriptive analysis to summarize the characteristics of the integrated surveillance systems, and a multiple-correspondence analysis (MCA) followed by a hierarchical cluster analysis (HCA) to identify potential typology for surveillance systems.
RESULTS: The literature search identified a total of 1330 records. After the screening phase, 59 references were kept from which 14 integrated surveillance systems were identified. They all operate in high-income countries and vary in terms of integration, both at informational and structural levels. The different systems combine information from a wide range of populations and commodities -in the human, animal and environmental domains, collection points, drug-bacterium pairs, and rely on various diagnostic and surveillance strategies. A variable level of collaboration was found for the governance and/or operation of the surveillance activities. The outcomes of integration are poorly described and evidenced. The 14 surveillance systems can be grouped into four distinct clusters, characterized by integration level in the two dimensions. The level of resources and regulatory framework in place appeared to play a major role in the establishment and organization of integrated surveillance.
CONCLUSIONS: This study suggests that operationalization of integrated surveillance for ABR is still not well established at a global scale, especially in low and middle-income countries and that the surveillance scope is not broad enough to obtain a comprehensive understanding of the complex dynamics of ABR to appropriately inform mitigation measures. Further studies are needed to better characterize the various integration models for surveillance with regard to their implementation context and evaluate the outcome of these models.
摘要：
背景：抗生素耐药性（ABR）已成为对健康的主要威胁。正确知情的决定，以减轻这种威胁需要监测系统，以整合有关人类耐药细菌和抗生素使用的信息，动物,和环境，符合“一个健康”的概念。尽管强烈呼吁实施这种综合监测系统,我们仍然缺乏对ABR综合监测现有组织模式的全面概述.为了解决这个差距，我们进行了范围审查,以描述现有的ABR综合监测系统的特征.
方法：使用PRISMA指南进行文献综述。选定的综合监测系统根据39个与其组织和功能相关的变量进行评估，其实施背景的社会经济和政治特征，达到了一体化的水平，以及他们的相关结果。我们进行了两个不同的，对提取的数据进行补充分析：描述性分析，总结综合监测系统的特点，和多重对应分析（MCA），然后进行层次聚类分析（HCA），以确定监测系统的潜在类型。
结果：文献检索共发现1330条记录。筛选阶段之后,保留了59个参考文献，从中确定了14个综合监测系统。它们都在高收入国家经营，在一体化方面各不相同，在信息和结构层面。不同的系统结合了来自广泛人群和商品的信息——在人类中，动物和环境领域，收集点,药物-细菌对，并依靠各种诊断和监视策略。在监督活动的治理和/或运作中发现了不同程度的合作。整合的结果描述和证据不足。14个监视系统可以分为四个不同的集群，以两个维度的集成水平为特征。现有的资源水平和监管框架似乎在建立和组织综合监督方面发挥了重要作用。
结论：这项研究表明，在全球范围内，ABR综合监测的可操作性仍未得到很好的确立。特别是在低收入和中等收入国家，监测范围不够广泛，无法全面了解ABR的复杂动态，从而为缓解措施提供适当的信息。需要进一步的研究，以更好地描述各种集成模型的实施背景，并评估这些模型的结果。
方法：使用PRISMA指南进行文献综述。选定的综合监测系统根据39个与其组织和功能相关的变量进行评估，其实施背景的社会经济和政治特征，达到了一体化的水平，以及他们的相关结果。我们进行了两个不同的，对提取的数据进行补充分析：描述性分析，总结综合监测系统的特点，和多重对应分析（MCA），然后进行层次聚类分析（HCA），以确定监测系统的潜在类型。
结果：文献检索共发现1330条记录。筛选阶段之后,保留了59个参考文献，从中确定了14个综合监测系统。它们都在高收入国家经营，在一体化方面各不相同，在信息和结构层面。不同的系统结合了来自广泛人群和商品的信息——在人类中，动物和环境领域，收集点,药物-细菌对，并依靠各种诊断和监视策略。在监督活动的治理和/或运作中发现了不同程度的合作。整合的结果描述和证据不足。14个监视系统可以分为四个不同的集群，以两个维度的集成水平为特征。现有的资源水平和监管框架似乎在建立和组织综合监督方面发挥了重要作用。
结论：这项研究表明，在全球范围内，ABR综合监测的可操作性仍未得到很好的确立。特别是在低收入和中等收入国家，监测范围不够广泛，无法全面了解ABR的复杂动态，从而为缓解措施提供适当的信息。需要进一步的研究，以更好地描述各种集成模型的实施背景，并评估这些模型的结果。
