Surveillance of antimicrobial resistance - what, how and whither?

Objective To express the views of a working party held to consider antibiot ic resistance surveillance systems, their strengths and weaknesses, and the ir current and future applications. Methods The participants, all of whom were experienced in this field, discu ssed the development of surveillance systems in relation to the increasing prevalence of resistance to antibacterial agents and the current interest i n surveillance systems shown by many official bodies, in both the human and veterinary fields. The problems inherent in surveillance systems were cons idered together with the applications of different systems. Results The properties of good antibiotic resistance surveillance systems w ere defined. Surveillance systems vary widely from those with a narrow base , focusing on few organisms in one disease area, to those covering many dis eases, many organisms (including normal flora) and many compounds. Whatever their design, they should be able to detect significant differences and sh ifts in susceptibility to various antibacterial agents, and the information derived from them should reach as many interested parties as possible in a timely manner. In using this information to decide strategies, criteria fo r action need to be determined by pragmatic consensus. Funding remains a ma jor problem, with few large studies being supported by official bodies in s pite of their professed enthusiasm for surveillance. In consequence, many c urrent systems are funded by the pharmaceutical industry and are of necessi ty restricted in their focus. Conclusions Antibiotic resistance surveillance studies should and can be we ll planned and well executed. Many current systems suffer from well-recogni zed but uncorrected biases. Consortium funding will be necessary for large schemes to be successful. There is no 'ideal' surveillance system.