CITATION: APUA. 1998. Surveillance systems around the world. APUA Newsletter 16(1): 5.

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Surveillance systems around the world
Alliance for the Prudent Use of Antibiotics

Several publicly and privately funded surveillance systems throughout the world are currently forming and working to monitor local, national and global trends in the development of bacterial resistance to antimicrobial agents Below are examples of these systems.

International Systems
This multinational monitoring system was developed to support the efforts of the World Health Organization (WHO) to track global trends in antimicrobial resistance. WHONET provides computer software to laboratories and medical centers to help systematic entry of antibiotic susceptibility results. The system also allows for both local and collaborative analysis of results. The WHONET software, developed by Drs. Thomas O'Brien and John Stelling, and colleagues at WHO, is currently used by over 30 countries and expansion of the system has been recommended by the WHO Scientific Working Group on Monitoring and Management of Bacterial Resistance to Antimicrobial Agents.

This worldwide surveillance project was designed by Dr. Ronald Jones and colleagues at the University of Iowa College of Medicine (USA) together with investigators at the Eijkman-Winkler Institute for Microbiology Infection and Inflammation at the University of Utrecht (Netherlands) and is funded by Bristol-Myers Squibb Company. Isolates from participating centers are tested to assess resistance patterns using more than 70 drugs and a variety of molecular testing mechanisms. Currently this project involves 68 medical centers around the world, with plans to expand to 100 centers in 1998.

This global project, started in 1992, is run by the Alexander Project Steering Committee, made up of experts from participating centers and chaired by Dr. Reuben Gruneberg of University College London Hospitals (United Kingdom). Funding comes from an unrestricted grant from SmithKline Beecham. Initially made up of centers in 6 countries, it has now expanded to at least 19 centers worldwide, including those in Europe, Hong Kong, South Africa, Saudi Arabia and the United States. Early data has assessed resistance to commonly used antibiotics in nearly 7000 isolates and its projects continue to grow and evolve.

National Systems
Founded in 1996, SWAB is the Dutch acronym for a surveillance system that represents the joined forces of the Society of Infectious Disease of the Netherlands and Flanders, and the professional societies of medical microbiologists and of hospital pharmacists, as a separate Working Party of Antibiotic Policy. SWAB's major goal is to improve health care through efforts to reduce antibiotic resistance. With funding by grants from the Ministry of Health, Welfare and Sport, SWAB's first projects are educational tools in the form of national antibiotic use tests, and the publication of a national blueprint for an antibiotic policy.

The Italian Surveillance Group for Antimicrobial Resistance (ISGAR), is coordinated by the Institute of Microbiology at the University of Verona. This system collects susceptibility data from over 30 centers, via data acquisition interfaces. Information is translated into a common file format, where it is managed by Dr. Giuseppe Cornaglia, APUA-Italy. Since from 1993, the ISGAR has been holding annual meetings in Verona to present up-to-date susceptibility trends, an appreciation of the group activities, and related lectures.

The National Antimicrobial Resistance Surveillance Program (NARSP) was established in 1991 by Australian National Health and Medical Research Council's Expert Panel on Antibiotics. For a description of this system as well as results of collected data, please see article by Dr. Robert W. Baird.

In the absence of a more unified surveillance system, many countries rely on the efforts of public and private laboratories to collect and analyze data. In Russia, for instance, information from separate work done by Drs. Leonid Stratchounski and S. Sidorenko, highlight the trends in antimicrobial resistance in that country.7 Data has been collected on S. pneumoniae, S. pyogenes, H. influenzae and staphylococci. Gram-negative nosocomial infections are the best studied, and show an increase in resistance to penicillin, emerging resistance to third generation cephalosporins, and a high rate of gentamicin resistance.

These are only a few of the growing number of National programs (e.g., programs through CDC, USAID, NHS, professional societies) that are recognizing the need for better information on antibiotic resistance surveillance.


  1. WHONET is an information system developed to support The World Health Organization's goal of global surveillance of bacterial resistance to antimicrobial agents.
  2. Stephenson J. 1997. Worry grows as antibiotic-resistant bacteria continue to gain ground. JAMA 278(23): 2049-2050.
  3. Two-Ten News Network. 1997. Antibiotic resistance continues to increase. (press release on Alexander Project).
  4. Personal communication with Dr. Henri A Verbrugh, Secretary, SWAB.
  5. Personal communication with Dr. Giuseppe Cornaglia, ISGAR.
  6. Baird RW. 1997. Antibiotic prescribing, controls and antimicrobial resistance: an Australian experience. APUA Newsletter 15(4):1.
  7. Personal communication with Professor Leonid Stratchounski, Russia.


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