Developing a national surveillance system for antimicrobial use and resistance in Australia: aura



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Developing a national surveillance system for antimicrobial use and resistance in Australia: AURA


Prof John Turnidge J1, Adj Prof Kathy Meleady2, Ms Naomi Poole3
1Senior Medical Advisor, 2Director, 3Project Manager

Commonwealth Programs, Australian Commission on Safety and Quality in Health Care
Australia has a high rate of antimicrobial use (AU) compared with many other countries, and increasing rates of some types of antimicrobial resistance (AMR).1 A nationally coordinated and comprehensive surveillance system for AU and AMR will enable a better understanding of the drivers of AMR in Australia; will further inform antimicrobial stewardship; and, minimise the threat that AMR poses to health care delivery.

OBJECTIVE


To establish a comprehensive coordinated surveillance system for AU and AMR in Australia, in collaboration with existing surveillance programs. The results of surveillance will enable high-quality information and data for practice improvement, health program and policy development, and to support research priorities.

METHODS


The Australian Commission on Safety and Quality in Health Care (the Commission) undertook wide-ranging consultation, planning and development activities to review current AU and AMR surveillance systems, identify the requirements of the national system, and negotiate with a range of stakeholders to build and improve surveillance infrastructure. The planning phase for the Antimicrobial Use and Resistance Australia (AURA) Surveillance System confirmed the key elements required for a comprehensive approach to surveillance in Australia.

RESULTS


The establishment of the AURA Surveillance System focused on identifying and sourcing data which covered eight information streams. These streams focus on AU and AMR from the community and acute sectors, through the use of passive and targeted data collections. These streams are illustrated in Figure 1.

Figure 1. AURA data streams
diagram of the eight information streams of the aura surveillance system. the system covers the capture of antimicrobial use and antimicrobial resistance information, each of which is split into passive surveillance and targeted surveillance. passive and targetted surveillance is further split into hospital surveillance (private and public) and community surveillance (general practitioners and residential aged care facilities).

Once the types of data needed were confirmed, AURA engaged with established programs, experts and key stakeholders. A collaborative approach was the basis for harnessing existing knowledge and expertise to improve the coverage, capture and quality of existing data collections and to inform the development of new collections where there were identified gaps. The key data collections coordinated through AURA are in Box 1.



Box 1. AURA Surveillance System

Existing data collections partnering with AURA:



  • Australian Group on Antimicrobial Resistance

  • National Antimicrobial Prescribing Survey (NAPS) and the pilot Aged Care NAPS

  • National Antimicrobial Utilisation Surveillance Program

  • Queensland Health OrgTRx System

Additional data sources used for AURA 2016 Report:



  • The National Neisseria Network

  • Office of Health Protection, National Notifiable Disease Surveillance Branch

  • Australian Mycobacterium Reference Laboratory Network

  • Pharmaceutical Benefit Scheme and the Repatriation Pharmaceutical Benefit Scheme

  • NPS MedicineWise MedicineInsight Program

  • Sullivan Nicolaides Pathology

As these collections have developed and been enhanced, AURA has published a range of national reports providing the results of analysis. The reports include: Antimicrobial Use in Australian Hospitals: 2014 Report of the National Antimicrobial Utilisation Surveillance Program, National Antimicrobial Utilisation Surveillance Program Annual Report 2014–2015, and the Antimicrobial Prescribing Practice in Australian Hospitals: Results of the 2014 National Antimicrobial Prescribing Survey.

First National Report on Antimicrobial Use and Resistance in Australia (AURA 2016)


AURA has consolidated the information from these collections, as well as a range of other data sources (Box 1) to develop AURA 2016: First Australian report on AU and AMR in human health. This report describes rates and patterns for AU in hospitals, residential aged care facilities and the community, as well as data on appropriateness of use. Results demonstrate a relatively high use of antimicrobials in Australian hospitals compared to similar countries (Figure 2).

The report also provides resistance rates for a set of 13 priority organisms, and discusses key emerging issues for AU and AMR. For example, in comparison to other countries, Australia has a notably higher rate of vancomycin resistance in Enterococcus faecium.

Antimicrobial use in Australian hospitals has declined since 2010, in parallel with the introduction of antimicrobial stewardship programs around the same time. AURA 2016 also highlights some unique results for Australia such as the comparatively low rate of resistance to fluoroquinolones, reflecting the restricted use of this antimicrobial class in Australia compared with that of many similar countries (Figure 3).

Figure 2. Comparison of community antimicrobial use in Australia and 28 European countries, 2014

bar chart showing that community antimicrobial use in europe ranges from 11 defined daily doses (ddd) per 1000 inhabitants per day in the netherlands to 34 ddd per 1000 inhabitants per day in greece. community use in australia (24 ddd per 1000 inhabitants per day) ranks sixth highest compared with european countries.
Data sources: PBS (Australia), ESAC-Net (Europe)

Figure 3. Resistance to Fluoroquinolones in invasive isolates of Escherichia coli in Australia and European countries, 2014

bar chart showing australia has the second lowest rate of resistance (10.4%) compared with 30 european countries. iceland has the lowest (7.8%) and cyprus has the highest (46.4%).

Note: In Australia, ciprofloxacin resistance is used to represent resistance to fluoroquinolone class.

Data sources: PBS (Australia), ESAC-Net (Europe)

A national alert system for critical antimicrobial resistances


A new national alert system for critical antimicrobial resistances, called CARAlert, has been established. CARAlert commenced in March 2016 and will help improve the timely identification of critical antimicrobial resistances across Australia, by providing a systematic and coordinated approach to the identification and communication of information about CARs when they are confirmed.
logo for caralert - the national alert system for critical antimicrobial resistance

CONCLUSION


The foundation of a comprehensive national surveillance system for AU and AMR has been established as part of the AURA Surveillance System. AURA coordinates data from a range of collections to produce integrated surveillance information and reports about the current state of play, trends over time, and where feasible, the interrelationships between AMR and AU. Further expansion and development of the AURA Surveillance System is planned, particularly focusing on increasing passive resistance and hospital antimicrobial use surveillance comparisons.

REFERENCE


  1. Australian Commission on Safety and Quality in Health Care. AURA 2016: First Australian report on antimicrobial use and resistance in human health. Sydney: ACSQHC, 2016.

Website: Commission AURA website - resources page


© Commonwealth of Australia 2016

This work is copyright. It may be reproduced in whole or in part for study or training purposes subject to the inclusion of an acknowledgement of the source. Requests and inquiries concerning reproduction and rights for purposes other than those indicated above requires the written permission of the Australian Commission on Safety and Quality in Health Care, GPO Box 5480 Sydney NSW 2001 or mail@safetyandquality.gov.au. The AURA Program is funded by the Australian Government Department of Health John





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