Rethinking Antimicrobial Resistance Surveillance: A Role for Lot Quality Assurance Sampling
Rethinking Antimicrobial Resistance Surveillance: A Role for Lot Quality Assurance Sampling
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DOI：
10.1093/aje/kwy276
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发表时间：
2019-04-01
影响因子：
5
通讯作者：
van Leth, Frank
中科院分区：
文献类型：
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作者：
Ginting, Franciscus;Sugianli, Adhi Kristianto;van Leth, Frank
全球抗菌素耐药性 (AMR) 监测是第 68 届世界卫生大会抗菌素耐药性全球行动计划的重要组成部分。基于实验室的监测本质上存在偏见，并且由于数据汇总而缺乏当地相关性。我们使用批量质量保证抽样 (LQAS) 评估了基于人群的 AMR 调查的可行性、敏感性和承受能力，该抽样根据先验定义的标准将人群分为 AMR 患病率高或低的人群。 2014 年 4 月至 2017 年 6 月期间，在印度尼西亚棉兰和万隆进行了三项研究。将 15 种抗生素的 LQAS 分类与传统的基于人群的调查的 AMR 估计值进行了比较，并使用微观成本法对印度尼西亚 11 个地点疑似尿路感染的患者进行单一 LQAS 分类的成本进行了评估。 LQAS的灵敏度在98%以上。该方法检测了不同地点 AMR 流行率的局部差异。获得 LQAS 结果的时间为 47 至 138 天。单个设施中 LQAS 分类的平均成本为 466 美元。研究结果表明，基于 LQAS 的 AMR 调查对于基于人群的 AMR 调查来说是一种可行、敏感且负担得起的策略，可为当地经验性治疗指南和抗菌药物管理工作提供重要数据。
Global surveillance of antimicrobial resistance (AMR) is a key component of the 68th World Health Assembly Global Action Plan on AMR. Laboratory-based surveillance is inherently biased and lacks local relevance due to aggregation of data. We assessed the feasibility, sensitivity, and affordability of a population-based AMR survey using lot quality assurance sampling (LQAS), which classifies a population as having a high or low prevalence of AMR based on a priori defined criteria. Three studies were carried out in Medan and Bandung, Indonesia, between April 2014 and June 2017. LQAS classifications for 15 antibiotics were compared with AMR estimates from a conventional population-based survey, with an assessment of the cost of a single LQAS classification using microcosting methodology, among patients suspected of urinary tract infection at 11 sites in Indonesia. The sensitivity of LQAS was above 98%. The approach detected local variation in the prevalence of AMR across sites. Time to reach LQAS results ranged from 47 to 138 days. The average cost of an LQAS classification in a single facility was US$466. The findings indicate that LQAS-based AMR survey is a feasible, sensitive, and affordable strategy for population-based AMR surveys, providing essential data to inform local empirical treatment guidelines and antimicrobial stewardship efforts.