Using information technology to improve surveillance of antimicrobial resistance in South East Asia

T he continual rise of antimicrobial resistance (AMR) was recognised by the United Nations in 2016 as a serious threat to global health and human development. Surveillance of AMR and monitoring antibiotic usage are complementary and fundamental to everyday clinical practice. They are also central to monitoring the effectiveness of national AMR prevention and containment programmes. The extent of AMR (eg, prevalence and trends, public health significance of resistance phenotypes or species) can be determined through quality laboratories interconnected in a well organised national surveillance network. Building this surveillance network remains a challenge in most countries, including those of the World Health Organization’s (WHO) South East Asia region (SEAR). A lack of information technology (IT) infrastructure is often cited as a barrier to comprehensive AMR surveillance and antibiotic usage programmes. Surveillance of AMR and antibiotic usage is complex as data generated from one single patient require analysis of several organisms. These must be tested for susceptibility to several antibiotics and combined with antibiotic treatment regimens. When surveillance data are captured by networks of clinical laboratories, only IT systems can readily manage and consolidate the information to allow timely and thorough analyses nationally and locally. Computers can be used efficiently to study the emergence of resistant genes and in systems to detect an outbreak within a hospital or nationally; for analysis of AMR clusters through antibiotic resistance profiles; for automated or manual entry of data for web based reporting that allows real time integration and timely analysis; and to provide automated reporting with the ability for space-time visualisation. Surveillance specialists in the region understand the potential benefits of automation offered through software, hardware, and communication infrastructure, although ways to set up an IT system are unclear. Major barriers to improving the quality of work are the costs of software and hardware, of maintaining systems, and of employing staff. Inadequate infrastructure also leads to limited/slow internet connectivity. We present here strategic directions and practical solutions for setting up an IT system to improve the AMR surveillance network for countries in the South East Asia region—developing their full participation in the Global AMR Surveillance System (GLASS).