Setting up an integrated surveillance system

The specific design of antimicrobial surveillance programs presents several challenges. Recognizing that not all countries have the same public health infrastructure for surveillance, it is important to establish a minimum set of criteria for surveillance systems.
A useful monitoring program must be sustainable over time to provide the data needed for public health decision making and allocation of resources. WHO recommends a working group be established that includes scientists from different disciplines (e.g., veterinarians, microbiologists, epidemiologists), as well as representatives from government agencies responsible for risk assessment and management.
A number of systems have been established in different countries that can be used as models for design of a surveillance system. These include, but are not limited to: the Danish Integrated Monitoring Program (DANMAP), The U.S. National Antimicrobial Resistance Monitoring System (NARMS) the Canadian Integrated Program on Antimicrobial Resistance (CIPARS), the Korean National Antimicrobial Resistance Monitoring Program (NAMP), Norway’s NORM-VET program, and the Swedish Veterinary Antimicrobial Resistance Monitoring (SVARM) program. 
The major issues that need to be addressed when establishing an integrated monitoring system are:
1) Study population – Humans, retail meats, food producing animals
2) Sampling strategy
   a)  Representativeness
   b)  Sampling bias
   c)  Frequency of testing
   d)  Sample size
   e)  Sample source
3) Culture methodology
   a)  Target organisms
   b)  In vitro antimicrobial susceptibility testing methods
   c)  Antimicrobials to be used in susceptibility testing
4) Data management and reporting
   a)  Database design for appropriate data extraction
   b)  Type of data to be reported
   c)  Analysis and interpretation of data
   d)  Information sharing
   e)  Confidentiality policies should be established to protect proprietary data
Additional and specific information on setting up an integrated surveillance system can be found in this document.