Proof-of-principle study

In parts of the WHO European Region, the implementation of a national antimicrobial resistance (AMR) surveillance system based on routine antibiotic susceptibility testing is limited by the underutilization of microbiological diagnostics in routine clinical practice. The main reasons reported for this include lack of funds for microbiological diagnostics and clinicians’ perceptions that susceptibility data lack clinical utility.

A proof-of-principle (PoP) study was set up with the aims of (i) stimulating the taking of blood cultures from patients with suspected bloodstream infections by providing case definitions and materials and (ii) starting to assess the antibiotic susceptibility patterns of the main pathogens causing community- and hospital-acquired bloodstream infections. It thereby:

  • establishes and supports a surveillance infrastructure as a point of departure for a national sentinel laboratory-based surveillance system for AMR;
  • demonstrates the value of clinical microbiological diagnostics in routine patient care by providing timely feedback of laboratory results to clinicians to guide the antibiotic treatment of bloodstream infections; and
  • establishes good clinical practice for routine clinical work-up in hospitals and strengthens AMR reference and surveillance capacity at national reference laboratories.

A pilot PoP study started in July 2015 in Tbilisi, Georgia, coordinated by the Richard Lugar Centre for Public Health Research of the National Centre for Disease Control and Public Health of Georgia. The first results were published in the 2016 Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR) report. Further PoP studies will start in 2017 in Armenia and Uzbekistan. The PoP study is a joint undertaking with the European WHO collaborating centres.