Links

ORGANIZATIONS

Alliance for the Prudent Use of Antibiotics
The Alliance for the Prudent Use of Antibiotics is a non-profit, international organization solely dedicated to preserving the power of antibiotics. Founded in 1981, the mission of the Alliance for the Prudent Use of Antibiotics (APUA) is to improve antibiotic access and use and contain antibiotic resistance (ABR) around the world through research and education.

U.S. Food and Drug Administration
The FDA Web site contains background information and news relating to antibiotic resistance, and documents presenting strategies and recommendations to address this growing problem.

Infectious Diseases Society of America (IDSA)
The Infectious Diseases Society of America (IDSA) represents physicians, scientists and other health care professionals who specialize in infectious diseases. IDSA’s purpose is to improve the health of individuals, communities, and society by promoting excellence in patient care, education, research, public health, and prevention relating to infectious diseases.

Society for Healthcare Epidemiology of America (SHEA)
The Society for Healthcare Epidemiology of America (SHEA) was organized in 1980 to foster the development and application of the science of health care epidemiology. SHEA member activities include epidemiologic and laboratory investigation, surveillance, risk reduction programs focused on device and procedure management, policy development and implementation, education and information dissemination, and cost-benefit assessment of prevention and control programs.

NCCLS
NCCLS (originally known as the National Committee for Clinical Laboratory Standards), formed in 1968, is a non-profit globally-recognized organization that enhances the value of medical testing within the healthcare community through the development of voluntary consensus standards, guidelines, and best practices. NCCLS's core business is the development of globally applicable voluntary consensus documents for healthcare testing. It manages two distinct processes:

• the NCCLS consensus process for developing globally applicable standards and guidelines; and
• the International Organization for Standardization or ISO process, for developing International standards as the Secretariat for ISO/TC 212, Clinical laboratory testing and in vitro diagnostic test systems.

World Health Organization
The World Health Organization (WHO) has developed a Global Strategy for Containment of Antimicrobial Resistance. The Strategy covers six key points required to respond to this problem, ranging from disease prevention, to access and appropriate use of antimicrobials, to surveillance, to the need for appropriate legislation and focused research. Addressed to policy-makers and managers in a range of sectors and agencies, the Strategy aims to both persuade governments to take urgent action and then to guide this action with expert technical and practical advice.

An Implementation Workshop on the Global Strategy for Containment of Antimicrobial Resistance took place in November 2002. This considered on a global scale the extent to which the implementation recommendations of the Global Strategy are being put into place at country level.

RESOURCES

A Public Health Action Plan To Combat Antimicrobial Resistance
The Public Health Action Plan to Combat Antimicrobial Resistance (Action Plan) was developed by an interagency Task Force on Antimicrobial Resistance that was created in 1999. The Task Force is co-chaired by the Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health and also includes the Agency for Healthcare Research and Quality, the Health Care Financing Administration, the Health Resources and Services Administration, the Department of Agriculture, the Department of Defense, the Department of Veterans Affairs, and the Environmental Protection Agency. The Action Plan provides a blueprint for specific, coordinated federal actions to address the emerging threat of antimicrobial resistance.

MASTER Web site
The CDC’s MASTER (Multi-level Antimicrobial Susceptibility Testing Educational Resources) Web site is intended to keep site visitors informed of antimicrobial susceptibility testing issues related to clinical microbiology laboratory practice. Each update provides

• A Case Study that addresses a contemporary antimicrobial susceptibility testing issue.
• A Q&A that answers to five or more questions asked by visitors to the Web site.
• A list of recent papers related to antimicrobial susceptibility testing.
• New information and upcoming continuing education offerings on antimicrobial susceptibility testing.
• A list of reference materials that provide antimicrobial susceptibility testing information.

Centers for Disease Control and Prevention. National Campaign for Appropriate Antibiotic Use in the Community.

HHS, public health partners unveil new campaign to promote proper antibiotic use. Press release. September 17, 2003.

Labeling requirements for systemic antibacterial drug products intended for human use.
U.S. Department of Health and Human Services: Food and Drug Administration. (2003). 21 CFR Part 201.

PUBLICATIONS

Using hospital antibiogram data to assess regional pneumococcal resistance to antibiotics. Stein CR,* Weber DJ,* Kelley M*. Emerg Infect Dis February 2003.
*The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Antimicrobial resistance to penicillin and macrolides in Streptococcus pneumoniae has increased in the United States over the past decade. Considerable geographic variation in susceptibility necessitates regional resistance tracking. Traditional active surveillance is labor intensive and costly. We collected antibiogram reports from North Carolina hospitals and assessed pneumococcal susceptibility to multiple agents from 1996 through 2000. Susceptibility in North Carolina was consistently lower than the national average. Aggregating antibiogram data is a feasible and timely method of monitoring regional susceptibility patterns and may also prove beneficial in measuring the effects of interventions to decrease antimicrobial resistance.

Tracking drug-resistant Streptococcus pneumoniae in Oregon: an alternative surveillance method. Chin AE,*† Hedberg K,* Cieslak PR,* Cassidy M,* Stefonek KR,* Fleming DW*.
Emerg Infect Dis October 1999.
*Oregon Health Division, Portland, Oregon, USA; and
†Centers for Disease Control and Prevention, Atlanta, Georgia, USA
With the emergence of drug-resistant Streptococcus pneumoniae, community-specific antimicrobial susceptibility patterns have become valuable determinants of empiric therapy for S. pneumoniae infections.Traditionally, these patterns are tracked by active surveillance for invasive disease, collection of isolates, and centralized susceptibility testing. We investigated whether a simpler and less expensive method— aggregating existing hospital antibiograms could provide community-specific antimicrobial susceptibility data. We compared 1996 active surveillance data with antibiogram data from hospital laboratories in Portland, Oregon. Of the 178 S. pneumoniae active surveillance isolates, 153 (86% [95% confidence interval (CI) = 80% to 91%]) were susceptible to penicillin. Of the 1,092 aggregated isolates used by hospitals to generate antibiograms, 921 (84% [95% CI = 82%-87%]) were susceptible to penicillin. With the exception of one hospital's erythromycin susceptibility results, hospital-specific S. pneumoniae susceptibilities to penicillin, cefotaxime, trimethoprim-sulfamethoxazole, and erythromycin from the two methods were statistically comparable. Although yielding fewer data than active surveillance, antibiograms provided accurate, community-specific drug-resistant S. pneumoniae data in Oregon.

Redefining Appropriate Use of Antibiotics>
Editorial. Gums J..Am Fam Physician. 2004 Jan 1;69(1):35, 39-40.