Antibiotic resistance - from pathogen to disease surveillance

Surveillance is central to defining the epidemiology of antibiotic resistance, developing new strategies for its control, informing disease management, identifying targets for new drugs and vaccines and in turn, evaluating and refining the impact of these interventions. Current surveillance systems often fall short of this ideal. Since antibiotics are prescribed for the treatment of specific disease, surveillance that reliably links diagnosis, pathogen and antibiotic usage is likely to be more informative. By identifying diseases that are readily recognized, and are usually reliably defined microbiologically, and in turn have clear links to public-health issues, a broader ownership of surveillance data should result. The case is argued for a more disease-focused microbiological surveillance approach than exists at present. Examples are provided which reflect a cross-section of community, nosocomial, zoonotic and imported infectious disease challenges, and where new approaches are urgently required to combat the upward spiral of resistance.