A roadmap for HOTspots and antimicrobial resistance (AMR) surveillance in the north

Roadmap for AMR surveillance in northern Australia

This translational research proposal seeks to support two main objectives, which are (1) to scale up integration of HOTspots into health service delivery (2) develop a roadmap for the establishment of cross-jurisdictional AMR surveillance in the region.

Resistance to antibiotics in bacterial pathogens is recognised as a major international public health threat. In northern Australia, rates of many bacterial infections exceed rates in other parts of Australia, yet a comprehensive, coordinated response to antimicrobial resistance (AMR) has been lacking. Healthcare providers, public health practitioners, guideline writers and policy makers all need access to up-to-date information on evolving AMR in the region.

This project will scale up integration of a recently-developed online tool providing AMR data into health service delivery, and develop a roadmap to define the strategic direction and goals for surveillance of antibioticresistance in northern Australia. A roadmap is the next necessary step in ensuring that end-users of AMR surveillance are the advocates for change in both the clinical management of AMR and an improved coordinated response. An evaluation of online tools already developed (HOTspots), combined with a set of recommendations from key stakeholders, will inform both the roadmap and advocacy resources required to put AMR on the local political agenda. Drafting a roadmap will require agreement, engagement and advocacy to plan for a coordinated response to AMR across the north.

This project is will support the HOT NORTH theme on antimicrobial resistance, however it is also related to skin health, respiratory health and emerging infectious diseases, as many of the pathogens that are developing antimicrobial resistance cause skin and respiratory infections, and they are a significant emerging infectious disease threat.

HOTspots is a laboratory-based, cross-jurisdictional online AMR surveillance tool developed by co-investigator Dr Teresa Wozniak. The HOTspots tool aims to support healthcare professionals to make empirical antibiotic therapy choices and to provide local and timely data to support the activities of antibiotic stewardship programs, pathology providers (in the development of local antibiograms) and those updating therapeutic guidelines.

There are three end-users of HOTspots susceptibility data: (1) healthcare professionals; (2) laboratory scientists/ microbiologists; and (3) public health authorities and policy-makers (relevant to AMR strategies, guidelines). HOTspots repackages already existing but under-utilised laboratory data from four main pathology providers across northern Australia– Western Diagnostics, Territory Pathology, PathWest and Queensland Pathology. Pathology data are provided to co-investigator Wozniak (HOT NORTH Career Development Fellowship 2018 & 2019) cleaned, interpreted and repackaged into an online geospatial tool that visualizes a heat map of hotspots of resistant infections (static per year) and displays graphs (i.e. number of isolates tested and changes in trends over time). Pathology data are currently available only until the year 2017, with discussions underway on formalised data transfer agreements for regular provision of susceptibility data. The PathWest director has agreed to this in principal and we are working toward agreement with other pathology providers.

In June 2019, we commenced an evaluation of the HOTspots tool using the US Centres for Disease Control (CDC) framework of evaluation of a surveillance system. The evaluation consists of qualitative and quantitative data collected from interviews, online surveys and a focus group discussion with key end-users and partners in AMR surveillance and response across northern Australia (HREC 2019-3425). The evaluation will produce evidence of the applicability of HOTspots as a surveillance system and will report a set of recommendations from the focus group for health system integration and scale up. All data generated in the evaluation are planned to be collected and analysed by December 2019.

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