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A new Technical Note from the World Health Organization (WHO) has been released to help countries worldwide improve their capacities to monitor antimicrobial resistance by using molecular tests. The Technical Note explains the value of using molecular diagnostic methods for surveillance and outlines the infrastructure and technological capabilities required. This information will enable health authorities to make informed choices on the most appropriate molecular tests in order to achieve a clearer picture of antimicrobial resistance globally.

Antimicrobial resistance (AMR) is a global health problem, with resistance to common antibiotics found in all regions of the world. This means it can be extremely difficult to treat some bacterial diseases such as MRSA, tuberculosis and gonorrhoea. Effective antibiotics are also essential for many medical procedures including routine surgery, emergency operations, transplants, and chemotherapy. The threat of infections with bacteria that are resistant to the last-line antibiotics is rising and this could lead to deaths from even minor infections in the future.

As part of a range of measures to address AMR, the WHO Global Antimicrobial Resistance Surveillance System (GLASS) was launched in 2015. Countries worldwide have joined GLASS, establishing national surveillance systems that can monitor antibiotic-resistant bacteria to help understand resistance trends and inform treatment guidelines. GLASS currently relies on tests that measure how bacteria respond to the presence of specific antibiotics, which gives limited information.

This Technical Note was developed by GLASS in collaboration with the WHO AMR Surveillance and Quality Assessment Collaborating Centres Network and partners. Researchers at the Centre for Genomic Pathogen Surveillance, based at the Wellcome Sanger Institute, were commissioned by the WHO to draft the Technical Note under the guidance of the Heads of WHO Collaborating Centres namely, Professor Neil Woodford (WHO Collaborating Centre for Reference and Research on Antimicrobial Resistance and Healthcare Associated Infections, UK), Professor Monica Lahra (WHO Collaborating Centre for Sexually Transmitted Diseases, Australia), and Professor Roman Kozlov (WHO Collaborating Centre for Capacity Building on Antimicrobial Resistance Surveillance and Research, Russia). This Technical Note will be especially helpful for countries that are just starting to use molecular technologies and will stand to benefit from the utility of these new methods. 

The WHO Technical Note details how molecular diagnostic tests using DNA or proteins can give reliable data that can complement current methods. The Technical Note considers three different laboratory contexts, each with different levels of capacities for molecular AMR testing: those with no prior experience in molecular AMR surveillance; newly established national reference laboratories (NRLs); and fully established NRLs with experience in molecular AMR surveillance.

The Technical Note details the advantages and limitations of existing molecular methods for the different types of laboratories and their cost effectiveness, providing a landscape analysis to assist decision making. 

Professor David Aanensen from the Centre for Genomic Pathogen Surveillance (CGPS) at the Wellcome Sanger Institute, and Big Data Institute, University of Oxford, said: “We were delighted to be involved in the development of this WHO technical note on how to use molecular methods for AMR surveillance. Our contribution to this technical note has been informed by our strong international partnerships with public health surveillance teams across the world and builds on our establishment of the NIHR Global Health Research Unit last year. We hope this will have a significant impact on informed choices that different laboratories and countries may make to improve AMR surveillance.”

Ghada Zoubiane, science and innovation lead for Wellcome’s drug-resistant infections programme, said: “Tracking the emergence and transmission of superbugs is incredibly difficult and quite patchy. Using innovative technologies such as sequencing will help to fill some of these gaps and deliver much better data on drug resistance around the world. As with all technologies, we will have to work through the hurdles of how it is implemented, but it’s fantastic to see the Wellcome Sanger Institute and WHO collaborating to strengthen the global surveillance system and help deliver countries’ national action plans.”

The report was funded by the WHO as part of a global effort to improve surveillance of antimicrobial resistance across the globe.

Dr Carmem Pessoa Da Silva from the WHO, said: “Urgent action is needed to combat antimicrobial resistance to prevent a post-antibiotic era, where common infections and minor injuries can be fatal. This real threat to global health needs worldwide cooperation to detect and track drug resistant bacteria. Using molecular diagnostics is a new paradigm in disease control which will inform public health decisions and drive regional, national and global action.”