A JPIAMR project aiming to develop an antimicrobial resistance (AMR) surveillance strategy in a One Health context, which is applicable in high-, middle-, and low-income countries.
OASIS moves from conventionally estimating AMR prevalence to classifying populations/settings as having a “high” or “low” AMR prevalence, by applying a Lot Quality Assurance Sampling approach.
OASIS aims to develop an antimicrobial resistance (AMR) surveillance strategy in a One Health context, and applicable in high-, middle-, and low-income countries. The proposed strategy challenges the strong reliance on laboratory-based AMR surveillance for meeting objectives of the Global Action Plan on AMR .
Inappropriate use of antibiotics is a key driver for AMR. Antimicrobial stewardship programmes aim at reducing inappropriate use by promoting evidence-based prescribing of antimicrobial drugs. Knowledge of the prevalence of AMR is central to this evidence base, and therefore for the design and implementation of antimicrobial stewardship programmes. The AMR prevalence estimates in the human and veterinary domains suffer from the same drawbacks: selection bias in isolates submitted for antibiotic susceptibility testing, and absence of locally-relevant information due to aggregated data on (sub-)national level. The required evidence base needs population-based AMR prevalence surveys. However, conventional surveys are time consuming, expensive, and preclude the identification of local variations in AMR prevalence, given the limitations in sample size.
OASIS moves from conventionally estimating AMR prevalence to classifying populations/settings as having a “high” or “low” AMR prevalence, by applying a Lot Quality Assurance Sampling (LQAS) approach. This requires much smaller sample sizes, and is uniquely positioned for population-based AMR surveillance.
The project validates the LQAS-based AMR surveillance approach against conventional AMR prevalence surveys in the veterinary domain for the first time. It additionally provides the evidence that aggregation of LQAS results (which are classifications of “high” or “low” AMR prevalence), can serve as a valid estimate of conventional AMR prevalence survey results (which are prevalence estimations). It is especially this latter validation step that will make LQAS-based AMR surveillance an attractive strategy for the health profession and policy makers alike, as the LQAS-based results provide the required local evidence for appropriate empirical antimicrobial treatment, while the aggregation of these results in a conventional AMR prevalence estimate provides policy makers with a tool for measuring the impact of interventions that are aimed at reducing AMR prevalence at district, regional, or national levels.
OASIS’ implementation research component engages domain-specific stakeholders throughout the project to optimise knowledge utilisation, and facilitate the translation of results into policy.
Lot quality Assurance Sampling (LQAS) is an approach that derives from industry, where it is used for a rapid assessment of the quality of goods within a specified batch. The methodology has made its way into the field of Public Health as a rapid assessment tool in program evaluation, e.g vaccination coverage.
The process involves several steps which are depicted in the Figure below
Within the field of antimicrobial resistance, the outcome refers to the prevelence of micro-organisms resistant for a given antibiotic. The threshold refers to the maximum acceptable prevalence of resistance for an antibiotic still being able to be given as empirical treatment. Whether or not the threshold has been passed is dependent on the used decision rule that is defined with respect to statistical parameters.
Kicking-off an exciting project.
This is our publication on the feasibility of LQAS for AMR surveillance. The results of this study performed in Indonesia sparked the design of the current OASIS project
abstract: Global surveillance of antimicrobial resistance (AMR) is a key component of the Global Action Plan on AMR. Laboratory-based surveillance is inherently biased and lacks local relevance due to aggregation of data. We assessed the feasibility, sensitivity, and affordability of a population-based AMR survey using Lot Quality Assurance Sampling (LQAS), which classifies a population as having a high or low prevalence of AMR based on a-priori defined criteria. Three studies were carried out in Medan and Bandung, Indonesia between April 2014 and June 2017. LQAS classifications for 15 antibiotics were compared with AMR estimates from a conventional population-based survey, with an assessment of the cost of a single LQAS classification using micro-costing methodology in patients suspected of urinary tract infection in eleven sites in Indonesia. The sensitivity of LQAS was above 98%. The approach detected local variation in the prevalence of AMR across sites. Time to reach LQAS results ranged from 44 to 138 days. The average cost of an LQAS classification in a single facility was 460 USD. The findings indicate that LQAS-based AMR survey is a feasible, sensitive and affordable strategy for population-based AMR surveys, providing essential data to inform local empirical treatment guidelines and antimicrobial stewardship efforts.
This is our publication on the feasibility of LQAS for AMR surveillance. The results of this study performed in Indonesia sparked the …
OASIS is funded in the 9th call (diagnositc and surveillance) of the Joint Programming Initiative on Antimicrobial Resistance ( JPIAMR ), established by the European Commision. JPIAMR is a global collaborative platform and has engaged 28 nations to curb antibiotic resistance (AMR) with a One Health approach. The initiative coordinates national funding to support transnational research and activities within the six priority areas of the shared JPIAMR Strategic Research and Innovation Agenda – therapeutics, diagnostics, surveillance, transmission, environment and interventions.
The following national funding agencies participate in the OASIS project: