ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network): a pilot protocol for case based antimicrobial resistance surveillance

<ns4:p><ns4:bold>Background</ns4:bold>: Antimicrobial resistance (AMR) / drug resistant infections (DRIs) are a major global health priority. Surveillance data is critical to inform infection treatment guidelines, monitor trends, and to assess interventions. However, most existing AMR / DRI surveillance systems are passive and pathogen-based with many potential biases. Addition of clinical and patient outcome data would provide considerable added value to pathogen-based surveillance.</ns4:p><ns4:p> <ns4:bold>Methods</ns4:bold>: The aim of the ACORN project is to develop an efficient clinically-oriented AMR surveillance system, implemented alongside routine clinical care in hospitals in low- and middle-income country settings. In an initial pilot phase, clinical and microbiology data will be collected from patients presenting with clinically suspected meningitis, pneumonia, or sepsis. Community-acquired infections will be identified by daily review of new admissions, and hospital-acquired infections will be enrolled during weekly point prevalence surveys, on surveillance wards. Clinical variables will be collected at enrolment, hospital discharge, and at day 28 post-enrolment using an electronic questionnaire on a mobile device. These data will be merged with laboratory data onsite using a flexible automated computer script. Specific target pathogens will be <ns4:italic>Streptococcus pneumoniae, Staphylococcus aureus, Salmonella </ns4:italic>spp<ns4:italic>., Klebsiella pneumoniae, Escherichia coli, </ns4:italic>and<ns4:italic> Acinetobacter baumannii</ns4:italic>. A bespoke browser-based app will provide sites with fully interactive data visualisation, analysis, and reporting tools.</ns4:p><ns4:p> <ns4:bold>Discussion</ns4:bold>: ACORN will generate data on the burden of DRI which can be used to inform local treatment guidelines / national policy and serve as indicators to measure the impact of interventions. Following development, testing and iteration of the surveillance tools during an initial six-month pilot phase, a wider rollout is planned.</ns4:p>