The AR-ISS surveillance system
Since 2001, the Istituto Superiore di Sanità (ISS) has been coordinating Italy’s antimicrobial resistance surveillance system (AR-ISS), consisting of a network of hospital clinical microbiology laboratories recruited on a voluntary basis. Its primary objective is to describe frequency and trends in antimicrobial resistance in a group of pathogens of clinical and epidemiological relevance. The Prime Ministerial Decree (DPCM) of 3 March 2017, “Identification of surveillance systems and registries of mortality, tumours and other diseases”, included the AR-ISS surveillance among those of national significance, and identified the ISS as its national reference body.
The AR-ISS is the core of the “Surveillance of antimicrobial resistance in humans”, an area of activity included in Italy’s 2017-2020 National Action Plan on Antimicrobial Resistance (Piano Nazionale di Contrasto dell’Antimicrobico-Resistenza – PNCAR). The AR-ISS protocol was updated in January 2019 (Ministry of Health circular of 18 January 2019) with the aim of improving its performance, by actively involving the Regions and including regional surveillance networks, where present. This has led to a significant increase in regional and national representation in the surveillance. Hospitals served by laboratories participating in the surveillance accounted for 36% of total National Health System beds in 2018, up from 21% in 2017.
The primary objective of the AR-ISS surveillance is to describe trends in antimicrobial resistance in a selected group of pathogens isolated from invasive infections (bacteraemia and meningitis), including community-acquired infections and healthcare-associated infections. This involves acquiring data routinely produced by hospital clinical microbiology laboratories on invasive strains of 8 species: Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecalis, Enterococcus faecium, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter species.
The AR-ISS surveillance relies on collaboration and support from:
- Regional coordinators for the surveillance of antimicrobial resistance in humans, assisted by a microbiologist. They identify the participating laboratories or, where surveillance systems with regional coverage are in place, provide data relating to the whole region
- Microbiology laboratories that produce data on antimicrobial resistance as part of their diagnostic routines and extract them from their management systems
- The Department of Infectious Diseases of the ISS, which provides epidemiological and microbiological coordination at central level. The department is responsible for: collecting information, ensuring the quality of the data reported by laboratories, collecting and studying bacterial strains with particular resistance phenotypes provided by laboratories (as part of ad hoc studies to examine specific topics that are relevant to public health), analyses, data transmission to the European Surveillance System database (TESSy) and data dissemination.
Every year, the collected data are published in an online report.
Through the AR-ISS, Italy participates in the European Antimicrobial Resistance Surveillance Network (EARS-Net), which is coordinated by the European Centre for Disease Prevention and Control (ECDC) and collects antimicrobial resistance data from 30 countries of the European Union and the European Economic Area through the TESSy platform. Italy’s data are processed, analyzed and compared with those of the other European countries, and published every year during the European Antibiotic Awareness Day (18 November). The collected data are available on the ECDC website, in the section of the “Surveillance Atlas of Infectious Diseases” dedicated to antimicrobial resistance.