Reality of developing a community-wide antibiogram.

Antimicrobial surveillance may be defined as a systematic collection, analysis, and dissemination of data that may be used to identify resistance trends and assess the need for intervention (2). In 1988 the Centers for Disease Control and Prevention published guidelines for evaluation of surveillance systems for antimicrobial resistance (7), and an American Society for Microbiology task force (1) highlighted the importance of performing antimicrobial surveillance through local, national, and global networks. Unfortunately, the recommendations from this task force were not implemented, in part due to lack of funding (6). To this end, however, international as well as more than 21 national programs designed to capture susceptibility data for most clinically significant organisms (e.g., SENTRY and TSN) and 24 programs that focused on specific organisms (e.g., CARE and TRUST), were identified in 1999 through the World Health Organization Antimicrobial Resistance Information Bank (9). These programs may be government (e.g., ICARE and NNIS,), commercial (e.g., TSN), or industry (e.g., ARMp, MYSTIC, PROTEKT, SENTRY, and TRUST) supported. Additional data may be gleaned from postmarketing surveillance studies by pharmaceutical companies who monitor their new antimicrobial for resistance, e.g., MYSTIC (meropenem), SMART (quinupristin-dalfopristin), and ZAP (linezolid). Since testing methods may vary between laboratories and may potentially bias multilaboratory databases, some programs rely on a central laboratory to generate standardized susceptibility data. Quantitative (MIC) rather than qualitative (susceptible, intermediate, and resistant) data and the use of molecular methods, as employed in the MYSTIC and SENTRY programs, generally offer greater value in identifying resistance trends and providing a genetic basis for observed resistance, respectively.