A national framework for an antimicrobial resistance surveillance system within Iranian healthcare facilities: Towards a global surveillance system

Objectives: The threat of antimicrobial resistance (AMR) is growing rapidly, perhaps more dramatically in developing countries. A demand to monitor, surveil and predict AMR has prompted the design and implementation of AMR surveillance systems (AMRSSs) at all geographic levels, especially in the national context. This study reviewed AMRSSs in leading countries and organisations in order to customise a comprehensive framework for a national system in Iran. Methods: The research was conducted in two phases: a review of the literature and comparative analysis; and a knowledge, attitude and practice study. In the first phase, the AMRSSs of pioneering organisations and countries were reviewed by examining related documents. In the second phase, important components for the Iranian national system were determined on the basis of the World Health Organization's Global Antimicrobial Resistance Surveillance System (WHO GLASS). Results: This study determined the surveillance methods, priority specimens and pathogens, testing methods, reporting protocols and scheduling, recommended data sets, and tools and information flow necessary for the Iranian system. On this basis, a national framework was developed using the class and activity diagrams in Unified Modelling Language. A context diagram was also designed on the basis of a generic biosurveillance architecture. Conclusions: The design and implementation of a national AMRSS for Iranian healthcare facilities is critically required because of irrational antimicrobial use in Iran and insufficient data regarding its consequences. (C) 2017 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.