Improving empirical antibiotic treatment The role of diagnostic accuracy and surveillance

Antimicrobial Resistance (AMR) is a global health and development threat quickly worsening, especially in low-middle and middle-income countries. Overuse of antibiotics and inappropriate antibiotic treatment are the main drivers of AMR. The thesis describes the use of the urinary dipstick and the adherence to clinical guidelines as ways to improve the diagnostic process of urinary tract infection (UTI) and sepsis, respectively. An improved diagnostic process steers the prescription of the right antibiotic at the right time. Empirical antibiotic treatment requires insight into the prevailing prevalence of AMR, which population-based surveillance provides, in general, more accurate data compared to laboratory-based surveillance. In Southeast Asian countries where the prevalence of AMR is high, there are limited surveillance activities precluding guidance to empirical antibiotic treatment. The thesis discusses findings from current AMR surveillance in Indonesia, showing an extremely high prevalence of AMR in bacterial isolates from urine samples of patients suspected of UTI, threatening rational choices for empirical treatment. The thesis introduces the technique of Lots Quality Assurance Sampling as a way to make AMR surveillance more efficient while obtaining relevant local data to facilitate the choice of an appropriate antibiotic treatment strategy and steer empirical treatment guidelines and antimicrobial stewardship efforts.