Strengthening antimicrobial resistance surveillance in Indonesia Strategies for surveillance of uropathogens

Antimicrobial resistance (AMR) represents one of the most important threats to global health. Inappropriate use of antibiotics is a key driver of AMR. Surveillance is one important approach for tackling AMR, in order to: (1) inform empirical antibiotic therapy, (2) monitor trends in AMR and antibiotic use, and (3) inform policy at national and international levels. However, there are multiple challenges when implementing AMR surveillance, including cost, logistics, availability of relevant and timely information of AMR, and laboratory capacity. Novel approaches are thus needed that require minimum resources to produce high-quality and relevant surveillance data. Uropathogens are the most common bacteria causing infections in hospitals and in the community, and are commonly treated with empirical antibiotics. AMR in uropathogens is associated with increasing morbidity and mortality. This thesis assesses surveillance practices in the Asia-Pacific region, including Indonesia, and investigates the use of rapid threshold surveillance approaches, in particular Lot Quality Assurance Sampling (LQAS), for AMR surveillance among uropathogens. The research highlights the importance of unbiased population-based sampling in the out-patient setting, and the need for quality-assured laboratory processes. LQAS-based AMR surveillance should be considered when implementing surveillance for obtaining locally relevant AMR data.