全球、區域和國家抗生素抗藥性監測系統的回顧

Antibiotic Resistance Surveillance Systems; a Systematic Review of Global, Regional and National Efforts

新冠肺炎（COVID-19）大流行凸顯我們身處的世界對於新興傳染病的脆弱性，而抗生素抗藥性（antimicrobial resistance, AMR）問題也持續威脅著全球健康，一項2019年的估計顯示抗生素抗藥性導致127萬人死亡。為了充分解決抗生素抗藥性問題需要對抗生素抗藥性進行有效和可靠的監測，在過去的幾十年裡，世界各國、區域間和全球都在努力改進抗生素耐藥性的監測，不同的監控系統都
有其關鍵特徵、的設計和目標。本研究目的在透過全面的回顧檢視來對比6個此類系統進行比較和排名，此外也使用相同的方法對臺灣醫院感染監測系統（Taiwan Nosocomial Infections Surveillance System, TNISS）進行了審查以提出可能的改進建議。我們的研究發現全球抗生素抗藥性監測系統（Global Antimicrobial Resistance Surveillance System, GLASS）（得分80/100）處於全球領先地位，該系統旨在指導各國抗生素抗藥性數據的收集，使各國的努力具有可比性並全面概述當前全
球抗菌素耐藥性的狀況。在區域層面，歐洲抗生素抗藥性監測網絡（European Antimicrobial Resistance Surveillance Network, EARS-Net）（得分80/100）多年來一
直處於領先地位，指導歐盟的抗菌素耐藥性監測。從個別國家來看日本的醫院感
染監測（Japan's Nosocomial Infection Surveillance, JANIS）（得分79/100）正在不斷進步，是GLASS系統中最傑出的參與者之一，幾乎報告了GLASS-AMR監測參數的所有關鍵指標。TNISS得分為48分（滿分100分）但還有改進的潛力，通過參考日本的實施經驗可以使TNISS達到GLASS制定的國際標準，讓臺灣能更有準備地因應島上日益嚴重的抗生素抗藥性問題的威脅。我們的結論是臺灣未來需要改
進抗生素抗藥性的監測來提出基於證據的因應抗生素抗藥性風險的政策。

The COVID-19 pandemic has shown the world's vulnerability to emerging infectious diseases. Simultaneously bacterial antimicrobial resistance (AMR) is also threatening global health; recent estimates for 2019 indicated that 1.27 million deaths were attributed to bacterial AMR. In order to adequately address bacterial AMR, efficient and reliable surveillance of bacterial resistance is needed, and over the last decades, national, regional and global efforts have been undertaken to spark and improve antibiotic resistance surveillance. Surveillance systems all have their own key characteristics, reflecting choices that have been made in line with the aim and design of such systems. This study developed a comprehensive methodology to compare and rank six of such systems at different operational levels. Additionally, the Taiwan Nosocomial Infections Surveillance System (TNISS) was reviewed with the same methodology to recommend possible improvements. Leading globally is the Global Antimicrobial Resistance Surveillance System (GLASS) (score 80/100), which aims to guide national collection of AMR data, to make national efforts comparable and provide a comprehensive overview of the current global status of AMR. At the regional level, the European Antimicrobial Resistance Surveillance Network (EARS-Net) (score 80/100) has been leading for years, guiding AMR surveillance in the European Union. Regionally, Japan's Nosocomial Infection Surveillance (JANIS) (score 79/100) is advancing and one of the most outstanding participants in the GLASS system, reporting on almost all key indicators possible for the GLASS-AMR surveillance parameters. TNISS scored 48 out of 100 but has the potential for improvement; by bringing TNISS up to international standards as set by GLASS, through the usage of Japan's implementation experience, Taiwan will be better prepared for the increasing bacterial AMR threat on the island. Future policies to tackle the risk of bacterial AMR in Taiwan require an evidence-based approach. Hence improvement of surveillance for bacterial AMR is needed.