The 2015 global action plan on antimicrobial resistance (1) stresses the need to strengthen the evidence base on antimicrobial resistance (AMR) and use (AMU) through surveillance and research. Comprehensive and quality-assured data on the global and national incidence, prevalence and patterns of AMR in bacterial and fungal infections, as well as the quantity and way in which antimicrobials are used, are essential to address AMR. These data are needed to understand the extent of the problem and its drivers, detect trends and emerging threats, define targets and measure the impact of interventions.
The Global Antimicrobial Resistance and Use Surveillance Systems (GLASS) incorporates official national data on AMR and AMU in human health. Since its inception in 2016, GLASS has expanded in scope and coverage and comprises several modules such as routine surveillance on AMR in common bacterial and fungal pathogens, periodic nationally representative surveys to estimate AMR and its attributable mortality, and surveillance of AMU in the community and health care settings.
As of December 2022, 127 countries, territories, and areas (CTAs) contributed data to GLASS on AMR (GLASS-AMR) and/or antimicrobial use (GLASS-AMC). Please note that originally, GLASS referred to aggregated national antimicrobial use data as antimicrobial consumption (AMC), differentiating antimicrobial use (AMU) derived from individual patient. Since this distinction is partly artificial and may be confusing, the term “antimicrobial use - AMU” will be used for both types of data.
A comprehensive set of AMR and AMU data up to 2021 is currently available on the GLASS dashboard. It enables data visualization and complements GLASS annual reports.
GLASS data visualization dashboard for antimicrobial resistance:
The GLASS dashboard summarises resistance rates for twenty-three antibiotics in eleven antibacterial classes, across eight bacterial pathogens commonly isolated from patients with bloodstream, gastrointestinal, urinary, or genital infectious syndromes.
The dashboard provides insights into the implementation status, quality assurance, and standards of national AMR surveillance systems as well as the participation of CTAs in GLASS, from 2016 to 2021. Global GLASS coverage between 2016 and 2021 is measured through summary statistics, including the number of CTAs reporting interpretable Antibiotic Susceptibility Test (AST) results, absolute counts of Bacteriologically Confirmed Infections (BCIs) and interpretable AST results, and the median number of BCIs with interpretable AST reported per million population.
Additionally, the dashboard presents AMR rates for 2020 and 2021, considering differences in testing coverage among individual CTAs to inform the interpretation of global estimates, as well as a time series of AMR rates, considering only CTAs with uninterrupted reporting of ten or more BCIs with AST from 2017 to 2021.
The dashboard allows global-, regional- and CTA-level summaries of 2016-2021 GLASS data, and AMR rates in 2020 or 2021. A detailed description of GLASS methods underlying the 2023 GLASS dashboard is given in previous report editions (2,3,4,5,6) and the manual for early implementation (7).
GLASS data visualization dashboard for antimicrobial use:
The GLASS-AMC dashboard displays the data on annual national antimicrobial use globally and by WHO Region (Global AMC data) for each selected year or by CTA (Country, territory or area profiles) for the 2016 to 2021 period. It first provides contextual information related to the antimicrobial use surveillance, i.e. data sources, and the population and health system sectors under surveillance. It then shows the overall use, as well as the relative consumption by AWaRe (Access, Watch, Reserve) categories, pharmacological subgroups and route of administration. It also displays the list of the antibacterials that make up 75% of the national antibacterial use.
The current GLASS AMC dashboard shows data for the period 2016 – 2021, reported to WHO until the end of 2022. By then, 79 CTAs had enrolled in GLASS-AMC, and 61 of them reported data for either 2021 (n=55) or any other year back to 2016.
The validated data from 57 CTAs for either 2021 (n=51) or any other year back to 2016 are displayed on the current dashboard. In 2021, 67% of the CTAs (n=34) met or exceeded WHO’s target of at least 60% of the national consumption from Access antibiotics, and 25% (n=13) exceeded 80%.
The number of countries enrolling and reporting data on antimicrobial use to GLASS has been increasing over the years, and WHO strives to work with countries to expand further. Continuous efforts are made to improve the data quality and the user experience. WHO is developing a guide on how to use AMU surveillance data for policy and practice which should be available by the end of 2024.
References:
Global action plan on antimicrobial resistance [Internet]. Geneva: World Health Organization; 2015. Available from: https://apps.who.int/iris/handle/10665/193736.
Tornimbene B, Eremin S, Escher M, Griskeviciene J, Manglani S, Pessoa-Silva CL. WHO Global Antimicrobial Resistance Surveillance System early implementation 2016–17. The Lancet Infectious Diseases. 2018 Mar 1;18(3):241–2.
Global antimicrobial resistance surveillance system (GLASS) report: early implementation 2017-2018 [Internet]. Geneva: World Health Organization; 2018. Available from: https://www.who.int/glass/resources/publications/early-implementation-report-2017-2018/en/
Global antimicrobial resistance surveillance system (GLASS) report: early implementation 2020 [Internet]. Geneva: World Health Organization; Available from: https://www.who.int/glass/resources/publications/early-implementation-report-2020/en/
Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report: 2021 [Internet]. Geneva: World Health Organization; Available from: https://www.who.int/publications/i/item/9789240027336
Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report: 2022 [Internet]. Geneva: World Health Organization; Available from: https://www.who.int/publications/i/item/9789240062702
Global Antimicrobial Resistance Surveillance System (GLASS): Manual for early Implementation [Internet]. Geneva: World Health Organization; 2015. Available from: http://www.who.int/iris/bitstream/10665/188783/1/9789241549400_eng.pdf?ua=1