Convergence of surveillance blind spots with antimicrobial resistance hotspots

Antimicrobial resistant pathogens that are detected and reported cause an estimated 700,000 deaths per year.1 The global distribution of antimicrobial resistance (AMR) means that future generations can expect to stay in hospital longer, have increased treatment complications and be at greater risk of dying following surgical procedure.2,3 The economy will also suffer from escalating healthcare costs and loss of productivity due to excess morbidity and premature mortality.1,4 An appropriate response relies on accurate data; however, it is becoming increasingly clear that the true burden of infection is significantly greater than what is reported through clinical surveillance data. Indeed, resourceconstrained and geographically isolated regions have limited infrastructure, resources and are often outside of surveillance reach. This surveillance blind spot limits health services’ ability to provide early warning signs and response at regional, national and international level. The consequences of delayed disease response are now, more than ever, recognised in the context of the current pandemic. Globally, Australia is considered a low-AMR region with a reported national average of 10% resistance for eight priority bacteria.1 However, this omits the striking geographical variation of AMR across the country, with as much as 56% of Staphylococcus aureus clinical isolates resistant to methicillin and an emergence of inducible-clindamycin co-resistance in northern Australia.5 Accurate geographical and temporal changes of AMR are invaluable for guiding empiric treatment, particularly in light of high community MRSA in regional Australia.5,6 Persistent clusters of AMR hotspots are converging with surveillance blind spots in regional Australia and to effectively contain this threat, we need innovative, region-specific solutions