Table 2 Practical deliveries identified in AMR data linkage studies
Recommendations for clinical practice | Implications for guiding future policies | Suggestions for further research | Suggestions for surveillance | |
|---|---|---|---|---|
Antibiotic use + AMR (n = 9) | Take into account certain patient characteristics and local conditions in AMS programs and/or antibiotic prescribing [14,13,15, 17] Reduce (overall) antibiotic prescription/consumption [14, 16, 17] Use different antibiotic as first-line treatment [17] | More international cooperation [5] Need for policy to discourage overuse of antibiotics [5] Support development of new antibiotics [5] | Further research on whether found associations hold in other settings [10, 12] Update the study with more data [11] Examine the role of patient related factors [15] Perform individual-level studies [16] | |
Antibiotic use + AMR + population characteristic (n = 7) | Preferred level of action is national [24] Increase governance efficiency at global level [20] | Study from one health perspective [20] Other study design to confirm causal relationship [22] Examine the role of patient related factors [18] Update the study with more data [19] | Use of data linking show potential to monitor causal links in longitudinal manner [23] | |
Antibiotic use + population characteristic (n = 10) | Take into account certain patient characteristics and local conditions in AMS programs and/or antibiotic prescribing [33,34,31, 33, 34] | Take into account local context in AMS programs [25, 32] Improve awareness in care home setting [30] Consider influenza vaccination to decrease antibiotic use [27] | Update the study with more data [32] Replicate findings over time [34] | |
AMR + population characteristic (n = 13) | Take into account certain patient characteristics and local conditions in AMS programs, AST, and antibiotic prescribing [40, 45, 46] | Take population characteristics and/or local conditions into account for policy attentions [39, 41] Ongoing efforts to limit entry and spread of resistant strains in environmental and healthcare settings [35] Implement quality indicators on antibiotic prescription on national or regional levels [42] | Examine the role of patient related factors [36] Examine the role of strain factors on clinical outcomes [35] Other study design to confirm causal relationship [39] | Surveillance of resistance is recommended to ensure empirical treatment guidelines are appropriate [43, 45] Increase investment in surveillance and improve treatment capacity [37] Make surveillance systems flexible to simplify implementing new elements [45] Surveillance for specific patient group [40] |
Antibiotic use + AMR + animal data (n = 5) | Integrated approach: focus on social development and poverty reduction as well [47] Closer medico-veterinary collaboration to create guidelines to promote reducing antibiotic use [51] | Update the study with more data [51] | Surveillance of resistance among animal [50] | |
Anticiotic use + AMR + third (n = 4) | Take into account certain patient characteristics and local conditions in antibiotic prescribing [53] Use different antibiotic as first-line treatment [4] | Perform individual-level studies [4] | Surveillance of resistance genes is recommended [52] Integrated surveillance (linking data on antibiotic use, microbiological testing, clinical background data and epidemiological data) [54] |