ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: Protocol for case based antimicrobial resistance surveillance

Yin Mo, Ying Ding, Yang Cao, Jill Hopkins, Elizabeth A. Ashley, Naomi Waithira, Prapass Wannapinij, Sue J. Lee, Claire L. Ling, Raph L. Hamers, Tamalee Roberts, Yoel Lubell, Abhilasha Karkey, Samuel Akech, Samantha Lissauer, Japheth Opintan, Iruka Okeke, Sergey Eremin, Barbara Tornimbene, Li Yang HsuLouise Thwaites, Minh Yen Lam, Ngoc Thach Pham, Tieu Kieu Pham, Jeanette Teo, Andrea Lay Hoon Kwa, Kalisvar Marimuthu, Oon Tek Ng, Shawn Vasoo, Suwatthiya Kitsaran, Siriluck Anunnatsiri, Pope Kosalaraksa, Darunee Chotiprasitsakul, Pitak Santanirand, Rongpong Plongla, Hock Hin Chua, Xun Ting Tiong, Ke Juin Wong, Sasheela Sri La Sri Ponnampalavanar, Helmi Bin Sulaiman, Mohd Zulfakar Mazlan, Zeti Norfidiyati Salmuna, Giri Shan Rajahram, Mohd Zaki Bin Mohd Zaili, Joshua R. Francis, Nevio Sarmento, Helio Guterres, Tessa Oakley, Jennifer Yan, Ari Tilman, Muhammad Osama Rehman Khalid, Madiha Hashmi, Syed Faisal Mahmood, Azizullah Khan Dhiloo, Ambreen Fatima, Inke Nadia D. Lubis, Hendri Wijaya, Cybele L. Abad, Arthur Dessi Roman, Cecilia C.Maramba Lazarte, Gazi Md Salahuddin Mamun, Rosmonaliza Asli, Muhd Haziq Fikry bin Haji Abdul Momin, Khurelbaatar Nyamdavaa, Ulziijargal Gurjav, Sotharith Bory, George M. Varghese, Lalit Gupta, Pratik Tantia, Robert Sinto, Yohei Doi, Basudha Khanal, Greco Malijan, Jezreel Lazaro, Samanmalee Gunasekara, Sumudu Withanage, Po Yu Liu, Yonghong Xiao, Minggui Wang, David L. Paterson, H. Rogier van Doorn, Paul Turner

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Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest.

Original languageEnglish
Article number179
Pages (from-to)1-28
Number of pages28
JournalWellcome Open Research
Publication statusPublished - 2023


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