Title: Multi-Hospital Antimicrobial Resistance Surveillance Programmes and Their Role in Stewardship Policy Development
Authors: Habeeb Damilola Yusuf, Kazeem Abdulrazaq, Sylviastella Favour Peteranaba, Florence Eribenne
Volume: 10
Issue: 9
Pages: 1-25
Publication Date: 2026/09/28
Abstract:
Antimicrobial resistance (AMR) is now a first-order threat to health systems, and the commitments made in the 2024 United Nations political declaration, including a 10% reduction by 2030 in deaths associated with bacterial resistance and at least 70% of human antibiotic use drawn from the World Health Organization Access group, are measurement claims before they are policy claims. None can be verified without surveillance that is comparable across facilities and across countries. This narrative review characterises the multi-hospital AMR and antimicrobial use surveillance programmes operating as of 2025 and examines how, and how reliably, their outputs are converted into antimicrobial stewardship policy. Peer-reviewed literature and official programme documentation published to the end of 2025 were searched, supplemented by an adjacent literature on diagnostic laboratory infrastructure, pharmaceutical quality and supply governance, health system financing, clinical workforce and service delivery, public health informatics, and One Health microbiology, on the reasoning that surveillance capability is determined at least as much by these upstream conditions as by protocol design. Programmes were characterised by scope, data source, standardisation, denominators and metrics, risk adjustment, quality assurance, and feedback architecture, and their policy influence was assessed at facility, network, jurisdictional, and supranational levels. Four archetypes dominate the landscape: a global aggregating system, regional isolate-based networks, national hospital reporting systems with mandatory or accreditation-linked participation, and voluntary survey networks. The 2025 GLASS report drew on more than 23 million laboratory-confirmed infections reported by 110 countries between 2016 and 2023 and found approximately one in six bacterial infections to be resistant. Policy translation was strongest where standardised risk-adjusted metrics, compelled participation, and structured return of comparative data to named facilities coincided, with the Standardised Antimicrobial Administration Ratio the clearest instance; evidence of effect on prescribing was reasonably consistent, while evidence of effect on resistance incidence remained thin and confounded. The binding constraint on the field appears to be organisational and infrastructural rather than technical. A reported global data completeness of 53.8%, combined with weak laboratory capacity and denominator bias in low- and middle-income countries, means that the settings reporting the highest apparent resistance are the least equipped to act on their own data, and priority investment belongs in diagnostic capacity, external quality assurance, infection-origin attribution, and the funded analytic staff who turn data into local guidance.