To gain control over the problem it is essential to undertake appropriate surveillance as stated at the " microbial threat " conference (3). The need to coordinate international surveillance was recognised, as resistance rates found in different surveys cannot be compared owing to differences in study design, study population, and time period. Acting on the recommendations of the Copenhagen meeting, the European Commission has funded the European Antimicrobial Resistance Surveillance System (EARSS) (4). The Commission also funds the Enter-net and EuroTB international surveillance systems, which monitor resistance in salmonella and tuberculosis, respectively. Several different surveillance activities exist, each with its own study question (5). With the growing awareness that publicly funded data are publicly owned, it is imperative that data are shared and accessible, while safeguarding confidentiality.

Although EARSS collects routinely generated laboratory data, individual national surveillance may incorporate aspects of different surveillance strategies, for example the addition of intermittent national surveys to answer specific questions. To optimise the functioning and impact of antimicrobial resistance surveillance two things are essential. Firstly, electronic exchange of data is essential for both the rapid recognition of events where early warning is required, and for the collection of routinely generated data. Secondly, a national intersectoral board (including healthcare professionals, government, consumers, and other interested parties) to allocate resources to develop and implement national action plans to control antimicrobial resistance.

The development of new drugs cannot be relied on to contain antimicrobial resistance. This (and the previous) issue of Eurosurveillance provides a good overview of what is being undertaken in different EU countries (6). In some Member States it has proved possible to bring about a change in the level of resistance by restricting the use of antibiotics (7, 8). Such action is needed at all levels: in hospitals, and at national and international level (9).

The surveillance of antimicrobial usage is just as important as the surveillance of resistance. Recently the Commission launched a call for proposals to provide information per country on the quantities of antimicrobial agents used in human medicine, on systems for monitoring their consumption, prescription patterns and evaluation systems regarding the appropriateness of their use in all Member States of the EU. Creation of such surveillance systems should be given high priority. 

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2. Metly J, Hoffmann J, Cetron M, Fine M, Farley M, Whitney C, Breiman R. Impact of penicillin susceptibility on medical outcomes for adult patients with bacteremic pneumococcal pneumonia. Clin Infect Dis 2000; 30: 520-8.

3. Weinberg J. From the editors: European Union conference on the microbial threat. Eurosurveillance Weekly 1998; 2: 980903. (http://www.eurosurv.org/1998/989893.html)

4. Bronzwaer SLAM, Goettsch W, Olsson-Liljequist B, Wale MCJ, Vatopoulos AC, Sprenger MJW. European Antimicrobial Resistance Surveillance System (EARSS): objectives and organisation. Eurosurveillance 1999; 4; 4:41

5. Goettsch W, Bronzwaer SLAM, Neeling de AJ, Wale MCJ, Aubry-Damon H, Olsson-Liljequist B, Sprenger MJW, Degener JE. Standardisation and quality assurance for antimicrobial resistance of Streptococcus pneumoniae and Staphylococcus aureus within the European Antimicrobial Resistance Surveillance System (EARSS). CMI 2000; 6; 59-63.

6. Eurosurveillance 2000; 5(12): December.

7. Mölstad S, Cars O. Major change in the use of antibiotics following a national programme: Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance (STRAMA). Scand J Infect Dis 1999; 31(2): 191-5.

8. Stephenson J. Icelandic researchers are showing the way to bring down rates of antibiotic-resistant bacteria [news]. JAMA 1996; 275: 175.

9. Williams R, Ryan M. Surveillance of antimicrobial resistance – an international perspective. BMJ 1998; 317; 651.