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An important cornerstone in the control of antimicrobial resistance (AMR) is a well-designed quantitative system for the surveillance of spread and temporal trends in AMR. Since 2008, the Dutch national AMR surveillance system, based on routine data from medical microbiological laboratories (MMLs), has developed into a successful tool to support the control of AMR in the Netherlands. It provides background information for policy making in public health and healthcare services, supports development of empirical antibiotic therapy guidelines and facilitates in-depth research. In addition, participation of the MMLs in the national AMR surveillance network has contributed to sharing of knowledge and quality improvement. A future improvement will be the implementation of a new semantic standard together with standardised data transfer, which will reduce errors in data handling and enable a more real-time surveillance. Furthermore, the scientific impact and the possibility of detecting outbreaks may be amplified by merging the AMR surveillance database with databases from selected pathogen-based surveillance programmes containing patient data and genotypic typing data.


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  1. World Health Organisation (WHO). Antimicrobial resistance: global report on surveillance 2014. Geneva: WHO; 2014. Available from: http://www.who.int/drugresistance/documents/surveillancereport/en/
  2. World Health Organisation (WHO). World health day 2011. Geneva: WHO; 2011. Available from: http://www.who.int/mediacentre/news/statements/2011/whd_20110407/en/
  3. World Health Organisation (WHO). Antimicrobial resistance in the European Union and the world. Geneva: WHO; 2012. Available from: http://www.who.int/dg/speeches/2012/amr_20120314/en/
  4. Science and Technology Committee. Wednesday 23 January 2013 Meeting started at 10.12am, ended 11.11am. London: UK parliament; 2013. Available from: http://parliamentlive.tv/event/index/c7df492a-f492-4953-a9bf-2cba88857c82
  5. O’Neill J. Tackling drug-resistant infections globally: final report and recommendations. Review of antimicrobial resistance. London: HM Government and Wellcome trust; 2016. Available from: https://amr-review.org/sites/default/files/160518_Final%20paper_with%20cover.pdf
  6. World Health Organisation (WHO). Global action plan on antimicrobial resistance. Geneva: WHO; 2015. Available from: http://www.who.int/antimicrobial-resistance/publications/global-action-plan/en/
  7. World Health Organisation Regional Office for Europe (WHO/Europe). Central Asian and Eastern European Surveillance on Antimicrobial Resistance (CAESAR). Copenhagen: WHO/Europe. [Accessed: October 2016]. Available from: http://www.euro.who.int/en/health-topics/disease-prevention/antimicrobial-resistance/about-amr/central-asian-and-eastern-european-surveillance-of-antimicrobial-resistance-caesar
  8. World Health Organisation (WHO). Global Antimicrobial Resistance Surveillance System (GLASS). Geneva: WHO. [Accessed: October 2016]. Available from: http://www.who.int/antimicrobial-resistance/global-action-plan/surveillance/glass/en/
  9. Leverstein-van Hall MA, van de Sande-Bruinsma N. (ISIS-AR: A new system for surveillance of antimicrobial resistance). ISIS-AR: een nieuw systeem voor surveillance van antimicrobiële resistentie. Ned Tijdschr Med Microbiol.2008;16(3):10-6.
  10. van de Sande-Bruinsma N, Thijsen S, Leverstein-van Hall MA. (Surveillance of antibiotic resistance in the Netherlands: ISIS-AR and ISISweb). Antibioticaresistentiesurveillance in Nederland: ISIS-AR en ISISweb. Ned Tijdschr Med Microbiol.2010;18(4):10-8.
  11. Leenstra T, Thijssen SFT, Van der Bij AK. (ISIS-AR – insight in 7 years local and national trends in antibiotic resistance). ISIS-AR - inzicht in 7 jaar lokale en nationale antibioticaresistentietrends. Ned Tijdschr Med Microbiol.2015;23(1):22-8.
  12. Werkgroep Infectie Preventie (WIP). WIP richtlijn voor maatregelen tegen overdracht van bijzonder resistente micro-organismen (BRMO) in ziekenhuizen. [WIP guideline on measures against transmission of highly resistant micro-organisms in hospitals]. Bilthoven: National Institute for Public Health and the Environment (RIVM); 2011. Dutch. Available from: http://www.rivm.nl/Documenten_en_publicaties/Professioneel_Praktisch/Richtlijnen/Infectieziekten/WIP_Richtlijnen/WIP_Richtlijnen/Ziekenhuizen/WIP_richtlijn_BRMO_Bijzonder_Resistente_Micro_Organismen_ZKH
  13. European Committee on Antimicrobial Susceptibility Testing (EUCAST). Antimicrobial susceptibility testing. Växjö: EUCAST. [Accessed: October 2016]. Available from: http://www.eucast.org/ast_of_bacteria/
  14. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing. Wayne: CLSI. [Accessed: Oct 2016]. Newest version available from: https://clsi.org/standards/products/microbiology/documents/m100/
  15. Netherlands Society of Medical Microbiologists (NVMM). NVMM Guideline. Laboratory detection of highly resistant microorganisms (HRMO). Version 1.0. Leeuwarden: NVMM; 2016. Available from: http://www.nvmm.nl/media/1051/2012_hrmo_mrsa_esbl.pdf
  16. Leclercq R, Cantón R, Brown DF, Giske CG, Heisig P, MacGowan AP, et al. EUCAST expert rules in antimicrobial susceptibility testing. Clin Microbiol Infect. 2013;19(2):141-60.  https://doi.org/10.1111/j.1469-0691.2011.03703.x 
  17. van der Bij AK, van Dijk K, Muilwijk J, Thijsen SF, Notermans DW, de Greeff S, et al. Clinical breakpoint changes and their impact on surveillance of antimicrobial resistance in Escherichia coli causing bacteraemia. Clin Microbiol Infect. 2012;18(11):E466-72. http://dx.doi.org/ https://doi.org/10.1111/j.1469-0691.2012.03996.x PMID:22925456http://dx.doi.org/ https://doi.org/10.1111/j.1469-0691.2012.03996.x 
  18. Shannon KP, French GL. Antibiotic resistance: effect of different criteria for classifying isolates as duplicates on apparent resistance frequencies. J Antimicrob Chemother. 2002;49(1):201-4.  https://doi.org/10.1093/jac/49.1.201 
  19. Rempel OR, Laupland KB. Surveillance for antimicrobial resistant organisms: potential sources and magnitude of bias. Epidemiol Infect. 2009;137(12):1665-73.  https://doi.org/10.1017/S0950268809990100 
  20. Cornaglia G, Hryniewicz W, Jarlier V, Kahlmeter G, Mittermayer H, Stratchounski L, et al. European recommendations for antimicrobial resistance surveillance. Clin Microbiol Infect. 2004;10(4):349-83.  https://doi.org/10.1111/j.1198-743X.2004.00887.x 
  21. Schwaber MJ, De-Medina T, Carmeli Y. Epidemiological interpretation of antibiotic resistance studies - what are we missing? Nat Rev Microbiol. 2004;2(12):979-83.  https://doi.org/10.1038/nrmicro1047 
  22. de Greeff SC, Mouton JW, Schoffelen AF. NethMap 2017: consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria in the Netherlands/MARAN 2017: Monitoring of antimicrobial resistance and antibiotic usage in animals in the Netherlands in 2016. Bilthoven: National Institute for Public Health and the Environment (RIVM); 2016. Available from: http://www.rivm.nl/Documenten_en_publicaties/Wetenschappelijk/Rapporten/2017/Juni/NethMap_2017_Consumption_of_antimicrobial_agents_and_antimicrobial_resistance_among_medically_important_bacteria_in_the_Netherlands_MARAN_2017_Monitoring_of_antimicrobial_resistance_and_antibiotic_usage_in_animals_in_the_Netherlands_in_2016
  23. European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: European Centre for Disease Prevention and Control (ECDC). [Accessed: October 2016]. Available from: http://ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/index.aspx
  24. Damoiseaux RAMJ, Venekamp RP, Eekhof JAH, Bennebroek Gravenhorst FM, Schoch AG, Burgers JS, et al. (The Dutch College of General Practitioners’ guideline on the treatment of Otitis media acuta in children). NHG-Standaard Otitis media acuta bij kinderen. Huisarts Wet. 2014;57(12):648.
  25. Liu YY, Wang Y, Walsh TR, Yi LX, Zhang R, Spencer J, et al. Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: a microbiological and molecular biological study. Lancet Infect Dis. 2016;16(2):161-8.  https://doi.org/10.1016/S1473-3099(15)00424-7 
  26. Leverstein-van Hall MA, Waar K, Muilwijk J, Cohen Stuart J, Sabbe LJM, Frenay HME, et al. Consequences of switching from a fixed 2 : 1 ratio of amoxicillin/clavulanate (CLSI) to a fixed concentration of clavulanate (EUCAST) for susceptibility testing of Escherichia coli. J Antimicrob Chemother. 2013;68(11):2636-40.  https://doi.org/10.1093/jac/dkt218 
  27. Koningstein M, van der Bij AK, de Kraker MEA, Monen JC, Muilwijk J, de Greeff SC, et al. Recommendations for the empirical treatment of complicated urinary tract infections using surveillance data on antimicrobial resistance in the Netherlands. PLoS One. 2014;9(1):e86634.  https://doi.org/10.1371/journal.pone.0086634 
  28. Houben AJM, Oostdijk EAN, van der Voort PHJ, Monen JCM, Bonten MJM, van der Bij AK, et al. Selective decontamination of the oropharynx and the digestive tract, and antimicrobial resistance: a 4 year ecological study in 38 intensive care units in the Netherlands. J Antimicrob Chemother. 2014;69(3):797-804.  https://doi.org/10.1093/jac/dkt416 
  29. van der Bij AK, Frentz D, Bonten MJ, ISIS-AR Study Group. Gram-positive cocci in Dutch ICUs with and without selective decontamination of the oropharyngeal and digestive tract: a retrospective database analysis. J Antimicrob Chemother. 2016;71(3):816-20.  https://doi.org/10.1093/jac/dkv396 
  30. van der Steen M, Leenstra T, Kluytmans JAJW, van der Bij AK, ISIS-AR study group. Trends in expanded-spectrum cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae among Dutch clinical isolates, from 2008 to 2012. PLoS One. 2015;10(9):e0138088.  https://doi.org/10.1371/journal.pone.0138088 
  31. Vlek AL, Frentz D, Haenen A, Bootsma HJ, Notermans DW, Frakking FN, et al. Detection and epidemiology of carbapenemase producing Enterobacteriaceae in the Netherlands in 2013-2014. Eur J Clin Microbiol Infect Dis. 2016;35(7):1089-96.  https://doi.org/10.1007/s10096-016-2636-6 
  32. Feikje Hielkema-Raadsveld. Hoe plukt u de vruchten van LOINC, SNOMED CT en UCUM? [How can you enjoy the benefits of LOINC, SNOMED CT and UCUM?]. Den Haag: NICTIZ; 2016. Dutch. Available from:https://www.nictiz.nl/publicaties/whitepapers/hoe-plukt-u-de-vruchten-van-loinc-snomed-ct-en-ucum

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