The Greek System for the Surveillance of Antimicrobial Resistance is a national network for continuous monitoring of bacterial antibiotic resistance in the Greek hospitals.

Its function is based on the assumption that the routine results of the antibiotic sensitivity tests performed daily in each hospital clinical laboratory should be considered as a major resource for antibiotic resistance surveillance.

Moreover and since the quality and compatibility of these data are in principle uncertain, our approach is to work in parallel, on both accessing the data and assessing its quality.

This is accomplished through the establishment of a quality control procedure and the adaptation of an electronic code and data format in all hospitals through the use of the WHONET software. The WHONET software was originally developed by WHO Collaborating Centre for Surveillance of Antibiotic Resistance in Boston USA and further developed in the Division of Emerging and other Communicable Diseases Surveillance and Control, WHO (WHO/EMC), Geneva, Switzerland. WHONET is distributed free of charge by WHO/EMC and facilitates the management of antibiotic susceptibility test results from routine clinical isolates. A full description of the software and its potentials has been published elsewhere [1-3].

The analysis of the information facilitates:

1. The understanding of the trends of resistance.
2. The detection of epidemics.
3. The differentiation of epidemic from endemic infections
4. The development of a national antibiotic policy.
5. The hierarchy of priorities for further studying the genetic and molecular mechanisms responsible for the emergence of resistance.

Moreover and since the acquisition of the data is performed automatically, no additional workload at the laboratory level is generally required, and thus the system can function on a routine basis.

Antibiotic susceptibility is performed either by the disc diffusion method on Mueller-Hinton agar or by various automatic systems. At present, the current recommendations of the Clinical and Laboratory Standards Institute (CLSI) are followed.

All hospitals receive the QC strains provided by the European Antimicrobial Resistance Surveillance Network (EARS-Net)

The WHONET software is being adopted as the common program, because it is found to be friendly, flexible, easy of expanding the pyramidal reporting structure and capable to interface with other statistical packages and programs.

This enables each laboratory to configure its result entry format to its own testing practices and to the specific patient locations it serves. The file format for all laboratories, however, is universal so a common analytical procedure is in use by all the laboratories.

The Greek System for Surveillance of Antimicrobial Resistance participates in both the European Antimicrobial Resistance Surveillance Network (EARS-Net - ECDC) and the Global Antimicrobial Surveillance System (GLASS - WHO). WHONET-Greece is coordinated by the Central Public Health Laboratory of the NPHO (34 Al. Fleming st, 16672 Vari, Greece) under the supervision of the Infectious Control Committee of NPHO.

References

1. O'Brien TF & Stelling JM. WHONET: an information system for monitoring antimicrobial resistance. Emerging Infectious Diseases, 1995; 1:66.
2. Stelling J.M & O'Brien T.F. Surveillance of antimicrobial resistance: The WHONET program. Clinical Infectious Diseases, 1997, 24(suppl 1):s157-168.
3. Vatopoulos AC, Kalapothaki, V, Legakis NJ and the Greek Network for the Surveillance of Antimicrobial Resistance: An Electronic Network for the Surveillance of Antimicrobial Resistance in Bacterial Nosocomial Isolates in Greece.WHO Bulletin 1999 77:595-601.