Standard for Monitoring and Reporting

of Antimicrobial Resistance (AMR)

TEMPLATE 5:
Standard
Document Title: Standard for Monitoring and Reporting of Antimicrobial Resistance (AMR)

Document Ref. Number: DOH/HSED/ST/0017-002/HS_EHSMS/ V 2 Version: V2

New / Revised: Revised

Publication Date: March, 2024

Effective Date: March, 2024

Document Control: DoH Strategy Sector

Applies To: All DoH licensed Healthcare facilities and Providers (Public standard)

Owner: Abu Dhabi Public Health Center

Revision Date: March, 2026

Revision Period: Every 2 years

Contact: AMR@adphc.gov.ae

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1. Standard Scope

1.1. The purpose of this standard is to set the requirements for the laboratory-based surveillance
system for antimicrobial resistance (AMR) in the emirate of Abu Dhabi, and to demonstrate the
requirements for healthcare facilities to collect, monitor and report to Abu Dhabi Public Health
Center (ADPHC) results of antimicrobial susceptibility testing (AST) procedures, related data and
information. Appendix 1
1.2. This standard applies to all enrolled DOH licensed healthcare facilities in the Emirate of Abu Dhabi.

2. Definitions and Abbreviations

No. Term / Abbreviation Definition

1.1. ADPHC Abu Dhabi Public Health Center

1.2. AMR Antimicrobial Resistance

1.3. ARS Antimicrobial Resistance Surveillance

1.4. AST Antimicrobial Susceptibility Testing

1.5. CLSI Clinical and Laboratory Standards Institute

DoH Department of Health

1.6.

EUCAST European Committee on Antimicrobial Susceptibility Testing

1.7.

EHSMS Environment, Health and Safety Management System

1.8.

1.9. ESBL Extended Spectrum Beta Lactamase

1.10. ICC Infection Control Committee

1.11. MIC Minimal Inhibitory Concentration

MDRO Multi Drug Resistant Organism

1.12.

1.13. MOHAP Ministry of Health and Prevention

1.14. MRSA Methicillin-Resistant Staphylococcus Aureus

1.15. PTC Pharmaceutics and Therapeutics Committee

1.16. SOP Standard Operating Procedure

Free software developed by the WHO Collaborating Center

for Surveillance of Antimicrobial Resistance for laboratory-
1.17. WHONET /BacLink based surveillance of infectious diseases and antimicrobial
resistance

VRE Vancomycin-Resistant Enterococci

1.18.

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3. Standard Requirements and Specifications

3.1. This standard will demonstrate and set the requirements for selected Healthcare Facilities to
collect, monitor and report to Abu Dhabi Public Health Center (ADPHC) results of antimicrobial
susceptibility testing (AST) procedures, related data, and information. Requirements reflected in
Appendix 1
3.2. AMR surveillance system is laboratory-based which was established to monitor, report, and
observe AMR pathogens levels and trends in Abu Dhabi Emirate.
3.3. Enrollment to the AMR surveillance system will be selected by ADPHC team based on geographical
needs. Selected healthcare facilities are expected to submit the AMR data on a regular basis.
3.4. Mechanism and requirement for reporting AMR data explained in detail in clause 4.2.2 and 4.2.3.

4. Key stakeholder Roles and Responsibilities

4.1. Roles and responsibilities of selected healthcare facilities

Selected Healthcare facility must:
4.1.1. Nominate an employee, or group of employees, on behalf of the facility to be responsible for
collecting, monitoring and reporting of antimicrobial susceptibility testing results and related
data and to act as a focal point of contact for ADPHC AMR surveillance focal points. In case of
any update or change in focal points, ADPHC should be informed within five days of the change
via AMR@adphc.gov.ae
4.1.2. Develop a policy and/or standard operating procedure (SOP) for antimicrobial resistance
monitoring and reporting as part of their antibiotic stewardship or infection prevention and
control policy and procedures manual, align with DoH Standards and applicable international
best practice guidelines.
4.1.3. Use either CLSI or EUCAST standards for generating AST data, and interpretation of
antimicrobial susceptibility testing results, in the most recent applicable version.

4.2. Roles and responsibilities of selected healthcare Professionals (Focal points)

4.2.1. Monitoring Requirements

All selected Healthcare Facilities must:
4.2.1.1. Monitor levels, patterns and trends of antimicrobial resistance of relevant pathogens
isolated from inpatients (hospital-acquired) and outpatients (community-acquired);
• Note: Monitoring trends in the incidence of target MDROs in the facility over time using
appropriate statistical methods allows to determine whether MDRO rates are decreasing
and whether additional interventions are needed (Appendix 1: Category IA).
• Health Facilities are strongly encouraged to use specialized statistical software to
analyze AST data and monitor trends, e.g., BacLink/WHONET

4.2.1.2. Notify infection control staff or the medical director/designee by clinical microbiology
laboratories (in-house and outsourced) and ADPHC team via AMR@adphc.gov.ae within
five days when a novel resistance pattern for the facility is detected (Appendix 2:
Category IB). The AMR team will perform a complete investigation, develop action
plans/recommendations accordingly.

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 4.2.1.3. Develop and implement laboratory protocols for storing isolates of selected MDROs for
molecular typing when needed to confirm transmission or delineate the epidemiology of
the MDRO within the healthcare setting (Appendix 2: Category IB).

4.2.1.4. Compile on an annual basis (by January 31) a facility- and special care unit-specific
summary ARS report on antimicrobial resistance levels and trends.

• The report and its implications must be discussed within the concerned committees,
such as e.g., Antibiotic Stewardship Committee (ASP), Pharmaceutics & Therapeutics
Committee (PTC), and/or Hospital Infection Control Committee (ICC), and then
approved by the ASP, PTC, and/or ICC Chairman and the Medical Director of the
Facility, as applicable.
• The report must be actively communicated by means of awareness and education
sessions and made available (hard copy, soft copy or on the intranet) to all concerned
physicians, nurses, pharmacists, and other concerned staff.
• Any action items resulting from the report must be followed up by the concerned ASP
Committee, PTC Committee, and/or ICC Committee, as applicable.

4.2.2. Reporting Requirements

4.2.2.1. Report to ADPHC individual results of antimicrobial susceptibility tests conducted, and
related data as per Appendix 1.
4.2.2.2. Reportable are at minimum data related to all identified and tested organisms and
antibiotics included in Appendix 3.
• Note: If technically feasible, complete AST data for all organisms and antimicrobials
that were tested for antimicrobial susceptibility should be reported.
• Note: Additional testing for surveillance purposes only is not required, as long as the
minimum testing requirements of Appendix 2 are met.
4.2.2.3. Upon request, provide the annual Healthcare Facility ARS Monitoring Summary report
and resulting action items to ADPHC AMR surveillance focal points by E-Mail to
AMR@adphc.gov.ae.

4.2.3. Reporting Mechanism

4.2.3.1. Data must be submitted to ADPHC AMR surveillance focal points at regular intervals, on
annual basis.
4.2.3.2. Data should be submitted in an electronic format (Reference: AMR Data Structure and
Specification Exchange Format), either per email to ADPHC AMR surveillance focal points
(AMR@adphc.gov.ae), or by file upload to the DoH e-service platform
4.2.3.3. Data should be reported as raw data (i.e., patient/isolate-level data), not as aggregate
data or %RIS statistics.
• Elimination of copy strains/duplicate strains will take place later in the analysis phase
of data at ADPHC.

4.3. Roles and responsibility of ADPHC AMR Surveillance team/focal points

4.3.1. Statistical Analysis of Antimicrobial Resistance Surveillance Data at ADPHC level.
4.3.2. Reporting of Surveillance Results and Recommendations
4.3.3. The ADPHC AMR surveillance focal points will compile periodical and ad hoc reports on
antimicrobial resistance levels, patterns, and trends for Abu Dhabi Emirate.
4.3.4. The annual Abu Dhabi AMR surveillance report will be finalized and approved by management
to be published on ADPHC/DoH website and distributed to:
• ADPHC and DoH Senior Management.
• All selected Healthcare Facilities participated in the program.
• The scientific community, researchers, universities etc. – on request.

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5. Monitoring and Evaluation

Rate of compliance in reporting AMR data by selected DoH licensed healthcare facilities will be monitored
by the ADPHC team on an annual basis.

6. Enforcement and Sanctions

DOH may impose sanctions in relation to any breach of requirements under this Standard in accordance
with the disciplinary regulation of the healthcare sector.

7. Exempted from Scope

Healthcare facilities that have not been selected by ADPHC team to be enrolled in AMR surveillance system
to report and monitor Antimicrobial Resistance.

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8. Relevant Reference Documents

Reference Relation Explanation / Coding /

No. Reference Name
Date Publication Links

https://www.who.int/news-
Antimicrobial resistance. World Health room/fact-
1 17 Nov 2021
Organization. sheets/detail/antimicrobial-
resistance/

http://www.ecdc.europa.eu/en
European Antimicrobial Resistance Surveillance /activities/surveillance/EARS-
2 March 2023
Network (EARS-Net). Net/Pages/index.aspx

EUCAST - The European Committee on

Antimicrobial Susceptibility Testing. The https://www.eucast.org/
3
European Society for Clinical Microbiology and
Infectious Diseases.

Multidrug-resistant organisms (MDRO)

Management. Healthcare Infection Control https://www.cdc.gov/infectionc
4
Practices Advisory Committee (HICPAC), Centers ontrol/guidelines/mdro/
for Disease Prevention and Control.

Antimicrobial Resistance. U.S. Centers for http://www.cdc.gov/drugresist

5
Disease Control and Prevention. ance/index.html

WHONET/Baclink - WHO Collaborating Centre for

https://whonet.org
6 Surveillance of Antimicrobial Resistance. Boston,
Massachusetts, USA

Available document upon

UAE National AMR Surveillance – Data Structure request
7 and sample data v3.1. Ministry of Health and
Prevention (MOHAP).

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 Open data portal.
https://mohap.gov.ae/en/open
-data/mohap-open-data/

google.com/url?sa=t&rct=j&
q=&esrc=s&source=web&cd
=&cad=rja&uact=8&ved=2ah
UKEwiL4_WO9eCAAxWp3gI
UAE National Report on Surveillance of HHUETBbQQFnoECA0QAQ&
8 23 Sept 2022 Antimicrobial Resistance, 2022. Ministry of url=https%3A%2F%2Fmohap
Health and Prevention (MOHAP)
.gov.ae%2Fassets%2Ff5a570
5%2FNational%2520AMR%2
520Surveillance%2520Repor
t%25202022%2520MOHAP_
638205230312192483.pdf.as
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NkHK6S6iqoQfw&opi=89978
449

Replacing the HAAD EHSMS Standard Monitoring HAAD/HSED/ST/0017-

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and Reporting of Antimicrobial Resistance 002/HS_EHSMS

This Standard is related to, and has effect

together with, the HAAD EHSMS Standard for HAAD/HSED/ST/0017/HS_EHS
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Healthcare Providers – Infection Prevention and MS
Control Management

DoH e-service platform. AMR page for healthcare https://bpmweb.doh.gov.ae/

11 facilities focal points to upload annual required AMRFileUpload/Home.aspx).
AMR data

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 9. Appendices
:
Appendix 1: Data Fields Collected for AMR Surveillance

Nr. Data Field Description Format Classification

1 PATIENT_ID Patient ID (medical record Required TEXT
number)
2 PATIENT_EID Patient Emirates ID nr. Desirable TEXT
3 PATIENT_NAME Patient name Desirable TEXT
4 PATIENT_DOB Patient date of birth (DOB) Required DATE
(dd/mm/yyyy)
5 PATIENT_AGE Patient age Required NUMERICAL
6 PATIENT_GENDER Patient gender Optional TEXT
7 PATIENT_NATIONALITY Patient nationality Desirable TEXT
8 PATIENT_NAT_STATUS Patient nationality status Desirable TEXT
9 PATIENT_ADM_DATE Date of patient admission Required DATE
(dd/mm/yyyy)
10 PATIENT_DISC_DATE Date of discharge (for Desirable DATE
inpatients) (dd/mm/yyyy)
11 FACILITY_NAME Healthcare facility name Required TEXT
12 FACILITY_ID Healthcare facility ID Optional TEXT
13 FACILITY_LICENCE_NR Healthcare facility licensing Required TEXT
number
14 FACILITY_EMIRATE Healthcare facility Emirate Condition TEXT
al
15 FACILITY_DEPT_NAME Department/specialty name Required TEXT
16 PATIENT_LOCATION_NAME Patient location name Required TEXT
17 PATIENT_LOCATION_TYPE Patient location type Desirable TEXT
18 LAB_NAME Laboratory name Required TEXT
19 SPECIMEN_PROC_ORDER_NAM Microbiological procedure Required TEXT
E ordered
20 SPECIMEN_LAB_NR Specimen lab number Required TEXT
21 SPECIMEN_TYPE Specimen type Required TEXT
22 SPECIMEN_DATE_COLLECTED Specimen collection date Required DATE
(dd/mm/yyyy)
23 ORGANISM_NAME Name of identified organism Required TEXT
24 AST_METHOD AST susceptibility Method Condition TEXT
al
25 AST_RESULT_CAT AST result Required TEXT
(categorical/interpreted)
26 AST_RESULT_NUM AST result (numerical) Required TEXT
27 ANTIBIOTIC_NAME Antimicrobial agent tested Required TEXT
28 PATIENT_DISC_STATUS Patient discharge status Desirable TEXT
29 DIAGNOSIS Diagnosis Desirable TEXT

Note: List of minimum reportable data fields is tentative and might change without the need to revise this
standard (Reference: AMR Data Structure and Specification Exchange Format).

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Appendix 2: Healthcare Infection Control Practices Advisory Committee (HICPAC) Recommendation Categories

Rank Description
Category IA Strongly recommended for implementation and strongly supported by well-designed
experimental, clinical, or epidemiologic studies.
Category IB Strongly recommended for implementation and supported by some experimental,
clinical, or epidemiologic studies and a strong theoretical rationale.
Category IC Required for implementation, as mandated by federal and/or state regulation or
standard.
Category II Suggested for implementation and supported by suggestive clinical or epidemiologic
studies or a theoretical rationale.
No recommendation Unresolved issue. Practices for which insufficient evidence or no consensus regarding
efficacy exists.

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Appendix 3: Minimum list of key organisms and antibiotics for which individual results of antimicrobial
susceptibility testing results must be reported to ADPHC:

# Organism Mandatory minimum range of antibiotics to be tested,

monitored and reported to ADPHC-DoH

1 Staphylococcus aureus Oxacillin, Vancomycin, Penicillin, 2nd and 3rd generation

cephalosporin, group IV fluoroquinolone (e.g., Moxifloxacin),
Gentamicin, Clindamycin, one macrolide, Linezolid

2 Streptococcus pneumoniae Penicillin, Ampicillin, Ceftriaxone or Cefotaxime, group IV

fluoroquinolone (e.g., Moxifloxacin), Tetracycline, Clindamycin,
Erythromycin, Cotrimoxazole, Vancomycin

3 Enterococcus faecalis Vancomycin, Ampicillin, Tetracycline, Ciprofloxacin and/or

Levofloxacin and/or Moxifloxacin, Gentamicin, Linezolid
4 Enterococcus faecium

5 Escherichia coli Imipenem and/or Meropenem and/or Ertapenem, group II

fluoroquinolone (e.g., Ciprofloxacin), 3rd generation
cephalosporin (Ceftazidime and Cefotaxime or similar),
6 Klebsiella spp. Piperacillin/Tazobactam, Amoxicillin/Clavulanic acid, Amikacin
and/or Gentamicin
7 Salmonella spp.

8 Shigella spp.

9 Pseudomonas aeruginosa Imipenem and Meropenem, group II fluoroquinolone (e.g.,

Ciprofloxacin), Ceftazidime, Piperacillin/ Tazobactam, Amikacin
10 Acinetobacter baumannii and/or Gentamicin, Colistin

11 Stenotrophomonas maltophilia Imipenem and Meropenem, group II fluoroquinolone (e.g.,

Ciprofloxacin), Ceftazidime, Piperacillin/ Tazobactam, Amikacin
and/or Gentamicin, Cotrimoxazole

12 Neisseria gonorrhoeae Penicillin, Ceftriaxone, Ciprofloxacin, Tetracycline

13 Mycobacterium tuberculosis Isoniazid (INH), Rifampicin (INN), Ethambutol (EMB),

complex Pyrazinamide (PZA), Streptomycin, second line anti-TB
medications when indicated.

14 Candida albicans Fluconazole

15 Candida auris All antifungals routinely tested

Note: Additional AST results for other organisms and antibiotics tested routinely and related data should be
reported as well if available and technically feasible.

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