Japan nosocomial infections surveillance (JANIS): a model of sustainable national antimicrobial resistance surveillance based on hospital diagnostic microbiology laboratories.
BACKGROUND
Antimicrobial resistance (AMR) is now recognized as a major threat to public health, and surveillance of AMR is essential for successful containment. In 2000, Japan Nosocomial Infections Surveillance (JANIS) Clinical Laboratory (CL) division has been launched as a voluntary AMR surveillance funded by the Ministry of Health, Labour and Welfare and managed by the National Institute of Infectious Diseases. In this study, we aimed to propose a model of sustainable national AMR surveillance which provides not only national AMR surveillance reports but also benchmarking reports to each hospital to facilitate infection control practices.


METHODS
JANIS CL division collects comprehensive specimen-based data complies with JANIS data format from participating hospitals each month. It had targeted only blood and cerebrospinal fluid samples but was expanded to all types of specimens in 2007 at revision of JANIS. The JANIS system interprets the antimicrobial susceptibility according to the same criteria and conducts removal of duplicates to allow accurate comparison between hospitals. Monthly feedback reports are created automatically within 48 h, while quarterly and annual reports are generated after data validation.


RESULTS
At the beginning, 468 hospitals were enrolled in the JANIS CL division, but the number of hospitals that submitted data decreased to 210 (45%) in 2006. After surveillance revision in 2007, annual recruitment of hospitals was initiated and as of 2015, 1475 hospitals participated, and 1461 (99%) of them submitted data throughout the year. Nationwide surveillance data collected over the past decade revealed that the prevalence of methicillin-resistant Staphylococcus aureus has decreased since 2008, and that its prevalence is higher in the western part of Japan, where the number of hospitals per capita is higher than in the eastern part.


CONCLUSIONS
JANIS CL division serves a model of sustainable national AMR surveillance system. Comprehensive data for all specimens promotes understanding of the sampling frequency and prevalence of AMR. As a well-established system for providing rich information to guide action both locally and nationally, JANIS may also be utilized for sharing AMR data globally.
['Tsutsui|Atsuko|A|', 'Suzuki|Satowa|S|http://orcid.org/0000-0001-5062-0425']
D000900:Anti-Bacterial Agents D003428:Cross Infection D024881:Drug Resistance, Bacterial D024901:Drug Resistance, Multiple, Bacterial D004812:Epidemiologic Methods D006801:Humans D007564:Japan D007755:Laboratories, Hospital D055624:Methicillin-Resistant Staphylococcus aureus D008954:Models, Biological
Surveillance Antimicrobial resistance Diagnostic microbiology laboratories Comprehensive data collection