The need for antimicrobial resistance surveillance.

Although antimicrobial agents drastically reduced patient morbidity and mortality, bacterial resistance to these agents developed shortly after their introduction. Because the laboratory diagnosis of respiratory tract infection (RTI) is not always possible, and rarely of immediate use, treatment success or failure often depends upon the availability of reliable susceptibility information at the time of therapeutic decision-making. Hence, the need for accurate, up-to-date and timely data is obvious. This information can also be used to help determine the cause of antimicrobial resistance and how it spreads. Desired components of a global RTI surveillance study fall into four categories: programme design, methodology, clinical and dissemination of information. PROTEKT (Prospective Resistant Organism Tracking and Epidemiology for the Ketolide Telithromycin) is an RTI surveillance study designed to fulfil these requirements. PROTEKT includes all of the features of other successful RTI surveillance studies (e.g. the Alexander Project, SENTRY) and improves on these studies by the addition of other desirable features, such as the determination of resistance mechanisms and the availability of up-to-date local data that can be downloaded to hand-held computers via the worldwide web for use at the bedside.