Unbiased antimicrobial resistance prevalence estimates through population-based surveillance

Background: Current antimicrobial resistance surveillance (AMR) is mainly laboratory based. This approach can have inherent biases given the potential for selective specimen submission for microbiological analysis and for its inability to map antibiotic susceptibility test results to a clinical syndrome. Objectives: To discuss the need for population-based surveillance of AMR, and highlight the pros and cons of threshold surveys. Sources: Studies on methodology for AMR surveillance published in the last 10 years, obtained through a PubMed search on antimicrobial resistance (all fields) and surveillance/method (MeSH term). Content: We discuss the use of threshold surveys to overcome the challenge of sample size in population-bases AMR surveys, which are a suitable approach in both low- and high-resource settings. Implications: Scale up in the use of population-based threshold survey on the prevalence of AMR will provide necessary information to triangulate the data from routinely-reported laboratory-based AMR surveillance at the local, national, and global level