The CINAMR (Clinical Information Network-Antimicrobial Resistance) Project: A pilot microbial surveillance using hospitals linked to regional laboratories in Kenya

Globally, antimicrobial resistance (AMR) has been identified as a major threat to human health, but effective surveillance in lower and middle-income countries (LMICs) has been difficult to establish. Public facilities lack reliable basic infrastructure for microbiological services and antibiotic use is largely empirical. There are renewed global efforts to establish AMR surveillance and similarly Kenya has developed an action plan for tracking AMR. It is unrealistic to implement microbiology processes based purely on high-income country practice models, and a model appropriate to LMIC settings is required. We propose to demonstrate a hub-and-spoke embedded surveillance programme using the Clinical Information Network (CIN), an already established collaboration between KEMRI-Wellcome Trust Research Programme (KWTRP), the Kenya Paediatric Association (KPA), Kenya's Ministry of Health and selected County Referral Hospitals in Kenya. Implementation will produce AMR surveillance data from CIN hospitals, but also demonstrate the feasibility of our hub-and-spoke approach for other settings, build capacity for uptake of microbiology data in Kenyan hospitals and describe the impact of these data in clinical practice. CINAMR will also feed into other initiatives such as ACORN network in Southeast Asia, WHO's Global Antimicrobial Resistance Surveillance System (GLASS), and the Global Research on Antimicrobial Resistance (GRAM) Study