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One Health integrated surveillance of AMR and AMU

Antimicrobial resistance (AMR) is a global health threat caused by the overuse and misuse of antimicrobials across humans, animals, plants, and the environment, which fosters the development and spread of resistance. Preventing and controlling AMR is vital to maintain the efficacy of existing antimicrobials and protect human and animal health, food and water security, and the environment. A One Health approach, which integrates AMR and AMU surveillance across sectors, is essential for an effective response.

Integrated surveillance of AMR and AMU consists of continuous, collaborative, coordinated, systematic collection, collation, validation, analysis, interpretation, communication and sharing of data on AMU and AMR. The data include data from humans, animals and products, plants/ crops and the environment, which are used to provide information for sectors and actions to reduce the burden of AMR-associated infections and preserve the efficacy of antimicrobial agents in all One Health sectors. Integrated surveillance requires sharing of data, laboratory and epidemiological resources and expertise across two or more sectors to maximise synergies and reduce the cost of surveillance.

In 2026, the Quadripartite organizations published an overarching guidance on One Health integrated surveillance of AMR and AMU, which provides objective-driven roadmaps for developing and strengthening context-appropriate systems for integrated surveillance. Based on feedback from regional and country consultations during the development of the Overarching OHISA Guidance, the Quadripartite will develop complementary procedural technical guidance, documents and tools needed to establish, improve, and implement context-specific national systems for One Health integrated surveillance of AMR and AMU.

The Quadripartite will jointly establish the GISSA IT platform. This will serve as a dynamic global repository that will provide public access to global and regional data in a user-friendly manner (with country level data envisioned for future iterations). These data will be validated and provided by countries to the pertinent Quadripartite organization responsible on patterns and trends in AMR and AMU in humans, animals, crops/plants and the environment, while recognizing that sectors may vary in the level of advancement of their surveillance system. The platform will be progressively expanded to incorporate information from the surveillance of AMR and residues in the environment as well to facilitate the future harmonization of data across sectors to embrace a One Health approach.

FAO: Surveillance of AMR in Animals and Food

The Food and Agriculture Organization (FAO) of the United Nations has been actively supporting countries in building and consolidating antimicrobial Resistance (AMR) surveillance and laboratory capacities to generate, collect and analyze high-quality epidemiological data in food-producing animals and food within national AMR surveillance systems. Strengthened, harmonized AMR data from animals and food, together with antimicrobial use (AMU) data from plants and crops, are essential for countries to understand their specific risks, design targeted interventions, and meet global reporting expectations. 

To address this need, FAO established the International FAO Antimicrobial Resistance Monitoring (InFARM) system, a global, country-driven mechanism for consolidating AMR data across food-producing animals, food, and related food production environments, as well as data on antimicrobial pesticide use in plant production and protection. Aligned with international guidelines and standards, InFARM has been recognized as a core mechanism for implementing both the 2024 UN General Assembly Political Declaration on AMR and FAO Conference Resolution 14/2025 and serves as the surveillance and measurement backbone of FAO's flagship initiative, Reduce the Need for Antimicrobials on Farms for Sustainable Agrifood Systems Transformation (RENOFARM).

InFARM's current focus for AMR data centres on supporting the collection, collation, and analysis of results generated through routine antimicrobial susceptibility testing (AST). Its initial scope covers key bacterial species of public health, food safety, and animal health importance, including zoonotic and foodborne pathogens, commensal indicator bacteria, and selected veterinary pathogens, in alignment with standards established by Codex Alimentarius and the World Organisation for Animal Health (WOAH).  A defining feature of InFARM is its surveillance framework, which provides a flexible structure to ensure global harmonization in data sharing while accommodating countries at very different stages of system development.

To build this evidence base, FAO has invited Members to participate in the InFARM annual open call for data since 2024. Launched at the beginning of the third quarter of each year, the call also accepts retrospective data from 2015 up to one year preceding each call. Drawing on data contributed through the first open call, InFARM recently published its first global report, providing an initial overview of AMR surveillance systems and available AMR data from animals and food worldwide.

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UNEP: Surveillance of AMR and residues in the environment

The environment is a critical component of the One Health response to antimicrobial resistance (AMR) and plays a leading role in ensuring that environmental dimensions including antimicrobial residues are integrated into surveillance systems. UNEP’s approach emphasizes science-based environmental surveillance to better understand how antimicrobial residues and resistant microorganisms circulate in ecosystems such as water, soil and air. Under mandates from the UN Environment Assembly, UNEP is tasked with supporting the development of environmental monitoring methods, collecting data from member states, and contributing these data to global surveillance platforms (e.g., GISSA). This focuses on building a globally coordinated evidence base for AMR in the environment.

A central pillar of UNEP’s work is reducing pollution sources that drive resistance, particularly antimicrobial residues entering the environment by healthcare systems, agriculture, and pharmaceutical manufacturing. These residues can accumulate in wastewater, soils, and natural waters, creating conditions for the emergence and spread of resistant organisms.

UNEP actively promotes wastewater and environmental surveillance as a key tool for monitoring AMR trends. Wastewater analysis can detect resistant pathogens at the population level, complement clinical surveillance, and provide early warning of emerging risks. More broadly, UNEP supports wastewater surveillance initiatives and capacity-building programmes to improve data collection, water-quality monitoring, and pollution control, particularly in low- and middle-income settings.

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WHO: Surveillance of AMR in humans

In 2015, following the adoption of the Global Action Plan on AMR, the Global Antimicrobial Resistance and Use Surveillance System (GLASS) was launched at the request of the assembly in resolution WHA 68.7, with the aim of supporting the GAP-AMR, specifically its second objective, which is to strengthen knowledge through surveillance and research and to enhance existing activities. AMR data at the national level are collected through a system that gathers results from antimicrobial susceptibility testing (AST) of common human bacterial pathogens from four specimens routinely sent to laboratories for clinical purposes. The “population under surveillance” is defined as patients seeking care in health care facilities. Based on the rationale that the growth of a pathogen in selected specimens is a proxy of infection in the associated anatomical sites, AMR data are collected for four infection sites: bloodstream infections caused by Acinetobacter spp., E. coli, K. pneumoniae, Salmonella spp., S. aureus and S. pneumoniae; urinary tract infections caused by E. coli and K. pneumoniae; gastrointestinal infections caused by Salmonella spp. and Shigella spp.; and genital infections caused by N. gonorrhoeae. Together with patients’ microbiological results (i.e., bacterial isolation and identification, AST), countries are also invited to report demographic and epidemiological variables in an aggregated format, such as age, gender, and origin of infection, with the latter used as a proxy to define where the infection has been contracted (hospital versus community). For all samples taken for microbiological testing, GLASS also collects data on both the number of patients with positive samples for a specific specimen type (including both isolates of the target pathogens and other bacteria, as well as antibiotic susceptibility of positive isolates) and the number of patients with negative samples (no microbial growth).

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Surveillance of AMU in humans

 For measuring the use of antimicrobials, WHO took a two-pronged approach: 1) routine surveillance of quantities and types of antimicrobials consumed at country or facility levels referred to as antimicrobial use (AMU); 2) use of these medicines by individuals. At the same time, the GLASS was launched at the request of the World Health Assembly in resolution WHA68.7 to support the GAP-AMR. For the surveillance of antimicrobial use in humans, GLASS is proposing two sets of tools to monitor use at the country or facility level. The first set of tools allows countries to estimate the quantities and types of antimicrobials consumed at the country level. These data can be collected annually at the national level and provide baseline information to identify patterns and trends in antimicrobial consumption. These data can be used by policy makers to strengthen pharmaceutical systems and optimize the use of antimicrobials. These data can also inform the development of standard treatment guidelines and can be correlated with national resistance statistics and use in other sectors, e.g., animals and agriculture.

The second set of tools allows countries to estimate the quantities and types of antimicrobials used at the health facility level. The facility-based surveillance of AMU is based on the same principles as national surveillance but targets individual facilities to generate facility-level consumption patterns and trends over the years. These data can be used at facility levels to improve procurement and supply of antimicrobials, can guide hospital antimicrobial stewardship programs, and can explain partly the level of resistance in the facility. At national levels, these facility-level data can be used for benchmarking among facilities to address incorrect patterns of use or worrisome trends.  More information about the WHO two-pronged approach for measuring the use of antimicrobials is available on the GLASS website

The WHO integrated global surveillance on ESBL-producing E. coli using a “One Health” approach – the ‘Tricycle’ Protocol

The WHO integrated global surveillance on ESBL-producing E. coli using a “One Health” approach, also known as the ‘Tricycle’ protocol, is a standard protocol for one of the models for integrated multisectoral surveillance. The model targets monitoring one indicator, the extended-spectrum β-lactamase (ESBL) producing Escherichia coli across the human, animal and environmental sectors, the “Tricycle protocol”. This protocol includes standard methodologies in the human, food chain, and environmental sectors that has been implemented in low-resource settings to facilitate the establishment of integrated multisectoral surveillance on AMR. Countries can build from this simple approach in a stepwise manner towards a national integrated surveillance system that involves other cross-sectoral pathogens and resistance mechanisms. Countries can also expand implementation across different cities and provinces to gather more evidence on the spread of AMR across sectors and enable the holistic implementation of interventions to contain AMR.

This model is under revision to expand the approach and to allow countries to continue building the national integrated surveillance system of AMR and AMU

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WOAH: surveillance of AMU in animals

WOAH has worked actively for more than two decades on AMR and developed a coherent Strategy on AMR and the Prudent Use of Antimicrobials for its activities in this area, in alignment with the updated Global Action Plan on Antimicrobial Resistance 2026–2036. Within this strategic framework, WOAH took the lead in building a global database on antimicrobial agents intended for use in animals. Since 2015, Veterinary Services and other national authorities have been reporting information on antimicrobial agents intended for use in animals at a national level to WOAH, which are available in the ANIMUSE platform. The database is designed to:

• Monitor the quantities and usage patterns of antimicrobial agents adjusted by animal biomass globally in aquatic and terrestrial animals
• Support WOAH Members in implementing international standards in WOAH’s Terrestrial Code (Chapters 6.9. and 6.10) and Aquatic Code (Chapter 6.3)
• Monitoring the use of antimicrobials as growth promoters
• Evaluate the quality and authenticity of antimicrobial products in use

ANIMUSE represents a major milestone in global AMR efforts, with ongoing expansion due to the commitment of its Members.  WOAH’s Annual Reports on Antimicrobial Agents Intended for Use in Animals have been published every year since 2016 and highlight steady progress in participation and the details of data provided to WOAH.

The reporting is open to both WOAH Members or non-members. National Veterinary Services can submit general information and, if quantitative information is available, they can choose among different options, according to the degree of detail of their data. Learn more in this infographic.

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