Supplementary Table S1. Surveillance activities in EU/EAA identified and classified according to the study criteria.
Country / Included systems / Excluded systemsAustria / Austrian Nosocomial Infection Surveillance System
National Reference Centre for Nosocomial infection and Antimicrobial Resistance / Austrian surveillance of nosocomial infections in Neonatal Care1
Epidemiologischesmeldesystem/national reference centres 3,4
Belgium / Scientific Institute of Public Health (IPH) - InstitutScientifique de Santé Publique
Croatia / Intersectoral Coordination Mechanism for the Control of AMR / Croatian Institute of Public Health2
Cyprus / National antimicrobial resistance surveillance system2
CzechRepublic / SZU-Statnizdravotni Listav2
Denmark / Hospital-acquired infections database
Danish integrated antimicrobial resistance monitoring and research programme / Danish microbiology database 5
North Denmark region microbiological bacteraemia research database2
Compulsory notification of MRSA4
Estonia / National institute for health development2
Finland / Finnish hospital infection program
Finnish study group for antimicrobial resistance / National infectious diseases register
France / l’ObservatoireNational de l’Epidémiologie de la RésistanceBactérienneauxAntibiotiques / Enquêtenationale de prévalence des infections associées aux soins et des traitementsantibiotiquesen EHPAD1
Réseaud’Alerte, d’Investigation et de Surveillance des Infections Nosocomiales / Centre de coordination de la luttecontre les infections nosocomiales (C.CLIN) 1 (HAI)
Institut de vieille sanitaire 1
Germany / Krankenhausinfektions surveillance system
Antibiotic resistance surveillance
Surveillance of antibiotic use and resistance in ICU
Antibiotikaresistenz monitoring in Niedersachsen
German network for antimicrobial resistance surveillance / National reference centre for Streptococci 3
Compulsory notification of MRSA, carbapenem-resistant or carbapenemase-producing Acinetobacter spp. Enterobacteriaceae4
Statutory notification of multidrug-resistant bacteria4
Greece / Greek system for the surveillance of antimicrobial resistance / Procrustes, compulsory notification of bacteraemia due to AMR 4
Greek national reference centre for Neisseria gonorrhoeae3
National Salmonella and Shigella Reference Centre 3
Hungary / OrzágosEpidemiológiaiKözpont (National Center for Epidemiology) - National Nosocomial Surveillance System
Iceland / Landlknisembtti, Directorate of Health / EPI_ICE 2
Ireland / Health Protection Surveillance Centre
Italy / Sorveglianzaregionaledelleinfezioni in terapia intensiva
SorveglianzaprospetticadelleinfezioninosocomialinellaUnità di Terapia Intensiva
Sistema nazionale di sorveglianzadelleinfezioni del sito chirurgico
Margherita PROSAFE
Antibiotico resistenza - Istituto Superiore di Sanitá
Sorveglianzadell’antibioticoresistenza e uso di antibioticisistemici in Emilia-Romagna
Sorveglianzaantibioticoresistenza Toscana
Micronet / National reference centre for Neisseria
Laboratory-based surveillance of invasive infections 3
Latvia / Infectology Centre Department of Epidemiological Safety and Public Health (DESPH)2
Centre for Disease Prevention and Control (CDPC) 2
Liechtenstein
Lithuania / Healthcare-associated infections epidemiological surveillance* / National public health surveillance laboratory and Institute of hygiene Vilnus2
Luxemburg / Centre de RecherchePublic de la Santé2
Malta / Mater Dei Hospital 2
The Netherlands / Preventie van ziekenhuisinfecties door surveillance*
Surveillance network for infectious diseases in nursing homes*
Infectious disease surveillance and information system for antibiotic resistance / Kinderdagverblijveninfectieziekten surveillance systeem5
Compulsory notification of MRSA4
Surveillance of antimicrobial resistance in the Netherlands5
Norway / NasjonaltFolkehelseinstitutt (FHI) / The Norwegian Institute of Public Health (NIPH): Healthcare Asssociated Infections module for SSI (NOIS-SSI); Antimicrobial drug Resistance module (NORM) / Norwegian Arthroplasty Register 3
Norwegian Hip Fracture Register 3
Norwegian Surveillance System for Communicable Diseases (MSIS) 4
Portugal / Antibiotic Resistance Surveillance Program in Portugal
Poland / Active Supervision of nosocomial infections Program 2
National Medicines Institute 2
National reference centre for diagnosis of bacterial infections of the central nervous system3
Romania / Sentinel Surveillance System of Nosocomial Infections and AMR 2
Slovakia / Slovak national antimicrobial resistance surveillance system / EPIS, Epidemiology information system 2
National reference centre for Salmonella 3
Slovenia / National Institute of Public Health, University of Ljubljana2
Spain / Sistema de Vigilancia, prevención y control de IRAS en Principado de Asturias
Sistema de Vigilancia Nosocomial de Galicia
Vigilancia de les InfeccionsnosocomialsalsHospitals de Cataluya (VINCAT)
Programa Integral de Prevención, control de las Infecciones relacionadas con la Asistencia Sanitaria y Uso apropiado de los Antimicrobianos en Andalucía (PIRASOA)
Plan INOZ - InfekzioNosocomialakZaintzeko eta Kontrolatzeko del País Vasco
Vigilancia de las Infecciones Relacionadas con la Asistencia Sanitaria de Madrid (VIRAS)
Sistema de Vigilancia Epidemiológica de Canarias
Estudio nacional de vigilancia de Infección nososcomial en servicios de medicina intensiva (ENVIN-UCI)
Estudio de Prevalencia de las Infecciones Nosocomiales en España (EPINE) / Red Nacional de Vigilancia epidemiológica (RENAVE)1
Programa de Vigilancia y control de microorganismos multirresistentes4
Spanish national nosocomial infection surveillance network 2
Sweden / Swedish surveillance of antimicrobial resistance
Annual resistance monitoring and quality control programme / ICU STRAMA Program 2
Bi-annual point-prevelance surveillance of HAI*
Mandatory/voluntary notification of infections 4
National reference laboratory for pathogenic Neisseria 3
Switzerland / SWISSNOSO
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) surveillance system
Swiss centre for antibiotic resistance / Mandatory notification of carbapenemase-producing Enterobacteriaceae4
Hygiene hospitaliere prevention et contrôle de línfection*
United Kingdom / Healthcare Infection Centre
Public Health England(Healthcare Protection Agency: inactive)
Health Protection Scotland
Welsh Healthcare Associated Infections Programme / The Pan Celtic Network 1
EU/EEA (ECDC) / Healthcare-Associated Infections Surveillance Network
European Antimicrobial Resistance Surveillance Network
WHO / Central Asian and Eastern European Surveillance of Antimicrobial Resistance
Global Antimicrobial Resistance Surveillance System
* Systems exclusively declaring/notifying individual cases of a specific disease or pathogen (e.g., compulsory reporting of individual cases without denominators); systems providing only animal, environmental or food data; surveillance data promoted by private companies; studies not including continuous or periodic surveillance; and outbreaks reports are not display in this table.
NR/ UNK= Not reported / Unknown; HAI: Healthcare Associated Infections; AMR: Antimicrobial Resistance
1. Data included in other surveillance systems
2. Not public access or data available from primary sources
3. Reference centers / Quality registers
4. Statutory notification/ passive surveillance
5. Currently not intended for HAI / AMR surveillance / Does not meet all eligible criteria
Supplementary Table S2. General features of healthcare associated infection (HAI) and antimicrobial resistance (AMR) surveillance systems for which data were extracted.
Country / Coverage / Surveillance systems / Focus / Population targeted / Age groups / Modality of reporting (frequency / type) / Quality audits / Available information, yearsAustria / National / ANISS / Austrian Nosocomial Infection Surveillance System / HAI / Inpatients / All ages / Yearly / pooled data / External, voluntary / 2012-2016
National / NRZ / National Reference Centre for Nosocomial infection and Antimicrobial Resistance / AMR / Inpatients and outpatients / All ages / Yearly / pooled data / External, voluntary / 2014-2016
Belgium / National / WIV-ISSP / Scientific Institute of Public Health (IPH) - InstitutScientifique de Santé Publique / HAI, AMR / Laboratory-based / All ages / Yearly / individual site and pooled data / NR/UNK / 2011
Croatia / National / ISKRA / Intersectoral Coordination Mechanism for the Control of AMR / AMR / Laboratory-based / All ages / Yearly / pooled data / NR/UNK / 2014
Denmark / National / HAIBA / Hospital-acquired infections database / HAI / Inpatients / All ages / Weekly / individual site data / NR/UNK / 2015, 2016
National / DANMAP / Danish integrated antimicrobial resistance monitoring and research programme / AMR / Inpatients and outpatients / All ages / Yearly / pooled data / External, voluntary / 2014-2016
Finland / National / SIRO / Finnish hospital infection program / HAI / Inpatients / All ages / Yearly / pooled data / External, voluntary / 2006, 2011, 2014, 2016
National / FIRE / Finnish study group for antimicrobial resistance / AMR / Inpatients and outpatients / All ages / Yearly / pooled data / External, voluntary / 2014-2016
France / National / ONERBA / l’ObservatoireNational de l’Epidémiologie de la RésistanceBactérienneauxAntibiotiques / AMR / Inpatients and outpatients / All ages / Yearly / NR/UNK / Local / 2015
National / RAISIN / Réseaud’Alerte, d’Investigation et de Surveillance des Infections Nosocomiales / HAI, AMR / Inpatients / All ages / Yearly / comparative data with other HCF / NR/UNK / 2009-2016
Germany / National / KISS / Krankenhausinfektions surveillance system / HAI, AMR / Inpatients and outpatients / All ages / Yearly / pooled data / NR/UNK / 2010, 2012-2016
National / ARS / Antibiotic resistance surveillance / AMR / Inpatients and outpatients / All ages / Yearly / pooled data / External, voluntary / 2015, 2016
National / SARI / Surveillance of antibiotic use and resistance in ICU / AMR / ICU patients / All ages / Yearly / pooled data / NR/UNK / 2009,2016
Regional / ARMIN / Antibiotika resistenz monitoring in niedersachsen / AMR / Inpatients and outpatients / All ages / Yearly / pooled data / NR/UNK / 2015, 2016
National / GENARS / German network for antimicrobial resistance surveillance / AMR / Laboratory-based / All ages / NR/UNK / pooled data / NR/UNK / 2002, 2007
Greece / National / GSSAR / Greek system for the surveillance of antimicrobial resistance / AMR / Inpatients / All ages / Yearly / comparative data with other HCF / External, voluntary / 2015, 2016
Hungary / National / OEK / OrzágosEpidemiológiaiKözpont - National Center for Epidemiology / HAI, AMR / Inpatients / All ages / Mixed / pooled data / NR/UNK / 2006, 2010
Ireland / National / HPSC / Health Protection Surveillance Centre / HAI, AMR / NR/UNK / All ages / Mixed / pooled data / NR/UNK / 2014, 2016
Italy / Regional / SITIER / Sorveglianzaregionaledelleinfezioni in terapia intensiva / HAI, AMR / ICU patients / All ages / Real time / comparative data with other HCF / NR/UNK / 2013
National / SNICh / Sistema nazionale di sorveglianzadelleinfezioni del sito chirurgico / HAI, AMR / Surgical patients / All ages / Yearly / comparative data with other HCF / Local, compulsory / 2014
National / SPIN-UTI / SorveglianzaprospetticadelleinfezioninosocomialinellaUnità di Terapia Intensiva / HAI, AMR / ICU patients / All ages / Yearly / pooled data / NR/UNK / 2009, 2013, 2015
National / Margherita / Margherita PROSAFE / HAI, AMR / Inpatients / All ages / Yearly / comparative data with other HCF / Local / 2014
National / AR-ISS / Antibioticoresistenza - IstitutoSuperiore di Sanitá / AMR / Laboratory-based / All ages / Mixed / comparative data with other HCF / External, voluntary / 2013
Regional / LAB / Sorveglianzadell’antibioticoresistenza e uso di antibioticisistemici in Emilia-Romagna / AMR / Inpatients and outpatients / All ages / Yearly / comparative data with other HCF / Local / 2003 - 2014
Regional / SART / Sorveglianzaantibioticoresistenza Toscana / AMR / Inpatients and outpatients / All ages / NR/UNK / pooled data / NR/UNK / 2015
National / Micronet / Micronet / AMR / Laboratory-based / All ages / NR/UNK / pooled data / NR/UNK / 2007
Lithuania / National / HAI E.S.LI / Healthcare-associated infections epidemiological surveillance / HAI / Inpatients / All ages / Yearly / pooled data / NR/UNK / 2015,2016
The Netherlands / National / PREZIES / Preventie van ziekenhuisinfecties door surveillance / HAI / Inpatients / All ages / Yearly / pooled data / NR/UNK / 2015,2016
National / SNIV / Surveillance network for infectious diseases in nursing homes / HAI / Nursing homes / Only adults / Yearly / pooled data / NR/UNK / 2014-2016
National / ISIS-AR / Infectious disease surveillance and information system for antibiotic resistance / AMR / Inpatients and outpatients / All ages / Quarterly / pooled data / NR/UNK / 2012, 2015, 2016
Norway / National / FHI / NasjonaltFolkehelseinstitutt: Healthcare Asssociated Infections module for SSI (NOIS-SSI); Antimicrobial drug Resistance module (NORM) / HAI, AMR / NR/UNK / All ages / Yearly / comparative data with other HCF / NR/UNK / 2014
Portugal / National / ARSIP / Antibiotic Resistance Surveillance Program in Portugal / HAI, AMR / Inpatients and outpatients / All ages / NR/UNK / comparative data with other HCF / NR/UNK / 2014
Slovakia / National / SNARS / Slovak national antimicrobial resistance surveillance system / AMR / Inpatients and outpatients / All ages / Yearly / pooled data / External, compulsory / 2016
Spain / Regional / SVPCIPA / Sistema de Vigilancia, prevención y control de IRAS en Principado de Asturias / HAI, AMR / Inpatients / All ages / Yearly / individual site data / NR/UNK / 2011
Regional / SVIN / Sistema de Vigilancia Nosocomial de Galicia / HAI, AMR / Inpatients and outpatients / All ages / Monthly / comparative data with other HCF / Local / 2000
Regional / VINCAT / Vigilancia de les InfeccionsnosocomialsalsHospitals de Cataluya / HAI, AMR / Inpatients / All ages / Yearly / comparative data with other HCF / NR/UNK / 2015
Regional / PIRASOA / Programa Integral de Prevención, control de las infecciones relacionadas con la asistencia sanitaria y uso apropiado de los antimicrobianos en Andalucía / HAI, AMR / Inpatients and outpatients / All ages / Quarterly / comparative data with other HCF / NR/UNK / 2014
Regional / INOZ / InfekzioNosocomialakZaintzeko eta Kontrolatzeko del País Vasco / HAI / Inpatients / All ages / NR/UNK /individual site data / NR/UNK / 2016
Regional / VIRAS / Vigilancia de las Infecciones Relacionadas con la Asistencia Sanitaria de Madrid / HAI / Inpatients / All ages / Yearly / individual site data / NR/UNK / 2012
Regional / SVE Canarias / Sistema de Vigilancia epidemiológica de Canarias / HAI / Inpatients and outpatients / All ages / Yearly / pooled data / NR/UNK / 2014
National / ENVIN-UCI / Estudio nacional de vigilancia de Infección nososcomial en servicios de medicina intensiva / HAI, AMR / Inpatients and outpatients / All ages / Yearly / individual site data / NR/UNK / 2014
National / EPINE / Estudio de Prevalencia de las Infecciones Nosocomiales en España / HAI / Inpatients / All ages / Yearly / comparative data with other HCF / External / 2015
Sweden / National / RESNET / Annual resistance monitoring and quality control programme / AMR / NR/UNK / NR/UNK / Yearly / pooled data / NR/UNK / 2014, 2016
National / SVEBAR / Swedish surveillance of antimicrobial resistance / AMR / Inpatients and outpatients / All ages / Yearly / pooled data / External, compulsory / 2016
Switzerland / National / SWISSNOSO / SWISSNOSO / HAI / Inpatients / All ages / Yearly / pooled data / Local, compulsory / 2015, 2016
Regional / HPCI / Hygiènehospitalièreprévention et contrôle de l'infection / HAI, AMR / Inpatients and outpatients / All ages / NR/UNK / NR/UNK / 2016
Regional / CA-MRSA / Community-associated methicillin-resistant Staphylococcus aureus surveillance system / AMR / Inpatients and outpatients / All ages / NR/UNK / pooled data / NR/UNK / 2006, 2012,2016
National / ANRESIS / Swiss centre for antibiotic resistance / AMR / Inpatients and outpatients / All ages / Yearly / pooled data / External, voluntary / 2015, 2016
United Kingdom / Regional / WHAIP / Welsh Healthcare Associated Infections Programme / HAI, AMR / Inpatients and outpatients / All ages / Monthly / comparative with other HCFs / NR/UNK / 2016
Regional / HPS / Health Protection Scotland / HAI, AMR / Inpatients / All ages / Quarterly / comparative with others HCFs / External / 2015
Regional / PHE / Public Health England / HAI, AMR / Laboratory / All ages / Mixed / access to individual site data of all HCF / NR/UNK / 2014
Regional / HISC/HPA / Healthcare Infection Centre / Healthcare Protection Agency / HAI, AMR / Laboratory / All ages / NR/UNK /pooled data / Local / 2008
EU/EEA (ECDC) / Transnational / HAI-Net / Healthcare-Associated Infections Surveillance Network / HAI, AMR / Laboratory / All ages / Mixed / pooled data by country / External / 2015 ICU; 2012 SSI
Transnational / EARS-Net / European Antimicrobial Resistance Surveillance Network / AMR / NR/UNK / All ages / Yearly / pooled data by country / External / 2015
WHO / Transnational / CAESAR / Central Asian and Eastern European Surveillance of Antimicrobial Resistance / AMR / Inpatients and outpatients / All ages / Comparative with others HCFs / External, voluntary / 2015
Transnational / GLASS / Global Antimicrobial Resistance Surveillance System / AMR / Laboratory-based / All ages / Yearly / Comparative with others HCFs / Local, compulsory / 2015
NR/UNK= Not Reported or unknown; HCF= Healthcare facilities.
Supplementary Table S3. Characteristics of surveillance systems on antimicrobial resistance included.
Pathogens includedCountry / Surveillance system acronym / Primary source of data / Duplicates policy / Resistance criteria / Case definition / Indicators used / Data on predisposing factors / Streptococcus pneumoniae / Staphylococcus aureus / Enterococcus faecalis / Enterococcus faecium / Escherichia coli / Klebsiella pneumoniae / Pseudomonas aeruginosa / Acinetobacter baumannii / Clostridium difficile
Austria / NRZ / Laboratory / Yes / EUCAST/CLSI / Infections / PRI / NR/UNK
Belgium / WIV-ISSP / Laboratory / NR/UNK / NR/UNK / Any clinical sample / CI / Antibiotics, comorbidities
Croatia / ISKRA / Laboratory / Yes / EUCAST / Any clinical sample / NR/UNK / NR/UNK
Denmark / DANMAP / Laboratory / Yes / EUCAST/CLSI / Any clinical sample / PRI, CI1 / NR/UNK
Finland / FIRE / Laboratory / Yes / EUCAST / Infections / PRI / NR/UNK
France / ONERBA / Laboratory / Yes / Local / Infections / NR/UNK / NR/UNK
RASIN / Laboratory / Yes / NR/UNK / Any clinical sample / PRI, CI, ID / NR/UKN
Germany / KISS / Charts/ Laboratory / Yes / Local / Any clinical sample / PRI, CI, ID / Invasive procedures, antibiotic use
ARS / Laboratory / Yes / EUCAST/CLSI/ Local / NR/UNK / PRI / NR/UNK
SARI / Laboratory / Yes / EUCAST/CLSI/Local / NR/UNK / PRI, ID / Antibiotic use
ARMIN / Laboratory / Yes / EUCAST/CLSI/Local / NR/UNK / PRI / NR/UNK
GENARS / Laboratory / NR/UNK / Local / NR/UNK / PRI / NR/UNK
Greece / GSSAR / Laboratory / Yes / CLSI / NR/UNK / PRI / NR/UNK
Hungary / OEK / Charts/Laboratory / Yes / EUCAST / Infections / PRI, CI, ID / Invasive procedures, antibiotic use, comorbidities, previous hospitalisation
Ireland / HPSC / Charts/Laboratory / Yes / EUCAST / Infections / PRI, ID / Previous hospitalisations, ICU stay
Italy / SITIER / Laboratory / NR/UNK / NR/UNK / Infections / PRI, CI / Invasive procedures
SNICh / Laboratory / NR/UNK / NR/UNK / Infections / CI / Antibiotic use
SPIN-UTI / Laboratory / NR/UNK / NR/UNK / Any clinical sample / PRI, ID / Invasive procedures, antibiotic use, comorbidities, previous hospitalisation
Margherita / Laboratory / Yes / NR/UNK / Infections / PRI / Invasive procedures, antibiotic use, comorbidities, previous hospitalisation
AR-ISS / Laboratory / Yes / EUCAST / NR/UNK / PRI / NR/UNK
LAB / Laboratory / Yes / EUCAST / Any clinical sample / PRI, ID / NR/UNK
SART / Laboratory / Yes / EUCAST / Any clinical sample / PRI / Antibiotic use, length of stay, comorbidities
Micronet / Laboratory / NR/UNK / NR/UNK / Any clinical sample / PRI / NR/UNK
Lithuania / HAI E.S.LI / NR/UNK / NR/UNK / NR/UNK / NR/UNK / NR/UNK / NR/UNK
The Netherlands / ISIS-AR / Laboratory / Yes / EUCAST / Any clinical sample / PRI / NR/UNK
Norway / FHI / Charts/Laboratory / Yes / EUCAST / NR/UNK / PRI / Antibiotic use
Portugal / ARSIP / Laboratory / NR/UNK / NR/UNK / Infections / NR/UNK / NR/UNK
Slovakia / SNARS / Laboratory / Yes / EUCAST/CLSI / Any clinical sample / PRI / NR/UNK
Spain / SVPCIPA / Laboratory / NR/UNK / NR/UNK / Any clinical sample / ID / NR/UNK
SVIN / Laboratory / NR/UNK / NR/UNK / Infections / NR/UNK / Antibiotic use
VINCAT / Laboratory / Yes / NR/UNK / Any clinical sample / NR/UNK / Antibiotic use
PIRASOA / Laboratory / Yes / EUCAST/CLSI / Any clinical sample / ID / Invasive procedures, antibiotic use
ENVIN-UCI / Laboratory / NR/UNK / EUCAST/CLSI / Any clinical sample / ID / Antibiotic use
Sweden / RESNET / Laboratory / NR/UNK / EUCAST / NR/UNK / PRI / NR/UNK
SVEBAR / Laboratory / NR/UNK / EUCAST / Any clinical sample / PRI / NR/UNK
Switzerland / HPCI / Charts/Laboratory / NR/UNK / EUCAST / Any clinical sample / CI, ID / NR/UNK
CA-MRSA / Charts/Laboratory / NR/UNK / EUCAST / Any clinical sample1 / NR/UNK / Invasive procedures, antibiotic use, comorbidities, previous hospitalisation, others2
ANRESIS / Laboratory / Yes / EUCAST/CLSI / Any clinical sample / PRI / NR/UNK
United Kingdom / WHAIP / Laboratory / NR/UNK / NR/UNK / Any clinical sample / CI / NR/UNK
HPS / Charts/Laboratory / Yes / NR/UNK / Any clinical sample / PRI, CI / Antibiotic use
PHE / Charts/Laboratory / Yes / NR/UNK / Any clinical sample / PRI, CI, ID / Invasive procedures, antibiotic use
HISC/HPA / Laboratory / NR/UNK / NR/UNK / NR/UNK / NR/UNK / NR/UNK
ECDC / HAINET / Charts/Laboratory / Yes / EUCAST / Infections / PRI, CI, ID / Invasive procedures, antibiotic use, comorbidities, previous hospitalisation
EARSNET / Laboratory / Yes / EUCAST/CLSI / Infections / PRI / Invasive procedures, antibiotic use, comorbidities, previous hospitalisation, exposure to colonised patients
WHO / GLASS / Laboratory / Yes / EUCAST/CLSI / Any clinical simple / PRI / NR/UNK
CAESAR / Laboratory / Yes / EUCAST/CLSI / Any clinical sample / PRI, CI / NR/UNK
Black: Yes; Grey= NR/UNK: not reported or unknown. PRI: Proportion of resistant isolates. CI: cumulative incidence of resistant isolate/cases. ID: incidence density of resistantisolates/cases.