{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T03:28:54Z","timestamp":1792466934645,"version":"4.5.0"},"reference-count":21,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T00:00:00Z","timestamp":1710892800000},"content-version":"unspecified","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100003024","name":"International Society for Infectious Diseases","doi-asserted-by":"publisher","award":["63019455"],"award-info":[{"award-number":["63019455"]}],"id":[{"id":"10.13039\/100003024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,3,8]]},"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Antimicrobial resistance (AMR) has become a significant public health threat. Without any interventions, it has been modelled that AMR will account for an estimated 10\u2009million deaths annually by 2050, this mainly affects low\/middle-income countries. AMR has a systemic negative perspective affecting the overall healthcare system down to the patient\u2019s personal outcome. In response to this issue, the WHO urged countries to provide antimicrobial stewardship programmes (ASPs). ASPs in hospitals are a vital component of national action plans for AMR, and have been shown to significantly reduce AMR, in particular in low-income countries such as Madagascar.<\/jats:p>\n                    <jats:p>As part of an ASP, AMR surveillance provides essential information needed to guide medical practice. We developed an AMR surveillance tool\u2014Technique de Surveillance Actualis\u00e9e de la R\u00e9sistance aux Antimicrobiens (TSARA)\u2014with the support of the M\u00e9rieux Foundation. TSARA combines bacteriological and clinical information to provide a better understanding of the scope and the effects of AMR in Madagascar, where no such surveillance tool exists.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>A prospective, observational, hospital-based study was carried out for data collection using a standardised data collection tool, called TSARA deployed in 2023 in 10 hospitals in Madagascar participating in the national Malagasy laboratory network (R\u00e9seau des Laboratoires \u00e0 Madagascar (RESAMAD)). Any hospitalised patient where the clinician decided to take a bacterial sample is included. As a prospective study, individual isolate-level data and antimicrobial susceptibility information on pathogens were collected routinely from the bacteriology laboratory and compiled with clinical information retrieved from face-to-face interviews with the patient and completed using medical records where necessary. Analysis of the local ecology, resistance rates and antibiotic prescription patterns were collected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>This protocol obtained ethical approval from the Malagasy Ethical Committee n\u00b007-MSANP\/SG\/AGMED\/CNPV\/CERBM on 24 January 2023. Findings generated were shared with national health stakeholders, microbiologists, members of the RESAMAD network and the Malagasy academic society of infectious diseases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-078504","type":"journal-article","created":{"date-parts":[[2024,3,20]],"date-time":"2024-03-20T02:06:03Z","timestamp":1710900363000},"page":"e078504","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Implementation of an antibiotic resistance surveillance tool in Madagascar, the TSARA project: a prospective, observational, multicentre, hospital-based study protocol"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6962-161X","authenticated-orcid":false,"given":"Christelle","family":"Elias","sequence":"first","affiliation":[{"name":"Service Hygi\u00e8ne et Epid\u00e9miologie, Hospices Civils de Lyon, Lyon, France"},{"name":"Public Health, Epidemiology & Evolutionary Ecology of Infectious Diseases (PHE3ID) team, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, Universit\u00e9 Claude Bernard Lyon 1, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Raad","sequence":"additional","affiliation":[{"name":"Direction des Op\u00e9rations Internationales, Fondation M\u00e9rieux, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saida","family":"Rasoanandrasana","sequence":"additional","affiliation":[{"name":"Service de Biologie, H\u00f4pital Befelatanana, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antso Hasina","family":"Raherinandrasana","sequence":"additional","affiliation":[{"name":"D\u00e9partement de Sant\u00e9 Publique, Facult\u00e9 de M\u00e9decine de l\u2019Universit\u00e9 d\u2019Antananarivo, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Volatiana","family":"Andriananja","sequence":"additional","affiliation":[{"name":"Service des Maladies Infectieuses, H\u00f4pital Befelatanana, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8857-5834","authenticated-orcid":false,"given":"Mihaja","family":"Raberahona","sequence":"additional","affiliation":[{"name":"Service des Maladies Infectieuses, H\u00f4pital Befelatanana, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catrin E","family":"Moore","sequence":"additional","affiliation":[{"name":"Centre for Neonatal and Paediatric Infection, St. George\u2019s, University of London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamy","family":"Randria","sequence":"additional","affiliation":[{"name":"Service de Biologie, H\u00f4pital Befelatanana, Antananarivo, Madagascar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurent","family":"Raskine","sequence":"additional","affiliation":[{"name":"Direction des Op\u00e9rations Internationales, Fondation M\u00e9rieux, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Vanhems","sequence":"additional","affiliation":[{"name":"Service Hygi\u00e8ne et Epid\u00e9miologie, Hospices Civils de Lyon, Lyon, France"},{"name":"Public Health, Epidemiology & Evolutionary Ecology of Infectious Diseases (PHE3ID) team, Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, Universit\u00e9 Claude Bernard Lyon 1, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran\u00e7ois-Xavier","family":"Babin","sequence":"additional","affiliation":[{"name":"Direction des Op\u00e9rations Internationales, Fondation M\u00e9rieux, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2024,3,19]]},"reference":[{"key":"2025121523575488000_14.3.e078504.1","unstructured":"O\u2019Neill J , Davies S , Rex J , et al . 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