title: The Alexander Project: the benefits from a decade of surveillance.
abstract: The Alexander Project, initiated in 1992 as an international, multicentre, longitudinal surveillance study of antimicrobial susceptibility among common respiratory pathogens, has been pivotal in defining the role of global surveillance. At the time, there were few studies in which data were collected in a way that allowed meaningful comparisons to be made between studies, locations or over time. The project instituted the use of a central laboratory and standardized methods for the collection of isolates and determination of susceptibility, and this was continued with the addition of two further reference laboratories. Data from the study have provided a resource for measuring trends in the susceptibility patterns of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis at country, regional and global levels. Determination and publication of quantitative MICs enabled detailed assessment of changes in susceptibility distributions and assessment of microbiological and potential clinical susceptibility using different breakpoints, including those based on pharmacokinetic/pharmacodynamic parameters. Comparisons of antimicrobial usage patterns and resistance prevalences over time allowed hypotheses to be examined with respect to the role of quantity and type of antimicrobial use in the selection and spread of resistance. The resulting collection of isolates has provided a valuable resource for molecular studies into the evolution of resistance over time and location; a substantial proportion of this collection is now in the public domain. This paper reviews the 10 years of the Alexander Project and the benefits it has brought to an understanding of the evolution of antibacterial resistance in community respiratory bacteria.
authors.affiliation: GR Micro, Limited, 7-9 William Road, London NW1 3ER, UK. d.felmingham@grmicro.co.uk
authors.forename: David
authors.initials: D
authors.lastname: Felmingham
authors.forename: Anthony R
authors.initials: AR
authors.lastname: White
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jacobs
authors.forename: Peter C
authors.initials: PC
authors.lastname: Appelbaum
authors.forename: James
authors.initials: J
authors.lastname: Poupard
authors.forename: Linda A
authors.initials: LA
authors.lastname: Miller
authors.forename: Reuben N
authors.initials: RN
authors.lastname: Grüneberg
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001208:Asia; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D024881:Drug Resistance, Bacterial; D005060:Europe; D006193:Haemophilus influenzae / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000379:methods / Q000592:standards; D001936:Moraxella catarrhalis / Q000187:drug effects / Q000302:isolation & purification; D015337:Multicenter Studies as Topic; D011159:Population Surveillance; D012141:Respiratory Tract Infections / Q000188:drug therapy / Q000382:microbiology*; D013019:South Africa; D013020:South America; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents