Antimicrobial surveillance: a 20-year history of the SMART approach to addressing global antimicrobial resistance into the future

Antimicrobial resistance (AMR) is a major global public health threat, particularly affecting patients in resource-poor settings. Comprehensive surveillance programs are essential to reducing the high mortality and morbidity associated with AMR and integral to informing treatment decisions and guidelines, appraising effectiveness of intervention strategies, and directing development of new antibacterial agents. Various surveillance programs exist worldwide, including those administered by government bodies or funded by the pharmaceutical industry. One of the largest and longest-running industry-sponsored AMR surveillance programs is the Study for Monitoring Antimicrobial Resistance Trends (SMART), which recently completed its 20th year. The SMART database has grown to almost 500,000 isolates from over 200 sites in more than 60 countries, encompassing all major geographic regions and including many sites in low- and middle-income countries. The SMART surveillance program has evolved in scope over time, including additional antibacterial agents, pathogens, and infection sites in line with changing epidemiology and medical need.