Re-inventing antimicrobial resistance reference laboratories, the Public Health Microbiology keystones of AMR National Action Plans

Detection of antimicrobial resistance (AMR) in microbiology laboratories provides the foundation for our understanding of where, when and how resistance occurs and spreads. Laboratory investigation is a prerequisite for AMR surveillance programmes and provides the evidence by which the success of interventions and policies can be measured. The remit of an AMR reference laboratory is to support a national or regional network of frontline diagnostic laboratories by providing specialized services to confirm, characterize and investigate new and emerging resistances. It must address resistance in many different bacterial pathogens causing many types of infections and must collaborate with partners across healthcare settings and One Health sectors to assess new risks. Effective AMR reference services are scarce national capabilities. We discuss how AMR reference laboratories must adapt to use the latest technologies and the opportunities and challenges that these present. There is a growing gap between what is technologically possible and what is affordable, and so AMR reference laboratories will increasingly need to focus on services that will deliver the greatest public health benefit