NSIH-AMR - National surveillance of antimicrobial resistance

Last updated on 6-3-2023 by Katrien Latour
January 1, 1994
Project with no end date

Sciensano's project investigator(s):


In short

Infections caused by bacteria can be treated with antibiotics. When these drugs are used regularly, unnecessarily (e.g. in case of a viral infection) or incorrectly (e.g. stopping the antibiotic treatment too soon and/or using the leftovers later on), bacteria can become ‘resistant’. When you get an infection with such a resistant bacterium, antibiotics may no longer help. This can make you seriously ill, potentially resulting in a hospital admission, a longer duration of illness or sometimes even death.  

Sciensano’s Healthcare-associated infections and antimicrobial resistance (NSIH) service organises, collects and analyses surveillance data on antimicrobial resistance (AMR) in Belgian hospitals. These results are fed back to the hospitals so that they can prevent the emergence of resistance and/or stop the spread of resistant germs through careful use of antibiotics and thorough hygiene measures.

Project summary

The surveillance of antimicrobial resistance (AMR) in Belgian hospitals consists of 3 parts, as described below. The data are described in a study protocol (available in Dutch and French) and collected by means of a surveillance form (available in File Dutch and File French). 

1. Surveillance of methicillin-resistant Staphylococcus aureus (MRSA)

Staphylococcus aureus is a gram-positive bacterium that is frequently found on the skin and in the nose of humans. When this bacterium becomes non-susceptible (resistant) to treatment with certain antibiotics, including methicillin, we speak of MRSA.

MRSA is one of the so-called nosocomial bacteria that Sciensano is monitoring since 1994. Since 2006, participation in this surveillance is mandatory for all Belgian hospitals.

2. Surveillance of multidrug-resistant gram-negative bacteria (MRGN)

Like other European countries, Belgium is faced with the rapid emergence of multidrug-resistant gram-negative bacteria. These bacteria (e.g. Escherichia coli and Klebsiella pneumoniae) are commonly found in the human intestines and can cause infections, especially in seriously ill patients. Via different mechanisms, these gram-negative bacteria can become non-susceptible (resistant) to various classes of antibiotics. The most common resistance mechanism is the production of enzymes, such as extended spectrum beta-lactamases (ESBL) and carbapenemases. 

Sciensano started this epidemiological surveillance in 2000. Since 2014, participation in this surveillance is mandatory for all Belgian hospitals (Royal Decree of 8 January 2015).

3. Surveillance of vancomycin or linezolid resistant enterococci (VRE)

Enterococci are part of the normal intestinal flora of humans. There are various enterococci, but only a small number cause infections in humans (e.g. Enterococcus faecium and Enterococcus faecalis). Most infections (e.g. urinary tract infections, wound infections, bloodstream infections and endocarditis) occur in immunocompromised or seriously ill patients. 

Vancomycin-resistant enterococci (VRE) are non-susceptible to antibiotics belonging to the group of glycopeptides (vancomycin, teicoplanin). For several years, the number of reports on VRE outbreaks in hospitals has been increasing.

Since 2014, the VRE surveillance is part of the four optional surveillance programmes from which hospitals must choose one to participate in (Royal Decree of 8 January 2015).

In addition to these surveillances, Sciensano also participates in the European Surveillance of Antimicrobial Resistance (EARS-Net), organised by the European Centre for Disease Prevention and Control.


Every year, Sciensano publishes a report with the most important surveillance results:  

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