The use of WHONET for antimicrobial resistance surveillance: a systematic review

Antimicrobial Resistance (AMR) is a global public health threat. Several surveillance systems/networks were established to provide critical data to detect resistance patterns, guide treatments, and inform policies to mitigate AMR’s public health impact. WHONET software was developed in 1989 as a free software that manages and analyses microbiology laboratory data, entirely dedicated to antimicrobial susceptibility test results. A systematic search was conducted in five electronic databases, PubMed, ScienceDirect, Web of Science, Scopus, and Embase, from their inception until December 31st, 2024. It included all articles that reported using WHONET. From the initial 4,636 articles retrieved, 511 were included. Most studies were cross-sectional or prevalence studies (72.4%), with the majority utilizing secondary data sources (83.2%). Articles included data from 110 countries, with the highest amount coming from China, and the number of publications increased over time. Additionally, most articles included data from 2 to 3 years before publication. Of the 2160 organisms examined across the studies, Enterobacterales (43.8%), Staphylococcus spp. (12.5%) and Pseudomonas spp. (9.3%) were the most covered microorganisms. In conclusion, the review highlights the growing interest in WHONET and AMR. WHONET’s ability to leverage routine and secondary data for AMR monitoring is advantageous compared to other systems. However, expanding WHONET’s application and integrating advanced analytics are essential for enhancing its role in a comprehensive One Health approach to combat AMR, particularly in LMICs.