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Bowry A, Plant AJ. Bacterial Tree of Life: assessing the efficacy of microbiology teaching for foundation year doctors. Infect Prev Pract 2024; 6:100384. [PMID: 39139186 PMCID: PMC11321277 DOI: 10.1016/j.infpip.2024.100384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/20/2024] [Indexed: 08/15/2024] Open
Affiliation(s)
- Ajay Bowry
- Foundation Year 1 Doctor, Walsall Health NHS Trust, Walsall, United Kingdom
| | - Aiden J. Plant
- Consultant Medical Microbiologist, Walsall Healthcare NHS Trust, Walsall, United Kingdom
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Zay Ya K, Lambiris MJ, Levine GA, Tediosi F, Fink G. Coverage of policies to improve antimicrobial stewardship in human medicine in low and middle income countries: results from the Global Survey of Experts on Antimicrobial Resistance. BMC Public Health 2024; 24:2297. [PMID: 39180027 PMCID: PMC11342495 DOI: 10.1186/s12889-024-19542-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/19/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) constitutes a major threat to global health. While antimicrobial misuse or overuse is one of the main drivers for AMR, little is known about the extent to which antibiotic misuse is due to a lack of national government-led efforts to enforce rational use in low and middle-income countries (LMICs). METHODS To assess antimicrobial stewardship and national implementation measures currently in place for optimizing antimicrobial use and for slowing the spread of AMR, we invited public health experts from 138 LMICs to participate in a Global Survey of Experts on Antimicrobial Resistance (GSEAR). Key coverage measures, as reported by experts, were compared across countries and also juxtaposed with estimates collected in the 2020-21 World Health Organization-organized Tripartite AMR Country Self-Assessment Survey (TrACSS). RESULTS A total of 352 completed surveys from 118 LMICs were analysed. Experts in 67% of the surveyed countries reported a national action plan (NAP) on AMR, 64% reported legislative policies on antimicrobial use, 58% reported national training programs for health professionals, and 10% reported national monitoring systems for antimicrobials. 51% of LMICs had specific targeted policies to limit the sale and use of protected or reserve antibiotics. While 72% of LMICs had prescription requirements for accessing antibiotics, getting antibiotics without a prescription was reported to be possible in practice in 74% of LMICs. On average, country efforts reported in TrACSS were substantially higher than those seen in GSEAR. CONCLUSIONS In many LMICs, despite the existence of policies aimed at slowing down the spread of AMR, there are still significant gaps in their implementation and enforcement. Increased national efforts in the areas of enforcement and monitoring of antibiotic use as well as regular monitoring of national efforts are urgently needed to reduce inappropriate antibiotic use in LMICs and to slow the spread of AMR globally.
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Affiliation(s)
- Kyaw Zay Ya
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Mark J Lambiris
- Health Economics Facility, Department of Public Health, University of Basel, Basel, Switzerland
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
| | - Gillian A Levine
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabrizio Tediosi
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Switzerland
- University of Basel, Basel, Switzerland
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Kreuzstrasse 2, Allschwil, 4123, Switzerland.
- University of Basel, Basel, Switzerland.
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Bertagnolio S, Dobreva Z, Centner CM, Olaru ID, Donà D, Burzo S, Huttner BD, Chaillon A, Gebreselassie N, Wi T, Hasso-Agopsowicz M, Allegranzi B, Sati H, Ivanovska V, Kothari KU, Balkhy HH, Cassini A, Hamers RL, Weezenbeek KV. WHO global research priorities for antimicrobial resistance in human health. THE LANCET. MICROBE 2024:100902. [PMID: 39146948 DOI: 10.1016/s2666-5247(24)00134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 05/13/2024] [Accepted: 05/15/2024] [Indexed: 08/17/2024]
Abstract
The WHO research agenda for antimicrobial resistance (AMR) in human health has identified 40 research priorities to be addressed by the year 2030. These priorities focus on bacterial and fungal pathogens of crucial importance in addressing AMR, including drug-resistant pathogens causing tuberculosis. These research priorities encompass the entire people-centred journey, covering prevention, diagnosis, and treatment of antimicrobial-resistant infections, in addition to addressing the overarching knowledge gaps in AMR epidemiology, burden and drivers, policies and regulations, and awareness and education. The research priorities were identified through a multistage process, starting with a comprehensive scoping review of knowledge gaps, with expert inputs gathered through a survey and open call. The priority setting involved a rigorous modified Child Health and Nutrition Research Initiative approach, ensuring global representation and applicability of the findings. The ultimate goal of this research agenda is to encourage research and investment in the generation of evidence to better understand AMR dynamics and facilitate policy translation for reducing the burden and consequences of AMR.
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Affiliation(s)
| | | | - Chad M Centner
- Antimicrobial Resistance Division, WHO, Geneva, Switzerland
| | - Ioana Diana Olaru
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK; Institute of Medical Microbiology, University of Münster, Münster, Germany
| | - Daniele Donà
- Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | - Stefano Burzo
- Antimicrobial Resistance Division, WHO, Geneva, Switzerland
| | | | | | | | - Teodora Wi
- Global HIV, Hepatitis and STI Programme, WHO, Geneva, Switzerland
| | | | | | - Hatim Sati
- Antimicrobial Resistance Division, WHO, Geneva, Switzerland
| | | | | | - Hanan H Balkhy
- Antimicrobial Resistance Division, WHO, Geneva, Switzerland
| | - Alessandro Cassini
- Public Health Department, Canton of Vaud, Lausanne, Switzerland; Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Raph L Hamers
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Kim H, Park JS, Kim D, Kim HJ, Shin JH, Kim YA, Uh Y, Kim SH, Shin JH, Jeong SH, Park KU. Standardization of an antimicrobial resistance surveillance network through data management. Front Cell Infect Microbiol 2024; 14:1411145. [PMID: 39135637 PMCID: PMC11317371 DOI: 10.3389/fcimb.2024.1411145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/02/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction The rapid spread of COVID-19 worldwide within 2 months demonstrated the vulnerability of the world's population to infectious diseases. In 2015, the Global Antimicrobial Resistance and Use Surveillance System (GLASS) was launched to combat antimicrobial resistance (AMR). However, there has been no comprehensive assessment of the decade-long global battle against AMR based on GLASS data. Methods South Korea established Kor-GLASS (Korean-GLASS) to proactively monitor data quality and enable international collaborations. A unique feature of Kor-GLASS is the quality control center (QCC), which uses network hubs and ensures standardized, high-quality data through interlaboratory proficiency testing (IPT) and external quality assessment (EQA). In addition, the QCC multifaceted endeavors for integrated data quality management. Results Since 2020, high-quality AMR data have indicated fluctuating antibiotic resistance rates in South Korea. This trend does not align with the decrease in antibiotic usage seen in humans but coincides with non-human antibiotic sales, indicating a need for greater monitoring of non-human antibiotic resistance. Comprehensive and robust management taking account of the intricate interplay among humans, animals, and the environment is essential. Kor-GLASS has been expanded into a "One Health" multiagency collaborative initiative. Discussion Although a standardized solution is not suitable for all countries, it must align with the local context and international standards. A centralized top-down management structure such as that of the QCC is essential to ensure continuous data quality coordination. Sustained efforts and surveillance systems are crucial for monitoring and managing AMR and safeguarding human health.
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Affiliation(s)
- Hyunji Kim
- Department of Laboratory Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Su Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dokyun Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hee Jung Kim
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeong Hwan Shin
- Department of Laboratory Medicine and Paik Institute for Clinical Research, Inje University College of Medicine, Busan, Republic of Korea
| | - Young Ah Kim
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Young Uh
- Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Soo Hyun Kim
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jong Hee Shin
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Un Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
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Keck JM, Viteri A, Schultz J, Fong R, Whitman C, Poush M, Martin M. New Agents Are Coming, and So Is the Resistance. Antibiotics (Basel) 2024; 13:648. [PMID: 39061330 PMCID: PMC11273847 DOI: 10.3390/antibiotics13070648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Antimicrobial resistance is a global threat that requires urgent attention to slow the spread of resistant pathogens. The United States Centers for Disease Control and Prevention (CDC) has emphasized clinician-driven antimicrobial stewardship approaches including the reporting and proper documentation of antimicrobial usage and resistance. Additional efforts have targeted the development of new antimicrobial agents, but narrow profit margins have hindered manufacturers from investing in novel antimicrobials for clinical use and therefore the production of new antibiotics has decreased. In order to combat this, both antimicrobial drug discovery processes and healthcare reimbursement programs must be improved. Without action, this poses a high probability to culminate in a deadly post-antibiotic era. This review will highlight some of the global health challenges faced both today and in the future. Furthermore, the new Infectious Diseases Society of America (IDSA) guidelines for resistant Gram-negative pathogens will be discussed. This includes new antimicrobial agents which have gained or are likely to gain FDA approval. Emphasis will be placed on which human pathogens each of these agents cover, as well as how these new agents could be utilized in clinical practice.
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Affiliation(s)
- J. Myles Keck
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Alina Viteri
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | | | - Rebecca Fong
- Department of Pharmacy, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA
| | - Charles Whitman
- Department of Pharmacy, Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA
| | - Madeline Poush
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Marlee Martin
- Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Yang D, Dyar OJ, Yin J, Ma W, Sun Q, Lundborg CS. Antimicrobial resistance in China across human, animal, and environment sectors - a review of policy documents using a governance framework. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101111. [PMID: 38948912 PMCID: PMC11214315 DOI: 10.1016/j.lanwpc.2024.101111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 07/02/2024]
Abstract
Antimicrobial resistance (AMR) poses a multifaceted threat to the human, animal, and environment sectors. In response, China has formulated a series of policies since the 2000s. Thus far, there has been no comprehensive assessment of these policy documents. This study aims to review the content of AMR policy documents at the national level using a governance framework covering three areas: Policy Design; Implementation Tools; and Monitoring and Evaluation. We identified 44 AMR documents from 2003 to 2022 sourced from government agency websites. Our findings have revealed noticeable discrepancies across the three governance areas. The Policy Design and Monitoring and Evaluation areas should be strengthened, particularly in the domains of 'Coordination', 'Accountability', 'Sustainability', and 'Effectiveness'. From a 'One Health' perspective, the environment sector has received less attention compared to the human and animal sectors. Effectively addressing these challenges requires a stronger commitment and widespread support from diverse stakeholders.
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Affiliation(s)
- Ding Yang
- Department of Global Public Health, Karolinska Institutet, 17177, Stockholm, Sweden
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Oliver James Dyar
- Department of Public Health and Caring Sciences, Uppsala University, 75122, Uppsala, Sweden
| | - Jia Yin
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Wenwen Ma
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Qiang Sun
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
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Allel K, Fernandez-Miyakawa M, Gaze W, Petroni A, Corso A, Luna F, Barcelona L, Boden L, Pitchforth E. Opportunities and challenges in antimicrobial resistance policy including animal production systems and humans across stakeholders in Argentina: a context and qualitative analysis. BMJ Open 2024; 14:e082156. [PMID: 38889938 PMCID: PMC11191766 DOI: 10.1136/bmjopen-2023-082156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Gaps in antimicrobial resistance (AMR) surveillance and control, including implementation of national action plans (NAPs), are evident internationally. Countries' capacity to translate political commitment into action is crucial to cope with AMR at the human-animal-environment interface. METHODS We employed a two-stage process to understand opportunities and challenges related to AMR surveillance and control at the human-animal interface in Argentina. First, we compiled the central AMR policies locally and mapped vital stakeholders around the NAP and the national commission against bacterial resistance. Second, we conducted qualitative interviews using a semistructured questionnaire covering stakeholders' understanding and progress towards AMR and NAP. We employed a mixed deductive-inductive approach and used the constant comparative analysis method. We created categories and themes to cluster subthemes and determined crucial relationships among thematic groups. RESULTS Crucial AMR policy developments have been made since 1969, including gradually banning colistin in food-producing animals. In 2023, a new government decree prioritised AMR following the 2015 NAP launch. Our qualitative analyses identified seven major themes for tackling AMR: (I) Cultural factors and sociopolitical country context hampering AMR progress, (II) Fragmented governance, (III) Antibiotic access and use, (IV) AMR knowledge and awareness throughout stakeholders, (V) AMR surveillance, (VI) NAP efforts and (VII) External drivers. We identified a fragmented structure of the food production chain, poor cross-coordination between stakeholders, limited surveillance and regulation among food-producing animals and geographical disparities over access, diagnosis and treatment. The country is moving to integrate animal and food production into its surveillance system, with most hospitals experienced in monitoring AMR through antimicrobial stewardship programmes. CONCLUSION AMR accountability should involve underpinning collaboration at different NAP implementation levels and providing adequate resources to safeguard long-term sustainability. Incorporating a multisectoral context-specific approach relying on different One Health domains is crucial to strengthening local AMR surveillance.
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Affiliation(s)
- Kasim Allel
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
- Heatlh Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxfordshire, UK
| | | | - William Gaze
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Alejandro Petroni
- Instituto Nacional de Enfermedades Infecciosas, Buenos Aires, Argentina
| | - Alejandra Corso
- Instituto Nacional de Enfermedades Infecciosas, Buenos Aires, Argentina
| | | | - Laura Barcelona
- Comisión Nacional de Control de la Resistencia Antimicrobiana, Buenos Aires, Argentina
| | - Lisa Boden
- University of Edinburgh Royal Dick School of Veterinary Studies, Easter Bush Campus, Midlothian, UK
| | - Emma Pitchforth
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
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Buetti N, Tabah A, Setti N, Ruckly S, Barbier F, Akova M, Aslan AT, Leone M, Bassetti M, Morris AC, Arvaniti K, Paiva JA, Ferrer R, Qiu H, Montrucchio G, Cortegiani A, Kayaaslan B, De Bus L, De Waele JJ, Timsit JF. The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections. Intensive Care Med 2024; 50:873-889. [PMID: 38498170 PMCID: PMC11164726 DOI: 10.1007/s00134-024-07348-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/05/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE The primary objective of this study was to evaluate the associations between centre/country-based factors and two important process and outcome indicators in patients with hospital-acquired bloodstream infections (HABSI). METHODS We used data on HABSI from the prospective EUROBACT-2 study to evaluate the associations between centre/country factors on a process or an outcome indicator: adequacy of antimicrobial therapy within the first 24 h or 28-day mortality, respectively. Mixed logistical models with clustering by centre identified factors associated with both indicators. RESULTS Two thousand two hundred nine patients from two hundred one intensive care units (ICUs) were included in forty-seven countries. Overall, 51% (n = 1128) of patients received an adequate antimicrobial therapy and the 28-day mortality was 38% (n = 839). The availability of therapeutic drug monitoring (TDM) for aminoglycosides everyday [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.03-2.14] or within a few hours (OR 1.79, 95% CI 1.34-2.38), surveillance cultures for multidrug-resistant organism carriage performed weekly (OR 1.45, 95% CI 1.09-1.93), and increasing Human Development Index (HDI) values were associated with adequate antimicrobial therapy. The presence of intermediate care beds (OR 0.63, 95% CI 0.47-0.84), TDM for aminoglycoside available everyday (OR 0.66, 95% CI 0.44-1.00) or within a few hours (OR 0.51, 95% CI 0.37-0.70), 24/7 consultation of clinical pharmacists (OR 0.67, 95% CI 0.47-0.95), percentage of vancomycin-resistant enterococci (VRE) between 10% and 25% in the ICU (OR 1.67, 95% CI 1.00-2.80), and decreasing HDI values were associated with 28-day mortality. CONCLUSION Centre/country factors should be targeted for future interventions to improve management strategies and outcome of HABSI in ICU patients.
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Affiliation(s)
- Niccolò Buetti
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, World Health Organization Collaborating Centre, Geneva, Switzerland.
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France.
| | - Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia
- Queensland Critical Care Research Network (QCCRN), Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Nour Setti
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
| | - Stéphane Ruckly
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
- Biostatistic Department, Outcomerea, 93700, Drancy, France
| | - François Barbier
- Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, 14, Avenue de L'Hôpital, 45000, Orléans, France
- Institut Maurice Rapin, Hôpital Henri Mondor, Créteil, France
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Abdullah Tarik Aslan
- Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey
- Faculty of Medicine, Centre for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
- Division of Immunology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, Cb2 1QP, UK
- JVF Intensive Care Unit, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - José-Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário Sao Joao, Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal
- Infection and Sepsis ID Group, Porto, Portugal
| | - Ricard Ferrer
- Intensive Care Department, SODIR-VHIR Research Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Nanjing Zhongda Hospital, Southeast University, Nanjing, 210009, China
| | - Giorgia Montrucchio
- Department of Anesthesia, Intensive Care and Emergency, Città della Salute e della Scienza University Hospital, Turin, Italy
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy
- Department of Anesthesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, University of Palermo, Via del Vespro129, 90127, Palermo, Italy
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Liesbet De Bus
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jan J De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jean-François Timsit
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75877, Paris Cedex, France
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Lim K, Lum E, Olsen A, Nissen L, Broom A, Seale H. Determining a future policy focus to support antimicrobial stewardship in community pharmacy: A modified Delphi study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 14:100456. [PMID: 38948387 PMCID: PMC11214505 DOI: 10.1016/j.rcsop.2024.100456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/18/2024] [Accepted: 05/22/2024] [Indexed: 07/02/2024] Open
Abstract
Background Over the past decade, the pharmacy sector's policy, academic and professional spheres have increasingly drawn attention to the opportunities to better leverage the untapped potential of the community pharmacy sector in contributing to global efforts to reduce antimicrobial resistance (AMR). While efforts are in train, progress is slow. Objective To draw insights from global experts in the field to identify a broad range of potential future policy directions to support community pharmacists' involvement in antimicrobial stewardship (AMS). Methods A modified Delphi technique, comprising two survey rounds to build consensus amongst global community pharmacy sector stakeholders and opinion leaders. In Round 1, participants rated their level of agreement with 28 statements across the three domains of policy design, implementation design, and monitoring and evaluation. Participants were also invited to contribute feedback in Round 1, which was reflected as new statements (n = 10) in Round 2. In Round 2, participants were asked to re-assess Round 1 statements in view of the group consensus and to rate the new statements. Results 289 participants were invited to participate. 48/289 (17% response rate) completed Round 1, and 25/42 (60% response rate) completed Round 2. Consensus (defined as >70% agreement) was achieved for 79% (n = 30) of the statements across the three domains. Conclusion Pharmacy sector experts agreed that acknowledging community pharmacists in AMS national action plans is an important component, signalling a recognition of the sector's contribution to whole-of-nation AMS efforts. Implementation components that achieved consensus reflect the profession's evolution to a professional service driven model, particularly in complementary AMS initiatives including infection prevention and control measures. Context-specific adjustments to support implementing these AMS measures will be required, in addition to striking the appropriate balance to support the pace of increased community pharmacists'involvement in AMS with building whole-of-profession buy-in.
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Affiliation(s)
- Kathryn Lim
- School of Population Health, University of New South Wales, Australia
| | - Elaine Lum
- Duke-NUS Medical School, National University of Singapore, Singapore
| | - Anna Olsen
- ANU College of Health and Medicine, Australian National University, Australia
| | - Lisa Nissen
- Centre for the Business and Economics of Health, The University of Queensland, Australia
| | - Alex Broom
- School of Social and Political Sciences, The University of Sydney, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Australia
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10
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Al Meslamani AZ. Is the world crippled by antimicrobial resistance, or simply lacking information? Expert Rev Anti Infect Ther 2024; 22:365-368. [PMID: 38381552 DOI: 10.1080/14787210.2024.2322429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/20/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Ahmad Z Al Meslamani
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
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11
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Weltweite Bekämpfung von Antibiotikaresistenzen: Wie ist der Stand? Laryngorhinootologie 2024; 103:333. [PMID: 38697082 DOI: 10.1055/a-2210-6818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
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Carelli DE, Ogne JB, Pierre J. Coming of age: governance challenges in updated AMR national action plans in the EU. Eur J Public Health 2024:ckae067. [PMID: 38578613 DOI: 10.1093/eurpub/ckae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND National action plans (NAPs) are key instruments for governing antimicrobial resistance (AMR). In Europe, we can now observe many countries updating their NAPs which raise two key research questions; what substantial modifications are states opting for, and how do they wish to address challenges related to AMR governance in a comparative perspective? METHODS Building on a previous analytical classification, we address these two questions by examining data of updated versions of NAPs in 13 European Union member states covering seventeen elements related to AMR governance. RESULTS Our results substantiate the large variation with regard to both substantive issues and governance-related matters. Most tellingly, they highlight the growing importance of the One Health approach in updated versions of NAPs. Our analysis also shows that while substantive issues remain important, One Health and the coordination and collaboration issues it entails are becoming more salient in the second or third generation of NAPs. CONCLUSIONS Updated NAPs suggest that EU member states are becoming increasingly knowledgeable on the causes and consequences of AMR and how it needs to be addressed. The enhanced level of knowledge also leads these countries to address the next set of issues and challenges; to improve domestic and international coordination and collaboration. Thus, the revised NAPs present a noticeable development from substantive issues towards governance issues.
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Affiliation(s)
- Daniel E Carelli
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Josefin B Ogne
- School of Public Administration, University of Gothenburg, Gothenburg, Sweden
| | - Jon Pierre
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
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13
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Avello P, Collins LM, Gómez SA, Luna F, Fernández Miyakawa ME, West HM, Iossa G. National action plans on antimicrobial resistance in Latin America: an analysis via a governance framework. Health Policy Plan 2024; 39:188-197. [PMID: 38179856 PMCID: PMC10883663 DOI: 10.1093/heapol/czad118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 12/05/2023] [Accepted: 01/03/2024] [Indexed: 01/06/2024] Open
Abstract
In 2015, the World Health Assembly adopted a global action plan (GAP) on antimicrobial resistance (AMR). Member states were encouraged to develop their own national action plans (NAPs) in alignment with the GAP. To-date, in systematic assessments of NAPs, the Latin American specific context has not been previously analysed. Here we examined 11 Latin American NAPs published between 2015 and 2021 using content analysis. We focused on two approaches: (1) alignment between the strategic objectives and actions defined in the GAP, and those outlined in the NAPs via a content indicator; and (2) assessment of the NAPs via a governance framework covering 'policy design', 'implementation tools' and 'monitoring and evaluation' areas. We observed a high alignment with the strategic objectives of the GAP; however, the opposite was observed for the corresponding actions. Our results showed that the governance aspects contained within coordination and participation domains were addressed by every Latin American NAP, whereas monitoring and assessment areas, as well as incorporating the environment, would need more attention in subsequent NAPs. Given that AMR is a global health threat and collective efforts across regions are necessary to combat it, our findings can benefit member states by highlighting how to strengthen the AMR strategies in Latin America, while also supporting global policy formulation.
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Affiliation(s)
- Paula Avello
- Faculty of Biological Sciences, School of Biology, University of Leeds, Woodhouse, Leeds LS2 9JT, UK
| | - Lisa M Collins
- Faculty of Biological Sciences, School of Biology, University of Leeds, Woodhouse, Leeds LS2 9JT, UK
| | - Sonia A Gómez
- Servicio Antimicrobianos, INEI—ANLIS ‘Dr. Carlos G. Malbrán’, Buenos Aires CP1281, Argentina
| | - Federico Luna
- Servicio Nacional de Sanidad y Calidad Agroalimentaria (SENASA), Buenos Aires CP1063, Argentina
| | | | - Helen M West
- School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough LE12 5RD, UK
| | - Graziella Iossa
- School of Life and Environmental Sciences, University of Lincoln, Lincoln LN6 7TS, UK
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14
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Serwacki P, Gajda M, Świątek-Kwapniewska W, Wałaszek M, Nowak K, Wójkowska-Mach J. Re-evaluating the suitability of using fluoroquinolones in the treatment of infections in the context of FQ consumption and correlating changes to microorganism resistance levels in EU/EEA countries between 2016 and 2021. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:795-805. [PMID: 37493678 PMCID: PMC10791944 DOI: 10.1007/s00210-023-02622-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/10/2023] [Indexed: 07/27/2023]
Abstract
The aim of this study was to re-evaluate fluoroquinolone (FQ) use in treatment by analyzing the consumption of FQ and the resistance levels of selected Gram‑negative bacilli, as well as Neisseria gonorrhoeae and Mycobacterium tuberculosis complex in EU/EEA countries and in Poland between 2016 and 2021. Data from ECDC surveillance systems EARS-Net, Euro-GASP, and the European Tuberculosis Surveillance Network were included in the description of pathogen resistance. And the ESAC-Net project for determining FQ consumption. In over half of the EU/EEA countries, the consumption of fluoroquinolones decreased in both the community sector and the hospital sector between 2016 and 2021. The prevalence of FQ-R Escherichia coli, Klebsiella pneumoniae, Acinetobacter spp., Mycobacterium tuberculosis complex, and Neisseria gonorrhoeae exceeded 20%. The prevalence of fluoroquinolone-resistant (FQ-R) Pseudomonas aeruginosa in EU/EEA countries was less than 20% except for 2017. In most EU/EEA countries, the use of FQ has reduced in last years, except for countries like Poland where FQ were an overused group of antibiotics in the treatment of various types of infections. Fluoroquinolones, as life-saving antibiotics in severe infections, should be withdrawn from empirical treatment in Poland and in countries with a high prevalence of FQ-R microorganisms.
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Affiliation(s)
- Piotr Serwacki
- Department of Anesthesiology and Intensive Care, St. Luke's Provincial Hospital, Lwowska 178A, 33-100, Tarnów, Poland.
| | - Mateusz Gajda
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 18 Czysta Street, 31-121, Kraków, Poland
| | - Wioletta Świątek-Kwapniewska
- Department of Anesthesiology and Intensive Care, St. Luke's Provincial Hospital, Lwowska 178A, 33-100, Tarnów, Poland
| | - Marta Wałaszek
- Department of Anesthesiology and Intensive Care, St. Luke's Provincial Hospital, Lwowska 178A, 33-100, Tarnów, Poland
- Academy of Science in Tarnów - Public University in Tarnów, Mickiewicza 8, 33-100, Tarnów, Poland
| | - Karolina Nowak
- 5th Military Hospital with Policlinic, Wrocławska 1-3, 30-901, Kraków, Poland
| | - Jadwiga Wójkowska-Mach
- Department of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, 18 Czysta Street, 31-121, Kraków, Poland.
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15
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Wieters I, Johnstone S, Makiala-Mandanda S, Poda A, Akoua-Koffi C, Abu Sin M, Eckmanns T, Galeone V, Kaboré FN, Kahwata F, Leendertz FH, Mputu B, Ouedraogo AS, Page N, Schink SB, Touré FS, Traoré A, Venter M, Vietor AC, Schubert G, Tomczyk S. Reported antibiotic use among patients in the multicenter ANDEMIA infectious diseases surveillance study in sub-saharan Africa. Antimicrob Resist Infect Control 2024; 13:9. [PMID: 38273333 PMCID: PMC10809765 DOI: 10.1186/s13756-024-01365-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Exposure to antibiotics has been shown to be one of the drivers of antimicrobial resistance (AMR) and is critical to address when planning and implementing strategies for combatting AMR. However, data on antibiotic use in sub-Saharan Africa are still limited. Using hospital-based surveillance data from the African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA), we assessed self-reported antibiotic use in multiple sub-Saharan African countries. METHODS ANDEMIA included 12 urban and rural health facilities in Côte d'Ivoire, Burkina Faso, Democratic Republic of the Congo, and Republic of South Africa. Patients with acute respiratory infection (RTI), acute gastrointestinal infection (GI) and acute febrile disease of unknown cause (AFDUC) were routinely enrolled, and clinical, demographic, socio-economic and behavioral data were collected using standardized questionnaires. An analysis of ANDEMIA data from February 2018 to May 2022 was conducted. Reported antibiotic use in the ten days prior to study enrolment were described by substance and by the WHO AWaRe classification ("Access", "Watch", "Reserve", and "Not recommended" antibiotics). Frequency of antibiotic use was stratified by location, disease syndrome and individual patient factors. RESULTS Among 19,700 ANDEMIA patients, 7,258 (36.8%) reported antibiotic use. A total of 9,695 antibiotics were reported, including 54.7% (n = 5,299) from the WHO Access antibiotic group and 44.7% (n = 4,330) from the WHO Watch antibiotic group. The Watch antibiotic ceftriaxone was the most commonly reported antibiotic (n = 3,071, 31.7%). Watch antibiotic use ranged from 17.4% (56/322) among RTI patients in Côte d'Ivoire urban facilities to 73.7% (630/855) among AFDUC patients in Burkina Faso urban facilities. Reported antibiotic use included WHO Not recommended antibiotics but no Reserve antibiotics. CONCLUSIONS Reported antibiotic use data from this multicenter study in sub-Saharan Africa revealed a high proportion of WHO Watch antibiotics. Differences in Watch antibiotic use were found by disease syndrome, country and health facility location, which calls for a more differentiated approach to antibiotic use interventions including further evaluation of accessibility and affordability of patient treatment.
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Affiliation(s)
- Imke Wieters
- Institute of Tropical Medicine and International Health, Charité- Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
- Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany.
| | - Siobhan Johnstone
- Center for Enteric Diseases, National Health Laboratory Service, National Institute for Communicable Diseases, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Sheila Makiala-Mandanda
- Cliniques Universitaires de Kinshasa, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Armel Poda
- Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
| | - Chantal Akoua-Koffi
- Centre Hospitalier Universitaire Bouaké, Bouaké, Ivory Coast
- Université Alassane Ouattara de Bouaké, Bouaké, Ivory Coast
| | - Muna Abu Sin
- Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Tim Eckmanns
- Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | | | | | - François Kahwata
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Fabian H Leendertz
- Helmholtz Institute for One Health, Fleischmannstraße 42, 17489, Greifswald, Germany
| | - Benoit Mputu
- Institut National de Recherche Biomédicale, Kinshasa, Democratic Republic of the Congo
| | - Abdoul-Salam Ouedraogo
- Centre Hospitalier Universitaire Sourô Sanou de Bobo-Dioulasso, Bobo-Dioulasso, Burkina Faso
- Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | - Nicola Page
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, 31 Bophelo Rd, Prinshof 349-Jr, Pretoria, 0084, South Africa
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | | | | | | | - Marietjie Venter
- Department of Medical Virology, University of Pretoria, Pretoria, South Africa
| | | | - Grit Schubert
- Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
| | - Sara Tomczyk
- Robert Koch-Institute, Nordufer 20, 13353, Berlin, Germany
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16
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Kamara IF, Kanu J, Maruta A, Fofanah BD, Kamara KN, Sheriff B, Katawera V, D'Almeida SA, Musoke R, Nuwagira I, Lakoh S, Kamara RZ, Tengbe SM, Mansaray AR, Koroma Z, Thomas F, Abiri OT, Koroma AT, Russell JBW, Squire J, Vandi MA. Antibiotic use among hospitalised patients in Sierra Leone: a national point prevalence survey using the WHO survey methodology. BMJ Open 2023; 13:e078367. [PMID: 38159961 PMCID: PMC10759135 DOI: 10.1136/bmjopen-2023-078367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Inappropriate use of antibiotics is a major driver of antibiotic resistance. A few studies conducted in Africa have documented that about half of hospitalised patients who receive antibiotics should not have received them. A few hospital-based studies that have been conducted in Sierra Leone have documented a high usage of antibiotics in hospitals. Therefore, we conducted a nationwide point prevalence survey on antibiotic use among hospitalised patients in Sierra Leone. DESIGN We conducted a hospital-based, cross-sectional survey on the use of antibiotics using the WHO point prevalence survey methodology. SETTING The study was conducted in 26 public and private hospitals that are providing inpatient healthcare services. PARTICIPANTS All patients admitted to paediatric and adult inpatient wards before or at 08:00 on the survey date were enrolled. OUTCOME MEASURES Prevalence of antibiotic use, antibiotics Access, Watch and Reserve (AWaRe) categorisation, indication for antibiotic use prevalence and proportion of bacteria culture done. RESULTS Of the 1198 patient records reviewed, 883 (73.7%, 95% CI 71.1% to 76.2%) were on antibiotics. Antibiotic use was highest in the paediatric wards (306, 85.7%), followed by medical wards (158, 71.2%), surgical wards (146, 69.5%), mixed wards (97, 68.8%) and lowest in the obstetrics and gynaecology wards (176, 65.7%). The most widely prescribed antibiotics were metronidazole (404, 22.2%), ceftriaxone (373, 20.5%), ampicillin (337, 18.5%), gentamicin (221, 12.1%) and amoxicillin (90, 5.0%). Blood culture was only done for one patient and antibiotic treatments were given empirically. The most common indication for antibiotic use was community-acquired infection (484, 51.9%) followed by surgical prophylaxis (222, 23.8%). CONCLUSION There was high usage of antibiotics in hospitals in Sierra Leone as the majority of patients admitted received an antibiotic. This has the potential to increase the burden of antibiotic resistance in the country. We, therefore, recommend the establishment of hospital antimicrobial stewardship programmes according to the WHO core components.
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Affiliation(s)
- Ibrahim Franklyn Kamara
- Reproductive Maternal Newborn Child and Adolescent Health Unit, Universal Health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Joseph Kanu
- National Disease Surveillance Programme, Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
- Community Health, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Anna Maruta
- World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | | | - Kadijatu Nabie Kamara
- National Surveillance Program, Directorate of Health Security and Emergencies, Ministry of Health, Freetown, Sierra Leone
| | - Bockarie Sheriff
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Victoria Katawera
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Selassi A D'Almeida
- Universal health Coverage Life Course Cluster, World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Robert Musoke
- Emergency Preparedness and Response, World Health Organization Country Office, Sierra Leone, Freetown, Sierra Leone
| | - Innocent Nuwagira
- World Health Organisation Country Office Sierra Leone, Freetown, Sierra Leone
| | - Sulaiman Lakoh
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Rugiatu Z Kamara
- US Center for Disease Control and Prevention Country Office, Sierra Leone, Freetown, Sierra Leone
| | | | - Abdul Razak Mansaray
- Laboratory, Diagnostic and Blood Services, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Microbiology, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Zikan Koroma
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Fawzi Thomas
- Pharmacovigilance and Clinical Trials, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
| | - Onome T Abiri
- Pharmacovigilance and Clinical Trials Department, Pharmacy Board of Sierra Leone, Freetown, Sierra Leone
- Pharmacology, University of Sierra Leone College of Medicine and Allied Health Sciences, Freetown, Sierra Leone
| | - Aminata Tigiedankay Koroma
- National Surveillance Program, Directorate of Health Security and Emergency, Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - James Squire
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Mohamed Alex Vandi
- Government of Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
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Vaid S, Gupta A, Houchens N. Quality and safety in the literature: January 2024. BMJ Qual Saf 2023; 33:66-70. [PMID: 38097250 DOI: 10.1136/bmjqs-2023-016782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 12/18/2023]
Affiliation(s)
| | - Ashwin Gupta
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Nathan Houchens
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Ranganathan R, Ranjalkar J. Potential role of civil society organizations (CSOs) in antimicrobial resistance (AMR) mitigation efforts in low- and middle-income countries: A report from India. J Infect Public Health 2023; 16 Suppl 1:125-128. [PMID: 37973495 DOI: 10.1016/j.jiph.2023.10.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
Antibiotic resistance (ABR) is a global health threat with the potential to cause mortality and morbidity on an unprecedented scale. In the past, civil society organizations (CSOs) have been successful in complementing the efforts of government health systems, thereby shaping the course of various public health programs, especially in low- and middle-income countries (LMICs). This article reports the outcomes of a CSO sensitization workshop held by one of the regional nodes of ReAct and highlights the perspectives of CSOs on their role in supporting the implementation of national and sub-national action plans for AMR mitigation. CSOs can contribute to (i) redefining the AMR narrative, (ii) generating the data for action and policy change, (iii) advocating for policy change, (iv) promoting research and influencing decisions pertaining to research in AMR, and (v) undertaking behavioral change communication for different target groups, among others. Governments in LMICs could leverage the expertise of CSOs by playing the role of facilitator while ensuring that the interventions align with national priorities and are sustainable. Efforts to ensure diverse funding and capacity building among CSOs should happen in parallel to ensure maximum impact on communities.
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Fuller W, Kapona O, Aboderin AO, Adeyemo AT, Olatunbosun OI, Gahimbare L, Ahmed YA. Education and Awareness on Antimicrobial Resistance in the WHO African Region: A Systematic Review. Antibiotics (Basel) 2023; 12:1613. [PMID: 37998815 PMCID: PMC10669252 DOI: 10.3390/antibiotics12111613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 11/25/2023] Open
Abstract
This review documents the status of AMR education and awareness in the WHO African region, as well as specific initiatives by its member states in implementing education and awareness interventions, as a strategic objective of the Global Action Plan on AMR, i.e., improve knowledge and understanding on AMR through effective communication, education, and training. A systematic search was conducted in Google Scholar, PubMed, and African Journals Online Library according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, for articles published in English. Retrieval and screening of articles was performed using a structured search protocol following a pre-set inclusion/exclusion criterion. Eighty-five published articles reporting 92 different studies from 19 Member States met inclusion criteria and were included in the final qualitative synthesis. Nigeria (21) and Ethiopia (16) had most of the studies, while the rest were distributed across the remaining 17 Member States. The majority of the articles were on knowledge, attitude, and practices with regard to AMR and antimicrobial use and most of them documented a general lack and suboptimal knowledge, poor attitude and practices, and widespread self-medication. This review shows low levels of knowledge of AMR coupled with extensive misuse of antimicrobial medicines by different target audiences. These findings underscore the urgent need for enhanced and context-specific educational and positive behavioural change interventions.
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Affiliation(s)
- Walter Fuller
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (L.G.); (Y.A.A.)
| | - Otridah Kapona
- Zambia National Public Health Institute, Lusaka 10101, Zambia;
| | - Aaron Oladipo Aboderin
- Department of Medical Microbiology & Parasitology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife 220005, Nigeria; (A.O.A.); (A.T.A.); (O.I.O.)
| | - Adeyemi Temitayo Adeyemo
- Department of Medical Microbiology & Parasitology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife 220005, Nigeria; (A.O.A.); (A.T.A.); (O.I.O.)
| | - Oluwadamilare Isaiah Olatunbosun
- Department of Medical Microbiology & Parasitology, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife 220005, Nigeria; (A.O.A.); (A.T.A.); (O.I.O.)
| | - Laetitia Gahimbare
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (L.G.); (Y.A.A.)
| | - Yahaya Ali Ahmed
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (L.G.); (Y.A.A.)
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Duda-Madej A, Viscardi S, Topola E. Meropenem/Vaborbactam: β-Lactam/β-Lactamase Inhibitor Combination, the Future in Eradicating Multidrug Resistance. Antibiotics (Basel) 2023; 12:1612. [PMID: 37998814 PMCID: PMC10668789 DOI: 10.3390/antibiotics12111612] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/04/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
Due to the fact that there is a steadily increasing trend in the area of antimicrobial resistance in microorganisms, there is a need to look for new treatment alternatives. One of them is the search for new β-lactamase inhibitors and combining them with β-lactam antibiotics, with the aim of increasing the low-dose efficacy, as well as lowering the resistance potential of bacterial strains. This review presents the positive effect of meropenem in combination with a vaborbactam (MER-VAB). This latest antibiotic-inhibitor combination has found particular use in the treatment of infections with the etiology of carbapenem-resistant Enterobacterales (CRE), Gram-negative bacteria, with a high degree of resistance to available antimicrobial drugs.
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Affiliation(s)
- Anna Duda-Madej
- Department of Microbiology, Faculty of Medicine, Wroclaw Medical University, Chałubińskiego 4, 50-368 Wrocław, Poland
| | - Szymon Viscardi
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland; (S.V.); (E.T.)
| | - Ewa Topola
- Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland; (S.V.); (E.T.)
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21
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Patel J, Fernandes G, Mwamelo AJ, Sridhar D. Health systems appraisal of the response to antimicrobial resistance in low- and middle-income countries in relation to COVID-19: Application of the WHO building blocks. GLOBAL POLICY 2023; 14:790-796. [PMID: 38504997 PMCID: PMC10946709 DOI: 10.1111/1758-5899.13262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 03/21/2024]
Abstract
COVID-19 has inflicted both beneficial and damaging effects on health systems responding to antimicrobial resistance (AMR). Data shows that the positive impacts of the pandemic (including enhanced hygiene, mask wearing and widespread use of personal protective equipment), are likely to have been overshadowed by the negative effects: emerging AMR pathogens and mechanisms; further outbreaks and geographic spread of AMR to non-endemic countries; rising infections from multidrug-resistant pathogen; an overall higher burden of AMR. The multisectoral complexities of AMR and the totality of health systems challenge our ability to understand the impact of the COVID-19 pandemic on country responses to AMR. In this analysis, we synthesise international evidence characterising the role of the pandemic on the six key building blocks of health systems in responding to AMR across low- and middle-income countries (LMICs). We apply systems thinking within and between the building blocks to contextualise the impact of one pandemic on another.
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Affiliation(s)
- Jay Patel
- Global Health Governance ProgrammeUsher Institute, University of EdinburghEdinburghUK
- Faculty of Medicine and Health, University of LeedsLeedsUK
| | - Genevie Fernandes
- Global Health Governance ProgrammeUsher Institute, University of EdinburghEdinburghUK
| | - Ambele Judith Mwamelo
- Global Health Governance ProgrammeUsher Institute, University of EdinburghEdinburghUK
| | - Devi Sridhar
- Global Health Governance ProgrammeUsher Institute, University of EdinburghEdinburghUK
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Sartelli M, Barie PS, Coccolini F, Abbas M, Abbo LM, Abdukhalilova GK, Abraham Y, Abubakar S, Abu-Zidan FM, Adebisi YA, Adamou H, Afandiyeva G, Agastra E, Alfouzan WA, Al-Hasan MN, Ali S, Ali SM, Allaw F, Allwell-Brown G, Amir A, Amponsah OKO, Al Omari A, Ansaloni L, Ansari S, Arauz AB, Augustin G, Awazi B, Azfar M, Bah MSB, Bala M, Banagala ASK, Baral S, Bassetti M, Bavestrello L, Beilman G, Bekele K, Benboubker M, Beović B, Bergamasco MD, Bertagnolio S, Biffl WL, Blot S, Boermeester MA, Bonomo RA, Brink A, Brusaferro S, Butemba J, Caínzos MA, Camacho-Ortiz A, Canton R, Cascio A, Cassini A, Cástro-Sanchez E, Catarci M, Catena R, Chamani-Tabriz L, Chandy SJ, Charani E, Cheadle WG, Chebet D, Chikowe I, Chiara F, Cheng VCC, Chioti A, Cocuz ME, Coimbra R, Cortese F, Cui Y, Czepiel J, Dasic M, de Francisco Serpa N, de Jonge SW, Delibegovic S, Dellinger EP, Demetrashvili Z, De Palma A, De Silva D, De Simone B, De Waele J, Dhingra S, Diaz JJ, Dima C, Dirani N, Dodoo CC, Dorj G, Duane TM, Eckmann C, Egyir B, Elmangory MM, Enani MA, Ergonul O, Escalera-Antezana JP, Escandon K, Ettu AWOO, Fadare JO, Fantoni M, Farahbakhsh M, Faro MP, Ferreres A, Flocco G, Foianini E, Fry DE, Garcia AF, Gerardi C, Ghannam W, Giamarellou H, Glushkova N, Gkiokas G, Goff DA, Gomi H, Gottfredsson M, Griffiths EA, Guerra Gronerth RI, Guirao X, Gupta YK, Halle-Ekane G, Hansen S, Haque M, Hardcastle TC, Hayman DTS, Hecker A, Hell M, Ho VP, Hodonou AM, Isik A, Islam S, Itani KMF, Jaidane N, Jammer I, Jenkins DR, Kamara IF, Kanj SS, Jumbam D, Keikha M, Khanna AK, Khanna S, Kapoor G, Kapoor G, Kariuki S, Khamis F, Khokha V, Kiggundu R, Kiguba R, Kim HB, Kim PK, Kirkpatrick AW, Kluger Y, Ko WC, Kok KYY, Kotecha V, Kouma I, Kovacevic B, Krasniqi J, Krutova M, Kryvoruchko I, Kullar R, Labi KA, Labricciosa FM, Lakoh S, Lakatos B, Lansang MAD, Laxminarayan R, Lee YR, Leone M, Leppaniemi A, Hara GL, Litvin A, Lohsiriwat V, Machain GM, Mahomoodally F, Maier RV, Majumder MAA, Malama S, Manasa J, Manchanda V, Manzano-Nunez R, Martínez-Martínez L, Martin-Loeches I, Marwah S, Maseda E, Mathewos M, Maves RC, McNamara D, Memish Z, Mertz D, Mishra SK, Montravers P, Moro ML, Mossialos E, Motta F, Mudenda S, Mugabi P, Mugisha MJM, Mylonakis E, Napolitano LM, Nathwani D, Nkamba L, Nsutebu EF, O’Connor DB, Ogunsola S, Jensen PØ, Ordoñez JM, Ordoñez CA, Ottolino P, Ouedraogo AS, Paiva JA, Palmieri M, Pan A, Pant N, Panyko A, Paolillo C, Patel J, Pea F, Petrone P, Petrosillo N, Pintar T, Plaudis H, Podda M, Ponce-de-Leon A, Powell SL, Puello-Guerrero A, Pulcini C, Rasa K, Regimbeau JM, Rello J, Retamozo-Palacios MR, Reynolds-Campbell G, Ribeiro J, Rickard J, Rocha-Pereira N, Rosenthal VD, Rossolini GM, Rwegerera GM, Rwigamba M, Sabbatucci M, Saladžinskas Ž, Salama RE, Sali T, Salile SS, Sall I, Kafil HS, Sakakushev BE, Sawyer RG, Scatizzi M, Seni J, Septimus EJ, Sganga G, Shabanzadeh DM, Shelat VG, Shibabaw A, Somville F, Souf S, Stefani S, Tacconelli E, Tan BK, Tattevin P, Rodriguez-Taveras C, Telles JP, Téllez-Almenares O, Tessier J, Thang NT, Timmermann C, Timsit JF, Tochie JN, Tolonen M, Trueba G, Tsioutis C, Tumietto F, Tuon FF, Ulrych J, Uranues S, van Dongen M, van Goor H, Velmahos GC, Vereczkei A, Viaggi B, Viale P, Vila J, Voss A, Vraneš J, Watkins RR, Wanjiru-Korir N, Waworuntu O, Wechsler-Fördös A, Yadgarova K, Yahaya M, Yahya AI, Xiao Y, Zakaria AD, Zakrison TL, Zamora Mesia V, Siquini W, Darzi A, Pagani L, Catena F. Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action. World J Emerg Surg 2023; 18:50. [PMID: 37845673 PMCID: PMC10580644 DOI: 10.1186/s13017-023-00518-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023] Open
Abstract
Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules," for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.
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Galas M. Antimicrobial Resistance: A global, multisectoral concern that requires a coordinated response. Rev Argent Microbiol 2023; 55:291-293. [PMID: 38142109 DOI: 10.1016/j.ram.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023] Open
Affiliation(s)
- Marcelo Galas
- Antimicrobial Resistance Surveillance, Pan American Health Organization, Argentina
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24
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Hamers RL, Dobreva Z, Cassini A, Tamara A, Lazarus G, Asadinia KS, Burzo S, Olaru ID, Dona D, Emdin F, Van Weezenbeek K, Bertagnolio S. Global knowledge gaps on antimicrobial resistance in the human health sector: A scoping review. Int J Infect Dis 2023; 134:142-149. [PMID: 37301361 DOI: 10.1016/j.ijid.2023.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES To identify and summarize existing global knowledge gaps on antimicrobial resistance (AMR) in human health, focusing on the World Health Organization (WHO) bacterial priority pathogens, Mycobacterium tuberculosis, and selected fungi. METHODS We conducted a scoping review of gray and peer-reviewed literature, published in English from January 2012 through December 2021, that reported on the prevention, diagnosis, treatment, and care of drug-resistant infections. We extracted relevant knowledge gaps and, through an iterative process, consolidated those into thematic research questions. RESULTS Of 8409 publications screened, 1156 were included, including 225 (19.5%) from low- and middle-income countries. A total of 2340 knowledge gaps were extracted, in the following areas: antimicrobial research and development, AMR burden and drivers, resistant tuberculosis, antimicrobial stewardship, diagnostics, infection prevention and control, antimicrobial consumption and use data, immunization, sexually transmitted infections, AMR awareness and education, policies and regulations, fungi, water sanitation and hygiene, and foodborne diseases. The knowledge gaps were consolidated into 177 research questions, including 78 (44.1%) specifically relevant to low- and middle-income countries and 65 (36.7%) targeting vulnerable populations. CONCLUSION This scoping review presents the most comprehensive compilation of AMR-related knowledge gaps to date, informing a priority-setting exercise to develop the WHO Global AMR Research Agenda for the human health sector.
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Affiliation(s)
- Raph L Hamers
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Zlatina Dobreva
- Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland
| | - Alessandro Cassini
- Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland; Public Health Department, Canton of Vaud, Lausanne, Switzerland; Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Alice Tamara
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Gilbert Lazarus
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Koe Stella Asadinia
- Oxford University Clinical Research Unit Indonesia, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Stefano Burzo
- Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland
| | - Ioana Diana Olaru
- Institute of Medical Microbiology, University of Münster, Münster, Germany; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Daniele Dona
- Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland; Division of Paediatric Infectious Diseases, Department for Women's and Children's Health, University of Padua, Padua, Italy
| | | | - Kitty Van Weezenbeek
- Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland
| | - Silvia Bertagnolio
- Antimicrobial Resistance Division, World Health Organization, Geneva, Switzerland
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Boggs C, Shiferawe K, Karsten E, Hamlet J, Altheide ST, Marion JW. Evaluation of a Tetracycline-Resistant E. coli Enumeration Method for Correctly Classifying E. coli in Environmental Waters in Kentucky, USA. Pathogens 2023; 12:1090. [PMID: 37764898 PMCID: PMC10537314 DOI: 10.3390/pathogens12091090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/20/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
The global concern over antimicrobial resistance (AMR) and its impact on human health is evident, with approximately 4.95 million annual deaths attributed to antibiotic resistance. Regions with inadequate water, sanitation, and hygiene face challenges in responding to AMR threats. Enteric bacteria, particularly E. coli, are common agents linked to AMR-related deaths (23% of cases). Culture-based methods for detecting tetracycline-resistant E. coli may be of practical value for AMR monitoring in limited resource environments. This study evaluated the ColiGlow™ method with tetracycline for classifying tetracycline-resistant E. coli. A total of 61 surface water samples from Kentucky, USA (2020-2022), provided 61 presumed E. coli isolates, of which 28 isolates were obtained from tetracycline-treated media. Species identification and tetracycline resistance evaluation were performed. It was found that 82% of isolates were E. coli, and 18% were other species; 97% were identified as E. coli when using the API20E identification system. The MicroScan system yielded Enterobacter cloacae false positives in 20% of isolates. Adding tetracycline to ColiGlow increased the odds of isolating tetracycline-resistant E. coli 18-fold. Tetracycline-treated samples yielded 100% tetracycline-resistant E. coli when the total E. coli densities were within the enumeration range of the method. ColiGlow with tetracycline shows promise for monitoring tetracycline-resistant E. coli in natural waters and potentially aiding AMR surveillance in resource-limited settings among other environments.
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Affiliation(s)
- Callie Boggs
- Environmental Health Science and Sustainability Program, Eastern Kentucky University, Richmond, KY 40475, USA; (C.B.); (K.S.)
| | - Kidus Shiferawe
- Environmental Health Science and Sustainability Program, Eastern Kentucky University, Richmond, KY 40475, USA; (C.B.); (K.S.)
| | - Eckhardt Karsten
- Department of Microbiology, Miami University, Oxford, OH 45042, USA;
| | - Jayden Hamlet
- School of Natural Sciences and Mathematics, Stockton University, Galloway, NJ 08205, USA;
| | - S. Travis Altheide
- Medical Laboratory Science Program, Eastern Kentucky University, Richmond, KY 40475, USA;
| | - Jason W. Marion
- Environmental Health Science and Sustainability Program, Eastern Kentucky University, Richmond, KY 40475, USA; (C.B.); (K.S.)
- Eastern Scientific LLC, Richmond, KY 40475, USA
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26
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Walia K, Mendelson M, Kang G, Venkatasubramanian R, Sinha R, Vijay S, Veeraraghavan B, Basnyat B, Rodrigues C, Bansal N, Ray P, Mathur P, Gopalakrishnan R, Ohri VC. How can lessons from the COVID-19 pandemic enhance antimicrobial resistance surveillance and stewardship? THE LANCET. INFECTIOUS DISEASES 2023; 23:e301-e309. [PMID: 37290476 DOI: 10.1016/s1473-3099(23)00124-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 06/10/2023]
Abstract
COVID-19 demanded urgent and immediate global attention, during which other public health crises such as antimicrobial resistance (AMR) increased silently, undermining patient safety and the life-saving ability of several antimicrobials. In 2019, WHO declared AMR a top ten global public health threat facing humanity, with misuse and overuse of antimicrobials as the main drivers in the development of antimicrobial-resistant pathogens. AMR is steadily on the rise, especially in low-income and middle-income countries across south Asia, South America, and Africa. Extraordinary circumstances often demand an extraordinary response as did the COVID-19 pandemic, underscoring the fragility of health systems across the world and forcing governments and global agencies to think creatively. The key strategies that helped to contain the increasing SARS-CoV-2 infections included a focus on centralised governance with localised implementation, evidence-based risk communication and community engagement, use of technological methods for tracking and accountability, extensive expansion of access to diagnostics, and a global adult vaccination programme. The extensive and indiscriminate use of antimicrobials to treat patients, particularly in the early phase of the pandemic, have adversely affected AMR stewardship practices. However, there were important lessons learnt during the pandemic, which can be leveraged to strengthen surveillance and stewardship, and revitalise efforts to address the AMR crisis.
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Affiliation(s)
- Kamini Walia
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi 110029, India.
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Gagandeep Kang
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | | | - Rina Sinha
- World Health Organization, Country Office for India, New Delhi, India
| | - Sonam Vijay
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi 110029, India
| | | | - Buddha Basnyat
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Camilla Rodrigues
- Department of Microbiology, PD Hinduja Hospital, Mumbai, Maharashtra, India
| | - Nitin Bansal
- Division of Infectious Diseases, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Pallab Ray
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Purva Mathur
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | | | - Vinod C Ohri
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi 110029, India
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27
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Songnaka N, Lertcanawanichakul M, Hutapea AM, Nisoa M, Krobthong S, Yingchutrakul Y, Atipairin A. Atmospheric and Room Temperature Plasma (ARTP) Mutagenesis Improved the Anti-MRSA Activity of Brevibacillus sp. SPR20. Int J Mol Sci 2023; 24:12016. [PMID: 37569391 PMCID: PMC10419081 DOI: 10.3390/ijms241512016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Brevibacillus sp. SPR20 produced potentially antibacterial substances against methicillin-resistant Staphylococcus aureus (MRSA). The synthesis of these substances is controlled by their biosynthetic gene clusters. Several mutagenesis methods are used to overcome the restriction of gene regulations when genetic information is absent. Atmospheric and room temperature plasma (ARTP) is a powerful technique to initiate random mutagenesis for microbial strain improvement. This study utilized an argon-based ARTP to conduct the mutations on SPR20. The positive mutants of 40% occurred. The M27 mutant exhibited an increase in anti-MRSA activity when compared to the wild-type strain, with the MIC values of 250-500 and 500 μg/mL, respectively. M27 had genetic stability because it exhibited constant activity throughout fifteen generations. This mutant had similar morphology and antibiotic susceptibility to the wild type. Comparative proteomic analysis identified some specific proteins that were upregulated in M27. These proteins were involved in the metabolism of amino acids, cell structure and movement, and catalytic enzymes. These might result in the enhancement of the anti-MRSA activity of the ARTP-treated SPR20 mutant. This study supports the ARTP technology designed to increase the production of valuable antibacterial agents.
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Affiliation(s)
- Nuttapon Songnaka
- School of Pharmacy, Walailak University, Nakhon Si Thammarat 80161, Thailand;
- Drug and Cosmetics Excellence Center, Walailak University, Nakhon Si Thammarat 80161, Thailand
| | | | | | - Mudtorlep Nisoa
- School of Science, Walailak University, Nakhon Si Thammarat 80161, Thailand;
- Center of Excellence in Plasma Science and Electromagnetic Waves, Walailak University, Nakhon Si Thammarat 80161, Thailand
| | - Sucheewin Krobthong
- Center of Excellence in Natural Products Chemistry (CENP), Department of Chemistry, Faculty of Science, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Yodying Yingchutrakul
- National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Pathum Thani 12120, Thailand;
| | - Apichart Atipairin
- School of Pharmacy, Walailak University, Nakhon Si Thammarat 80161, Thailand;
- Drug and Cosmetics Excellence Center, Walailak University, Nakhon Si Thammarat 80161, Thailand
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28
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Carelli DE, Mitsouli ET, Ogne JB, Pierre J. The best laid plans?: international governance perspectives in AMR national action plans in Europe. Eur J Public Health 2023:7169436. [PMID: 37196335 PMCID: PMC10393504 DOI: 10.1093/eurpub/ckad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND There is a broad consensus in the European public health community that international collaboration and coordination are key in the fight against antimicrobial resistance (AMR). Yet, while experts typically testify the importance of cross-national learning and a coordinated effort to reduce the spread of multi-resistant bacteria, there are mixed views about how that is best realized in practice, particularly on the dichotomy between horizontal and vertical activities. METHODS National action plans (NAP) from all EU member states were systematically overviewed by two independent researchers. We followed a fixed procedure for locating a broad and comparable content on the international dimensions, and letting these vary on scales. RESULTS We find that countries adhere to four different strategies for international coordination, varying between 'high' and 'low' on values of vertical and horizontal activities. Most countries spend none or very little space to discuss international activities, while some countries use their NAPs to outline their aspiration for taking leading roles in the international struggle. Moreover, in line with previous research, we find that many countries directly mimic the Global Action Plan, but also that a large share of countries describe independent arrangements in their international strategies. CONCLUSIONS European countries recognize AMR and its inherent international governance challenge differently in their NAPs, which may have implications for coordinated action to address the issue.
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Affiliation(s)
- Daniel E Carelli
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | | | - Josefin B Ogne
- School of Public Administration, University of Gothenburg, Gothenburg, Sweden
| | - Jon Pierre
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
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29
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Ding D, Wang B, Zhang X, Zhang J, Zhang H, Liu X, Gao Z, Yu Z. The spread of antibiotic resistance to humans and potential protection strategies. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 254:114734. [PMID: 36950985 DOI: 10.1016/j.ecoenv.2023.114734] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/26/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
Antibiotic resistance is currently one of the greatest threats to human health. Widespread use and residues of antibiotics in humans, animals, and the environment can exert selective pressure on antibiotic resistance bacteria (ARB) and antibiotic resistance gene (ARG), accelerating the flow of antibiotic resistance. As ARG spreads to the population, the burden of antibiotic resistance in humans increases, which may have potential health effects on people. Therefore, it is critical to mitigate the spread of antibiotic resistance to humans and reduce the load of antibiotic resistance in humans. This review briefly described the information of global antibiotic consumption information and national action plans (NAPs) to combat antibiotic resistance and provided a set of feasible control strategies for the transmission of ARB and ARG to humans in three areas including (a) Reducing the colonization capacity of exogenous ARB, (b) Enhancing human colonization resistance and mitigating the horizontal gene transfer (HGT) of ARG, (c) Reversing ARB antibiotic resistance. With the hope of achieving interdisciplinary one-health prevention and control of bacterial resistance.
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Affiliation(s)
- Dong Ding
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China; College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Bin Wang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaoan Zhang
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junxi Zhang
- NHC Key Laboratory of Birth Defects Prevention & Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China
| | - Huanhuan Zhang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xinxin Liu
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zhan Gao
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Zengli Yu
- College of Public Health, Zhengzhou University, Zhengzhou, China; The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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30
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Mali SN, Anand A, Zaki MEA, Al-Hussain SA, Jawarkar RD, Pandey A, Kuznetsov A. Theoretical and Anti- Klebsiella pneumoniae Evaluations of Substituted 2,7-dimethylimidazo[1,2-a]pyridine-3-carboxamide and Imidazopyridine Hydrazide Derivatives. Molecules 2023; 28:molecules28062801. [PMID: 36985773 PMCID: PMC10051578 DOI: 10.3390/molecules28062801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/08/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
A series of multistep synthesis protocols was adopted to synthesize substituted imidazopyridines (IMPs) (SM-IMP-01 to SM-IMP-13, and DA-01-05). All substituted IMPs were then characterized using standard spectroscopic techniques such as 1H-NMR, 13C-NMR, elemental analyses, and mass spectrometry. Our both in vitro qualitative and quantitative results for antibacterial analysis, against Klebsiella pneumoniae ATCC 4352 and Bacillus subtilis ATCC 6051 suggested that all compounds essentially exhibited activity against selected strains of bacteria. Our DFT analyses suggested that the compounds of the SM-IMP-01-SM-IMP-13 series have HOMO/LUMO gaps within 4.43-4.69 eV, whereas the compounds of the DA-01-DA-05 series have smaller values of the HOMO/LUMO gaps, 3.24-4.17 eV. The lowest value of the global hardness and the highest value of the global softness, 2.215 and 0.226 eV, respectively, characterize the compound SM-IMP-02; thus, it is the most reactive compound in the imidazopyridine carboxamide series (except hydrazide series). This compound also depicted lesser MIC values against Klebsiella pneumoniae ATCC 4352 and Bacillus subtilis ATCC 6051 as 4.8 µg/mL, each. In terms of another series, hydrazide DA-05 depicted strong antimicrobial actions (MIC: 4.8 µg/mL against both bacterial strains) and also had the lowest energy gap (3.24 eV), higher softness (0.309 eV), and lesser hardness (1.62 eV). Overall, when we compare qualitative and quantitative antimicrobial results, it is been very clear that compounds with dibromo substitutions on imidazopyridine (IMP) rings would act as better antimicrobial agents than those with -H at the eighth position on the IMP ring. Furthermore, substituents of higher electronegativities would tend to enhance the biological activities of dibromo-IMP compounds. DFT properties were also well comparable to this trend and overall, we can say that the electronic behavior of compounds under investigation has key roles in their bioactivities.
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Affiliation(s)
- Suraj N Mali
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Ranchi 835215, India
| | - Amit Anand
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Ranchi 835215, India
| | - Magdi E A Zaki
- Department of Chemistry, Faculty of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11623, Saudi Arabia
| | - Sami A Al-Hussain
- Department of Chemistry, Faculty of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 11623, Saudi Arabia
| | - Rahul D Jawarkar
- Department of Medicinal Chemistry and Drug Discovery, Dr. Rajendra Gode Institute of Pharmacy, University Mardi Road, Amravati 444603, India
| | - Anima Pandey
- Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Ranchi 835215, India
| | - Aleksey Kuznetsov
- Department of Chemistry, Universidad Técnica Federico Santa Maria, Santiago 7660251, Chile
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