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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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Bhogal R, Powell N, Elkhalifa S. Management of BAME patients with a history of penicillin allergy: barriers to best practice and strategies to overcome these. Infect Prev Pract 2023; 5:100319. [PMID: 38107244 PMCID: PMC10724474 DOI: 10.1016/j.infpip.2023.100319] [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: 07/27/2023] [Accepted: 08/01/2023] [Indexed: 12/19/2023] Open
Affiliation(s)
- Rashmeet Bhogal
- The School of Pharmacy and Institute of Clinical Sciences, University of Birmingham, Birmingham United Kingdom
| | - Neil Powell
- Pharmacy Department, Royal Cornwall Hospital Trust, Truro, UK
| | - Shuayb Elkhalifa
- Allergy and Clinical Immunology Department, Respiratory Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
- Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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Mantegazza L, De Pascali AM, Munoz O, Manes C, Scagliarini A, Capua I. Circular Health: exploiting the SDG roadmap to fight AMR. Front Cell Infect Microbiol 2023; 13:1185673. [PMID: 37424780 PMCID: PMC10324666 DOI: 10.3389/fcimb.2023.1185673] [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: 03/13/2023] [Accepted: 05/10/2023] [Indexed: 07/11/2023] Open
Abstract
Circular Health is a novel approach to address complex health issues that is based on the expansion of the One Health Paradigm. Circular health recognizes the need for a multidisciplinary convergence effort to complement the biomedical dimension of health. Antimicrobial resistance (AMR) is one of the greatest global concerns for public health that is likely on the rise, given the extensive use of antibiotics during the early Covid-19 years. Prior to the Covid-19 pandemic, an expert group chaired by Jim O'Neill published "The Review on Antimicrobial Resistance", which contains a final report and recommendations on how to tackle AMR. The report, for the first time, considers AMR from a multi-perspective viewpoint highlighting how it cannot be successfully addressed unless there is a converging approach encompassing many dimensions of the problem. In this perspective, we propose to include the recommendations from that seminal report and other more recent reviews which include the lessons learnt from the Covid-19 pandemic, into the operational framework of the sustainable development goals (SDGs). AMR represents a perfect case study to explore how the SDG roadmap has the potential of becoming the driving force and implementation tool to address complex health issues by pursuing the optimization of resources and actions via a convergent and multi-stakeholder approach. The implementation of health-related policies through the whole spectrum of the SDGs could be both a novel and a well-established framework to inform multi-dimensional policies for more sustainable health in the future.
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Affiliation(s)
- Luca Mantegazza
- One Health Center of Excellence, University of Florida, Gainesville, FL, United States
| | - Alessandra Mistral De Pascali
- Section of Microbiology, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Olga Munoz
- One Health Center of Excellence, University of Florida, Gainesville, FL, United States
| | - Costanza Manes
- One Health Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Wildlife Ecology and Conservation, University of Florida, Gainesville, FL, United States
| | - Alessandra Scagliarini
- Section of Microbiology, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Ilaria Capua
- One Health Center of Excellence, University of Florida, Gainesville, FL, United States
- Johns Hopkins University, SAIS Europe, Bologna, Italy
- Institute of Food and Agricultural Sciences, University of Florida, Gainesville, FL, United States
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Charani E, Mendelson M, Pallett SJC, Ahmad R, Mpundu M, Mbamalu O, Bonaconsa C, Nampoothiri V, Singh S, Peiffer-Smadja N, Anton-Vazquez V, Moore LSP, Schouten J, Kostyanev T, Vlahović-Palčevski V, Kofteridis D, Corrêa JS, Holmes AH. An analysis of existing national action plans for antimicrobial resistance-gaps and opportunities in strategies optimising antibiotic use in human populations. Lancet Glob Health 2023; 11:e466-e474. [PMID: 36739875 DOI: 10.1016/s2214-109x(23)00019-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 12/27/2022] [Accepted: 01/03/2023] [Indexed: 02/05/2023]
Abstract
At the 2015 World Health Assembly, UN member states adopted a resolution that committed to the development of national action plans (NAPs) for antimicrobial resistance (AMR). The political determination to commit to NAPs and the availability of robust governance structures to assure sustainable translation of the identified NAP objectives from policy to practice remain major barriers to progress. Inter-country variability in economic and political resilience and resource constraints could be fundamental barriers to progressing AMR NAPs. Although there have been regional and global analyses of NAPs from a One Health and policy perspective, a global assessment of the NAP objectives targeting antimicrobial use in human populations is needed. In this Health Policy, we report a systematic evidence synthesis of existing NAPs that are aimed at tackling AMR in human populations. We find marked gaps and variability in maturity of NAP development and operationalisation across the domains of: (1) policy and strategic planning; (2) medicines management and prescribing systems; (3) technology for optimised antimicrobial prescribing; (4) context, culture, and behaviours; (5) operational delivery and monitoring; and (6) patient and public engagement and involvement. The gaps identified in these domains highlight opportunities to facilitate sustainable delivery and operationalisation of NAPs. The findings from this analysis can be used at country, regional, and global levels to identify AMR-related priorities that are relevant to infrastructure needs and contexts.
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Affiliation(s)
- Esmita Charani
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; National Institute for Health Research Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK; Department of Health Sciences Research, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India; ESCMID Study Group for Antimicrobial Stewardship, European Society of Clinical Microbiology and Infectious Diseases, Basel, Switzerland; Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Scott J C Pallett
- Centre for Defence Pathology, Royal Centre for Defence Medicine, Birmingham, UK; Infection and Immunity Clinical Academic Group, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Raheelah Ahmad
- National Institute for Health Research Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK; School of Health and Psychological Sciences, University of London, London, UK; Institute of Business and Health Management, Dow University of Health Sciences, Karachi, Pakistan; Surveillance and Epidemiology of Drug-resistant Infections Consortium, Wellcome Trust, London, UK
| | - Mirfin Mpundu
- Action on Antibiotic Resistance (ReAct) Africa, Lusaka, Zambia
| | - Oluchi Mbamalu
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Candice Bonaconsa
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Vrinda Nampoothiri
- Department of Health Sciences Research, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Sanjeev Singh
- Department of Health Sciences Research, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | | | - Vanesa Anton-Vazquez
- Infection and Immunity Clinical Academic Group, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Luke S P Moore
- National Institute for Health Research Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK; Chelsea and Westminster NHS Foundation Trust, London, UK
| | - Jeroen Schouten
- ESCMID Study Group for Antimicrobial Stewardship, European Society of Clinical Microbiology and Infectious Diseases, Basel, Switzerland; Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Tomislav Kostyanev
- ESCMID Study Group for Antimicrobial Stewardship, European Society of Clinical Microbiology and Infectious Diseases, Basel, Switzerland; Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium; Laboratoire National de Santé, Dudelange, Luxembourg
| | - Vera Vlahović-Palčevski
- ESCMID Study Group for Antimicrobial Stewardship, European Society of Clinical Microbiology and Infectious Diseases, Basel, Switzerland; Department of Clinical Pharmacology, Medical Faculty and Faculty of Health Studies, University Hospital Rijeka, University of Rijeka, Rijeka, Croatia
| | - Diamantis Kofteridis
- ESCMID Study Group for Antimicrobial Stewardship, European Society of Clinical Microbiology and Infectious Diseases, Basel, Switzerland; Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | - Alison H Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK; Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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Thomas GR, Corso A, Pasterán F, Shal J, Sosa A, Pillonetto M, de Souza Peral RT, Hormazábal JC, Araya P, Saavedra SY, Ovalle MV, Jiménez Pearson MA, Chacón GC, Carbon E, Mazariegos Herrera CJ, Velásquez SDCG, Satan-Salazar C, Villavicencio F, Touchet NM, Busignani S, Mayta-Barrios M, Ramírez-Illescas J, Vega ML, Mogdasy C, Rosas V, Salgado N, Quiroz R, El-Omeiri N, Galas MF, Ramón-Pardo P, Melano RG. Increased Detection of Carbapenemase-Producing Enterobacterales Bacteria in Latin America and the Caribbean during the COVID-19 Pandemic. Emerg Infect Dis 2022; 28:1-8. [PMID: 36286547 PMCID: PMC9622262 DOI: 10.3201/eid2811.220415] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
During 2020–2021, countries in Latin America and the Caribbean reported clinical emergence of carbapenemase-producing Enterobacterales that had not been previously characterized locally, increased prevalence of carbapenemases that had previously been detected, and co-production of multiple carbapenemases in some isolates. These increases were likely fueled by changes related to the COVID-19 pandemic, including empirical antibiotic use for potential COVID-19–related bacterial infections and healthcare limitations resulting from the rapid rise in COVID-19 cases. Strengthening antimicrobial resistance surveillance, epidemiologic research, and infection prevention and control programs and antimicrobial stewardship in clinical settings can help prevent emergence and transmission of carbapenemase-producing Enterobacterales.
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