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Fieldman T, Mossialos E, Anderson M. Enhancing global insight into AMR spread and generation: prospects and limitations of the WHO and quadripartite research agendas. J Antimicrob Chemother 2024; 79:207-210. [PMID: 38153237 DOI: 10.1093/jac/dkad393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
In Summer 2023, the World Health Organisation (WHO) and the Food and Agriculture Organization of the United Nations (FAO)-United Nations Environment Programme (UNEP) WHO-World Organisation for Animal Health (OIE) Quadripartite published two separate research agendas on antimicrobial resistance (AMR). While the publication of these research agendas on AMR creates a significant opportunity to align research priorities internationally, we emphasize a number of limitations. Firstly, the production of two separate AMR research agendas, in human health and One Health, rather than one integrated research agenda, risks the continued deprioritization of the One Health agenda. Furthermore, neither research agenda addressed the need to study the relationship between climate change and AMR despite growing evidence to suggest this may be significant. Finally, there are also missed opportunities in directing the study of appropriate treatment regimens and in clarifying the overall most resource-efficient path to combatting AMR. Moving forward, the international research agenda for AMR needs to be continually redefined in an inclusive, transparent and independent manner. This could be the task of the proposed, but so far not realized, Independent Panel on Evidence for Action against AMR.
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Affiliation(s)
- Thomas Fieldman
- Department of Clinical Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, UK
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, UK
| | - Michael Anderson
- Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, UK
- Health Organisation, Policy, Economics (HOPE), Centre for Primary Care & Health Services Research, The University of Manchester, Manchester M13 9PL, UK
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Petersen E, Shan Lee S, Blumberg L, Levison ME. Antimicrobial resistance - A global problem in need of global solutions. IJID REGIONS 2023; 9:102-103. [PMID: 38020183 PMCID: PMC10643227 DOI: 10.1016/j.ijregi.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Affiliation(s)
- Eskild Petersen
- Institute for Clinical Medicine, Faculty of Health Science, University of Aarhus, Denmark
- PandemiX, Department of Science and Environment, Roskilde University, Denmark
- ESCMID Emerging Infections Subcommittee, European Society for Clinical Microbiology and Infectious Diseases, Basel, Switzerland
- International Society for Infectious Diseases, Bpston, United States
| | - Shui Shan Lee
- International Society for Infectious Diseases, Bpston, United States
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong
- S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong
| | - Lucille Blumberg
- International Society for Infectious Diseases, Bpston, United States
- National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa
- Right to Care; University of Pretoria, Faculty of Veterinary Science, South Africa
| | - Matthew E. Levison
- Formerly Professor of Medicine and Chief, Division of Infectious Diseases, Drexel University College of Medicine, United States
- Formerly Associate Editor for ProMED Global & Top Moderator for ProMED-AMR
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Petersen E, Lee SS, Blumberg L, Levison ME. Antimicrobial resistance - A global problem in need of global solutions. Int J Infect Dis 2023; 137:73-74. [PMID: 37832932 DOI: 10.1016/j.ijid.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023] Open
Affiliation(s)
- Eskild Petersen
- Institute for Clinical Medicine, Faculty of Health Science, University of Aarhus, Denmark; PandemiX, Department of Science and Environment, Roskilde University, Denmark; ESCMID Emerging Infections Subcommittee, European Society for Clinical Microbiology and Infectious Diseases, Basel, Switzerland; International Society for Infectious Diseases, Boston, United States.
| | - Shui Shan Lee
- International Society for Infectious Diseases, Boston, United States; Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong; S.H. Ho Research Centre for Infectious Diseases, The Chinese University of Hong Kong, Hong Kong
| | - Lucille Blumberg
- International Society for Infectious Diseases, Boston, United States; National Institute for Communicable Diseases, Division of the National Health Laboratory Service, Johannesburg, South Africa; Right to Care; University of Pretoria, Faculty of Veterinary Science, South Africa
| | - Matthew E Levison
- Formerly Professor of Medicine and Chief, Division of Infectious Diseases, Drexel University College of Medicine, United States; Formerly Associate Editor for ProMED Global & Top Moderator for ProMED-AMR
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Ladines-Lim J, Scruggs-Wodkowski E, Adžemović T, Croxton R, Romero R, Lukela M, Rao K, Mehrotra P, Patel PK. Understanding refugee and immigrant health literacy and beliefs toward antimicrobial resistance. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e175. [PMID: 38028894 PMCID: PMC10644158 DOI: 10.1017/ash.2023.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/03/2023] [Accepted: 08/03/2023] [Indexed: 12/01/2023]
Abstract
Refugee and migrant populations have increased vulnerability to antimicrobial resistance, yet stewardship guidance is lacking. We addressed this gap through a cross-sectional survey, finding that these populations and immigrants from low and middle-income countries had lower health literacy on the issue compared to native-born Americans and those from high-income countries.
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Affiliation(s)
- Joseph Ladines-Lim
- Departments of Internal Medicine and Pediatrics, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - Elizabeth Scruggs-Wodkowski
- Division of Infectious Diseases, University of Michigan, Michigan Medicine, University Hospital South F4012A, Ann Arbor, MI, USA
| | - Tessa Adžemović
- Departments of Internal Medicine and Pediatrics, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - Rachel Croxton
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Michael Lukela
- Departments of Internal Medicine and Pediatrics, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA
| | - Krishna Rao
- Division of Infectious Diseases, University of Michigan, Michigan Medicine, University Hospital South F4012A, Ann Arbor, MI, USA
| | - Preeti Mehrotra
- Silverman Institute for Health Care Quality and Safety and Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Payal K. Patel
- Intermountain Medical Center – Infectious Disease, Murray, UT, USA
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Nanakali SS, Hassan O, Silva L, Al‐Oraibi A, Chaloner J, Gogoi M, Qureshi I, Sahare P, Pareek M, Chattopadhyay K, Nellums LB. Migrants' living conditions, perceived health needs and implications for the use of antibiotics and antimicrobial resistance in the United Kingdom: A qualitative study. Health Sci Rep 2023; 6:e1655. [PMID: 37885468 PMCID: PMC10599099 DOI: 10.1002/hsr2.1655] [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: 06/12/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
Background and Aims Antimicrobial resistance (AMR) is among the top public health concerns around the globe. Migrants, especially forced migrants, could be at higher risk of acquiring and transmitting AMR during their journeys or in host countries. There is limited understanding regarding migrants' living conditions and the wider factors contributing to their risk of acquiring infections, and behaviors around antimicrobial use, and AMR development. In this study, we aimed to explore transit experiences, living conditions, and antibiotic use of migrants living in the United Kingdom. Methods We conducted semistructured qualitative interviews with 27 participants and identified five themes regarding migrants' journey and their living conditions during transit and after arriving in the United Kingdom, their access to water, sanitation and hygiene (WASH), and their use of antibiotics. Results Migrants, particularly forced migrants, experienced unfavorable living conditions, poor access to WASH, and challenges in accessing healthcare, which further contributed to health conditions like urinary and skin problems. Isolation and difficulty in accessing healthcare played significant roles in migrants' perceived need for storing and using antibiotics as a safety net. Conclusion The findings highlight the need for coordinated and multilevel interventions to address these challenges and contribute toward tackling AMR and improving the health of this population group.
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Affiliation(s)
- Shajwan S. Nanakali
- Lifespan and Population Health Academic Unit, School of Medicine, Nottingham City HospitalUniversity of NottinghamNottinghamUK
| | - Osama Hassan
- Lifespan and Population Health Academic Unit, School of Medicine, Nottingham City HospitalUniversity of NottinghamNottinghamUK
| | - Luisa Silva
- Lifespan and Population Health Academic Unit, School of Medicine, Nottingham City HospitalUniversity of NottinghamNottinghamUK
| | - Amani Al‐Oraibi
- Lifespan and Population Health Academic Unit, School of Medicine, Nottingham City HospitalUniversity of NottinghamNottinghamUK
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
| | - Jonathan Chaloner
- Lifespan and Population Health Academic Unit, School of Medicine, Nottingham City HospitalUniversity of NottinghamNottinghamUK
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
| | - Mayuri Gogoi
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
| | - Irtiza Qureshi
- Lifespan and Population Health Academic Unit, School of Medicine, Nottingham City HospitalUniversity of NottinghamNottinghamUK
| | - Pankhuri Sahare
- Lifespan and Population Health Academic Unit, School of Medicine, Nottingham City HospitalUniversity of NottinghamNottinghamUK
| | - Manish Pareek
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
| | - Kaushik Chattopadhyay
- Lifespan and Population Health Academic Unit, School of Medicine, Nottingham City HospitalUniversity of NottinghamNottinghamUK
| | - Laura B. Nellums
- Lifespan and Population Health Academic Unit, School of Medicine, Nottingham City HospitalUniversity of NottinghamNottinghamUK
- College of Population HealthUniversity of New MexicoAlbuquerqueNew MexicoUSA
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Muresu N, Deiana G, Dettori M, Palmieri A, Masia MD, Cossu A, D’Avino C, Sechi I, Del Rio A, Piana A, Castiglia P. Infection Prevention Control Strategies of New Delhi Metallo-β-lactamase Producing Klebsiella pneumoniae. Healthcare (Basel) 2023; 11:2592. [PMID: 37761789 PMCID: PMC10530878 DOI: 10.3390/healthcare11182592] [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: 07/21/2023] [Revised: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
The spread of multi-drug resistant organisms (MDROs) is increasing at an alarming rate worldwide. Among these, Carbapenemase-producing New Delhi Metallo-β-lactamase (NDM) poses a significant clinical threat, and appropriate measures must be taken to prevent or limit its penetration into still-free territories. The present report describes two independent cases of patients from Ukraine colonized by NDM-producing Klebsiella pneumoniae and admitted to two separate wards of an acute university hospital in a territory not yet affected by Carbapenemase producers of this class. Moreover, this report illustrates the infection prevention control (IPC) strategies promptly implemented by the IPC operational team to verify the possible spread of the microorganism in the ward and avoid any possible further contamination. The identification of genes coding for Carbapenemases, performed using real-time PCR, revealed no other cases within the wards involved. These cases emphasize the importance of early case recognition of multidrug-resistant bacteria, the necessity of effective inter-hospital communication, the need for effective antimicrobial stewardship protocol, and the importance of adequate IPC policies. Additionally, we highlight the need to improve screening procedures in the case of patients from countries with a high prevalence of MDRO, as essential measures to prevent potential nosocomial outbreaks and/or endemization.
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Affiliation(s)
- Narcisa Muresu
- Department of Humanities and Social Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Giovanna Deiana
- Medical Management, Hygiene, Epidemiology and Hospital Infection, University Hospital of Sassari, 07100 Sassari, Italy; (M.D.); (A.P.); (C.D.); (A.P.); (P.C.)
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Marco Dettori
- Medical Management, Hygiene, Epidemiology and Hospital Infection, University Hospital of Sassari, 07100 Sassari, Italy; (M.D.); (A.P.); (C.D.); (A.P.); (P.C.)
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (A.C.); (I.S.)
- Department of Restorative, Pediatric and Preventive Dentistry, University of Bern, 3012 Bern, Switzerland
| | - Alessandra Palmieri
- Medical Management, Hygiene, Epidemiology and Hospital Infection, University Hospital of Sassari, 07100 Sassari, Italy; (M.D.); (A.P.); (C.D.); (A.P.); (P.C.)
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (A.C.); (I.S.)
| | - Maria Dolores Masia
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (A.C.); (I.S.)
| | - Andrea Cossu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (A.C.); (I.S.)
| | - Cristina D’Avino
- Medical Management, Hygiene, Epidemiology and Hospital Infection, University Hospital of Sassari, 07100 Sassari, Italy; (M.D.); (A.P.); (C.D.); (A.P.); (P.C.)
| | - Illari Sechi
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (A.C.); (I.S.)
| | - Arcadia Del Rio
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Andrea Piana
- Medical Management, Hygiene, Epidemiology and Hospital Infection, University Hospital of Sassari, 07100 Sassari, Italy; (M.D.); (A.P.); (C.D.); (A.P.); (P.C.)
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (A.C.); (I.S.)
| | - Paolo Castiglia
- Medical Management, Hygiene, Epidemiology and Hospital Infection, University Hospital of Sassari, 07100 Sassari, Italy; (M.D.); (A.P.); (C.D.); (A.P.); (P.C.)
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy; (M.D.M.); (A.C.); (I.S.)
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Yusuff SI, Tajudeen YA, Oladunjoye IO, Oladipo HJ, Bolarinwa OV, Popoola OT, Ahmed AF, Olana MD. The need to increase antimicrobial resistance surveillance among forcibly displaced persons (FDPs). Trop Dis Travel Med Vaccines 2023; 9:12. [PMID: 37653439 PMCID: PMC10472691 DOI: 10.1186/s40794-023-00198-6] [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: 09/27/2022] [Accepted: 06/19/2023] [Indexed: 09/02/2023] Open
Abstract
Antimicrobial resistance (AMR) poses a significant threat to human health as 4.95 million deaths were associated with bacterial AMR in 2019 and is projected to reach 10 million by 2050. To mitigate AMR, surveillance is an essential tool for determining the burden of AMR and providing the necessary information for its control. However, the global AMR surveillance is inadequate and particularly limited among forcibly displaced persons (FDPs) despite having higher risks of harboring these pathogens. Predisposing factors among this group include poor living conditions, limited access to treatment and diagnostic tests, and inadequate trained health professionals in refugee camps. Strengthening AMR surveillance among FDPs would address the identified gaps and facilitate formulation and implementation of evidence-based policies on AMR control and prevention response. This article provides information on the growing population of FDPs, factors contributing to the AMR burden and AMR surveillance gaps in FDPs and highlighted recommendations for control.
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Affiliation(s)
- Sodiq Inaolaji Yusuff
- Department of Medicine, Faculty of Clinical Sciences, Obafemi Awolowo University, Ibadan-Ife Rd, Ife, 220101, Osun State, Nigeria
| | - Yusuf Amuda Tajudeen
- Department of Microbiology, Faculty of Life Sciences, University of Ilorin, P.M.B. 1515, Ilorin, 240003, Nigeria
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, P.M.B 5017 G.P.O, Ibadan, Oyo State, Nigeria
| | - Iyiola Olatunji Oladunjoye
- Department of Microbiology, Faculty of Life Sciences, University of Ilorin, P.M.B. 1515, Ilorin, 240003, Nigeria
| | - Habeebullah Jayeola Oladipo
- Department of Microbiology, Faculty of Life Sciences, University of Ilorin, P.M.B. 1515, Ilorin, 240003, Nigeria
- Faculty of Pharmaceutical Sciences, University of Ilorin, P.M.B. 1515, Ilorin, 240003, Nigeria
| | | | - Olalekan Tolulope Popoola
- Department of Public Health, Health Sciences Centre, University College, Dublin, 4 Stillorgan Rd, Belfield, Dublin 4, Ireland
| | - Abdulhakeem Funsho Ahmed
- Faculty of Health Sciences, Department of Public Health, Al-Hikmah University, Ilorin, 240281, Kwara State, Nigeria
- Institute of Basic and Applied Science, Department of Science Laboratory Technology, Kwara State Polytechnic, P.M.B 1375, Ilorin, Kwara State, Nigeria
| | - Matifan Dereje Olana
- Department of Medical Laboratory Sciences, Collage of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia.
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia.
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Gao X, Wang W. The Etiological and Drug Resistance Characteristics of Multidrug-Resistant Pathogens in Patients Requiring Extracorporeal Membrane Oxygenation: A Retrospective Cohort Study. Infect Drug Resist 2023; 16:4929-4941. [PMID: 37546369 PMCID: PMC10402724 DOI: 10.2147/idr.s421413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/19/2023] [Indexed: 08/08/2023] Open
Abstract
Purpose Infections induced by multidrug-resistant (MDR) pathogens are one of the most common and serious complications in extracorporeal membrane oxygenation (ECMO) patients. However, there is currently little research about "ECMO and MDR bacteria". The purpose of our study was to clarify the epidemiological characteristics of MDR bacteria and provide references for empiric antibiotic treatments according to the drug susceptibility tests for ECMO patients. Patients and Methods There were 104 patients admitted to our department and receiving ECMO treatments between January 2014 and December 2022. Altogether, 61 veno-arterial ECMO (VA-ECMO) and 29 veno-venous ECMO (VV-ECMO) patients enrolled. The data on other intensive care unit (ICU) patients in our department in the same period are summarized. Results A total of 82 MDR bacteria were detected from ECMO patients, and most of these were MDR Gram-negative bacteria (MDR-GNB). There were also 5559 MDR-GNB collected from other patients in our department in the same period. We found that the distribution of MDR-GNB in ECMO patients was different from other critical patients. The proportion of Klebsiella pneumoniae (MDR-KP) in VV-ECMO patients was higher than other critical patients (35.1% and 21.3%, respectively). Moreover, the proportions of MDR Acinetobacter baumannii (MDR-AB) of VA-ECMO and VV-ECMO were higher than other critical patients (54.6%, 43.2% and 30.5%, respectively). In addition, MDR-AB and MDR-KP in ECMO patients exhibited higher percentages of drug resistance to possibly appropriate antibiotics for other critical patients, but showed better sensitivity to colistin. Conclusion Infections induced by MDR-GNB in ECMO patients were serious and exhibited higher degrees of drug resistance compared with other ICU patients. Colistin might be an option to consider if there is no medical contraindication. However, widespread use of broad spectrum antibiotics is something that should be discouraged, and alternative options are being explored.
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Affiliation(s)
- Xinjing Gao
- Department of Critical Care Medicine, The Third Central Hospital of Tianjin, Tianjin, People’s Republic of China
- Nankai University Affiliated Third Central Hospital, Nankai University, Tianjin, People’s Republic of China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, The Third Central Hospital of Tianjin, Tianjin, People’s Republic of China
- Artificial Cell Engineering Technology Research Center, The Third Central Hospital of Tianjin, Tianjin, People’s Republic of China
| | - Wenjiao Wang
- Department of Critical Care Medicine, The Third Central Hospital of Tianjin, Tianjin, People’s Republic of China
- Nankai University Affiliated Third Central Hospital, Nankai University, Tianjin, People’s Republic of China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, The Third Central Hospital of Tianjin, Tianjin, People’s Republic of China
- Artificial Cell Engineering Technology Research Center, The Third Central Hospital of Tianjin, Tianjin, People’s Republic of China
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Allel K, Day L, Hamilton A, Lin L, Furuya-Kanamori L, Moore CE, Van Boeckel T, Laxminarayan R, Yakob L. Global antimicrobial-resistance drivers: an ecological country-level study at the human-animal interface. Lancet Planet Health 2023; 7:e291-e303. [PMID: 37019570 DOI: 10.1016/s2542-5196(23)00026-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 01/20/2023] [Accepted: 02/01/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a pressing, holistic, and multisectoral challenge facing contemporary global health. In this study we assessed the associations between socioeconomic, anthropogenic, and environmental indicators and country-level rates of AMR in humans and food-producing animals. METHODS In this modelling study, we obtained data on Carbapenem-resistant Acinetobacter baumanii and Pseudomonas aeruginosa, third generation cephalosporins-resistant Escherichia coli and Klebsiella pneumoniae, oxacillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium AMR in humans and food-producing animals from publicly available sources, including WHO, World Bank, and Center for Disease Dynamics Economics and Policy. AMR in food-producing animals presented a combined prevalence of AMR exposure in cattle, pigs, and chickens. We used multivariable β regression models to determine the adjusted association between human and food-producing animal AMR rates and an array of ecological country-level indicators. Human AMR rates were classified according to the WHO priority pathogens list and antibiotic-bacterium pairs. FINDINGS Significant associations were identified between animal antimicrobial consumption and AMR in food-producing animals (OR 1·05 [95% CI 1·01-1·10]; p=0·013), and between human antimicrobial consumption and AMR specifically in WHO critical priority (1·06 [1·00-1·12]; p=0·035) and high priority (1·22 [1·09-1·37]; p<0·0001) pathogens. Bidirectional associations were also found: animal antibiotic consumption was positively linked with resistance in critical priority human pathogens (1·07 [1·01-1·13]; p=0·020) and human antibiotic consumption was positively linked with animal AMR (1·05 [1·01-1·09]; p=0·010). Carbapenem-resistant Acinetobacter baumanii, third generation cephalosporins-resistant Escherichia coli, and oxacillin-resistant Staphylococcus aureus all had significant associations with animal antibiotic consumption. Analyses also suggested significant roles of socioeconomics, including governance on AMR rates in humans and animals. INTERPRETATION Reduced rates of antibiotic consumption alone will not be sufficient to combat the rising worldwide prevalence of AMR. Control methods should focus on poverty reduction and aim to prevent AMR transmission across different One Health domains while accounting for domain-specific risk factors. The levelling up of livestock surveillance systems to better match those reporting on human AMR, and, strengthening all surveillance efforts, particularly in low-income and middle-income countries, are pressing priorities. FUNDING None.
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Affiliation(s)
- Kasim Allel
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Antimicrobial Resistance Centre, London School of Hygiene & Tropical Medicine, London, UK; Institute for Global Health, University College London, London, UK.
| | - Lucy Day
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Leesa Lin
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Laboratory of Data Discovery for Health, Hong Kong Science Park, Hong Kong Special Administrative Region, China; The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Luis Furuya-Kanamori
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Catrin E Moore
- The Centre for Neonatal and Paediatric Infection, Infection and Immunity Institute, St George's, University of London, UK
| | - Thomas Van Boeckel
- Eidgenössische Technische Hochschule, Zurich, Health Geography and Policy Group, Zurich, Switzerland
| | - Ramanan Laxminarayan
- The One Health Trust, Washington DC, USA; The High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA
| | - Laith Yakob
- Department of Disease Control, Faculty of Infectious & Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK; Antimicrobial Resistance Centre, London School of Hygiene & Tropical Medicine, London, UK
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Lin Q, Xavier BB, Alako BTF, Mitchell AL, Rajakani SG, Glupczynski Y, Finn RD, Cochrane G, Malhotra-Kumar S. Screening of global microbiomes implies ecological boundaries impacting the distribution and dissemination of clinically relevant antimicrobial resistance genes. Commun Biol 2022; 5:1217. [DOI: 10.1038/s42003-022-04187-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 10/28/2022] [Indexed: 11/19/2022] Open
Abstract
AbstractUnderstanding the myriad pathways by which antimicrobial-resistance genes (ARGs) spread across biomes is necessary to counteract the global menace of antimicrobial resistance. We screened 17939 assembled metagenomic samples covering 21 biomes, differing in sequencing quality and depth, unevenly across 46 countries, 6 continents, and 14 years (2005-2019) for clinically crucial ARGs, mobile colistin resistance (mcr), carbapenem resistance (CR), and (extended-spectrum) beta-lactamase (ESBL and BL) genes. These ARGs were most frequent in human gut, oral and skin biomes, followed by anthropogenic (wastewater, bioreactor, compost, food), and natural biomes (freshwater, marine, sediment). Mcr-9 was the most prevalent mcr gene, spatially and temporally; blaOXA-233 and blaTEM-1 were the most prevalent CR and BL/ESBL genes, but blaGES-2 and blaTEM-116 showed the widest distribution. Redundancy analysis and Bayesian analysis showed ARG distribution was non-random and best-explained by potential host genera and biomes, followed by collection year, anthropogenic factors and collection countries. Preferential ARG occurrence, and potential transmission, between characteristically similar biomes indicate strong ecological boundaries. Our results provide a high-resolution global map of ARG distribution and importantly, identify checkpoint biomes wherein interventions aimed at disrupting ARGs dissemination are likely to be most effective in reducing dissemination and in the long term, the ARG global burden.
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