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Sumon SA, Sarker S, Chowdhury ABMA, Abdullah SAHM, Shahjahan M, Sharmin S, Harun MGD. Antibiotic use in tertiary care hospitals in Bangladesh: Revealing the extent through a point prevalence survey. Am J Infect Control 2024; 52:1052-1059. [PMID: 38795902 DOI: 10.1016/j.ajic.2024.05.013] [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: 01/31/2024] [Revised: 05/18/2024] [Accepted: 05/19/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Prevalent use of antibiotics in hospitals results in antimicrobial resistance (AMR), rising mortality, and substantial financial burden. This study assessed the current pattern of antibiotic use among inpatients in tertiary hospitals in Bangladesh. METHODS Between August and November 2022, we conducted a point prevalence survey in 4 tertiary hospitals in Dhaka, Bangladesh. The World Health Organization-directed point prevalence survey methodology and tools were followed for the data collection. Descriptive and multivariate statistics were performed using Stata version 15. RESULTS Of 1,063 hospitalized patients, antibiotics were prescribed to 73.5% (781/1063, 95% confidence interval: 70.8-76.1) of patients. A total of 1,164 antibiotics were prescribed, and 49.1% of patients consumed multiple antibiotics. Only 31.4% of patients were prescribed antibiotics based on microbiology results. The reasons for antibiotic prescribing were mentioned only in 19.3% of patients. Infants (adjusted odds ratio: 8.52, P-value: <.001) and neonates (adjusted odds ratio: 4.32, P-value: <.001) were more likely to consume antibiotics compared to adults. Cephalosporins accounted for the majority (54.0%) of antibiotics used in hospitals. None of the hospitals had any antibiotic use guidelines. CONCLUSIONS Consumption of Watch group antibiotics empirically among all age groups demonstrates irrational antibiotic usage in Bangladeshi hospitals. Implementation of a tailored stewardship program, antibiotic use guidelines, and prescriber-patient awareness could improve the rational use of antibiotics.
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Affiliation(s)
- Shariful Amin Sumon
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh.
| | - Supta Sarker
- Health System and Population Studies Division, International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | - Md Shahjahan
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
| | - Sabrina Sharmin
- Department of Public Health, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
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Aboushady AT, Manigart O, Sow A, Fuller W, Ouedraogo AS, Ebruke C, Babin FX, Gahimbare L, Sombié I, Stelling J. Surveillance of Antimicrobial Resistance in the ECOWAS Region: Setting the Scene for Critical Interventions Needed. Antibiotics (Basel) 2024; 13:627. [PMID: 39061309 PMCID: PMC11273779 DOI: 10.3390/antibiotics13070627] [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: 06/11/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Antimicrobial resistance poses a significant challenge to public health globally, leading to increased morbidity and mortality. AMR surveillance involves the systematic collection, analysis, and interpretation of data on the occurrence and distribution of AMR in humans, animals, and the environment for action. The West African Health Organization, part of the Economic Community of West African States (ECOWAS), is committed to addressing AMR in the region. This paper examines the status of AMR surveillance in ECOWAS countries using available WHO data from the TrACSS survey and GLASS enrollments. The analysis reveals that while progress has been made, significant challenges remain. Twelve of the fifteen ECOWAS countries are enrolled in GLASS, and ten have developed national action plans (NAPs) for AMR. However, there is a need to ensure all countries fully implement their NAPs, continue reporting to GLASS, and use the data for evidence-based actions and decision making. Surveillance systems for AMR and antimicrobial consumption/use vary across countries with some demonstrating limited capacity. All countries, except Cabo Verde, reported having a reference laboratory for AMR testing. Strengthening laboratory capabilities, data management and use, and multisectoral coordination are crucial for effective AMR surveillance and response. Based on the findings and the regional context, it is essential to prioritize capacity building, data utilization, and the adoption of standardized guidelines for AMR surveillance. Collaboration among ECOWAS countries, the WAHO, and international partners is essential to address AMR comprehensively. Ensuring a consistent supply of essential antimicrobial medications and reagents is vital.
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Affiliation(s)
| | - Olivier Manigart
- West African Health Organization, Bobo-Dioulasso 01 BP 153, Burkina Faso (A.S.); (C.E.); (I.S.)
- GFA Consulting Group, 22359 Hamburg, Germany
- Ecole de Santé Publique, Université Libre de Bruxelles, 1050 Brussels, Belgium
| | - Abdourahmane Sow
- West African Health Organization, Bobo-Dioulasso 01 BP 153, Burkina Faso (A.S.); (C.E.); (I.S.)
- Institut Pasteur de Dakar, Dakar 220, Senegal
- Department de Santé Public, Faculté de Médecine, de Pharmacie et D’Odontostomatologie, Université Cheikh Anta Diop, Dakar 5005, Senegal
| | - Walter Fuller
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (W.F.); (L.G.)
| | - Abdoul-Salam Ouedraogo
- Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso 01 BP 390, Burkina Faso;
| | - Chinelo Ebruke
- West African Health Organization, Bobo-Dioulasso 01 BP 153, Burkina Faso (A.S.); (C.E.); (I.S.)
- GFA Consulting Group, 22359 Hamburg, Germany
| | | | - Laetitia Gahimbare
- World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo; (W.F.); (L.G.)
| | - Issiaka Sombié
- West African Health Organization, Bobo-Dioulasso 01 BP 153, Burkina Faso (A.S.); (C.E.); (I.S.)
| | - John Stelling
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
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Chan OS, Wu P, Cowling B, Lee E, Yeung M, St-Hilaire S, Tun H, Wernli D, Lam W. Prescribing antibiotics prudently-A survey of policy implementation drivers among physicians and veterinarians. One Health 2024; 18:100752. [PMID: 38832078 PMCID: PMC11145358 DOI: 10.1016/j.onehlt.2024.100752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024] Open
Abstract
Background As the antimicrobial resistance (AMR) problem accelerates, humans and animals are suffering from the consequences of infections with diminishing antimicrobial treatment options. Within the One Medicine and One Health mandate, which denotes a collaborative, multisectoral, and transdisciplinary approach to improve medicine and health across human and animal sectors, we investigate how human and veterinary medical practitioners apply their medical and policy knowledge in prescribing antimicrobials. Different regions and locations establish different intermediary policies and programs to support clinicians in that pursuit. In Hong Kong, there are locally adapted programs at governance and clinical levels in the human medical field. However, there is no locally adapted veterinary antibiotic prescription guideline or stewardship program, and veterinarians adopt overseas or international professions' antimicrobial use guidelines. Such a policy environment creates a natural experiment to compare local policy implementation conditions and clinicians' knowledge, perception, and practice. Method We construct the investigative survey tool by adaptation of Knowledge, Attitude, and Practice (KAP) and Capacity, Opportunity, and Motivation-Behavior (COM-B) models. We identify, compare and contrast factors that influence clinicians' antimicrobial prescription behavior. The factors are considered both intrinsically, such as personal attributes, and extrinsically, such as societal and professional norms. Findings The absence of locally adopted antimicrobial guidelines influences AMR stewardship program implementation in local Hong Kong veterinary community. As medical allies, physicians and veterinarians share similar demographic influence, organization considerations and perception of public awareness. Both cohorts prescribe more prudently with more years-in-practice, time available to communicate with patients or caretakers, and public awareness and support.
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Affiliation(s)
- Olivia S.K. Chan
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Peng Wu
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ben Cowling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Elaine Lee
- Agriculture, Fisheries and Conservation Department, 5/F, Cheung Sha Wan Government Offices, 303 Cheung Sha Wan Road, Kowloon, Hong Kong SAR, China
| | - Michelle Yeung
- Agriculture, Fisheries and Conservation Department, 5/F, Cheung Sha Wan Government Offices, 303 Cheung Sha Wan Road, Kowloon, Hong Kong SAR, China
| | - Sophie St-Hilaire
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon Tong, Hong Kong SAR, People's Republic of China
| | - Hein Tun
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Didier Wernli
- Global Studies Institute, University of Geneva, Sciences II, Quai Ernest-Ansermet 30, CH-1211 Genève, Switzerland
| | - Wendy Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Haque T, Imtiaz SH, Hossain MI, Khan SH, Alam MM, Alam Z, Rokonuzzaman SM, Pulock OS, Pinky SD, Arbi AK, Murshid HB, Homaira N, Hassan MZ. The portrayal of antimicrobial resistance in Bangladeshi newspapers during 2010-2021: Toward understanding the narrative. PLoS One 2024; 19:e0304582. [PMID: 38820494 PMCID: PMC11142656 DOI: 10.1371/journal.pone.0304582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 05/13/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a major global public health crisis and around the last decade, newspapers were one of the main sources of public dissemination of information for so. This study highlights how Bangladeshi mainstream newspapers represented AMR-related news and how they created the narrative of AMR in Bangladesh. METHODS We conducted both quantitative and qualitative content analysis on 275 AMR-related news articles published in the twelve highest circulated dailies (January 2010 to September 2021). We divided the articles into report, opinion, and editorials and analyzed how their contents built the narrative of AMR in Bangladesh. RESULTS Bangladeshi newspapers reported misuse of antibiotics by the consumers the most (32.2%), followed by selling without prescriptions (29%), and over-prescription by the health providers (26.1%). There were hardly any news reports describing the impact of pharmaceutical companies in prescribing and selling antibiotics. Around 45% of the news articles were event-oriented. Moreover, they suggested inadequate recommendations to battle AMR. CONCLUSION Valid, consistent, and reliable AMR news coverage can play a crucial role in creating mass awareness, making providers accountable, and supporting national action plan in mitigating AMR threat. The Bangladeshi journalists interested in reporting AMR-issues should focus on disseminating more Bangla articles with scientific information, and reporting causes and recommendations responsibly.
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Affiliation(s)
- Tahmidul Haque
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Syed Hassan Imtiaz
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Imran Hossain
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sazzad Hossain Khan
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md. Mahfuj Alam
- Department of Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Zahidul Alam
- Department of Surgery, Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh
| | - S. M. Rokonuzzaman
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Orindom Shing Pulock
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Susmita Dey Pinky
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ataul Karim Arbi
- Directorate General of Health Services (DGHS), Ministry of Health and Family Welfare (MOHFW), Government of the People’s Republic of Bangladesh, Dhaka, Bangladesh
| | - Haroon Bin Murshid
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Nusrat Homaira
- Discipline of Pediatrics, University of New South Wales (UNSW), Sydney, Australia
| | - Md. Zakiul Hassan
- International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Davies AR, Chisnall T, Akter S, Afrad MMH, Sadekuzzaman M, Badhy SC, Hasan MZ, Rahman MT, Smith RP, Card RM, Brum E, Chowdhury MGA. Genomic characterisation of Escherichia coli isolated from poultry at retail through Sink Surveillance in Dhaka, Bangladesh reveals high levels of multi-drug resistance. Front Microbiol 2024; 15:1418476. [PMID: 38873136 PMCID: PMC11169737 DOI: 10.3389/fmicb.2024.1418476] [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: 04/16/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
The surveillance of antimicrobial resistance (AMR) in commensal Escherichia coli from livestock at slaughter is widely employed to assess the potential for risk to humans. There is currently a limited understanding of AMR in Bangladesh poultry at retail in live bird markets, with studies focussing solely on phenotypic characterisation of resistance. To address this evidence gap we performed antimicrobial susceptibility testing and whole genome sequencing on E. coli obtained from chickens from live bird markets in Dhaka in 2018 (n = 38) and 2020 (n = 45). E. coli were isolated from caeca samples following ISO guidelines and sequenced using short and long read methods. Multidrug resistance was extremely common (n = 77) and there was excellent concordance between AMR phenotype and the presence of corresponding AMR genes or mutations. There was considerable genomic diversity, with 43 different sequence types detected. Public health considerations included the high occurrence of resistance to ciprofloxacin (n = 75) associated with plasmid-residing qnrS or mutations in the gyrA and parC chromosomal genes; and the detection of a tigecycline resistant isolate harbouring tet(X4) on an IncHI1A/B-IncFIA mosaic plasmid. Thirty-nine isolates were resistant to azithromycin and harboured mphA, with a significant increase in the incidence of resistance between 2018 and 2020. Although azithromycin is banned for veterinary use in Bangladesh it remains an important treatment option for humans. Interestingly, mphA confers high-level resistance to azithromycin and erythromycin, and the latter is commonly used on poultry farms in Bangladesh. Seven isolates were colistin resistant and carried mcr1. For two isolates hybrid assemblies revealed that mcr1 resided on a highly conserved IncHI2 plasmid that had 93% nucleotide identity to a plasmid from the published genome of an E. coli isolate of Bangladeshi human origin. Six isolates had resistance to third generation cephalosporins, associated with plasmid-residing bla CTX-M-55, bla CTX-M-65, or bla DHA-1. By employing phenotypic and genomic approaches for AMR surveillance we have provided new insights into the potential for One Health AMR linkages in Bangladesh. Employing similar approaches in human and environmental sectors will help inform the One Health approach to addressing AMR, and generate evidence to support mitigation measures such as improved antimicrobial stewardship.
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Affiliation(s)
- Alistair R. Davies
- FAO Reference Centre for AMR, Department of Bacteriology, Animal and Plant Health Agency, Addlestone, United Kingdom
| | - Thomas Chisnall
- FAO Reference Centre for AMR, Department of Bacteriology, Animal and Plant Health Agency, Addlestone, United Kingdom
| | - Shamima Akter
- Central Disease Investigation Laboratory (CDIL), Dhaka, Bangladesh
| | - Md. Mohibul Hassan Afrad
- Emergency Centre for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), Dhaka, Bangladesh
| | | | | | - Md. Zakiul Hasan
- Emergency Centre for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), Dhaka, Bangladesh
| | - Md. Taifur Rahman
- Emergency Centre for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), Dhaka, Bangladesh
| | - Richard P. Smith
- WOAH Collaborating Centre for Risk Analysis & Modelling, Department of Epidemiological Sciences, Animal and Plant Health Agency, Addlestone, United Kingdom
| | - Roderick M. Card
- FAO Reference Centre for AMR, Department of Bacteriology, Animal and Plant Health Agency, Addlestone, United Kingdom
| | - Eric Brum
- Emergency Centre for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), Dhaka, Bangladesh
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Ali MZ, Srinivasan S, Akter S. CTX-M-127 with I176F mutations found in bacteria isolates from Bangladeshi circulating banknotes. Sci Rep 2024; 14:5866. [PMID: 38467683 PMCID: PMC10928162 DOI: 10.1038/s41598-024-56207-x] [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: 10/16/2023] [Accepted: 03/04/2024] [Indexed: 03/13/2024] Open
Abstract
Extended-spectrum beta-lactamase (ESBL)-producing organisms are widely recognized as clinically relevant causes of difficult-to-treat infections. CTX-M has formed a rapidly growing family distributed worldwide among a wide range of clinical bacteria, particularly members of Enterobacteriaceae. Circulating banknotes, exchanged daily among people, pose a potential vehicle for transmitting multidrug resistance. We screened for ESBL-carrying bacteria in the present study and reported CTX-M mutations in Bangladesh's banknotes. We sequenced the genes and performed homology modeling using the Swiss model with CTX-M-15 (4HBT) as a template. Then, we performed molecular docking of mecillinam with the template and the generated model using Autodock 4.2 (Release 4.2.6). After docking, we visually inspected the complexes built using Autodock tools for polar contacts and pi-pi interactions in PyMOL 2.5.4. Our partially sequenced blaCTX-M was related to blaCTX-M-10 and blaCTX-M-15. We observed multiple single-nucleotide substitution mutations, i.e., G613T (silent mutation), A626T (I176F), and A503G (N135D). Homology modeling showed high similarity when the model was superimposed over the template. The orientation of Asn (135) in the template and Asp (135) in the model does not show a significant difference. Likewise, Ile (176) in the template and Phe (176) in the model offer the same orientation. Our generated model could bind to Lys237, Ser240, and Asp135 residues with the lowest binding energy on docking. Our predicted binding of the mecillinam to the mutated D-135 residue in the model indicates contributions and supports previous reports proposing CTX-M-15 to CTX-M-127 mutational conversion on the mecillinum resistance phenotype.
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Affiliation(s)
- Md Zannat Ali
- Department of Microbiology, Jashore University of Science and Technology, Jashore, Bangladesh
| | | | - Selina Akter
- Department of Microbiology, Jashore University of Science and Technology, Jashore, Bangladesh.
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Bhatia R. Environmental aspects of antimicrobial resistance in India: Current progress & way forward. Indian J Med Res 2024; 159:10-15. [PMID: 38376372 PMCID: PMC10954102 DOI: 10.4103/ijmr.ijmr_2104_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Indexed: 02/21/2024] Open
Affiliation(s)
- Rajesh Bhatia
- Former Director, Communicable Diseases, WHO Regional Office for South-East Asia, New Delhi 110 002, India
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8
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Sujan MJ, Habib ZH, Rahman A, Rizvi SMS, Barua HT, Aboushady AT, Hasnat MA, Rasul SBG, Joh HS, Prifti K, Chi KYK, Kwon SY, Clark A, Gautam S, Holm M, Marks F, Stelling J, Shaw A, Poudyal N. Antimicrobial Resistance Surveillance Methods in Bangladesh: Present and Way Forward. Clin Infect Dis 2023; 77:S549-S559. [PMID: 38118018 PMCID: PMC10732563 DOI: 10.1093/cid/ciad561] [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] [Indexed: 12/22/2023] Open
Abstract
The Institute of Epidemiology, Disease Control and Research (IEDCR) conducts active, case-based national antimicrobial resistance (AMR) surveillance in Bangladesh. The Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia (CAPTURA) project accessed aggregated retrospective data from non-IEDCR study sites and 9 IEDCR sites to understand the pattern and extent of AMR and to use analyzed data to guide ongoing and future national AMR surveillance in both public and private laboratories. Record-keeping practices, data completeness, quality control, and antimicrobial susceptibility test practices were investigated in all laboratories participating in case-based IEDCR surveillance and laboratory-based CAPTURA sites. All 9 IEDCR laboratories recorded detailed case-based data (n = 16 816) in electronic format for a priority subset of processed laboratory samples. In contrast, most CAPTURA sites (n = 18/33 [54.5%]) used handwritten registers to store data. The CAPTURA sites were characterized by fewer recorded variables (such as patient demographics, clinical history, and laboratory findings) with 1 020 197 individual data, less integration of patient records with the laboratory information system, and nonuniform practice of data recording; however, data were collected from all available clinical samples. The analyses conducted on AMR data collected by IEDCR and CAPTURA in Bangladesh provide current data collection status and highlight opportunities to improve ongoing data collection to strengthen current AMR surveillance system initiatives. We recommend a tailored approach to conduct AMR surveillance in high-burden, resource-limited settings.
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Affiliation(s)
| | - Zakir Hossain Habib
- Department of Microbiology, Institute of Epidemiology, Disease Control and Research (IEDCR), Directorate General of Health Services, Ministry of Health and Family Welfare (MoHFW), Bangladesh
| | - Aninda Rahman
- Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - S M Shahriar Rizvi
- Communicable Disease Control, Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | | | - Ahmed Taha Aboushady
- International Vaccine Institute, Seoul, Republic of Korea
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Md Abul Hasnat
- International Vaccine Institute, Seoul, Republic of Korea
| | - Saima Binte Golam Rasul
- Department of Microbiology, Institute of Epidemiology, Disease Control and Research (IEDCR), Directorate General of Health Services, Ministry of Health and Family Welfare (MoHFW), Bangladesh
| | - Hea Sun Joh
- International Vaccine Institute, Seoul, Republic of Korea
| | - Kristi Prifti
- International Vaccine Institute, Seoul, Republic of Korea
| | | | - Soo Young Kwon
- International Vaccine Institute, Seoul, Republic of Korea
| | - Adam Clark
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sanjay Gautam
- International Vaccine Institute, Seoul, Republic of Korea
- Research & Collaboration, Anka Analytica, Melbourne, Australia
| | - Marianne Holm
- International Vaccine Institute, Seoul, Republic of Korea
| | - Florian Marks
- International Vaccine Institute, Seoul, Republic of Korea
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Madagascar Institute for Vaccine Research, University of Antananarivo, Antananarivo, Madagascar
| | - John Stelling
- Brigham & Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alina Shaw
- Public Health Surveillance Group, LLC, Princeton, New Jersey, USA
| | - Nimesh Poudyal
- International Vaccine Institute, Seoul, Republic of Korea
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Chua AQ, Verma M, Azupardo K, Lota MM, Hsu LY, Legido-Quigley H. A Qualitative Study on the Policy Process and Development of the National Action Plan on Antimicrobial Resistance in Singapore. Antibiotics (Basel) 2023; 12:1322. [PMID: 37627742 PMCID: PMC10451339 DOI: 10.3390/antibiotics12081322] [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: 07/17/2023] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
The global public health threat of antimicrobial resistance (AMR) has been accelerated by many interrelated factors spanning across One Health-human health, animal health, and the environment. Singapore launched its own National Strategic Action Plan (NSAP) on AMR in November 2017 with the aim of tackling the growing threat of AMR in Singapore through coordinated approaches. However, little is known about the policy process and development of the NSAP in Singapore. In this study, we analysed these aspects using an AMR governance framework. In-depth interviews were conducted with 20 participants across the One Health spectrum. The interviews were transcribed verbatim and analysed thematically. Areas that were well executed included (1) good coordination across various agencies, (2) a dedicated office to coordinate the work on the NSAP, and (3) a high level of governmental support. Areas that were lacking included (1) a lack of participation from certain sectors, (2) insufficient awareness around the AMR issue, (3) constraints in information sharing, and (4) a lack of ideal indicators to track the progress in addressing AMR. Improvements in these areas will provide a more holistic One Health engagement in support of the effective planning and implementation of the NSAP.
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Affiliation(s)
- Alvin Qijia Chua
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; (M.V.); (L.Y.H.); (H.L.-Q.)
| | - Monica Verma
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; (M.V.); (L.Y.H.); (H.L.-Q.)
| | - Karen Azupardo
- College of Public Health, University of the Philippines Manila, 625 Pedro Gil St, Ermita, Manila 1000, Philippines; (K.A.); (M.M.L.)
| | - Maria Margarita Lota
- College of Public Health, University of the Philippines Manila, 625 Pedro Gil St, Ermita, Manila 1000, Philippines; (K.A.); (M.M.L.)
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; (M.V.); (L.Y.H.); (H.L.-Q.)
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore; (M.V.); (L.Y.H.); (H.L.-Q.)
- The George Institute for Global Health UK, Imperial College London, 80 Wood Lane White City, London W12 0BZ, UK
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10
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Chua AQ, Verma M, Villanueva SYA, Roxas E, Hsu LY, Legido-Quigley H. A Qualitative Study on the Implementation of the National Action Plan on Antimicrobial Resistance in Singapore. Antibiotics (Basel) 2023; 12:1258. [PMID: 37627680 PMCID: PMC10451196 DOI: 10.3390/antibiotics12081258] [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: 07/03/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023] Open
Abstract
Antimicrobial resistance (AMR) is a global public health threat that affects humans, animals, and the environment across the One Health spectrum. Singapore launched its own National Strategic Action Plan (NSAP) on AMR in 2017 with the aim of tackling the growing threat of AMR in Singapore through coordinated approaches. However, little is known about the implementation of the NSAP. In this study, we analysed the implementation of the NSAP with guidance from an AMR governance framework. We conducted in-depth interviews with 20 participants across the One Health spectrum. The interviews were transcribed verbatim and analysed thematically. Overall, the implementation of activities against AMR was more advanced with respect to human health compared to other sectors such as (1) AMR and antimicrobial use (AMU) surveillance systems in hospitals; (2) the hospital antimicrobial stewardship (AMS) service and legislation to optimise AMU; (3) the national children and adults vaccination programme for IPC; (4) multiple avenues for education and awareness for both professionals and public; and (5) extensive research and collaboration networks with many sources of funding. Areas that were lacking presented problems including (1) an incomplete surveillance system for AMR and AMU across all sectors; (2) the need for better AMS and legislation in some sectors; (3) insufficient innovation in education for sustained behavioural modification; and (4) the need for more open research collaborations and the translation of research into policy outcomes. Improvements in these areas will enhance the overall implementation of the NSAP through a more holistic One Health approach.
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Affiliation(s)
- Alvin Qijia Chua
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore; (M.V.); (L.Y.H.); (H.L.-Q.)
| | - Monica Verma
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore; (M.V.); (L.Y.H.); (H.L.-Q.)
| | | | - Evalyn Roxas
- College of Public Health, University of the Philippines Manila, 625 Pedro Gil St, Manila 1000, Philippines; (S.Y.A.V.); (E.R.)
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore; (M.V.); (L.Y.H.); (H.L.-Q.)
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore; (M.V.); (L.Y.H.); (H.L.-Q.)
- The George Institute for Global Health UK, Imperial College London, 80 Wood Lane White City, London W12 0BZ, UK
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11
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Potential Antimicrobial and Antibiofilm Properties of Copper Oxide Nanoparticles: Time-Kill Kinetic Essay and Ultrastructure of Pathogenic Bacterial Cells. Appl Biochem Biotechnol 2023; 195:467-485. [PMID: 36087233 PMCID: PMC9832084 DOI: 10.1007/s12010-022-04120-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2022] [Indexed: 01/14/2023]
Abstract
Mycosynthesis of nanoparticle (NP) production is a potential ecofriendly technology for large scale production. In the present study, copper oxide nanoparticles (CuONPs) have been synthesized from the live cell filtrate of the fungus Penicillium chrysogenum. The created CuONPs were characterized via several techniques, namely Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), transmission electron microscope (TEM), scanning electron microscope (SEM), and energy-dispersive X-ray spectroscopy (EDX). Furthermore, the biosynthesized CuONPs were performed against biofilm forming Klebsiella oxytoca ATCC 51,983, Escherichia coli ATCC 35,218, Staphylococcus aureus ATCC 25,923, and Bacillus cereus ATCC 11,778. The anti-bacterial activity result was shown with the zone of inhibition determined to be 14 ± 0.31 mm, 16 ± 0.53 mm, 11 ± 0.57 mm, and 10 ± 0.57 mm respectively. Klebsiella oxytoca and Escherichia coli were more susceptible to CuONPs with minimal inhibitory concentration (MIC) values 6.25 and 3.12 µg/mL, respectively, while for Staphylococcus aureus and Bacillus cereus, MIC value was 12.5 and 25 μg/mL, respectively. The minimum biofilm inhibition concentration (MBIC) result was more evident, that the CuONPs have excellent anti-biofilm activity at sub-MIC levels reducing biofilm formation by 49% and 59% against Klebsiella oxytoca and Escherichia coli, while the results indicated that the MBIC of CuONPs on Bacillus cereus and Staphylococcus aureus was higher than 200 μg/mL and 256 μg/mL, respectively, suggesting that these CuONPs could not inhibit mature formatted biofilm of Bacillus cereus and Staphylococcus aureus in vitro. Overall, all the results were clearly confirmed that the CuONPs have excellent anti-biofilm ability against Klebsiella oxytoca and Escherichia coli. The prepared CuONPs offer a smart approach for biomedical therapy of resistant microorganisms because of its promoted antimicrobial action, but only for specified purposes.
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12
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Thornber K, Bashar A, Ahmed MS, Bell A, Trew J, Hasan M, Hasan NA, Alam MM, Chaput DL, Haque MM, Tyler CR. Antimicrobial Resistance in Aquaculture Environments: Unravelling the Complexity and Connectivity of the Underlying Societal Drivers. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:14891-14903. [PMID: 36102785 PMCID: PMC9631993 DOI: 10.1021/acs.est.2c00799] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 05/26/2023]
Abstract
Food production environments in low- and middle-income countries (LMICs) are recognized as posing significant and increasing risks to antimicrobial resistance (AMR), one of the greatest threats to global public health and food security systems. In order to maximize and expedite action in mitigating AMR, the World Bank and AMR Global Leaders Group have recommended that AMR is integrated into wider sustainable development strategies. Thus, there is an urgent need for tools to support decision makers in unravelling the complex social and environmental factors driving AMR in LMIC food-producing environments and in demonstrating meaningful connectivity with other sustainable development issues. Here, we applied the Driver-Pressure-State-Impact-Response (DPSIR) conceptual framework to an aquaculture case study site in rural Bangladesh, through the analysis of distinct social, microbiological, and metagenomic data sets. We show how the DPSIR framework supports the integration of these diverse data sets, first to systematically characterize the complex network of societal drivers of AMR in these environments and second to delineate the connectivity between AMR and wider sustainable development issues. Our study illustrates the complexity and challenges of addressing AMR in rural aquaculture environments and supports efforts to implement global policy aimed at mitigating AMR in aquaculture and other rural LMIC food-producing environments.
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Affiliation(s)
- Kelly Thornber
- Biosciences,
Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, United
Kingdom
- Centre
for Sustainable Aquaculture Futures, University
of Exeter, Stocker Road, Exeter EX4
4QD, United Kingdom
| | - Abul Bashar
- Department
of Aquaculture, Bangladesh Agricultural
University, Mymensingh 2202, Bangladesh
| | | | - Ashley Bell
- Biosciences,
Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, United
Kingdom
| | - Jahcub Trew
- Biosciences,
Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, United
Kingdom
| | - Mahmudul Hasan
- Department
of Aquaculture, Bangladesh Agricultural
University, Mymensingh 2202, Bangladesh
| | - Neaz A. Hasan
- Department
of Aquaculture, Bangladesh Agricultural
University, Mymensingh 2202, Bangladesh
| | - Md. Mehedi Alam
- Department
of Aquaculture, Bangladesh Agricultural
University, Mymensingh 2202, Bangladesh
| | - Dominique L. Chaput
- Biosciences,
Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, United
Kingdom
| | | | - Charles R. Tyler
- Biosciences,
Geoffrey Pope Building, University of Exeter, Stocker Road, Exeter EX4 4QD, United
Kingdom
- Centre
for Sustainable Aquaculture Futures, University
of Exeter, Stocker Road, Exeter EX4
4QD, United Kingdom
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