Green Nano-semiconductors and Nanometals to Avert Complex Phenomena of Antimicrobial Resistance (AMR)

Antimicrobial Use and Resistance in Eight US Hospitals: Complexities of Analysis and Modeling

1The Review on AMR was an expert panel commissioned by the UK Government in 2014 tasked with analysing the economic and social impacts of AMR and proposing solutions to these. 2NICE is a UK non-departmental public body that sponsored by but separate from the Department of Health that produces evidence-based guidance for health practitioners. 3NHS England is a non-departmental public body sponsored by the Department of Health that oversees planning and delivery of health services in England. 4Note that circulation of the News of the World ceased in July 2011; the Sun on Sunday was launched by the same newsgroup in 2012, but is unavailable on the Nexis database.

Making sense of antimicrobial use and resistance surveillance data: application of ARIMA and transfer function models

Objective The aim of the present study was to describe the process of establishment and coordination of the national Antimicrobial Use and Resistance in Australia (AURA) surveillance system. Methods Existing surveillance programs conducted by health organisations at state or multi-jurisdictional levels were reviewed, and gaps and opportunities identified for the development of a national system. In view of the time frame available as part of the Australian Government Department of Health funding agreement, the strategy used by the Australian Commission on Safety and Quality in Health Care was to commence work with existing surveillance programs, expanding and enhancing them and developing new systems where gaps were identified. Using the specifications of the AURA national system, the data from each of these elements were then analysed and reported. The system provides coverage for the acute and community sectors for antimicrobial use and antimicrobial resistance. Results The AURA surveillance system integrates eight streams of surveillance activities, including passive and targeted surveillance of antimicrobial use and resistance from hospitals (public and private) and the community (general practitioners and aged care homes). A gap was identified in timely surveillance of critical antimicrobial resistances (CARs), which resulted in the development of the national CARAlert system. The first comprehensive analyses of data across the surveillance programs was published in June 2016, providing baseline data for future reports to build on. Conclusion The AURA surveillance system has established the framework and foundation systems for an integrated and comprehensive picture of both antimicrobial use and resistance in Australia over time. National coordination and support will improve data collection, standardisation and analysis, and will facilitate collaboration across the states and territories, the Australian Government and the private sector. AURA publications will inform policy development and clinical decision making and improve consumer awareness of antimicrobial use and resistance. The system will continue to develop as a comprehensive system, with additional data over time, and appropriate clinical and epidemiological review. What is known about this topic? Surveillance of antimicrobial use and resistance is critical to inform effective policy development and public health responses to the growing problem of antimicrobial resistance. Until now, surveillance of antimicrobial use and resistance in Australia has been fragmented, with state and territory and professional group differences in data collection, analysis and reporting. What does this paper add? This paper profiles the development of the AURA surveillance system, the first nationally coordinated surveillance system for antimicrobial use and resistance, and its use of a partnership approach with contributing programs in order to promote participation and to obtain data to inform strategies to prevent and contain antimicrobial resistance. This paper highlights the establishment phase, noting that the system continues to be improved with growing participation from all sectors. What are the implications for practitioners? National surveillance data from the AURA surveillance system provides evidence for action to guide improvements in infection control, antimicrobial prescribing and the prevention and control of antimicrobial resistance across all healthcare sectors. It will also enable trends to be identified and reported on, and have the capability of determining the effect of interventions to improve and rationalise antimicrobial prescribing.

The study aims to demonstrate the antimicrobial and disinfectant resistance phenotypes and genotypes of Escherichia coli isolates obtained from giant pandas (Ailuropoda melanoleuca). Antimicrobial testing was performed according to the standard disk diffusion method. The minimal inhibitory concentrations (MICs) of disinfectants were determined using the agar dilution method. All isolates were screened for the presence of antimicrobial and disinfectant resistance genes and further analysed for genetic relatedness by pulse-field gel electrophoresis (PFGE). Results showed that 46·6% of the isolates were resistant to at least one antimicrobial. Escherichia coli isolates showed resistance to fewer antimicrobials as panda age increased. Among antimicrobial-resistant E. coli isolates, the antimicrobial resistance genes blaCTX-M (88·2%) and sul1 (92·3%) were most prevalent. The disinfectant resistance genes emrE, ydgE/ydgF, mdfA and sugE(c) were commonly present (68·2-98·9%), whereas qac and sugE(p) were relatively less prevalent (0-21·3%). The frequencies of resistance genes tended to be higher in E. coli isolated in December than in July, and PFGE profiles were also more diverse in isolates in December. The qacEΔ1 and sugE(p) genes were higher in adolescent pandas than in any other age groups. PFGE revealed that antimicrobial resistance correlated well with sampling time and habitat. This study demonstrated that antimicrobial and disinfectant resistance was common in giant panda-derived E. coli, and the antimicrobial resistance was associated with sampling time and habitat. Escherichia coli could serve as a critical vector in spreading disinfectant and antimicrobial resistance. This is the first study that demonstrated the phenotypic and genetic characterizations of antimicrobial and disinfectant resistance in E. coli isolates from more than 60 giant pandas. Frequent transfer of pandas to other cages may lead to the dissemination of antimicrobial resistance. The study highlights the need for regularly monitoring the antimicrobial and disinfectant resistance in bacteria from giant pandas.

Antimicrobial resistance: the Hydra among us

Background Antimicrobial Resistance (AMR) is a critical global public health concern, demanding effective tools for research, data analysis, and decision-making. This study proposes a groundbreaking approach to empower the global AMR research community by introducing interactive Geographic Information System (GIS) dashboards. These dashboards aim to facilitate comprehensive data analysis of AMR across multiple countries, providing insights into antimicrobial usage (AMU), resistance patterns, and geographic distribution. Methods The approach involves developing GIS dashboards that integrate and harmonize AMR data from diverse sources, including clinical laboratories, surveillance networks, and public health agencies. A comprehensive dashboard was created to encompass data from multiple countries, providing advanced analysis and visualization tools. Another dashboard was developed with a specific focus on Kenya and Uganda to enable comparative analysis of AMR within these regions. Additionally, a simulated dataset for Kampala, Uganda, was generated to address data gaps in this area. Results The GIS dashboards serve as powerful tools for visualizing and analyzing AMR-related datasets, providing stakeholders with a comprehensive view of the global AMR landscape. These dashboards offer valuable insights into antimicrobial usage, resistance patterns, and geographical distribution. The centralized platform facilitates data exploration and analysis, aiding researchers, policymakers, and healthcare professionals in making informed decisions to combat AMR. Conclusions In conclusion, the study demonstrates that the developed GIS dashboards empower stakeholders by providing valuable insights and informed decision-making capabilities. The dashboards serve as essential tools for addressing the global challenge of AMR, allowing for a deeper understanding of the problem and informing effective strategies. The approach outlined in this study has the potential to significantly contribute to the ongoing efforts to combat AMR on a global scale.

IntroductionAntimicrobial resistance is still not given enough attention and the public is insufficiently aware of its existence, leading to behaviour, which propagates the rise of antimicrobial resistance (AMR). One of the objectives of Tanzania's national action plan on antimicrobial resistance is to improve awareness and understanding of antimicrobial use and resistance through effective communication, education and training. This task will need involvement of many stakeholders and sectors.ObjectivesTo assess the knowledge, attitudes and practices toward antimicrobial use and resistance among students in three secondary schools in Dodoma city.MethodsFor this interventional pre-post comparative study, data were collected before and after training on antimicrobial use and resistance. Secondary school students from Mkonze, Merriwa and Kiwanja cha Ndege secondary school who are members of AMR school clubs participated. Training included classroom teaching and arts and crafts. We used quantitative and qualitative data collection methods by using self-administered paper-based structured coded questionnaires delivered to the students with the supervision of school guardians. Analysis was done through Excel and SPSS.ResultsThree aspects were investigated: awareness of ways to reduce AMR; knowledge that antibiotics cannot be used to treat flu and factors that contribute to AMR. Before the training knowledge of these was below 37%. Three months after the training knowledge had increased to above 90%.ConclusionsTraining of secondary school students significantly improved awareness, knowledge and attitude regarding antimicrobial use and antimicrobial resistance. AMR school clubs are an effective vehicle to raise awareness and mitigate the AMR crisis. Focus on students will lead to wider awareness in the community.Table 1.Shows three aspects investigated: awareness of ways to reduce AMR; knowledge that antibiotics cannot be used to treat flu and factors that contribute to AMRAspect investigatedBefore trainingAfter trainingMeasure%Measure%Can antibiotics be used to treat flu?Yes38.3Yes90.6No50.0No5.6I don't know11.7I don't know3.6Knowledge on practices and behaviour that contribute to AMRAware31.2Aware99.3Not aware69.8Not aware0.7Knowledge on the consequences of AMRAware31.1Aware98.6Not aware69.9Not aware1.40

Background Antimicrobial Resistance (AMR) is a critical global public health concern, demanding effective tools for research, data analysis, and decision-making. This study proposes a groundbreaking approach to empower the global AMR research community by introducing interactive Geographic Information System (GIS) dashboards. These dashboards aim to facilitate comprehensive data analysis of AMR across multiple countries, providing insights into antimicrobial usage (AMU), resistance patterns, and geographic distribution. Methods The novel approach involves the development of GIS dashboards that integrate and harmonize data from diverse sources, including clinical laboratories, surveillance networks, and public health agencies. Objective 1 focuses on creating a dashboard encompassing all countries, offering comprehensive data analysis capabilities and visualization tools. Objective 2 entails building a focused dashboard specifically for Kenya and Uganda, allowing for comparative analysis of AMR in these regions. Objective 3 involves the generation of a simulated dataset for Kampala, Uganda, addressing data limitations in that specific area. Results The GIS dashboards serve as powerful tools for visualizing and analyzing AMR-related datasets, providing stakeholders with a comprehensive view of the global AMR landscape. These dashboards offer valuable insights into antimicrobial usage, resistance patterns, and geographical distribution. The centralized platform facilitates data exploration and analysis, aiding researchers, policymakers, and healthcare professionals in making informed decisions to combat AMR. Conclusions In conclusion, the study demonstrates that the developed GIS dashboards empower stakeholders by providing valuable insights and informed decision-making capabilities. The dashboards serve as essential tools for addressing the global challenge of AMR, allowing for a deeper understanding of the problem and informing effective strategies. The approach outlined in this study has the potential to significantly contribute to the ongoing efforts to combat AMR on a global scale.

Assessing knowledge, attitudes, and risk perception of Nigerian broiler grow-out farmers (n = 152) to antimicrobial resistance (AMR) with a five sectional purposive-structured-questionnaire: demographics; knowledge; attitudes; risk-perception; and response to regulation of antimicrobial practices. Data were analyzed using descriptive statistics, chi-square test, and binary logistic regression. Respondents’ knowledge score, in total, was lower than average, with all (100%) respondents having the understanding that antibiotics kill/reduce bacteria, most participants (>73%) believing that feeding antibiotics to broiler chickens is a necessity for weight gain, and many (>69%) thinking that no negative side-effects exist with the use of antibiotics. Poor attitude towards antimicrobial usage was prevalent (>63%) with unsatisfactory performance in most instruments: >60% of farmers reported using antimicrobials every week and still use antimicrobials when birds appear sick, and most (>84%) arbitrarily increase the drug dosages when used. However, a satisfactory performance score was reported (68%) in risk perception of AMR with >63% perceiving that inappropriate use of antibiotics is the main factor causing the emergence of resistant bacteria; >65.8% expressed that AMR in broiler chickens is not essential for public health, that AMR cannot develop from broiler bacteria diseases, that increasing the frequency of antimicrobial use cannot increase AMR in future, and that usage cannot lead to antibiotic residue in broiler-meat products leading to AMR development in human. None of the respondents were aware of any regulation for monitoring antimicrobial use. Significant factors associated with knowledge, attitudes, and risk perception of antimicrobial use and resistance among broiler grow-out farmers include marital status, farm category, education, educational specialization, sales target, growth duration/cycle, broiler stocking batch, and feed source. Identified gaps exist in AMR awareness among Nigerian broiler farmers and should be targeted through stakeholders’ participation in combatting AMR threats.

Antimicrobial resistance: a top ten global public health threat.

Antimicrobial Use and Resistance in Pigs and Chickens: A Review of the Science, Policy and Control Practices from Farm to Slaughter – Executive Summary

Antimicrobial resistance (AMR) in bacteria is the end result of a multitude of factors. Some of the key factors beyond innate resistance include antimicrobial selective pressure (1–5), acquisition of a foreign genetic resistance element(s) (1–5), clonal dissemination (1) and new mutations (2,3,5); factors vary for different species and geographical locations. Increased global antimicrobial use is the foremost reason for the spread of AMR in the community setting (1). Social networks of individuals (households, schools and child care facilities) have served both as a reservoir for these bacteria and as a common route for their transmission. Similarly, hospitals, nursing homes and long-term care facilities have also served as reservoirs for antibiotic-resistant organisms, and the discharge of patients from these facilities contributes to the spread of resistance within communities. In addition, the use of antimicrobials in food animals has been an important contributing cause (1).

Background: Educational interventions targeting undergraduate medical students provide a great opportunity to strengthen the efforts to promote rational prescribing and to decrease antimicrobial resistance. A better understanding of knowledge and beliefs of students about issues of antimicrobial use and resistance, and analysing the improvement after educational session, can assist in devising an effectively tailored educational intervention. The objective of this study was to comparison of knowledge and attitude about antimicrobial prescribing and awareness about resistance amongst medical, dental and nursing undergraduates before and after an educational session on antimicrobial use and resistance. Methods: A pre-validated questionnaire on knowledge and attitude about antimicrobial use and resistance was distributed to second year medical (80), dental (61) and nursing (37) students before and after an educational session. Results obtained were compared within and between the groups by using paired t-test and one-way ANOVA respectively. P-value<0.05 was considered to be statistically significant. Results: All groups showed statistically significant improvement in knowledge and attitude scores following the session on antimicrobial use and resistance (P<0.001). Post-session attitude scores of medical students were better than that of dental and was statistically significant (P=0.006). The pre-session evaluation showed that medical students had better knowledge and attitude about antimicrobial use and resistance as compared to dental (P<0.001) and nursing students(P<0.001). Conclusions: Significant improvement in attitude and basic knowledge following an educational session about antimicrobial prescribing and awareness about antimicrobial resistance in undergraduate students suggest establishment of special course on rational prescription of antimicrobials in undergraduate curriculum.

To evaluate the relation between antimicrobial use and resistance in intensive-care unit (ICU) and non-ICU inpatient areas in eight US hospitals. We determined antimicrobial use in terms of defined daily doses, antimicrobial-use density (defined daily doses/1,000 patient days), and percentage resistance for five antimicrobial-organism combinations in the ICU and non-ICU inpatient areas of eight US hospitals participating in project Intensive Care Antimicrobial Resistance Epidemiology. Antimicrobial resistance and use varied tremendously among the eight hospitals. Antimicrobial resistance among these five nosocomial pathogens was significantly higher within the inpatient setting of these hospitals, compared with the outpatient setting. One hospital consistently ranked highest for use of all classes of antimicrobials examined. High antimicrobial use was not associated necessarily with high resistance for a particular antimicrobial-organism pair. Antimicrobial use varied significantly across these hospitals, but generally was higher in ICUs. These results suggest that concomitant surveillance of both antimicrobial resistance and antimicrobial use is helpful in interpreting antimicrobial resistance in a hospital or ICU and that further analysis is required to determine the role of variables other than antimicrobial use in a statistical model for predicting antimicrobial resistance.