Containment Of Antimicrobial Resistance Research Articles

Knowledge, attitudes and practices of antimicrobial resistance awareness among healthcare workers in India: a systematic review

ObjectivesThe study was conducted to identify and compile gaps in the Knowledge, Attitudes, and Practices (KAP) regarding Antimicrobial Resistance (AMR) among healthcare workers in India.MethodsA systematic review of published literature from PubMed, Google Scholar, and Scopus databases was conducted in compliance with the PRISMA guidelines. The inclusion criteria focused on studies evaluating KAP toward AMR among various healthcare workers in India without restricting context to specific diseases. We included articles published from inception to December 2023.ResultsFollowing the inclusion criterion, 19 studies were selected for the review. The study has a cumulative sample size of 4,544 healthcare providers across India. We found that doctors and medical students have significant knowledge about AMR, followed by nurses and pharmacists. However, the attitudes toward AMR were higher among informal providers, followed by doctors and medical students. The study also observed a gap between theoretical knowledge and practical application of AMR principles among healthcare providers in India.ConclusionThe study highlights the need for targeted training and policy interventions to bridge the gap between KAP regarding AMR. Healthcare providers can significantly contribute to mitigating AMR threat by improving KAP related to AMR. This systematic review provides a foundation for developing and implementing effective evidence-based strategies to enhance AMR containment in India.

Experience of rigorous practice of antimicrobial stewardship program and its impact on antibiotic consumption

Objectives: Antimicrobial resistance (AMR) is the next pandemic with a huge global economic burden. A customized antimicrobial stewardship program (AMSP) is a well-recognized tool for containment of AMR. The current study was undertaken to identify the impact of AMSP measures on the trends of antibiotic consumption rates, e.g., defined daily dose (DDD) and days of therapy (DOT) per 100 patient days in pre-identified areas of the hospital. Materials and Methods: The present study was a case-record-based extended cross-sectional study carried out in a tertiary care institute in central India from January 2021 to September 2021. Time-bound feasible sampling was undertaken, and all cases were included without any exclusion criteria. The study was approved by the Ethics Committee of the Institute and funded by the Indian Council of Medical Research (ICMR). Statistical Analysis: The data was entered into a spreadsheet. The calculation of DDD and DOT was performed individually for each antibiotic as per WHO tool per 100 patient days. Results: In high-priority areas such as intensive care unit and high dependency unit, the top three DDD/100 days were meropenem (77.9), colistin (41.4), and piperacillin-tazobactam (13.5) versus the top 3 DOT/100 patient days were meropenem (40.5), colistin (20.9), and piperacillin-tazobactam (15.7). In low-priority areas such as general wards, the top 3 DDD/100 patient days were meropenem (45.4), piperacillin-tazobactam (22.6), and cefoperazone (5.0) versus the top three DOT/100 patient days were meropenem (45.4), cefoperazone (44.9), and piperacillintazobactam (22.6). There was a downward trend of consumption of almost all these antibiotics when measured at baseline and the next two quarters. DDD and DOT per 100 patient days had a positive linear correlation during the study period. Conclusions: The present study demonstrates about 50% reduction in consumption of ICMR priority antibiotics with a yearlong AMSP. DDD and DOT per 100 patient days can be calculated with minimal effort, even in extremely busy hospitals. DOT tools are less labor-intensive and, hence, should be the pivotal tool for antibiotic exposure measurement.

Assessment of the Implementation of Pakistan's National Action Plan on Antimicrobial Resistance in the Agriculture and Food Sectors.

The agriculture and food (agrifood) sectors play key roles in the emergence, spread, and containment of antimicrobial resistance (AMR). Pakistan's first National Action Plan (NAP) on AMR was developed to guide One Health interventions to combat AMR through 2017-2022. To improve subsequent iterations, we assessed the implementation of Pakistan's NAP in the agrifood sectors (NAPag) in October 2022, using the Progressive Management Pathway on AMR tool developed by the Food and Agriculture Organization of the United Nations (FAO). The assessment tool addressed four crucial focus areas of the NAPag: governance, awareness, evidence, and practices. Each focus area contains multiple topics, which involve four sequential stages of activities to progressively achieve systematic management of AMR risk in the agrifood sectors. High-level representatives of the NAPag stakeholders provided information for the assessment through pre-event documentary review and workshop discussions. The assessment results showed that Pakistan's NAPag had an overall moderate coverage (59%) of the anticipated activities. Gaps were particularly notable in strengthening governance, good practices, and interventions in non-livestock sectors. Furthermore, only 12% of the evaluated activities were fully executed and documented, consistently remaining at the planning and piloting stages in the livestock sector across all the examined topics. Insufficient attention to non-livestock sectors, inadequate regulation and enforcement capacity, and resource constraints have hindered scalable and sustainable interventions under the current plan. This assessment provides valuable insights to strengthen the inclusiveness and contribution of the agrifood sectors in the next NAP iteration. In the short-to-medium term, strategic prioritization is necessary to optimize the use of limited resources and target the most critical gaps, such as improving awareness among key stakeholders and fortifying regulations for prudent antimicrobial use. In the long term, integration of AMR into the country's broader health, development, and agricultural transformation agendas will be needed to generate sustainable benefits.

Health Policy Analysis on the Containment of Antimicrobial Resistance (AMR) in India: A Mixed Methods Study of Antimicrobial Stewardship as a Pivotal Intervention in Tackling AMR

Objective: This policy report aimed at two goals, that is, to report the findings of the literature review and explore the perceptions of the key stakeholders in seeking better insight into the antimicrobial stewardship program (AMSP), and to develop antimicrobial resistance (AMR) policy recommendations for the Ministry of Health and Family Welfare (MoHFW), India, based on the findings from the rapid systematic review of the literature (both published and grey) and the views of key stakeholders. Method: A mixed method approach using literature review and qualitative interviews has been applied. A rapid systematic literature review focusing on the antimicrobial stewardship pro-gram’s key achievements and its implementation and impact, implementation challenges, gaps and barriers, and opportunities, has been carried out, which has been followed by conducting interviews of key stakeholders and reporting the findings along with the recommendations. Results: The findings have shown significant progress towards AMSP, such as expanding to 90 secondary-level hospitals and district-level hospitals/nursing homes, and the Indian Council of Medical Research antimicrobial resistance surveillance and research network (ICMR AMRSN) program. Education, training, and microbiological testing have been found to be the current focus areas. However, there exist challenges, including a lack of leadership support, diagnostic stew-ardship, and staffing of clinical pharmacists and infectious control nurses. Key gaps and barriers identified include setting up microbiology laboratories and hiring ICN nurses and clinical phar-macists. Opportunities have also been identified. Based on these findings, we have made succinct recommendations to address the themes and issues identified. Conclusion: Without new medicines, India will struggle to manage antimicrobial resistance. This situation calls for national oversight. This study has demonstrated AMSP as crucial for fighting this silent pandemic. The Indian government and policymakers must swiftly address critical chal-lenges, gaps, and opportunities. These findings and recommendations might potentially strengthen the future antimicrobial resistance national action plan (AMR NAP).

Public perception and community-level impact of national action plans on antimicrobial resistance in Vietnam.

Vietnam was the first country from the WHO Western Pacific Region to adopt a national action plan (NAP) on antimicrobial resistance (AMR) in 2013. The multilayered nature of AMR requires coordination across 'One Health' sectors, dedicated financing, multistakeholder involvement, and widespread community engagement to implement the action plans. This study explores the perceived impact of NAP implementation at the community level. Key informant interviews (KIIs) were used for data collection during 2021. An interview tool was used for the KIIs and purposive sampling was used to identify study participants from Vietnam. The study participants were those engaged with a substantial scale of antimicrobial usage, diagnosis of infections or concerned with antimicrobial content in effluents in their professional life. Twelve KIIs were conducted with participants from human health, animal health and the environmental sector. The data were entered into Microsoft Excel, and manifest and latent content analysis was done. The analysis highlighted themes such as limited public awareness of AMR, ongoing capacity building and quality assurance initiatives, implementation of guidelines and regulations for AMR containment, sustained investment in improving infrastructure, and challenges relating to accountability whilst prescribing and selling antibiotics. There were many positive critical developments during the NAP implementation period in Vietnam towards AMR mitigation. For better impact, there is a need to revitalize the implementation machinery of NAPs by improving the enforcement capacity of regulations, cross-sectoral collaboration and promoting community ownership.

Ground level utility of Access, Watch, Reserve classification: Insights from a tertiary care center in North India.

The overuse and misuse of antimicrobials contribute significantly to antimicrobial resistance (AMR), which is a global public health concern. India has particularly high rates of AMR, posing a threat to effective treatment. The World Health Organization (WHO) Access, Watch, Reserve (AWaRe) classification system was introduced to address this issue and guide appropriate antibiotic prescribing. However, there is a lack of studies examining the prescribing patterns of antimicrobials using the AWaRe classification, especially in North India. Therefore, this study aimed to assess the prescribing patterns of antimicrobials using the WHO AWaRe classification in a tertiary care centre in North India. To study the prescribing patterns of antimicrobials using WHO AWaRe classification through a cross-sectional study in All India Institute of Medical Sciences Rishikesh. A descriptive, cross-sectional study was conducted from July 2022 to August 2022 at a tertiary care hospital. Prescriptions containing at least one antimicrobial were included in the study. Data on prescriptions, including patient demographics, departments, types of antimicrobials prescribed, and duration of treatment, were collected. A questionnaire-based survey was also conducted to assess the knowledge and practices of prescribing doctors regarding the utility of AWaRe classification. The study involved a total of 123 patients, each of whom received at least one antimicrobial prescription. Most prescriptions were for inpatients, evenly distributed between Medicine (Internal medicine, Pediatrics, Dermatology) and Surgical departments (General surgery and specialties, Otorhinolaryngology, Ophthalmology, Obstetrics and Gynecology). Metronidazole and ceftriaxone were the most prescribed antibiotics. According to the AWaRe classification, 57.61% of antibiotics fell under the Access category, 38.27% in Watch, and 4.11% in Reserve. Most Access antibiotics were prescribed within the Medicine department, and the same department also exhibited a higher frequency of Watch antibiotics prescriptions. The questionnaire survey showed that only a third of participants were aware of the AWaRe classification, and there was a lack of knowledge regarding AMR and the potential impact of AWaRe usage. This study highlights the need for better antimicrobial prescribing practices and increased awareness of the WHO AWaRe classification and AMR among healthcare professionals. The findings indicate a high proportion of prescriptions falling under the Access category, suggesting appropriate antibiotic selection. However, there is a significant difference between the WHO Defined Daily Dose and the prescribed daily dose in the analysed prescriptions suggesting overuse and underuse of antibiotics. There is room for improvement and educational interventions and antimicrobial stewardship programs should be implemented to enhance knowledge and adherence to guidelines, ultimately contributing to the containment of AMR.

International Conclave on AMR and Future of Antibiotics (ICAFA - 2023)

Dear Esteemed Guests, Distinguished Speakers, Honourable Delegates, and all participants of the "International Conclave on AMR and Future of Antibiotics," It is a great pleasure to extend our warmest welcome to the International Conclave on AMR and Future of Antibiotics, organized by the Department of Biological Sciences, SRM University - AP, Andhra Pradesh, in collaboration with The AMR Insights, The Netherlands, Infection Control Academy of India (IFCAI), Federation of Asian Biotech Associations (FABA), and NITTE (Deemed to be University), Mangaluru. This conference is scheduled to take place at SRM University AP, Andhra Pradesh, on November 8 and 9, 2023. The conference addresses antimicrobial resistance issues and discusses antibiotic alternatives, which are paramount in our global healthcare landscape. During this conference, leading experts worldwide and across India will join hands to combat AMR and enlighten young participants on the direction of research, policies, and the significance of antibiotic alternatives. We aim to bring together experts from UK Innovate, AMR Insights (The Netherlands), Global AMR Hub (Berlin, Germany), leading Indian experts, innovators, and stakeholders of the Andhra Pradesh state action plan for the containment of AMR. Andhra Pradesh is the fourth state in India to acknowledge the danger of AMR and proactively initiate steps toward its containment by releasing the Andhra Pradesh Action Plan for the Containment of Antimicrobial Resistance. This conference will be held in a hybrid mode, with both in-person and virtual participants, facilitating the exchange of ideas, networking opportunities, education for the younger generation, and ensuring healthcare safety through policies, awareness, and action plans. Participants, both physical and online attendees, are now important social ambassadors in the fight against the surge of AMR. This two-day conference will include keynote lectures, presentations by young scientists, panel discussions, poster and oral sessions, and interactive networking. The conference will comprise the following seven sessions: AMR in One Health, AMR and Environment, AMR and Omics, AMR – Action Plans and Policy, Alternatives to Antibiotics, AMR and Pathogen Strategies, and the Young Scientist Session. In addition to the main conference event, on November 9, 2023, three roundtables with the themes: 1) One Health, 2) Therapeutics and Vaccines, and 3) Diagnostics and Therapeutics, each lasting 90 minutes, will include experts from UK Innovate, representatives from the Andhra Pradesh Government departments involved in the state action plan, leading researchers from AIIMS Mangalagiri and other universities, and industrial partners. These roundtables will discuss several actions to be taken forward and list "Ten Mantras to Contain AMR Pathogens" – emergency response and action protocols. We quote, " நோய்நாடி நோய்முதல் நாடி அதுதணிக்கும் வாய்நாடி வாய்ப்பச் செயல்" (Kural 948) – Thirukkural, which means diagnosing the root cause of disease, identifying the correct curing, and ensuring its success. Together, we can succeed in containing AMR. Once again, we are honored to welcome you to this unique conference, and let us work towards a safe future.

Quality of Data Recording and Antimicrobial Use in a Municipal Veterinary Clinic in Ghana.

The recording of antimicrobial use data is critical for the development of interventions for the containment of antimicrobial resistance. This cross-sectional study assessed whether dissemination activities and recommendations made after an operational research (OR) study in 2021 resulted in better data recording and improved the use of antimicrobials in a rural veterinary clinic. Routinely collected data from treatment record books were compared between 2013 and 2019 (pre-OR) and from July 2021 to April 2023 (post-OR). The most common animals presenting for care in the the pre - and post OR periods were dogs (369 and 206, respectively). Overall, antimicrobial use in animals increased from 53% to 77% between the two periods. Tetracycline was the most commonly used antimicrobial (99%) during the pre-OR period, while Penicillin-Streptomycin was the most commonly used antimicrobial (65%) during the post-OR period. All animals that received care at the clinic were documented in the register during both periods. Whereas the diagnosis was documented in 269 (90%) animals in the post-OR period compared to 242 (47%) in the pre-OR period, the routes and dosages were not adequately recorded during the both periods. Therefore, the quality of data recording was still deficient despite the dissemination and the recommendations made to some key stakeholders. Recommendations are made for a standardized antimicrobial reporting tool, refresher training, and continuous supervisory visits to the clinic.

Awareness Regarding Antimicrobial Resistance and Antibiotic Prescribing Behavior among Physicians: Results from a Nationwide Cross-Sectional Survey in India.

(1) Background: Understanding the physicians' knowledge, attitudes, and antimicrobial prescribing behavior is a crucial step towards designing strategies for the optimal use of these agents. (2) Methods: A cross-sectional online survey was conducted among clinicians across India between May and July 2022 using a self-administered questionnaire in English comprising 35 questions pertaining to demographic characteristics, knowledge, attitude, and practices domains. (3) Results: A total of 544 responses were received from 710 physicians contacted. Sixty percent of participants were males, with mean age of 34.7 years. Mean ± Standard Deviation scores for knowledge, attitude, and practices domains were 8 ± 1.6, 20.2 ± 3.5, and 15.3 ± 2.1, respectively. Higher scores were associated with basic [odds ratio (95% Confidence Interval), p value: 2.95 (1.21, 7.2), 0.02], medical and allied sciences [2.71 (1.09, 6.67), 0.03], and central zone [3.75 (1.39, 10.12), 0.009]. A substantial proportion of dissatisfactory responses were found regarding hospital antibiograms, antibiotics effective against anaerobes, WHO AWaRe (access, watch, and reserve) classification of antibiotics, and the role of infection prevention and control (IPC) measures in the containment of antimicrobial resistance (AMR). (4) Conclusions: There is a need to sensitize and educate clinicians on various issues related to antimicrobial use, such as antibiograms, double anaerobic cover, IPC practices, and guideline-based recommendations, to curb the AMR pandemic.

Development, roll-out and implementation of an antimicrobial resistance training curriculum harmonizes delivery of in-service training to healthcare workers in Kenya.

Antimicrobial resistance (AMR) is an increasingly severe threat to global public health that requires action across different sectors. Selection of appropriate antimicrobials is an urgent challenge due to the emergence of drug resistance. In 2017, Kenya developed an AMR policy and National Action Plan to drive prevention and containment of AMR. A priority activity under AMR surveillance strategic objective was to develop a national AMR training curriculum for in-service healthcare workers. In this paper we discuss the development process, gains achieved through implementation across the country and lessons learned. An initial stakeholders' forum was convened to brainstorm on the process for developing the curriculum and some issues deliberated upon include the design approach, development roadmap, curriculum outline and scope, delivery, and evaluation methodologies. A dedicated team of subject matter experts (SMEs), drawn from the project and government ministries, compiled the initial draft of the curriculum and later the training materials. A series of other stakeholders' meetings were convened to review these materials. The National Antimicrobial Stewardship Interagency Committee (NASIC) of the MOH in Kenya identified a team of experts from academia, research, and government to work with the SMEs in reviewing and providing valuable inputs to the curriculum. Additionally, principles of adult learning and a One Health approach for development were considered as AMR has drivers and impacts across sectors. A validation workshop was held to finalize the documents with a formal launch conducted during the World Antibiotics Awareness Week of 2020. A multisectoral AMR surveillance training curriculum and facilitator and trainee manuals were developed and endorsed by MOH and Ministry of Agriculture, Livestock, Fisheries and Cooperatives within one year. Over 500 healthcare workers in 19 counties were trained, with overwhelming adoption by other stakeholders in Kenya and beyond. This curriculum was developed to standardize training for AMR detection and surveillance. The central role played by the MOH ensured expeditious development and roll-out of this curriculum. The in-service curriculum, now available on an e-learning platform, provides a ready opportunity to build capacity of healthcare professionals. Additional resources are needed to standardize and scale these efforts to reach all healthcare workers.

The aftermath of corona virus disease on antimicrobial resistance across low- and middle-income countries

Antimicrobial resistance (AMR) poses a critical challenge to modern medicine. The number of resistance cases worldwide has been increasing exponentially, and it is estimated that by 2050, the AMR mortality rate will be ten times higher than it is today. The emergence of the coronavirus disease 2019 (COVID-19) pandemic compromised the research on AMR by deprioritizing proper monitoring of preventive measures and control programs, innovation and global health programs, and use antimicrobial stewardship (AS). With the current scenario of sporadic COVID-19 cases around the world, it is impossible to accurately evaluate the impact that the pandemic had on AMR and AS due to insufficient reports. However, it’s possible to speculate what the scenario will look like by surveying the escalation in unmethodical antimicrobial, the increase in secondary bacterial and fungal infections, and the extension in hospital stay and adverse medical exigency during the second wave when compared to the first wave. COVID-19 exposed the harsh reality that even countries with the best medical facilities struggled to meet national healthcare needs during a pandemic. In such circumstances, the clinical and scientific communities need to understand that available global medical amenities wouldbe insufficient to face an upcoming AMR pandemic. Therefore, international surveillance systems need to highlight the deficiencies in AMR containment and mitigation and develop strategies to address future challenges.

The association between ambient temperature and antimicrobial resistance of Klebsiella pneumoniae in China: a difference-in-differences analysis.

Antimicrobial resistance (AMR) of Klebsiella pneumoniae (K. pneumoniae) poses a significant global public health threat and is responsible for a high prevalence of infections and mortality. However, knowledge about how ambient temperature influences the AMR of K. pneumoniae is limited in the context of global warming. AMR data of 31 Chinese provinces was collected from the China Antimicrobial Resistance Surveillance System (CARSS) between 2014 and 2020. Socioeconomic and meteorological data were collected from the China Statistical Yearbook during the same period. A modified difference-in-differences (DID) approach was applied to estimate the association between ambient temperature and third-generation cephalosporin-resistant K. pneumoniae (3GCRKP) and carbapenem-resistant K. pneumoniae (CRKP). Furthermore, moderating effects of socioeconomic factors were also evaluated. Every 1°C increase in annual average temperature was associated with a 4.7% (relative risk (RR):1.047, 95% confidence intervals (CI): 1.031-1.082) increase in the detection rate of 3GCRKP, and a 10.7% (RR:1.107, 95% CI: 1.011-1.211) increase in the detection rate of CRKP. The relationships between ambient temperature and 3GCRKP and CRKP were found to be moderated by socioeconomic status (GDP per capita, income per capita, and consumption per capita; the interaction p-values <0.05), where higher economic status was found to strengthen the effects of temperature on the detection rate of 3GCRKP and weaken the effects on the detection rate of CRKP. Ambient temperature was found to be positively associated with AMR of K. pneumoniae, and this association was moderated by socioeconomic status. Policymakers should consider the impact of global warming and high temperatures on the spread of 3GCRKP and CRKP when developing strategies for the containment of AMR.

Влияние антибиотика и фитобиотика на состояние здоровья, продуктивность кур-несушек и качество яйца

Abstract. The study of phytobiotics application is one of the topical directions in the strategy of antimicrobial resistance containment. The aim of this work was to study the effects of separate and combined use of enrofloxacin and phytobiotic drugs in 400-day-old laying hens. Methods. The studies were conducted on four groups of Loman-classic layers; in the course of the experiment, enrofloxacin and a phytobiotic based on sea buckthorn cake and mustard, cedar and sea buckthorn oils were introduced into the diet. Results. It was found that the use of drugs had no significant effect on the composition of microflora and the level of antibiotic resistance of gastrointestinal bacteria in chickens because by the age of 400 days the intestinal microbiomes of laying hens were already formed, stable and contaminated with AMR agents. Also when combining antibiotic and phytobiotic there was an increase in egg laying rate, average egg weight, accelerated excretion of enrofloxacin from the body of layers and reduction of its content in the egg to the detection limit. While in the group of laying hens receiving only enrofloxacin, its residual content in the egg was detected 2 weeks after cessation of its introduction. Thus, in the course of this research, the most optimal was the combined use of enrofloxacin with a phytobiotic drug, which had the most noticeable positive effect on metabolic parameters, productivity and egg quality. The novelty of the work is to obtain data on the effect of phytobiotic drug on a number of health indicators, productivity of laying hens and egg quality, and the selection of promising scheme of its use.

Moving from assessments to implementation: promising practices for strengthening multisectoral antimicrobial resistance containment capacity

BackgroundAntimicrobial resistance (AMR) poses a global threat to human, animal, and environmental health. AMR is a technical area in the Global Health Security Agenda initiative which uses the Joint External Evaluation tool to evaluate national AMR containment capacity. This paper describes four promising practices for strengthening national antimicrobial resistance containment capacity based on the experiences of the US Agency for International Development’s Medicines, Technologies, and Pharmaceutical Services Program work with 13 countries to implement their national action plans on AMR in the areas of multisectoral coordination, infection prevention and control, and antimicrobial stewardship.MethodsWe use the World Health Organization (WHO) Benchmarks on International Health Regulations Capacities (2019) to guide national, subnational, and facility actions that advance Joint External Evaluation capacity levels from 1 (no capacity) to 5 (sustainable capacity). Our technical approach is based on scoping visits, baseline Joint External Evaluation scores, benchmarks tool guidance, and country resources and priorities.ResultsWe gleaned four promising practices to achieve AMR containment objectives: (1) implement appropriate actions using the WHO benchmarks tool, which prioritizes actions, making it easier for countries to incrementally increase their Joint External Evaluation capacity from level 1 to 5; (2) integrate AMR into national and global agendas. Ongoing agendas and programs at international, regional, and national levels provide opportunities to mainstream and interlink AMR containment efforts; (3) improve governance through multisectoral coordination on AMR. Strengthening multisectoral bodies’ and their technical working groups’ governance improved functioning, which led to better engagement with animal/agricultural sectors and a more coordinated COVID-19 pandemic response; and (4) mobilize and diversify funding for AMR containment. Long-term funding from diversified funding streams is vital for advancing and sustaining countries’ Joint External Evaluation capacities.ConclusionsThe Global Health Security Agenda work has provided practical support to countries to frame and conduct AMR containment actions in terms of pandemic preparedness and health security. The WHO benchmarks tool that Global Health Security Agenda uses serves as a standardized organizing framework to prioritize capacity-appropriate AMR containment actions and transfer skills to help operationalize national action plans on AMR.

Analysis of Cumulative Antibiotic Sensitivity Testing Data (Antibiogram) of Anwer Khan Modern Medical College Hospital

Background: Monitoring of antimicrobial resistance at local level is a very crucial aspect for clinical decision making, infection control interventions and antimicrobial-resistance containment strategies in this era of rising superbugs. The hospital antibiogram constructed by standardized method is a summary of antimicrobial susceptibilities of local bacterial isolates, with periodic review.&#x0D; Methods: This is a prospective observational study conducted in Microbiology Laboratory of Anwer Khan Modern Medical College Hospital (AKMMCH) over a period of three months from January to March 2021. All the samples which were received in the microbiology laboratory for aerobic bacterial culture and antibiotic sensitivity testing were considered in this study. The bacterial isolates from diagnostic clinical samples were subjected to culture in appropriate media for isolation of pathogens by standard methods and antibiotic sensitivity test (AST) was performed according to CLSI guidelines by modified Kirby Bauer disk diffusion techniques.&#x0D; Results: A total of 2917 samples were analysed in the microbiology department of AKMMCH for a period of three months of which 513(17.59%) were culture positive.Among the cultured samples of urine, respiratory sample, blood and pus, wound swabs, the rate of bacterial isolation was 266 (51.85%) ,161 (31.38%), 31 (6.04%) and 33 (6.4%) respectively. Most of the clinical isolates were Gram-negative bacilli404 (78.75%). The predominant isolate was Escherichia coli 186(36.26%) followed by Pseudomonas spp 102 (19.88%), Klebsiellaspp 79 (15.4%) and S. aureus 66 (12.87%). Antibiotic sensitivity in case of Gram-negative bacteria ranges from 30%-61% to amoxicillin-clavulanic acid, 18%-94% to third generation cephalosporin, 47%-75% to aminoglycosides, 27% -70% to ciprofloxacin, 26-70% to cotrimoxazole, 33-73% to nitrofurantoin, 27-69% to piperacillin- tazobactam and 100% to colistin. However, 53% of Escherichia coli and 58% of Klebsiella spp. were resistant to 3rd generation cephalosporins due to extended-spectrum beta-lactamase (ESBL) production. The carbapenem resistance in Escherichia coli was found 12%, Klebsiella spp 26%, Pseudomonas spp 29% and highest in Acinetobacter 46%. No superbug was detected in this study period.&#x0D; Conclusions: Antimicrobial susceptibility of various pathogen for different antibiotic is variable. Prompt antimicrobial therapy in an infection makes a lot of difference between recovery and death and most of the time prevents long term disability. Hence, antibiotic policy is one of the mandatory requirements and making an antibiogram is the first step before framing antibiotic policy.&#x0D; AKMMC J 2021; 12(2): 70-75

A qualitative approach for a situation analysis of AMR risks in the food animal production sector.

In response to the need to manage Antimicrobial Resistance (AMR), countries have produced National Action Plans (NAPs), which require detailed information of the AMR situation in all sectors. Considering the limited information that is publicly available for an analysis of the AMR situation in animal production, the FAO Regional Office for Latin America and the Caribbean (FAO RLC) developed the "FAO tool for a situation analysis of AMR risks in the food and agriculture sectors." The objective of this paper is to present the methodology developed for a qualitative evaluation of the risk factors of AMR toward animal and human health, based on terrestrial and aquatic production systems and their associated national public and private mitigation measures. The tool was developed reflecting the AMR epidemiological model and the guidelines to conduct a risk analysis of AMR from the Codex Alimentarius and WOAH. Applied in four stages of progressive development, the objective of the tool is to provide a qualitative and systematic assessment of the risks of AMR from animal production systems, to animal and human health, and to identify gaps in cross cutting factors in AMR management. The tool consists of three instruments: (i) a survey to collect data for a situation analysis of AMR risks; (ii) a methodological procedure for the analysis of the information obtained; (iii) instructions for the preparation of a national roadmap for the containment of AMR at a national level. Based on the results from the information analysis, a roadmap is prepared by guiding and prioritizing the needs and sectoral actions for the containment of AMR under an intersectoral, multidisciplinary and collaborative approach, and according to country priorities and resources. The tool helps to determine, visualize and prioritize the risk factors and challenges that contribute to AMR from the animal production sector and that need to be addressed to manage AMR.

Evidence of Antimicrobial Resistance in Bats and Its Planetary Health Impact for Surveillance of Zoonotic Spillover Events: A Scoping Review.

As a result of the COVID-19 pandemic, as well as other outbreaks, such as SARS and Ebola, bats are recognized as a critical species for mediating zoonotic infectious disease spillover events. While there is a growing concern of increased antimicrobial resistance (AMR) globally during this pandemic, knowledge of AMR circulating between bats and humans is limited. In this paper, we have reviewed the evidence of AMR in bats and discussed the planetary health aspect of AMR to elucidate how this is associated with the emergence, spread, and persistence of AMR at the human-animal interface. The presence of clinically significant resistant bacteria in bats and wildlife has important implications for zoonotic pandemic surveillance, disease transmission, and treatment modalities. We searched MEDLINE through PubMed and Google Scholar to retrieve relevant studies (n = 38) that provided data on resistant bacteria in bats prior to 30 September 2022. There is substantial variability in the results from studies measuring the prevalence of AMR based on geographic location, bat types, and time. We found all major groups of Gram-positive and Gram-negative bacteria in bats, which are resistant to commonly used antibiotics. The most alarming issue is that recent studies have increasingly identified clinically significant multi-drug resistant bacteria such as Methicillin Resistant Staphylococcus aureus (MRSA), ESBL producing, and Colistin resistant Enterobacterales in samples from bats. This evidence of superbugs abundant in both humans and wild mammals, such as bats, could facilitate a greater understanding of which specific pathways of exposure should be targeted. We believe that these data will also facilitate future pandemic preparedness as well as global AMR containment during pandemic events and beyond.

Carbapenem resistance in critically important human pathogens isolated from companion animals: a systematic literature review.

This study aimed to describe the presence and geographical distribution of Gram-negativebacteria considered critical on the priority list of antibiotic-resistant pathogens publishedby the World Health Organization, including carbapenem-resistant Enterobacteriaceae,carbapenem-resistant Acinetobacter spp., and carbapenem-resistant Pseudomonas aeruginosa.A systematic review of original studies published in 5 databases between 2010 and 2021 wasconducted, including genotypically confirmed carbapenem-resistant isolates obtained fromcanines, felines, and their settings. Fifty-one articles met the search criteria. Carbapenemresistant isolates were found in domestic canines and felines, pet food, and on veterinarymedical and household surfaces. The review found that the so-called "big five"-that is, the5 major carbapenemases identified worldwide in Enterobacterales (New Delhi metallo-βlactamase, active-on-imipenem, Verona integron-encoded metallo-β-lactamase, Klebsiellapneumoniae carbapenemase, and oxacillin [OXA]-48-like)-and the 3 most importantcarbapenemases from Acinetobacter spp. (OXA-23-like, OXA-40-like, and OXA-58-like) hadbeen detected in 8 species in the Enterobacteriaceae family and 5 species of glucose nonfermenting bacilli on 5 continents. Two publications used molecular analysis to confirmcarbapenem-resistant bacteria transmission between owners and dogs. Isolating criticallyimportant human carbapenem-resistant Gram-negative bacteria from domestic canines andfelines highlights the importance of including these animal species in surveillance programsand antimicrobial resistance containment plans as part of the One Health approach.

Existing Policies/Guidelines on the Environmental Dimension of Antimicrobial Resistance in India: An Insight into the Key Facets through Review and SWOT Analysis.

Antimicrobial resistance (AMR) is a multidimensional phenomenon. The environment acts as a mixing pot of drug-resistant bacteria from many sources such as pharmaceutical, biomedical, veterinary, and agricultural sectors. In this study, we analysed the existing AMR-related policies/guidelines/legislations in India in the above domains and how the current practices are being guided by them. We used a convergent parallel mix method design. Quantitative data were collected through a review of policies/guidelines/legislations in the said domains and analysed using the SWOT tool parallelly supported by key informant interviews of domain-specific stakeholders. Altogether, 19 existing AMR policies/guidelines/legislations were identified. The existence of few policies/guidelines in each domain indicated the evolving environment for policy interventions. However, the lack of capacity among farmers, inadequate provision for structured capacity building, high cost of alternatives to antimicrobials, and lack of provision of incentivisation in case of crop failure were identified as the major weaknesses prevalent across the domains. Opportunities for policy refinements/the introduction of new policies are ample. However, easy access to antimicrobials and injudicious use imposes threats to AMR containment in all sectors. Despite having a few policies for the containment of AMR, their implementation witnesses challenge due to the lack of collaborative approaches, the existence of policies disjointed from ground reality, infrastructural issues, and the lack of capacity and resources.

PENICILLIN: A JOURNEY FROM A MAGIC BULLET TO A RESISTANT DRUG

PENICILLIN: A JOURNEY FROM A MAGIC BULLET TO A RESISTANT DRUG