Containment Of Antimicrobial Resistance Research Articles

PHP2 - Schools' Perspective on Promoting Rational use of Antibiotics in New Delhi, India – A Qualitative Study

At community level, inappropriate antibiotic usage effected through factors like misinformed notions on antibiotics and self-medication are major factors contributing to antimicrobial resistance (AMR). The most malleable user group at community level is students. Teachers can have a deep impact on students who are both current and future users of antibiotics as well as influential advisors to parents. Hence, this study targeted high school students as well as teachers to assess their baseline knowledge, attitude and practices towards antibiotic use, acknowledging the role of schools in contributing to a sustainable mitigation of AMR. Five focus group discussions (FGDs) with high school students (class 9-11) and five with teachers were conducted in 2 private and 3 public schools in five municipal wards of Delhi. Qualitative data on antibiotic knowledge and behaviors with respect to antibiotics use were collected. There were 4-8 persons per FGD of teachers and 15-20 persons per student FGD. The findings had been previously analyzed but were re-analyzed in-depth to understand the imbalance in power relation between doctors and patients and strategies to improve antibiotic use. Emerging themes were: desire to get instant cure with some ‘strong medicines’; self-medication; using old prescriptions; unequal power relation between doctor and patient so patients cannot ask question; doctors do not/ are perceived by the group that do not undertake proper history/examination/proper counseling. Strategies suggested for improving use of antibiotics: awareness through mass media and also involving school teachers, students and celebrities as was done for polio program; school curriculum to include AMR and appropriate use of antibiotics; training the doctors for counseling and interactive with patients; and stricter regulation for labeling and selling for antibiotics. School education programs and public education could be used to promote behavior change with regard to antibiotic use and AMR containment.

Laboratory systems as an antibacterial resistance containment tool in Africa.

IntroductionAs crucial as clinical laboratories are to preventing, identifying and managing resistance problems, laboratory scientists are among the most overlooked stakeholders. This review outlines the contributions that diagnostic laboratory systems should make toward all five of the World Health Organization’s 2015 strategic objectives for antimicrobial resistance containment.Laboratory systems in resistance containmentAntimicrobial susceptibility testing and surveillance are central to antibacterial resistance management and control and need to be implemented more commonly and closer to sick patients. However, the scope of tests that promote judicious antimicrobial use extend beyond susceptibility testing. Laboratory tests for pathogens or their associated biomarkers confirm or rule out specific causes of signs and symptoms associated with infection. Laboratory systems also provide critical support to infection control programmes. All of these functions promote rational antimicrobial use and contain the spread of resistance. Routine laboratory data supports the development of vaccines and other technologies that could ease the pressure placed by antimicrobials. Laboratories are also a rich source of information for health professionals, policymakers and the general public about the urgency of the resistance problem and progress in containing it.ConclusionLaboratory systems are integral to antimicrobial resistance containment and contributions from African laboratories to addressing resistance need to be enhanced.

Thailand Antimicrobial Resistance Containment and Prevention Program.

The Thailand Antimicrobial Resistance (AMR) Containment and Prevention Program was founded to develop, co-ordinate and implement AMR Containment and Prevention (AMRCP) operational actions in Thailand following the 'One Health' approach. This article summarises the ten AMRCP operational actions initiated during the initial phase of the programme from 2012 to 2016: estimating the national AMR burden; establishing the dynamics of AMR chains to understand how AMR in Thailand develops and spreads; developing a national AMRCP infrastructure; developing laboratory and information technology systems for surveillance of AMR, antibiotic use and hospital-acquired infections; regulating the use and distribution of antibiotics in humans and food animals; generating local evidence for promoting responsible use of antibiotics and efficient practices for infection prevention and control; designing AMRCP campaigns; creating an AMRCP package; implementing the AMRCP package in selected pilot communities; and conducting research and development on diagnostics, therapy and prevention of antimicrobial-resistant bacterial infections. The programme's core campaign is to stop producing AMR by promoting responsible use of antibiotics, and to stop the acquisition and transmission of AMR by promoting good sanitation and hygiene as well as compliance with infection control and prevention practices.

Twitter: A tool to improve healthcare professionals’ awareness of antimicrobial resistance and antimicrobial stewardship

The World Health Organization urges international collaboration for the containment of antimicrobial resistance (AMR) or ‘superbugs’. If left unchecked, AMR could result in 4.1 million deaths in Africa by 2050. Furthermore, without effective antibiotics, surgical procedures would become much riskier and in many cases impossible. Antimicrobial stewardship requires a multidisciplinary approach; however, many programmes still struggle to achieve the ‘reach’ required to educate and engage all healthcare providers (HCPs). Twitter use among South Africans has grown by 129% in 12 months, from 2.4 million to 5.5 million. HCPs can use Twitter to network and connect with worldwide experts, obtain real-time news from medical conferences, participate in live Twitter chats conducted by experts or medical organisations, or participate in international journal clubs. Used responsibly and professionally, Twitter can spread the call to action and connect frontline healthcare professionals to help win the battle against AMR.

Antimicrobial potency assay of common antibiotics collected from different drug stores in Dhaka Metropolis

Antibiotic, known as the magic bullet, was developed to control the growth of pathogenic bacteria. Efficacy of an antibiotic depends on its target site on bacteria. The current public health issue is the emergence of resistant bacterial strains against these drugs. The present study was undertaken to perform the routine antibiotic susceptibility pattern of eight laboratory isolates (Escherichia coli, Bacillus spp., Staphylococcus spp., Vibrio spp., Salmonella spp., Pseudomonas spp., Klebsiella spp. and Listeria spp.) against eleven different categories of antibiotics (Ciprofloxacin, Cephradine, Metronidazole, Cefuroxime, Cefixime, Levofloxacin, Amoxicillin, Azithromycin, Doxycycline, Erythromycin and Flucloxacillin) available in local markets of Dhaka metropolis. Among these antibiotics, Azithromycin, Ciprofloxacin, Cefuroxime, Levofloxacin and Doxycycline showed the highest potency against these bacteria. On the contrary, Amoxicillin and Metronidazole showed almost no potency. Erythromycin, Cephradine and Flucloxacillin gave variable effectivity against the tested isolates. These findings reveal that measures for prevention and containment of antimicrobial resistance are necessary in Bangladesh. DOI: http://dx.doi.org/10.3329/sjm.v3i1.22749 Stamford Journal of Microbiology, Vol.3(1) 2013: 26-29

Engineering Biological Approaches for Detection of Toxic Compounds: A New Microbial Biosensor Based on the Pseudomonas putida TtgR Repressor.

Environmental contamination by toxic organic compounds and antimicrobials is one of the causes for the recent surge of multidrug-resistant pathogenic bacteria. Monitoring contamination is therefore the first step in containment of antimicrobial resistance and requires the development of simple, sensitive, and quantitative tools that detect a broad spectrum of toxic compounds. In this study, we have engineered a new microbial biosensor based on the ttgR-regulated promoter that controls expression of the TtgABC extrusion efflux pump of Pseudomonas putida, coupled to a gfp reporter. The system was introduced in P. putida DOT-T1E, a strain characterized by its ability to survive in the presence of high concentrations of diverse toxic organic compounds. This whole-cell biosensor is capable to detect a wide range of structurally diverse antibiotics, as well as compounds such as toluene or flavonoids.

Antimicrobial stewardship: what is it, and how does it work?

Antimicrobial stewardship is emerging as a vital management tool in the efforts to contain antimicrobial resistance and retain the efficacy of available agents. It is based on a set of concepts about antimicrobial use and resistance that have been developed over the past 70 years. There are seven basic requirements for a stewardship program to function at a local level, including (1) ‘executive’ ownership of the issue, (2) consensus prescribing guidelines, (3) a local formulary with various levels of restricted access, (4) a local champion (or champions) who is a trusted peer, (5) authority to intervene in prescribing and/or dispensing, (6) authority for measurement of use, audit and feedback, and (7) access to reliable laboratory services and their cumulative resistance data. Stewardship programs are most advanced in larger public hospitals, but there is considerable interest and need for developing programs tailored to a wide range of settings in human and animal health, each with their own particular characteristics of access to antimicrobials and potential controls. The potential value of stewardship in food animal production is now recognised globally, and Australia has taken the first steps towards surveillance and stewardship in this sector, supported by a recently released national One Health strategy on the containment of antimicrobial resistance.

A collaborative initiative for the containment of antimicrobial resistance in Mexico.

Antimicrobial resistance exacts worldwide an increasingly significant clinical and economic toll. Despite the international calls for urgent action, antimicrobial use and resistance have been low on the Mexican government's policy agenda. In early 2010, a multidisciplinary group of experts launched a national initiative for containment of antimicrobial resistance that was endorsed by major medical, veterinary and public health institutions. The initiative called for seven priority actions including the creation of an ad hoc intersectoral advisory group, a requirement that human and veterinary antibiotics be dispensed only with prescription, and the establishment of effective surveillance systems. A consensus document was disseminated among key decision-makers at the ministries of Health and Agriculture and the legislature. The Ministry of Health (MoH) enacted a decree effective as of August 2010, which enforced the regulations that required medical prescriptions for the sale of human antibiotics. While the information disseminated by the MoH did focus on the dangers of self-medication, it failed to highlight the inherent perils of antibiotic resistance or the consequences of antibiotic use in food-animals. Following the decree, there was a surge of medical offices controlled by retail pharmacies. In the veterinary sector, voluntary guidelines were developed for good husbandry practices, including antibiotic use in food animals; five antimicrobials for use in food-animals were banned. No intersectoral advisory group or surveillance systems were established. This study describes a bottom-top approach in Mexico for the development of a national strategy to improve antibiotic use and contain antimicrobial resistance. Its experiences suggest that, in countries such as Mexico that lack strong regulatory systems and surveillance capacities, a more systemic approach is warranted. Future efforts should begin with early involvement of key stakeholders and informing policy makers, professionals and the population at large about the critical importance of antibiotic resistance.

Containment of antimicrobial resistance due to use of antimicrobial agents in animals intended for food: WHO perspective

The use of antimicrobial agents in humans and food-producing animals has important consequences for human and animal health, as it can lead to the development of resistant bacteria (pathogens and/or commensals with resistance genes). Moreover, resistant bacteria in animals can be transferred to people--usually through the consumption of food, but also through direct contact with food-producing animals or through environmental spread. Ultimately, this can result in human infections with bacteria that are resistant to antimicrobial agents and that can therefore be difficult or impossible to cure. Of special concern is resistance to antimicrobial agents classified by the World Health Organization (WHO) as critically important for human medicine, such as fluoroquinolones, third- and fourth-generation cephalosporins, and macrolides. WHO encourages the agricultural, food, veterinary and health sectors to work together to eliminate the burden of antimicrobial resistance arising from the use of antimicrobial agents in food-producing animals. Joint efforts should be made to reduce the inappropriate use of antimicrobial agents (e.g. the use of antimicrobials as growth promoters) and limit the spread of bacteria resistant to antimicrobial agents. WHO will continueto address this issue in conjunction with the Food and Agriculture Organization of the United Nations, the World Organisation for Animal Health, the animal health/production industry and other important stakeholders. It will also continue to enhance the capacity of its Member States (through training courses and sentinel studies), particularly developing countries, to conduct integrated surveillance of antimicrobial use and resistance, to carry out risk assessments to support the selection of risk management options and to implement strategies for the containment of antimicrobial resistance.

Antimicrobial resistance and the activities of the Codex Alimentarius Commission

The Codex Alimentarius Commission has been working on the subject of antimicrobial resistance, mainly through the activities of the Committee on Residues of Veterinary Drugs in Foods and the ad hoc Intergovernmental Task Force on Antimicrobial Resistance. Principal texts developed by Codex include the 'Code of Practice to Minimize and Contain Antimicrobial Resistance (CAC/RCP 61-2005) and 'Guidelines for Risk Analysis of Foodborne Antimicrobial Resistance' (CAC/GL 77-2011). The successful containment of antimicrobial resistance requires the collaboration of a wide range of stakeholders, working together to protect consumer health by ensuring the safety of food products of animal origin.

Mobilizing political will to contain antimicrobial resistance

Vemu Lakshmi is one of several Indian physicians who had long been calling for more to be done about drug resistance. Then, last year, a whirlwind of controversy blew up in her country about the highly resistant superbugs, bacteria containing the so-called NDM-1 enzyme. [ILLUSTRATION OMITTED] Some Indian microbiologists had been flagging the urgent need for micro biological laboratory support for doctors and strict guidelines on antibiotic prescriptions and policies for quite some time;' says Lakshmi, who is professor and head of the Department of Microbiology at Nizam's Institute of Medical Sciences, in Hyderabad. Lakshmi and her colleagues knew that antimicrobial resistance would be the inevitable result of inappropriate use of antibiotics in hospitals and in the community (including sub-therapeutic doses due to ignorance about resistance mechanisms), widespread over-the-counter sales of antibiotics and patients failing to complete their courses of antibiotics. She discussed these problems in detail in an article in the Indian Journal of Medical Microbiology in 2008. The spread of the resistant bacteria in India, Pakistan and the United Kingdom of Great Britain and Northern Ireland was described in a paper published in the Lancet Infectious Diseases in August 2010. NDM-1, or New Delhi metallo-beta-lactamase, was first identified in a Swedish patient who had returned from New Delhi in 2008. Experts were particularly concerned about the fact that the enzyme was found in one of the most commonly encountered bacteria in the human population, Escherichia coli, and that at least one in 10 of the strains containing this enzyme appeared to be resistant to all known antibiotics. Antimicrobial resistance is a global problem that affects all countries. year's World Health on 7 April aims to make governments more aware of the problem and to encourage them to take measures to combat this global threat. [Antimicrobial resistance] is a real public health problem and it is emerging globally and in Europe. We have to do much more about it--both in the World Health Organization (WHO) and also in Member says Zsuzsanna Jakab, WHO Regional Director for Europe. Jakab is well aware that the struggle against antimicrobial resistance in Europe requires continuous vigilance if problems such as drug-resistant tuberculosis are not to get worse. This is the start of a process; we can and have to raise awareness among policy-makers and the public, and follow up with strategies after World Health Day Jakab says. is not the first time WHO has tackled the issue. In 2001, WHO released the Global Strategy for Containment of Antimicrobial Resistance, containing recommendations that countries could customize for their own use. But the launch in Washington DC coincided with the attacks of 11 September 2001 in the United States of (USA) and any momentum was lost in the subsequent turmoil. For Dr Gerald Dziekan, from WHO's Patient Safety Programme, the 2001 initiative nevertheless provided a start for some countries in tackling the problem. [ILLUSTRATION OMITTED] It certainly triggered the development of national plans in some countries, but all in all the response was quite weak in the sense of global awareness and coordinated action,' Dziekan says. One of the challenges governments face in Dziekan's view is enforcing laws banning over-the-counter sales of antibiotics. This is particularly difficult in [low- to middle-income] countries where there are often no doctors to prescribe medicines but people need to get the drugs somehow. But it is also in these countries where the problem is increasingly being felt. Antibiotic resistance is not confined to the emergency rooms of rich countries in Europe and North America according to Anthony So, professor at the Sanford School of Public Policy at Duke University in the USA. …

Surveillance of antimicrobial resistance in resource‐constrained settings – experience from five pilot projects

The rapid increase in antimicrobial resistance (AMR) among bacteria is a major public health concern. The WHO Global Strategy for Containment of Antimicrobial Resistance proposed that model systems be developed for AMR surveillance and for monitoring antimicrobial use. Pilot projects were established in three sites in India and two in South Africa to collect monthly AMR data on target bacteria for at least 12 months. Escherichia coli was used as the target bacterium in four sites (three in India, one in South Africa). One South African site used Streptococcus pneumoniae and Haemophilus influenzae. Each site sought to obtain at least 960 isolates per year. Resistance was determined by disc diffusion or minimum inhibitory concentration (MIC) methods. Data were collected for 12 and 16 months respectively in the South African sites and for 14 months in one Indian site and 24 months in the other two. All sites found difficulty collecting the required number of isolates, with three sites failing to do so. Escherichia coli isolates were more easily obtained and two sites developed methods to increase their yield. Disc diffusion testing provided more timely and reliable AMR data than did MIC determinations. Although methodological issues limit the comparability of data, high AMR rates were observed at all five sites. All five pilot sites provided data on AMR, but also raised several issues related to logistics of long-term surveillance in settings under resource constraints. For surveillance of AMR in such settings, E. coli is probably the best indicator bacterium.

Antimicrobial use in Swiss dairy farms: Quantification and evaluation of data quality

Data on antimicrobial use play a key role in the development of policies for the containment of antimicrobial resistance. On-farm data could provide a detailed overview of the antimicrobial use, but technical and methodological aspects of data collection and interpretation, as well as data quality need to be further assessed. The aims of this study were (1) to quantify antimicrobial use in the study population using different units of measurement and contrast the results obtained, (2) to evaluate data quality of farm records on antimicrobial use, and (3) to compare data quality of different recording systems. During 1 year, data on antimicrobial use were collected from 97 dairy farms. Antimicrobial consumption was quantified using: (1) the incidence density of antimicrobial treatments; (2) the weight of active substance; (3) the used daily dose and (4) the used course dose for antimicrobials for intestinal, intrauterine and systemic use; and (5) the used unit dose, for antimicrobials for intramammary use. Data quality was evaluated by describing completeness and accuracy of the recorded information, and by comparing farmers’ and veterinarians’ records. Relative consumption of antimicrobials depended on the unit of measurement: used doses reflected the treatment intensity better than weight of active substance. The use of antimicrobials classified as high priority was low, although under- and overdosing were frequently observed. Electronic recording systems allowed better traceability of the animals treated. Recording drug name or dosage often resulted in incomplete or inaccurate information. Veterinarians tended to record more drugs than farmers. The integration of veterinarian and farm data would improve data quality.

Experiences with the Dutch Working Party on Antibiotic Policy (SWAB)

The Dutch Working Party on Antibiotic Policy (Stichting Werkgroep AntibioticaBeleid, SWAB) was founded in 1996 as an initiative of the Society for Infectious Diseases, the Dutch Society for Medical Microbiology, and the Dutch Association of Hospital Pharmacists. Its primary goal is to contribute to the containment of antimicrobial resistance and the expanding costs incurred for the use of antibiotics. SWAB is the Intersectoral Coordinating Mechanism (ICM) for the Netherlands, and it is at present the National Antimicrobial Resistance (AMR) Focal Point. It coordinates the national surveillance of antibiotic resistance, in collaboration with the National Institute for Public Health and the Environment(RIVM), coordinates the surveillance of the use of antibiotics,and runs a guideline development programme. Information about consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria is presented annually in NethMap. Over the past decade, outpatient consumption of antibiotics has risen only slightly, but in the hospital setting there was an overall significant increase in antibiotic use, due mainly to the steady reduction in the average length of patient hospital stays. In 2006 we introduced our electronic national antibiotic guide 'SWAB-ID' for the antibiotic treatment and prophylaxis of common infectious diseases in hospitals.

Analysis and Presentation of Cumulative Antibiograms: A New Consensus Guideline from the Clinical and Laboratory Standards Institute

It is crucial to monitor emerging trends in resistance at the local level to support clinical decision making, infection-control interventions, and antimicrobial-resistance containment strategies. Monitoring of antimicrobial resistance trends is commonly performed in health care facilities using an annual summary of susceptibility rates, known as a cumulative antibiogram report. The Clinical and Laboratory Standards Institute M39-A2 consensus document, entitled "Analysis and Presentation of Cumulative Antimicrobial Susceptibility Test Data," provides guidance to clinical laboratories in the preparation of a cumulative antibiogram. The purpose of this review is to describe this document, explain the rationale for some of the recommendations, discuss limitations of its use, and propose new directions for future revisions. The document contains specific recommendations for the collection, storage, analysis, and presentation of data and includes sample templates highlighting the recommendations. Critical issues include the recommended frequency of reporting, the number of isolates to include in a statistic, and a mechanism for eliminating multiple isolates of a given bacterial species obtained from an individual patient.

Recent World Health Organization initiatives for antimicrobial resistance control

The World Health Organization (WHO) overseeing of antimicrobial resistance (AMR) containment issues in the last decade has varied in intensity. From 1999 onwards, concerted focus from the WHO led to the development of a multi-disciplinary framework for AMR containment at a country level. However, implementation of the WHO Global Strategy for the Containment of Antimicrobial Resistance (the Global Strategy) was overtaken first by events in the USA in 2001 and later by related and other bio-security issues. By 2003, loss of funding and a restructured WHO saw AMR initiatives curtailed. Interest in AMR at the WHO has been recently rekindled and it is hoped that renewed attention will again be focused on this issue by the WHO and its member states.

Pharmacists’ perceptions of the effectiveness of antimicrobial control programs

The perceptions of the effectiveness of antimicrobial control programs (ACPs) among infectious diseases (ID) pharmacists were studied. A survey asking pharmacists to characterize the ACP in their hospitals and rate the program's effectiveness was distributed electronically in 1999 and by regular mail in 2000 to all 365 members of the Society of Infectious Diseases Pharmacists residing in North America. Of the 365 surveys distributed, 323 (88.5%) were completed, 233 of which were eligible for analysis. Most respondents (99%) indicated the use of one or more ACP components (mean +/- S.D., 4.3 +/- 1.9) in their hospitals. The ACP components used most frequently included prescriber education, review of patient medical records, formularies, prior authorization, infectious diseases consultation, and clinical practice guidelines. A similar percentage of respondents indicated that ID pharmacists and ID physicians directly participated in implementing and monitoring the effectiveness of ACPs (57% and 58%, respectively). Of the 231 respondents whose hospitals had an ACP, 73% perceived that their ACP effectively addressed antimicrobial resistance, patient outcomes, or costs, with cost reduction viewed as being accomplished more often than the improvement of patient outcomes or containment of antimicrobial resistance (62%, 35%, and 38%, respectively; p < 0.001). Many indicated uncertainty regarding the effectiveness of their ACP, with a substantial percentage of respondents believing that the level of support for these programs was inadequate. ID pharmacists in 231 North American hospitals perceived that their ACP was not sufficiently effective at improving patient outcomes, containing antimicrobial resistance, and decreasing medication costs, possibly due to inadequate institutional support for the program.

Enhancement on surveillance of bacterial resistance to antimicrobial agents

Infection with resistant bacteria has been a great challenge to human health in this new century. WHO document “The global strategy for containment of antimicrobial resistance” emphasized the importance of surveillance on bacterial resistance. In this article some problems existed in resistance surveillance are pointed out, and proposals for the improvement of this work are suggested.

Resistencia a los antimicrobianos en las explotaciones

Bacteria that are resistant to antimicrobials are widespread. This article reviews the distribution of resistant bacteria in farm environments. Humans, animals, and environmental sites are all reservoirs of bacterial communities that contain some bacteria that are susceptible to antimicrobials and others that are resistant. Farm ecosystems provide an environment in which resistant bacteria and genes can emerge, amplify and spread. Dissemination occurs via the food chain and via several other pathways. Ecological, epidemiological, molecular and mathematical approaches are being used to study the origin and expansion of the resistance problem and its relationship to antibiotic usage. The prudent and responsible use of antibiotics is an essential part of an ethical approach to improving animal health and food safety. The responsible use of antibiotics during research is vital, but to fully contribute to the containment of antimicrobial resistance 'prudent use' must also be part of good management practices at all levels of farm life.

Resistance to Anti-Infective Drugs and the Threat to Public Health

Increasing resistance of pathogens to anti-infective drugs is an urgent public health problem that must be addressed through more prudent use of these drugs in human medicine and in animal husbandry, agriculture, and aquaculture.