Awareness Of Antimicrobial Resistance Research Articles

Creative usage of Vivli’s Antimicrobial Resistance Surveillance Open Data through the Re-Use Data Challenge

The escalation of infections caused by drug-resistant bacteria worldwide poses a formidable challenge to global health, necessitating innovative approaches to combat this issue. In 2022, Vivli launched the Antimicrobial Resistance (AMR) Register, a platform that consolidates antimicrobial susceptibility data from pharmaceutical industry surveillance programs. This register provides a freely available and fully searchable user-friendly repository to facilitate scientific understanding of resistance patterns and support development of innovative strategies to address AMR globally. To promote the register’s utility, raise AMR awareness and encourage further re-use of the available data, Wellcome funded the Vivli AMR Surveillance Open Data Re-Use Data Challenge in 2023. This data challenge successfully fostered diverse, impactful, and innovative solutions that leveraged the AMR Register data to contribute to resolving the AMR crisis. The outcomes of the initiative underscore the importance of access to open data in stimulating collaboration and innovation in the public health domain, particularly in combatting the growing threat of drug-resistant infections.

Understanding the awareness of antimicrobial resistance amongst commercial poultry farmers in northwestern Nigeria

The emergence of antimicrobial resistance (AMR) in both humans and animals is a growing health threat worldwide. Significant quantities of antibiotics are used in the livestock production sector, particularly in poultry farming to enhance growth and productivity. A cross-sectional study was conducted in three states of northwestern Nigeria to understand the level of knowledge, attitude, and practice of commercial poultry farmers on antimicrobial resistance. A total of 247 poultry farmers enrolled in the study comprising 100 (40.5%) from Sokoto, 68 from Kebbi (27.5%) and 79 (32.0%) from Zamfara States. A significant number of the farmers have good knowledge of antimicrobial use (94.74%), and the potential emergence of antimicrobial resistant bacteria due to irrational administration of antibiotics (83.0%). Kruskal-Wallis test showed a significant difference in farmers’ knowledge of AMR based on their educational qualification (p<0.001) as farmers with bachelor’s degree (BSc) being more knowledgeable than those with Ordinary National Diploma (OND) and those who only completed primary or secondary education. A statistically significant difference was also observed in the attitude of the participants based on State (p<0.001) and educational qualification (p=0.013). The study provided valuable insight into the understanding of antimicrobial resistance amongst commercial poultry farmers in the region. The findings necessitate the need for educational interventions and initiatives through enlightenment campaigns and deployment of extension workers to reach farmers with low level of education to further improve their attitudes and practice towards responsible use of antibiotics.

Knowledge, Attitudes, and Practices of Rural Communities Regarding Antimicrobial Resistance and Climate Change in Adadle District, Somali Region, Ethiopia: A Mixed-Methods Study.

There is an urgent need for interventions in addressing the rapid and disproportionate impact of antimicrobial resistance (AMR) and climate change (CC) on low- and middle-income countries. Within this context, it is important to understand indigenous knowledge in rural communities, which are highly affected. This study examined knowledge, attitude, and practices (KAP) regarding AMR and CC in the Adadle district, Somali region, Ethiopia, utilizing mixed methods, including 362 surveys and 12 focus group discussions among rural communities. Findings showed that 39% and 63% of participants were familiar with AMR and CC, respectively. Of those surveyed, 57% attributed AMR to inappropriate antimicrobial use in animals and humans, while CC was often associated with Allah/God. Multivariable analysis indicated that males exhibited superior knowledge and a positive attitude towards AMR and CC. Additionally, individuals aged 26-35 and 36-45 years showed heightened awareness of AMR and CC, respectively. Moreover, participants who were government employees, pastoralists, and business owners showed better knowledge on CC compared to family caretaker. Religious education and households with more than six members were linked to lower AMR knowledge. This study underlines a greater awareness of CC than AMR and highlights gender-based disparities, recommending integrated educational AMR programs targeting different demographics through a One Health lens, actively involving females, and incorporating local beliefs and practices.

National action on antimicrobial resistance and the political economy of health care

ABSTRACT Antimicrobial Resistance (AMR) is one of the biggest threats to human health in the twenty-first century. A key dimension of global governance in this domain consists of encouraging governments to create national action plans (NAPs) aimed at improving awareness of AMR, improving knowledge through surveillance and research, reducing infection, optimising the use of antimicrobial medicines, and investing in new drugs, vaccines and other interventions. The adoption and implementation of NAPs occur in the context of great political and institutional diversity across countries, and this article examines the consequences of different ways of financing health care. We expect the implementation of NAPs to be more successful in optimising antibiotics use when governments play a larger role in financing health care compared to private expenditure. An analysis of patterns of antibiotic consumption in 191 countries between 2000 and 2018 supports the hypothesis.

Towards monitoring the invisible threat: a global approach for tackling AMR in water resources and environment

The global threat of antimicrobial resistance (AMR) is now increasingly recognized for the danger posed by its environmental spread. Aquatic environments and wastewater represent a significant diffusion and selection pathway for antibiotic resistance genes and antibiotic resistant bacteria (ARGs and ARBs). During a collaborative hackathon event, the “Innovation Workshop on Water Quality Monitoring &amp;amp; Assessment,” held in September 2023, experts addressed four challenges related to water quality, including the challenge of globalization AMR surveillance in water. This paper, derived from the workshop findings, proposes a globally adaptable model for antimicrobial resistance surveillance intended as an advance to improve future monitoring systems. The new framework aims to address significant challenges, such as the lack of standardized methodological approaches or lack of funding, coordination, and awareness across a short-, medium- and long-term plan, integrating sustainability concepts, extending participation and monitoring capacity of countries, and offering efficient solutions. This vision is first articulated by creating a technical committee that promotes awareness of antimicrobial resistance and develops a single data management and communication platform. Subsequently, by developing local, national, and international policies, centralized laboratories will be established at the regional level, and built based on existing realities. These laboratories will include facilities to make the management of analyses more efficient, from sampling to reporting the final result. In the long term, activities that allow the maintenance of the created framework and continuous technological development and advancement will be promoted. All this will be achieved in collaboration with national and supranational bodies that are already addressing the issue at a global level.

Antimicrobial Resistance and Sports: The Scope of the Problem, Implications for Athletes' Health and Avenues for Collaborative Public Health Action.

Antimicrobial resistance (AMR) poses a global threat, leading to increased mortality and necessitating urgent action-however, its impact on athletes and the world of sports has hitherto been neglected. Sports environments (including athletic and aquatic) exhibit high levels of microbial contamination, potentially contributing to the spread of resistant microorganisms during physical activities. Moreover, the literature suggests that travel for sports events may lead to changes in athletes' gut microbiomes and potentially impact their antibiotic resistance profiles, raising questions about the broader implications for individual and public/global health. The prevalence of Staphylococcus aureus (S. aureus) among athletes (particularly those engaged in contact or collision sports) ranges between 22.4% and 68.6%, with MRSA strains being isolated in up to 34.9% of tested individuals. Factors such as training frequency, equipment sharing, delayed post-training showers, and a history of certain medical conditions are linked to higher colonization rates. Moreover, MRSA outbreaks have been documented in sports teams previously, highlighting the importance of implementing preventive measures and hygiene protocols in athletic settings. In light of the growing threat of AMR, there is a critical need for evidence-based treatment guidelines tailored to athletes' unique physiological demands to ensure responsible antibiotic use and mitigate potential health risks. While various initiatives-such as incorporating AMR awareness into major sporting events-aim to leverage the broad audience of sports to communicate the importance of addressing AMR, proactive measures (including improved AMR surveillance during large sporting events) will be indispensable for enhancing preparedness and safeguarding both athletes' and the general public's health. This narrative review thoroughly assesses the existing literature on AMR and antibiotic usage in the context of sports, aiming to illuminate areas where information may be lacking and underscoring the significance of promoting global awareness about AMR through sports.

Assessment of global antimicrobial resistance campaigns conducted to improve public awareness and antimicrobial use behaviours: a rapid systematic review

IntroductionPublic health campaigns with a well-defined outcome behaviour have been shown to successfully alter behaviour. However, the complex nature of antimicrobial resistance (AMR) creates challenges when evaluating campaigns aimed at raising awareness and changing behaviour.AimsTo determine what campaigns have been conducted and which reported being effective at improving awareness of antimicrobial resistance and changing behaviour around antimicrobial use in members of the public. It also sought to determine the outcome measures studies have used to assess campaign effectiveness.MethodsA systematic search of Ovid MEDLINE and Embase, was conducted in October 2022 using a predefined search strategy. Studies which were published between 2010 and September 2022 that outlined a campaign or invention aimed at the public and focusing on AMR or antibiotic usage were eligible for inclusion and studies which solely targeted healthcare professionals (HCP) were excluded.ResultsLiterature searches retrieved 6961 results. De-duplication and screening removed 6925 articles, five articles from grey literature and reference screening were included, giving a total of 41 studies and 30 unique interventions. There was a distribution of campaigns globally with the majority run in Europe (n = 15) with most campaigns were conducted nationally (n = 14). Campaigns tended to focus on adult members of the public (n = 14) or targeted resources towards both the public and HCPs (n = 13) and predominately assessed changes in knowledge of and/or attitudes towards AMR (n = 16). Campaigns where an improvement was seen in their primary outcome measure tended to use mass media to disseminate information, targeted messaging towards a specific infection, and including the use of HCP-patient interactions.DiscussionThis review provides some evidence that campaigns can significantly improve outcome measures relating to AMR and antibiotic usage. Despite a lack of homogeneity between studies some common themes emerged between campaigns reported as being effective. However, the frequent use of observational study designs makes it difficult to establish causation between the campaign and changes seen in the studies outcome measures. It is important that clear evaluation processes are embedded as part of the design process for future campaigns; a campaign evaluation framework for use by campaign developers may facilitate this.

Monitoring progress on Antimicrobial Resistance (AMR) response in the World Health Organization African region: Insights from the Tracking AMR Country Self-Assessment Survey (TrACSS) 2021 results for the human health sector.

Antimicrobial resistance (AMR) is a major 21st century global health challenge. The WHO African Region Member States committed to develop and implement multisectoral national action plans (NAPs) that address AMR, in line with the Global Action Plan on AMR (GAP). The aim of this paper is to present the progress of AMR response in the WHO African Region based on the annual Tracking AMR Country Self-Assessment Survey (TrACSS), with a focus on human health indicators. This was a secondary data analysis of responses from forty-one countries that participated in the 2021 TrACSS. Of the 41 countries that responded to the 2021 TrACSS, 35(85%) have developed NAPs. Fifteen 15(37%) of countries have functional AMR multisector working groups. 55% (21/41) of countries are collating data nationally on AMR surveillance. Forty nine percent of countries conducted small-scale AMR awareness campaigns and 53% (21/41) covered AMR in some pre- and in-service training for human health workers. While 83% of countries reported having laws and regulations on the prescription and sale of antimicrobials, only 32% (13/41) have national systems for monitoring antimicrobial use. Twenty-three (58%, 23/41) reported having Infection Prevention and Control (IPC) programs at select health facilities. Countries have developed and are implementing AMR NAPs. Gaps still exist across key indicators monitored through TrACSS. Effective AMR response requires established functional multisectoral governance mechanisms in the One Health approach; political commitment, sustainable funding, and clear monitoring and reporting is critical.

Drivers of antimicrobial resistance within the communities of Nepal from One Health perspective: a scoping review.

A major driver of antimicrobial resistance (AMR) is the inappropriate use of antimicrobials. At the community level, people are often engaged in behaviors that drive AMR within human, animal, and environmental (One Health) impacts. This scoping review consolidates research to determine (a) the community's knowledge, attitudes, and practices around AMR; (b) existing community-based interventions; and (c) barriers and enablers to addressing AMR in Nepal. This scoping review follows the Joanna Briggs Institute scoping review methodology. Literature indexed in PubMed, Scopus, CINAHL, Global Index Medicus, HINARI-SUMMON, Embase (Ovid), Global Health (Ovid), CAB Abstracts (Ovid), Web of Science, and Google Scholar between January 2000 and January 2023 were reviewed for inclusion. Articles were included in the review if they considered the issues of AMR at the community level in Nepal; this excluded clinical and laboratory-based studies. A total of 47 studies met these criteria, were extracted, and analyzed to consolidate the key themes. A total of 31 (66%) articles exclusively included human health; five (11%) concentrated only on animal health; no studies solely focused on environmental aspects of AMR; and the remaining studies jointly presented human, animal, and environmental aspects. Findings revealed inadequate knowledge accompanied by inappropriate practice in both the human and animal health sectors. Four community interventions improved knowledge and practices on the appropriate use of antimicrobials among community people. However, various social and economic factors were found as barriers to the appropriate use of antimicrobials in the community. Community engagement and One Health approaches could be key tools to improve awareness of AMR and promote behavioral change related to AM use in communities, as current studies have revealed inadequate knowledge alongside inappropriate practices shared in both human and animal health sectors. DOI: 10.17605/OSF.IO/FV326.

Improving Antimicrobial Resistance Awareness Among Medical Students in India: The Sensitization of Medical Students on Antimicrobial Resistance (SOS-AMR) Study.

To evaluate the impact of an online educational intervention on improving knowledge of antimicrobial resistance (AMR) and stewardship among final-year medical students in Chennai, India. This was a prospective 'before-after' study conducted across 5 medical colleges in Chennai, India. Participants who were final-year (fourth year) undergraduate medical students were administered a pretest to evaluate baseline knowledge. Students were then provided access to online educational material comprising 20 short lectures. Lectures were delivered by content experts and covered a range of topics which included basics of microbiology, fundamental concepts in AMR and stewardship, diagnosis and management of common infections, basics of antimicrobial pharmacokinetics and pharmacodynamics, and vaccination. Students were required to take a posttest at the end of these modules. Primary outcome was improvement in test scores from pretest baseline which was analyzed using a t test. A 30% improvement in the mean scores from baseline was predefined as a measure of success. A total of 599 students participated from 5 medical colleges among whom 339 (56.6%) were female participants; 542 (90.4%) students completed the posttest. Mean pretest score was 11.6 (maximum possible score of 25) (SD: 4.3) and the mean posttest score was 14.0 (SD: 4.6). Comparing pre and posttest scores, there was an improvement of 2.4 marks (20%) from the baseline (95% confidence interval: 1.9, 2.9) (P < .001). Improvement in scores was similar for male and female participants. In this before-after study evaluating the impact of an educational intervention on AMR among final-year medical students, there was an improvement in knowledge; however, the extent of improvement did not meet the predefined metric of success.

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.

Establishing a One Health AMR Community of Practice in Nigeria

Abstract To support the objectives set out in Nigeria’s national action plan for Antimicrobial Resistance (AMR), we established a One Health AMR Community of Practice comprised of Fleming Fund Fellows and their mentors. This community is a multi-disciplinary team dedicated to addressing AMR in human and animal health sectors, with members from Nigeria, Denmark, and the United Kingdom. We undertook gap analyses of the systems in Fleming Fellows’ laboratories and institutions to identify areas for support. Tailor-made capacity support programmes were developed for each Fellow. Fellows visited their mentors’ institutes for in-person coaching, and subsequently implemented strengthened processes at their home institutes. The community has trained 178 Nigerian scientists from Government, academic, and private laboratories, by delivering courses comprising classroom teaching and hands-on laboratory sessions. This up-skilling of Nigerian laboratory staff, through the ‘train-the-trainer’ approach, has enhanced capacity to produce high-quality microbiological data. The community has completed One Health collaborative projects investigating AMR in livestock, in-contact humans, the farm environment, and hospital submissions. We have held feedback sessions with stakeholders to raise awareness of AMR and provided advice on measures such as biosecurity, which can help to prevent disease and therefore reduce the need for antimicrobial use. The establishment of this community has helped to strengthen personal and institutional capacities in Nigeria, Denmark, and the United Kingdom and created a network of scientists working together to tackle AMR. This community has contributed to One Health AMR surveillance systems and supported the implementation of Nigeria’s national action plan for AMR. Information © The Authors 2023

The Impact of COVID-19 on Knowledge, Beliefs, and Practices of Ni-Vanuatu Health Workers Regarding Antibiotic Prescribing and Antibiotic Resistance, 2018 and 2022: A Mixed Methods Study.

Antimicrobial resistance (AMR) is included in the ten most urgent global public health threats. Global evidence suggests that antibiotics were over prescribed during the early waves of the COVID-19 pandemic, particularly in low- and middle-income countries. Inappropriate use of antibiotics drives the emergence and spread of antibiotic resistance. This study aimed to examine the impact of COVID-19 on Ni-Vanuatu health worker knowledge, beliefs, and practices (KBP) regarding antibiotic prescribing and awareness of antibacterial AMR. A mixed methods study was conducted using questionnaires and in-depth interviews in 2018 and 2022. A total of 49 respondents completed both baseline (2018) and follow-up (2022) questionnaires. Knowledge scores about prescribing improved between surveys, although health workers were less confident about some prescribing activities. Respondents identified barriers to optimal hand hygiene performance. More than three-quarters of respondents reported that COVID-19 influenced their prescribing practice and heightened their awareness of ABR: "more careful", "more aware", "stricter", and "need more community awareness". Recommendations include providing ongoing continuing professional development to improve knowledge, enhance skills, and maintain prescribing competency; formalising antibiotic stewardship and infection, prevention, and control (IPC) programmes to optimise prescribing and IPC practices; and raising community awareness about ABR to support more effective use of medications.

Appraising Nigeria's approach to combating antimicrobial resistance.

Antibiotic consumption has increased dramatically in recent years, and this increase is predominantly fuelled by low- and middle-income countries. This is a worrying report, as antimicrobial resistance (AMR) is primarily driven by antibiotic consumption. To combat AMR, the Nigerian Ministry of Health established the Antimicrobial Resistance Technical Working Group (AMR-TWG), which developed and implemented the National Action Plan on Antimicrobial Resistance. This study aims to identify and appraise the current situation in the fight against AMR in Nigeria. This study contains a qualitative descriptive assessment of the advancements and the present status of efforts to combat AMR in Nigeria following the execution of the 2017-2022 National Action Plan (NAP) for AMR. The data for this study is soured primarily from the official national policy document on AMR and the responses of the Tracking AMR Country Self-assessment Survey (TrACSS). The results from this study reveal that there have been significant efforts aimed at addressing AMR in Nigeria. These efforts have been focused on improving public awareness of AMR, improving One Health surveillance of AMR, improving infection prevention and control, improving antimicrobial stewardship practices in the country, and investing in research on AMR. However, significant gaps still exist in each of these focus areas that can potentially undermine the attempts that have been made hitherto. Nigeria's commitment to the fight against AMR, as exemplified by the 2017-2022 National Action Plan, needs to be sustained and reinforced to safeguard public health and promote responsible antimicrobial use.

Antibiotic-Dispensing Patterns and Awareness of Anti-microbial Resistance Among the Community Pharmacists in South-Central India.

Background Anti-microbial resistance (AMR) is an ongoing epidemic contributing to extremely high healthcare costs and hospital admissions. Inappropriate dispensing of antibiotics is one of the root causes of AMR. Hence, our study aimed to assess antibiotic-dispensing patterns and AMR awareness among pharmacists from South-Central India. Methodology This cross-sectional observational study was conducted over a period of two months from June to July 2023. The pharmacies in urban and semi-urban areas of coastal and central districts of the Indian state of Andhra Pradesh were surveyed. Data were collected using a predesigned questionnaire for antibiotic-dispensing patterns and awareness of AMR, as approved by the Institutional Ethics Committee of Aster Ramesh Hospital, Vijayawada, India. The data were collected and analyzed descriptively by cross-tabulation. Results Among the 389 pharmacies that responded, 78% (n = 303) were dispensing antibiotics over the counter (OTC) and 22% (n = 86) were dispensing antibiotics only for valid prescriptions. It was found that antibiotics were dispensed OTC for common ailments such as the common cold, cough, sore throat, nasal congestion, fever, diarrhea, and urinary tract infections. As per the World Health Organization-recommended Access, Watch, and Reserve (AWaRe) criterion, antibiotics under the Watch group such as macrolides (azithromycin), fluoroquinolones (ciprofloxacin, norfloxacin, levofloxacin, and ofloxacin) and third-generation cephalosporins (cefixime and cefpodoxime) were found to be widely dispensed OTC. The most common antibiotics dispensed OTC were azithromycin (54.1%), amoxicillin (47.5%), cefixime (40%), amoxicillin + clavulanic acid (15.2%), ofloxacin (13.5%), ciprofloxacin (10%), and doxycycline (6.6%). Among the OTC dispensers, 82.5% (n = 250) were unaware of AMR and 17.5% were partially aware. However, 57% (n = 49) were unaware of AMR and its effects, in pharmacies dispensing antibiotics for valid prescriptions. Conclusion Our findings aggregateevidence on the alarming trend of inappropriate antibiotic-dispensing patterns that may further exacerbate AMR. Strict regulatory enforcement and periodical monitoring to regulate antibiotic dispensing to control unethical dispensing are inevitably necessary.

Antibiotic Use, Awareness of Antimicrobial Resistance and Residue in Veterinary Professionals and Farmers in Selected Districts of Kellem Wollega Zone, Ethiopia.

Antimicrobials have a crucial role in reducing mortality and morbidity in animals, but misuse of them may cause antimicrobial resistance and residues which are challenging in animal production and public health. These problems are mostly aggravated in developing countries including Ethiopia. Assessment of antibiotic use, awareness of antimicrobial resistance and antimicrobial residue in veterinary professionals and farmers. A cross-sectional study was conducted from September 2021 to August 2022 in three districts (Seyo, Hawa Gelan, and Dale Sadi) of the Kellem Wollega zone, selected by purposive sampling. The study population was farmers and veterinary professionals. Data was collected from a total of 312 respondents; 230 farmers and 82 veterinary professionals using interviews and questionnaires, respectively. Out of 312 total respondents, 230 (73.71%) were farmers and 82 (26.28%) were veterinary professionals. From the farmer respondents, 127 (55.22%), 153 (66.52%), and 142 (61.74%) had an awareness of antibiotics and their usage, antimicrobial resistance, and withdrawal period, respectively. Out of 82 veterinary professional respondents, 92.68% practice dose calculation during animal treatment, 79.27% diagnose systemic infections by tentative diagnosis, 85.37% have no laboratory facility for bacterial disease, and 81.71% give broad-spectrum antibiotics for undifferentiated cases. The income type of respondents looks to have a strong association (P < 0.05) with awareness of antibiotics (OR: 3.427, SE: 1.404, CI: 1.535-7.654), antimicrobial resistance (OR: 3.536, SE: 1.339, CI: 1.683-7.430) and withdrawal periods (OR: 3.297, SE: 1.267, CI: 1.552-7.004). This study shows most farmers have awareness about antibiotics and their use, antimicrobial resistance, and residue but inappropriate use of antimicrobials in farmers and lack of laboratory facilities in most veterinary professionals observed.

Drivers of antimicrobial resistance in layer poultry farming: Evidence from high prevalence of multidrug-resistant Escherichia coli and enterococci in Zambia.

Inappropriate use of antimicrobials exacerbates antimicrobial resistance (AMR) in the poultry sector. Information on factors driving AMR in the layer poultry sector is scarce in Zambia. This study examined the drivers of AMR in the layer poultry sector in the Lusaka and Copperbelt Provinces of Zambia. This cross-sectional study employed a structured questionnaire in 77 layer poultry farms in the provinces of Lusaka and Copperbelt, Zambia, from September 2020 to April 2021. Data analysis was conducted using Stata version 16.1. Antimicrobial resistance was defined as the presence of multidrug resistance (MDR) isolates. Multivariable regression analysis was used to identify drivers of AMR. In total, 365 samples were collected, from which 339 (92.9%) Escherichia coli and 308 (84.4%) Enterococcus spp. were isolated. Multidrug resistance was identified in 39% of the E. coli and 86% of the Enterococcus spp. The overall prevalence of AMR in layer poultry farms was 51.7% (95% confidence interval [CI]: 40.3%-63.5%). Large-scale farmers (Adjusted odds ratio [AOR] = 0.20, 95% CI: 0.04%-0.99%) than small-scale and farmers who were aware of AMR than those who were unaware (AOR = 0.26, 95% CI: 0.08%-0.86%) were less likely to experience AMR problems. This study found a high prevalence of AMR in layer poultry farming linked to the type of farm management practices and lack of AMR awareness. Evidence of high MDR in our study is of public health concern and requires urgent attention. Educational interventions must increase AMR awareness, especially among small- and medium-scale poultry farmers.

Physicians’ Antibiotics Prescribing Patterns for Common Diseases and Knowledge on Antimicrobial Resistance: A descriptive cross-sectional study

Purpose: This study was conducted to assess the Knowledge, Attitude, and Practice (KAP) of patients or their caregivers, and prescribers of antibiotics toward antimicrobial resistance in Bangladesh. Method: This was a mixed-method research study. Data were collected from pre-determined study areas using a sample survey of 583 respondents, 11 Focus Group Discussions (FGDs), 11 Key-Informant Interviews (KIIs), and 11 In-depth Interviews (IDIs). A scale of 11 points was used to measure attitudes. Results: About 59% of the respondents (patients or carers) were between 1 to 20 years old. The difference of age of patients by sex was found statistically significant at .001 level. About 25.7% of the respondents visited an MBBS doctor and 8.1% visited a BDS dentist, and 66.2% went to traditional healers and the pharmacy. Men take more antibiotics for treatment purposes compared to their female counterparts. The difference between men and women, with regard to the treatment of common diseases, was found to be statistically significant. Usually, new graduate doctors and traditional healers prescribe antibiotics of longer duration. The duration of prescriptions for antibiotics and type of the physician was found statistically significant. Physicians prescribed common antibiotics for upper respiratory tract infections (26%), cold and fever (21%), diarrhea (12%), STDs (9%), HTN (8%), UTIs (7.5%), diabetes (5%), and lower respiratory infections (4%). Cephalosporin (31.4%), macrolides (27.6%), quinolones (17.8%), metronidazole (13%), and penicillin (10.10%) were used. About 65.8% of the caregivers did not have any knowledge about antimicrobial resistance and the negative effects of the overuse of antibiotics. Conclusion: The majority of the respondents had poor knowledge of antimicrobial resistance and the negative effects of the overuse of antibiotics. A community-based awareness program was found important to create awareness of antimicrobial resistance and the negative effects of the overuse of antibiotics.

Understanding the role of veterinarians in antimicrobial stewardship on Canadian dairy farms: A mixed-methods study.

The aim of this study was to describe the factors that influence dairy cattle veterinarians´ antimicrobial prescribing, their attitudes toward reducing antimicrobial use (AMU) in the dairy industry, awareness of antimicrobial resistance (AMR), and perceived barriers to improving antimicrobial stewardship (AMS) on Canadian dairy farms. We used quantitative and qualitative research methods to consider the complexity of the antimicrobial prescription decision-making process. We designed and distributed an online survey, followed by four online focus groups with practicing veterinarians. We used frequency tables and unconditional associations to analyze quantitative data, and thematic analysis to analyze qualitative data. In total, 107 participants from four Canadian provinces responded to the survey, and 26 veterinarians participated in the focus groups. Results from both studies were triangulated to draw our key findings. We found that 1) Veterinarians must weigh numerous intra-personal and contextual considerations that could be conflicting in their decision-making process for prescribing antimicrobials. 2) Although less experienced veterinarians showed greater awareness of AMR and motivation to improve AMS than more experienced veterinarians, they also reported feeling more pressure to adapt their prescribing practices to farmers' wishes than more experienced veterinarians. 3) Some veterinarians experienced conflict between prescribing antimicrobials to maintain animal health, productivity, and welfare, and AMS, which could result in blaming others for inappropriate antimicrobial use and reducing the opportunity to critically review their own prescribing practices. 4) There were strategies and barriers in common between veterinarians and farmers such as collaborative reviews of disease treatment protocols and improving preventive medicine on dairy farms. 5) The main barriers to reducing AMU on dairy farms reported by veterinarians were concerns about animal welfare and AMU on dairy farms without consultation with the veterinarian. Our results can inform the development of AMS programs in the Canadian dairy industry.

Large-scale questionnaire survey of parents and guardians on antimicrobial resistance using group health checkups for infants and toddlers in Japan

BackgroundIt is important to improve the knowledge of antimicrobial resistance (AMR) among parents and guardians, to promote AMR stewardship in pediatrics. However, a large-scale survey on parents' knowledge and awareness of AMR has not yet been conducted in Japan. Furthermore, the current status of knowledge and awareness is unknown. Infant and toddler health checkups are large-scale administrative activities that approximately all children and their parents undergo in Japan. Therefore, we conducted a knowledge and awareness survey using a questionnaire during the group health checkups. MethodsAll parents and guardians who participated in the group health checkups (4-month, 1.5-year, and 3-year) in Chiba City during the year were targeted. Parents' knowledge and awareness of AMR and their wishes for future information on AMR were surveyed using a one-choice questionnaire. ResultsThe questionnaire collection rate was 87.5% (16,663/19,047), and the valid response rate was 77.0% (14,674/19,047). Of the parents, 37.2% answered that "antibiotics are not effective for colds." However, 58.9% answered that they "had never heard of the drug-resistant bacteria."While 8.3% of parents answered that they "sometimes want my child to be prescribed antibiotics even if the doctor deemed it unnecessary," 46.1% of parents answered that "they were unaware of whether their children were prescribed antimicrobials." ConclusionsKnowledge and awareness of AMR among parents in Japan are inadequate, and there is room for improvement. Continuous awareness-raising activities combining multiple methods are needed in the future.