Awareness Of Antimicrobial Resistance Research Articles

The antimicrobial resistance travel tool, an interactive evidence-based educational tool to limit antimicrobial resistance spread.

BackgroundInternational travel has been recognized as a risk factor contributing to the spread of antimicrobial resistance (AMR). However, tools focused on AMR in the context of international travel and designed to guide decision-making are limited. We aimed at developing an evidence-based educational tool targeting both healthcare professionals (HCPs) and international travellers to help prevent the spread of AMR.MethodsA literature review on 12 antimicrobial-resistant bacteria (ARB) listed as critical and high tiers in the WHO Pathogen Priority List covering four key areas was carried out: AMR surveillance data; epidemiological studies reporting ARB prevalence data on carriage in returning travellers; guidance documents reporting indications on screening for ARB in returning travellers and recommendations for ARB prevention for the public. The evidence, catalogued at country-level, provided the content for a series of visualizations that allow assessment of the risk of AMR acquisition through travel.ResultsUp to January 2021, the database includes data on: (i) AMR surveillance for 2.018.241 isolates from 86 countries; (ii) ARB prevalence of carriage from 11.679 international travellers and (iii) 15 guidance documents published by major public health agencies. The evidence allowed the development of a consultation scheme for the evaluation of risk factors, prevalence of carriage, proportion and recommendations for screening of AMR. For the public, pre-travel practical measures to minimize the risk of transmission were framed.ConclusionsThis easy-to-use, annually updated, freely accessible AMR travel tool (https://epi-net.eu/travel-tool/overview/), is the first of its kind to be developed. For HCPs, it can provide a valuable resource for teaching and a repository that facilitates a stepwise assessment of the risk of AMR spread and strengthen implementation of optimized infection control measures. Similarly, for travellers, the tool has the potential to raise awareness of AMR and outlines preventive measures that reduce the risk of AMR acquisition and spread.

Hospital-Based Antimicrobial Stewardship Programs Used in Low- and Middle-Income Countries: A Scoping Review.

The burden of antimicrobial resistance (AMR) is considerable in many low- and middle-income countries (LMICs), and it is important to describe the antimicrobial stewardship program (ASP) activities found in these countries and report their impact. Importantly, as these programs target prescribing behavior, the factors influencing prescription of antimicrobials must also be taken into account. This scoping review aimed to (1) describe hospital-based ASP activities, (2) report methods used to measure the impact of ASPs, and (3) explore factors influencing antimicrobial prescribing behavior in LMICs. PubMed was searched from database inception until April 2021. Factors influencing antimicrobial prescribing behavior were canvassed using the Capability-Opportunity-Motivation and Behavior framework. Most of ASP studies in LMICs were predominantly conducted in tertiary care and university-based hospitals. Audit of antimicrobial prescriptions with feedback and restrictive-based strategies was the main reported activity. Total antimicrobial consumption was the main method used to measure the impact of ASPs. Positive outcomes were observed for both clinical and microbiological outcomes; however, these were measured from nonrandomized controlled trials. Dominant factors identified through the behavioral framework were a limited awareness of AMR as a local problem, a perception that overprescription of antimicrobials had limited consequences and was mainly driven by a motivation to help improve patient outcomes. In addition, antimicrobial prescribing practices were largely influenced by existing hierarchy among prescribers. Our scoping review suggests that LMICs need to evaluate antimicrobial appropriateness as an added measure to assess impact. Furthermore, improvements in the access of microbiology and diagnostic facilities and ensuring ASP champions are recruited from senior prescribers will positively influence antimicrobial prescribing behavior, helping improve stewardship of antimicrobials in these countries.

Awareness of Antimicrobial Resistance and Associated Factors among Layer Poultry Farmers in Zambia: Implications for Surveillance and Antimicrobial Stewardship Programs.

Antimicrobial resistance (AMR) is a global public health problem affecting animal and human medicine. Poultry production is among the primary sources of income for many Zambians. However, the increased demand for poultry products has led to a subsequent increase in antimicrobial use. This study assessed the awareness of AMR and associated factors among layer poultry farmers in Zambia. A cross-sectional study was conducted among 77 participants from September 2020 to April 2021. Data was analysed using Stata version 16.1. The overall awareness of AMR among the farmers was 47% (n = 36). The usage of antibiotics in layer poultry production was high at 86% (n = 66). Most antibiotics were accessed from agrovets (31%, n = 24) and pharmacies (21%, n = 16) without prescriptions. Commercial farmers were more likely to be aware of AMR compared to medium-scale farmers (OR = 14.07, 95% CI: 2.09–94.70), as were farmers who used prescriptions to access antibiotics compared to those who did not (OR = 99.66, 95% CI: 7.14–1391.65), and farmers who did not treat market-ready birds with antibiotics compared to those who did (OR = 41.92, 95% CI: 1.26–1396.36). The awareness of AMR among some layer farmers was low. Therefore, policies that promote the rational use of antibiotics need to be implemented together with heightened surveillance activities aimed at curbing AMR.

The effectiveness of raising Hong Kong parents\u2019 awareness of antimicrobial resistance through an education program with peer support on social media: a randomized, controlled pilot study

BackgroundThe aim of this study was to address the misuse of antibiotics and test the feasibility of an education program with peer support on social media in improving parents’ knowledge on antimicrobial resistance at a regional level in Hong Kong. This pilot, if successful, will be developed into a main study.MethodsA cluster randomized controlled trial with two-arms were implemented. The intervention program consisted of two weekly sessions and each session lasted for 90 min. Parents in the intervention group would join a Facebook Page of Antibiotic Use, this online platform would allow participants to build a social network. A total of 48 parents had participated in the program. Parental knowledge and attitude were measured before and after the program using the Parental Perception on Antibiotics (PAPA) scale and the General Self-Efficacy Scale (GSE) to assess differences between and within the intervention and control groups.ResultsAll parents in the intervention group had an understanding that antibiotics could be effective at treating some infections only, as compared to 40% in the control group. All parents in the intervention group and 85% of the control group disagreed that they should reduce the dose of antibiotics when their children were recovering. The test was statistically significant (p = 0.039) at p < 0.05. There were a significant difference and a strong negative correlation between peer support on Facebook and the parents’ belief that antibiotics could be stopped when their children felt better, with Pearson coefficient of − 0.78 at p < 0.001. In general, there was no significant difference between the two groups with respect to the scale.ConclusionsBased on the findings in this pilot study, a further study focused on the education program with enhancement and peer support should be implemented on a larger scale with considerations of how it might support reducing incidence of antimicrobial resistance and potentially influencing prescription expectations of patients when seeking healthcare.Trial registrationRetrospectively registered Chinese Clinical Trial Registry ChiCTR2100044870.Registered on 31 March 2021.

‘Superbugs’: raising public awareness of antimicrobial resistance through a pop-up science shop

‘Superbugs: A Pop-up Science Shop’ was a public engagement event in the school summer holidays of 2019, organised by members of Cardiff University’s School of Medicine. We transformed an empty retail unit in the centre of Wales’s largest shopping centre into an interactive and immersive microbiology experience. We facilitated two-way dialogue to impart positive impact on the awareness of antibiotic resistance, while concurrently evaluating the efficacy of an engagement strategy focused on the utilisation of public spaces to attract public demographics diverse to those who would normally engage with conventional science, technology, engineering and mathematics (STEM) outreach. Over the course of 14 days, we welcomed 6,566 visitors, with 67 per cent attending as part of the natural footfall of the shopping centre. We created 1,626 young Antibiotic Resistance Champions, located in over two hundred schools, across many of the most deprived areas in Wales. We imparted a positive impact to our stakeholders, with a significant increase in the knowledge and understanding of the subject of antimicrobial resistance (AMR); 91.7 per cent indicated that they had a better understanding after the event. In this article, we discuss the evolution of ‘Superbugs’ from concept, planning and design, to the logistics of delivering an engagement event of this scale. We focus in particular on the learning outcomes of the project, and on how this will shape the future of our ‘Superbugs’ project, and engagement events beyond.

The impact of antimicrobial resistance awareness interventions involving schoolchildren, development of an animation and parents engagements: a pilot study

BackgroundAntimicrobial resistance (AMR) is a global health challenge, particularly in low- and middle-income countries where antibiotics are widely available to consumers, leading to their misuse. However, AMR educational interventions for engaging parents of schoolchildren are mainly lacking in Sub-Saharan Africa. This study aimed to assess the potential of AMR animation and schoolchildren in influencing parents’ AMR knowledge, attitudes, and beliefs.MethodsParents of schoolchildren aged 11–15 years in Tema, a city in Ghana, watched and discussed an AMR animation designed with ideas from the schoolchildren’s top stories and picture drawings. The children from two schools were first engaged with AMR lessons, with one school using storytelling, the other school using picture drawing, and none serving as a control. The children were then asked to discuss the lessons with their parents. Baseline surveys of parents of randomly selected children were conducted to assess AMR knowledge, attitudes and beliefs before engaging the students and parents, and immediately after the parents participated in viewing and discussing the animation. McNemar and t-tests were used to assess changes in AMR knowledge, attitudes and beliefs.ResultsParents who participated in the animation event, and whose schoolchildren were in the storytelling intervention school had significantly improved knowledge regarding the statement “Antibiotics will cure any infection” (p = 0.021, χ2 = 0.711; 88% vs 50%) between baseline and endline. However, these parents also had statistically significant decreased scores regarding the statement “Antibiotics do not kill our good bacteria” (p = 0.021, χ2 = 1.042; 71.4% vs 40%) between baseline and endline. There was no significant effect on any statement among parents whose children were in the picture drawing school. However, t-test results combining the statements as composite scores showed statistically significant difference in only the attitude construct among parents whose children participated in storytelling intervention (p = 0.043) or picture drawing intervention (p = 0.019). There were no statistically significant changes in knowledge and beliefs constructs.ConclusionsThis study shows that interventions involving schoolchildren with parents engagements and AMR animation could influence parents’ AMR attitudes. The intervention could also positively or negatively impact parents’ AMR knowledge. Modifications of the interventions may be needed for tackling AMR.

Knowledge, attitudes, and perceptions of dairy farmers regarding antibiotic use: Lessons from a developing country

In lower- and middle-income countries, uncontrolled use of antibiotics is causing antimicrobial resistance, affecting both animal welfare and public health. Meanwhile, studies on antibiotic use in these countries are limited. A crucial step to limit the spread of antimicrobial resistance (AMR) is to examine the use of these drugs and identify its determinants. The aim of our study, the first of its kind in Lebanon, was to assess dairy farmers' knowledge and awareness of antimicrobial use (AMU) and AMR. For this, 18 farmers from different regions, educational backgrounds, experience levels, and herd sizes were interviewed. Results showed that owners of larger farms were more aware of AMU and AMR, and trying to implement preventive actions, whereas nonsystematic antimicrobial use was prevalent among the smaller farms. Mastitis and laminitis were the most treated diseases, and antibiotics used were oxytetracycline, penicillin, streptomycin, and florfenicol. Overall, antibiotic use was found as a preventive measure and a treatment of nonbacterial diseases. Irregular uses were linked to easy access of farmers to antibiotics, interrupted relations with veterinary authorities, and lack of self-assessment and inspection. Lebanese dairy farmers and owners reported feeling disadvantaged in their local trade field, facing illegal competition and unauthorized farms and industries, and lacking support from the government. Training and awareness programs must be implemented, and policies and regulations must be set, to reduce antibiotic use and hinder the spread of AMR in Lebanon.

Antibiotic usage in surgical sperm retrievals among IVF centers.

Surgical sperm retrieval (SSR) is currently one of the most common procedures in in vitro fertilization (IVF). However, a gap between the guidelines and routine clinical practice regarding antibiotic use in SSR, which might lead to antibiotic resistance, is a challenging problem worldwide. A cross-sectional survey was conducted from May 1, 2021, to July 15, 2021, to investigate antibiotic usage by medical professionals when performing SSR in IVF centers in Vietnam. The confidential questionnaire comprised 12 items, including characteristics of the study population, awareness of antimicrobial resistance, attitude toward prescribing antibiotics, and current practice of prescribing antibiotics when performing SSR. Surveys were completed by 30 of 45 registered IVF centers (66.7%). Among 67 physicians working at those centers, the age and work-experience years (mean ± standard deviation [s.d.]) were 38.6 ± 6.6 years and 11.2 ± 7.0 years, respectively. Over 60% of them held a degree in Obstetrics and Gynecology, and over four-fifths were men. Most respondents "often/very often/always" raised awareness of antimicrobial resistance to their patients (83.3%), but only half of them "often/occasionally" prescribed antibiotics to patients with SSR in cases where the prescription would be optional. About one-tenth of respondents followed the recommendation from the American Urological Association using "prophylaxis only" for SSR patients. For more invasive SSR, physicians tended to prescribe more complicated and sometimes inappropriate regimens. In conclusion, antibiotic usage in SSR was not always appropriate among IVF centers. Further studies may define specific recommendations for regimens, intervention strategies, and programs to promote appropriate antibiotic use for SSR patients among IVF specialists.

A Study Design for Awareness Regarding Appropriate Antimicrobial use and Antimicrobial Resistance among Health Care Professionals and Lay Persons

Aim: This study is designed to determine the awareness of anti-microbial resistance and appropriate antimicrobials use among health care professionals (intern, junior residents and nurses) and lay persons.&#x0D; Methods: The study will be held at rural tertiary care hospital in central India including junior resident, Interns and nurses, patient and their relatives. Survey tool and data questionnaire will be provided to participants in English and Marathi.&#x0D; Results: Comparison of knowledge of antimicrobial resistance among hospital staff, patient and their relatives will be done.&#x0D; Conclusion: There is a need to frame policies to prevent excessive use of Antimicrobials and to increase awareness about the knowledge of proper usage antimicrobial and antimicrobial resistance among lay person.

AB014. Does poor awareness of antimicrobial resistance among general public and health professionals lead to high prevalence of it?—a study in a Sri Lankan urban setting

Background: Antimicrobial resistance can be the next global pandemic. Because of high population density, urban areas will be more vulnerable. Urban wild animals may be exposed to antimicrobials through livestock, humans, and the environment. Hence, they could act as reservoirs and indicators of environmental contamination. This study aimed to investigate the antimicrobial resistance profile in Escherichia coli isolated from livestock and wild animals in an urban ecosystem and to investigate the knowledge, awareness and perception of antibiotics and antimicrobial resistance among general public and health professionals in an urban setting in Sri Lanka.

Population knowledge and awareness of antibiotic use and antimicrobial resistance: results from national household survey 2019 and changes from 2017

BackgroundLack of knowledge and awareness on antimicrobial resistance (AMR) can result in irrational use of antibiotics, which is one of the major drivers of AMR. One goal of the Thailand National Strategic Plan on AMR (2017-2021) is a 20% increase in public knowledge and awareness of antibiotic use and AMR by 2021. This study assesses antibiotic use, level of knowledge and awareness of antibiotic use and AMR and the factors associated with their knowledge and awareness in the Thai population in 2019. It compares findings with a similar national survey in 2017.MethodsAn AMR module was integrated into the Health and Welfare Survey, a biennial national household survey conducted by the National Statistical Office since 2017. The 2019 survey took place in March, through face-to-face interviews with 27,900 Thai adults aged 15 years or above who participated in the survey and compares 2019 findings with those from 2017.ResultsOne month prior to the survey, 6.3% of population reported use of antibiotics (reduced from 7.9% to 2017), of which 98.1% received antibiotics through healthcare professionals and almost half (43.2%) for flu symptoms. During the last 12 months, 21.5% of Thai adults received information on the appropriate use of antibiotics and AMR (increased from 17.8% to 2017); mostly through health professionals (82.7%). On knowledge, 24.3% of adults gave correct answers to more than three out of six statements (three true and three false statements) (increased from 23.7% to 2017). The overall mean score of awareness of appropriate antibiotic use and AMR is 3.3 out of total score of 5.ConclusionsAlthough progress was made on knowledge and awareness between 2017 and 2019, certain practices, such as use of antibiotics for flu symptoms and receiving information about antibiotic use and AMR, are inappropriate and inadequate. These findings require significant action, notably strengthening health professionals’ ability to prescribe and dispense antibiotics appropriately and effective communication with patients. The government should promote specific information on rational use of antibiotics and AMR to specific target groups.

A Co-Association Network Analysis Reveals Putative Regulators for Health-Related Traits in Pigs.

In recent years, the increase in awareness of antimicrobial resistance together with the societal demand of healthier meat products have driven attention to health-related traits in livestock production. Previous studies have reported medium to high heritabilities for these traits and described genomic regions associated with them. Despite its genetic component, health- and immunity-related traits are complex and its study by association analysis with genomic markers may be missing some information. To analyse multiple phenotypes and gene-by-gene interactions, systems biology approaches, such as the association weight matrix (AWM), allows combining genome wide association study results with network inference algorithms. The present study aimed to identify gene networks, key regulators and candidate genes associated to immunocompetence in pigs by integrating multiple health-related traits, enriched for innate immune phenotypes, using the AWM approach. The co-association network analysis unveiled a network comprised of 3,636 nodes (genes) and 451,407 edges (interactions), including a total of 246 regulators. From these, five genes (ARNT2, BRMS1L, MED12L, SUPT3H and TRIM25) were selected as key regulators as they were associated with the maximum number of genes with the minimum overlapping (1,827 genes in total). The five regulators were involved in pathways related to immunity such as lymphocyte differentiation and activation, platelet activation and degranulation, megakaryocyte differentiation, FcγR-mediated phagocytosis and response to nitric oxide, among others, but also in immunometabolism. Furthermore, we identified genes co-associated with the key regulators previously reported as candidate genes (e.g., ANGPT1, CD4, CD36, DOCK1, PDE4B, PRKCE, PTPRC and SH2B3) for immunity traits in humans and pigs, but also new candidate ones (e.g., ACSL3, CXADR, HBB, MMP12, PTPN6, WLS) that were not previously described. The co-association analysis revealed new regulators associated with health-related traits in pigs. This approach also identified gene-by-gene interactions and candidate genes involved in pathways related to cell fate and metabolic and immune functions. Our results shed new light in the regulatory mechanisms involved in pig immunity and reinforce the use of the pig as biomedical model.

Antimicrobial stewardship: Assessment of knowledge, awareness of antimicrobial resistance and appropriate antibiotic use among healthcare students in a Nigerian University

BackgroundInappropriate use of antibiotics is a major cause of antimicrobial resistance (AMR). Inadequate knowledge about AMR among healthcare students could affect their practice of antimicrobial stewardship as future healthcare professionals. This study aims to assess the use of antibiotics and knowledge of AMR among future healthcare professionals of a Nigerian University.MethodsRespondents’ knowledge of antimicrobial resistance, use of antibiotics, and source of antibiotics in the past 12 months was explored using a self-administered questionnaire. Multivariate analyses were used to evaluate the relationship between specific variables and respondents’ knowledge.ResultsOf the 939 questionnaires administered to the students, 866 were filled given a response rate of 92.2 %. A total of (765; 88.3 %) of the respondents were aware that antimicrobial resistance makes it harder to eliminate the infection from the body as existing drugs become less effective. In all 824, (95.2 %) of the respondents had use antibiotics in the past 12 months. The use of antibiotics to treat malaria was self-reported by (175; 21.2 %). About half (432; 52.4 %) purchased the antibiotics from community pharmacies, while others obtained their antibiotics from the hospitals (192; 23.3 %), patent medicine stores (150; 18.2 %), and friends and family (50; 6.1 %) in the last 12 months. In all 506, (58.4 %) had good knowledge of antimicrobial resistance. Logistic regression shows that students in 3rd to 6th year 9.29 [AOR = 9.29, 95 % CI: (3.7–22.96)], had greater knowledge of antimicrobial resistance.ConclusionsThe healthcare students demonstrated a moderate knowledge of AMR. This underscores the need to adopt several educational tactics to introduce the concepts of AMR to the students and ensure there are strict policies to regulate the flow of antibiotics.

Impact of the World Antimicrobial Awareness Week on public interest between 2015 and 2020: A Google Trends analysis

ObjectivesTo evaluate the impact of the World Antimicrobial Awareness Week (WAAW) on public awareness of antimicrobial resistance using Google Trends analysis. MethodsThe impact of WAAW on public awareness of ‘antimicrobial resistance’ (AMR), ‘antibacterial’, and ‘antibiotics’ in Japan, the UK, the United States, and worldwide from 2015 to 2020 was analyzed, using the relative search volume (RSV) of Google Trends as a surrogate. A joinpoint regression analysis was performed to identify a statistically significant time point of a change in trend. ResultsNo joinpoints around WAAW were identified in Japan, the United Kingdom, or the United States from 2015 to 2020 with RSVs of ‘AMR’, whereas increasing RSVs were noted worldwide in 2017 and 2020. Further, there were decreasing RSVs of ‘antibiotics’ in the first half of 2020, which could be due to the COVID-19 pandemic. The study results suggest that WAAW did little to improve public awareness of AMR in the selected countries despite its contribution worldwide. ConclusionsThis study implies that we need to develop a more effective method to improve public awareness to fight against AMR.

Reducing the Risk of Transmission of Critical Antimicrobial Resistance Determinants From Contaminated Pork Products to Humans in South-East Asia.

Antimicrobial resistance (AMR) is a critical challenge worldwide as it impacts public health, especially via contamination in the food chain and in healthcare-associated infections. In relation to farming, the systems used, waste management on farms, and the production line process are all determinants reflecting the risk of AMR emergence and rate of contamination of foodstuffs. This review focuses on South East Asia (SEA), which contains diverse regions covering 11 countries, each having different levels of development, customs, laws, and regulations. Routinely, here as elsewhere antimicrobials are still used for three indications: therapy, prevention, and growth promotion, and these are the fundamental drivers of AMR development and persistence. The accuracy of detection of antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARG) depends on the laboratory standards applicable in the various institutes and countries, and this affects the consistency of regional data. Enterobacteriaceae such as Escherichia coli and Klebsiella pneumoniae are the standard proxy species used for indicating AMR-associated nosocomial infections and healthcare-associated infections. Pig feces and wastewater have been suspected as one of the hotspots for spread and circulation of ARB and ARG. As part of AMR surveillance in a One Health approach, clonal typing is used to identify bacterial clonal transmission from the production process to consumers and patients – although to date there have been few published definitive studies about this in SEA. Various alternatives to antibiotics are available to reduce antibiotic use on farms. Certain of these alternatives together with improved disease prevention methods are essential tools to reduce antimicrobial usage in swine farms and to support global policy. This review highlights evidence for potential transfer of resistant bacteria from food animals to humans, and awareness and understanding of AMR through a description of the occurrence of AMR in pig farm food chains under SEA management systems. The latter includes a description of standard pig farming practices, detection of AMR and clonal analysis of bacteria, and AMR in the food chain and associated environments. Finally, the possibility of using alternatives to antibiotics and improving policies for future strategies in combating AMR in a SEA context are outlined.

The Impact of the Covid-19 Pandemic on Food Consumers' Awareness of Antimicrobial Resistance, OneHealth, and Animal Welfare Information on Food Labels.

Covid-19 is a OneHealth crisis with far-reaching and unexpected impacts on many aspects of society. Previous OneHealth issues, such as antimicrobial resistance (AMR), have not received a similar level of attention or action from the public despite representing significant public health and economic threats to society. The current study aimed to explore whether the Covid-19 pandemic may act as a catalyst to increase public awareness related to OneHealth issues, in particular, AMR. This short paper presents overview findings from a survey carried out in September 2020 with a representative sample of food consumers on the island of Ireland (n = 972). The survey revealed Covid-19 had increased awareness of AMR amongst 47% of respondents; increased awareness of connected animal and human health amongst 43% of respondents; and increased awareness of animal welfare information on food labels amongst 34% of respondents. A cluster analysis revealed five distinct consumer segments impacted differently by Covid-19. These segments differed in their levels of objective and subjective knowledge of antibiotic use practises in farming, AMR risk perception, and attributions of responsibility for action on AMR. Findings are discussed with respect to future efforts by the agri-food sector to communicate with the public about AMR and responsible antibiotic use in farming, with particular emphasis on the implications for strategies that incorporate front-of-pack labelling.

Development and Pilot of an Interactive Online Course on Antimicrobial Stewardship in Companion Animals.

A holistic approach to antimicrobial use (AMU) and prescribing is needed to combat the problem of antimicrobial resistance (AMR). Previously, an antimicrobial stewardship programme (ASP) was developed, introduced, and evaluated in 44 Dutch companion animal clinics, which resulted in an optimization of AMU. As a follow-up to this, an online course was developed to promote awareness of AMU, AMR, and responsible antimicrobial prescribing. The aim of this paper is to describe the development and pilot, including evaluation, of this course, which will be disseminated more widely among Dutch companion animal veterinarians. The interactive programme consists of a major e-learning component and two online, face-to-face meetings. The course comprises five different parts corresponding with five consecutive weeks. Theory on several topics is offered, for example on AMU and AMR in general, Dutch regulations and guidelines on veterinary AMU, behavioural change, and possible methods to quantify AMU. Additionally, several assignments are offered, for example to reflect upon one’s own current antimicrobial prescribing behaviour. Interactive discussion and peer-to-peer learning are promoted. Since September 2020, the course has been offered in a pilot phase, and the feedback is promising. Evaluation of the pilot phase will result in recommendations for further optimization and dissemination.

Antibiotic Prescribing Habits and Antimicrobial Resistance Awareness of Dental Practitioners in Primorsko-Goranska County, Croatia.

Purpose: The goal of this study was to investigate the differences in dentists' knowledge, attitudes, and practice regarding antibiotic use and resistance among two areas of Primorsko-Goranska County (P-GC), Croatia. Materials and Methods: A cross-sectional study based on a structured questionnaire that was given to 230 dental practitioners in outpatient settings of P-GC in 2018. Results: The overall response rate was 68.3% (157/230) and 72.2% (83/115) in the city of Rijeka and 64.3% (74/115) in the rest of P-GC. Dentists from two areas of P-GC held similar knowledge about prescribing antibiotics and attitudes regarding antibiotic use (p > 0.05). Most of the dental practitioners chose penicillins (65.0% amoxicillin with clavulanic acid and 33.1% amoxicillin) as the first-choice antibiotic in patients with no medical allergies. The trend of prescribing amoxicillin decreases with the age of the dentists (p = 0.046). Clindamycin (86.6%) was the first choice for patients allergic to penicillin. Postgraduate education changed the attitude toward taking more time to consider whether or not an antibiotic is needed. Croatian dentists had a high awareness of antimicrobial resistance (99.4%). The most common situations for which dentists would prescribe antibiotics were periapical abscess (84.7%), periodontal abscess (72.6%), and implant placement (59.9%). Patient request or expectation (43.4%) and treatment uncertainty (41.5%) were found to be the main factors for prescribing antibiotics with more frequency. Conclusions: Although there is a high level of antimicrobial resistance awareness among dental practitioners, there is still too much overuse of antibiotics and personal responsibility for prudent antibiotic use should be increased. The results of this study indicate that antibiotics are frequently prescribed for indications where surgical treatment should be the first option and the broad spectrum antibiotic is the preferred treatment option.

Antimicrobial resistance: Nurse’s knowledge and perception in a tertiary level care hospital in North-Eastern Nigeria

Nursing staff has a significant role to play in the control of Antimicrobial Resistance (AMR) through infection control and patient education. We studied the knowledge of nurses on AMR for purpose of planning AMR control efforts. A cross-sectional study was conducted between 21st June and 30th July 2017, among nurses working at Federal Medical Center Nguru, Yobe State. Responses were presented as frequencies and percentages. Relative risks and 95% confidence intervals were computed to describe factors associated with knowledge of AMR. Only 37.2% of the respondents had good knowledge of AMR. Age more than or equal to 40 years versus less than 40 years (RR=2.66, 95% CI: 1.253-5.662), work experience greater than or equal to 10 years versus less than 10 years (RR=2.94, 95% CI: 1.518-5.686) predicted good knowledge of AMR. A significant knowledge gap on AMR among nurses has been identified. We recommend a robust AMR awareness initiative to educate nursing staff on AMR. Further studies among other cadre of healthcare workers should be conducted to define and address the AMR knowledge gap among all Nigerian healthcare workforces.

Antimicrobial Use, Residues, Resistance and Governance in the Food and Agriculture Sectors, Tanzania.

All infections are potentially curable as long as the etiological agents are susceptible to antimicrobials. The increased rate at which antimicrobials are becoming ineffective is a global health risk of increasing concern that threatens withdrawal of beneficial antimicrobials for disease control. The increased demand for food of animal origin, in particular eggs, meat and milk has led to intensification and commercial production systems where excessive use and misuse of antimicrobials may prevail. Antimicrobials, handled and used by farmers and animal attendants with no formal education, may be predisposed to incorrect dosages, misuse, incorrect applications and non-adherence to withdrawal periods. This study was conducted to assess the regulatory roles and governance of antimicrobials, establish the pattern and extent of their use, evaluate the antimicrobial residues and resistance in the food animals and crop agriculture value chains, and relate these findings to existing strategies in place for combating the emergence of antimicrobial resistance in Tanzania. A multimethod approach (desk review, field study and interviews) was used. Relevant establishments were also visited. High levels of resistance to penicillin G, chloramphenicol, streptomycin and oxytetracycline have been reported, especially for Actinobacter pyogenes, Staphylococcus hyicus, Staphylococcus intermedius and Staphylococcus aureus from dairy cattle with mastitis and in humans. Similar trends were found in poultry where eggs and meat are contaminated with Escherichia coli strains resistant to amoxicillin + clavulanate, sulphamethoxazole and neomycin. An increasing trend of emerging multidrug resistant E. coli, Klebsiella pneumoniae, Staphylococcus aureus and Salmonella was also found in food animals. An increase in methicillin resistant Staphlococcus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL) in the livestock sector in Tanzania have been reported. The pathogens isolated in animals were resistant to ampicillin, augmentin, gentamicin, co-trimoxazole, tetracycline, amoxicillin, streptomycin, nalidixic acid, azithromycin, chloramphenicol, tylosin, erythromycin, cefuroxime, norfloxacin and ciprofloxacin. An increased usage of antimicrobials for prophylaxis, and therapeutics against pathogens and for growth promotion in livestock, aquaculture and crop production were observed. A One Health strategic approach is advocated to combat antimicrobial resistance (AMR) in the food and agriculture sectors in Tanzania. Practical recommendations include (a) legislation review and implementation; (b) antimicrobial use (AMU), AMR and antimicrobial residue (AR) awareness and advocacy among stakeholders along the value chain; (c) strengthening of surveillance and monitoring programs for AMU, AMR and AR; (d) enhanced development and use of rapid and innovative diagnostic tests and the promotion of biosecurity principles; and (e) good husbandry practices. The utilization of this information to improve public health policies and reduce the burden of AMR will be beneficial.