Prevention Of Antimicrobial Resistance Research Articles

Knowledge, Attitudes, and Practices of Antimicrobial Use and Resistance among Livestock Producers in Cambodia

The development of antimicrobial resistance (AMR) due to over or misuse of antibiotics/antimicrobials is a globally increasing public health concern. This study was conducted to assess the current knowledge, attitudes, and practices (KAP) of swine and poultry producers on antimicrobial use (AMU) and antimicrobial resistance (AMR). A total of 254 swine and poultry producers of 5 provinces in Cambodia were purposively surveyed using validated KAP questionnaires, a useful tool for promoting the rational use of antimicrobials in livestock. Collectively, this study found out that livestock producers in Cambodia have a low level of knowledge, neutral rather than positive attitudes, and employed poor practices on the AMU and AMR. Thus, there is a need to promote among producers the rational and responsible use of antimicrobials. Furthermore, public awareness of the AMR implications on public health can contribute to the prevention or reduction of AMU and AMR in Cambodia.

One health: harmonizing infection prevention and control, and antimicrobial stewardship in combating antimicrobial resistance to improve patient safety

One of the greatest successes in the fight against infectious diseases is the discovery of antimicrobials. This has remained a cornerstone in subsequent advancements in healthcare delivery. However, the emergence of Antimicrobial Resistance (AMR) dampened the celebrations. Currently, AMR is a major hindrance to patient safety because of the emergence, re-emergence and continued spread of multidrug resistant (MDR) pathogens. The speed and extent of AMR spread is a major threat to human health globally. Several efforts and approaches have been tried at different levels to combat this global menace. However, the continued emergence of different MDR pathogens has escalated the seriousness of the threat, especially the rising burden of healthcare associated infections. Improving antimicrobial stewardship (AMS) has been advocated worldwide to preserve the available antimicrobials for use against the right pathogens. The interrelationship between AMR, AMS, and infection prevention and control (IPC) in the context of Patient Safety can best be understood by integration into the “One Health” concept. The One Health concept was introduced to break barriers and minimize compartmentalization of efforts without losing the benefit of specialization and expertise in addressing human challenges. We argue that One Health concept should be universally embraced and used in harmonizing all efforts at combating AMR through AMS and IPC to improve Patient Safety and healthcare quality across human, animal and environmental healthcare systems. This perspective is our effort to bring all the components under the One Health umbrella.

Prevalence and antimicrobial susceptibility level of typhoid fever in Ethiopia: A systematic review and meta-analysis

Typhoid fever continues to be a health challenge in low-and middle-income countries where access to clean water and sanitation infrastructure is scarce. The non-confirmatory diagnostic method continues to hinder effective diagnosis and treatment, ensuring in a high antimicrobial resistance. This systematic review and meta-analysis aimed to estimate the pooled prevalence and antimicrobial susceptibility level of typhoid fever in Ethiopia.The review was designed based on the condition-context-population review approach. Fifteen eligible articles were identified from PubMed, Google Scholar, and Science Direct databases. Risk of bias and quality of studies were assessed using the Joanna Briggs Institute’s appraisal criteria. Heterogeneity was assessed using Cochran’s Q test and I2 statistics. The review protocol was registered in PROSPERO (registration number CRD42021224478).The estimated pooled prevalence of typhoid fever from blood and stool culture diagnosis was 3% (95% CI: 2%–4%, p < 0.01) (I2 = 82.25) and Widal test examination 33% (95% CI: 22%–44%) (I2 = 99.14). The sub-group analyses identified a lower detection of typhoid fever of 2% (95% CI: 1%–3%) among febrile patients compared to typhoid suspected cases of 6% (95% CI: 2%–9%). The stool culture test identified was twofold higher, value of 4% (95% CI: 2%-7%) salmonella S. Typhi infection than blood culture test of 2% (95% CI: 1%–4%). The antimicrobial susceptibility of salmonella S. Typhi for antibiotics was 94%, 80% and 65% for ceftriaxone, ciprofloxacin, and gentamycin respectively. Low susceptibility of salmonella S. Typhi isolates against nalidixic acid 22% (95% CI: 2%–46%) and chloramphenicol 11% (95% CI: 2%–20%) were observed. The diagnosis of typhoid fever was under or overestimated depending on the diagnostic modality. The Widal test which identified as nonreliable has long been used in Ethiopia for the diagnosis of salmonella S. Typhi causing high diagnosis uncertainties. Antimicrobial susceptibility of salmonella S. Typhi was low for most nationally recommended antibiotics. Ethiopian Food and Drug Authority must strengthen its continued monitoring and enhanced national antimicrobial surveillance system using the best available state-of-the-art technology and or tools to inform the rising resistance of salmonella S. Typhi towards the prescription of standard antibiotics. Finally, it is crucial to develop an evidence-based clinical decision-making support system for the diagnosis, empiric treatment and prevention of antimicrobial resistance.

149. Impact of Stewardship on Antibiotic Utilization Rates During the COVID-19 Pandemic: Successes and Challenges in a Regional Hospital

BackgroundAntibiotic stewardship (AS) is at the core of patient safety and prevention of antimicrobial resistance. Healthcare providers prescribe antibiotics for COVID-19 despite low rates of bacterial co-infection. Our regional hospital had antibiotic utilization (AU) rates higher than other health systems even prior to the emergence of SARS-Cov2. We analyzed the effect AS on AU during the pandemic.Total Antibiotic Utilization Rates Before and During COVID-19 Pandemic MethodsTotal and specific AU rates were benchmarked using BD MedMined’s medication analytics system from 2nd quarter 2019 to 1st quarter 2021. The AS team released yearly antibiogram and individual prescriber’s AU rates and performed weekly, and as needed, review of antibiotic ordering and feedback. To assist in appropriate prescribing decisions, remote educational sessions or mini-lectures and local antibiotic guidelines were developed during the pandemic period. AU rates were monitored quarterly to determine the effects of the AS interventions to prescribing practices.ResultsTotal and specific AU rates were higher (up to 34% and 80%, respectively) in our index hospital compared to other non-teaching hospitals nationally prior to the pandemic. Total antibiotic utilization increased by only 5.5% in the 2nd quarter 2020, peak of AU during the pandemic. Total, vancomycin, piperacillin-tazobactam and quinolone utilization rates decreased by 19%, 41%, 38%, and 52%, respectively, at 1st quarter 2021 compared to 4th quarter 2019. Steeper decreases were noted with implementation of educational activities. Ceftriaxone use remained high and was 50% greater than comparator hospitals at 1st quarter 2021.ConclusionAlthough problematic during the COVID-19 pandemic, AS can have significant impact on provider prescribing practices and decrease total and specific antibiotic utilization rates. The use of ceftriaxone, an antibiotic commonly used for empiric bacterial coverage for community acquired pneumonia, presents as a continuing challenge.Disclosures All Authors: No reported disclosures

Novel strategies for prevention and treatment of antimicrobial resistance in sexually-transmitted infections.

Antimicrobial resistance in sexually acquired infection (STI) pathogens is an important global public health threat. There is an urgent need for novel STI treatment and prevention strategies to tackle the rising incidence of STIs in high-income settings and the static progress in low- and middle-income settings over the past decade. The purpose of this review was to describe the research outlining the emergence of resistance in common STI pathogens and new strategies for their treatment and prevention. Rates of STIs have dramatically increased over the past decade. Further, antimicrobial resistance to first-line agents among key STI pathogens continues to emerge globally. Recent findings demonstrate promising results regarding the efficacy of novel antimicrobial treatment strategies for these pathogens, including several new, repurposed and unique combinations of antimicrobials. In addition, a number of new biomedical prevention strategies, such as antibacterial mouthwash and doxycycline chemoprophylaxis, are being investigated as novel prevention strategies for bacterial STIs. Significant progress has been made in the development of novel antimicrobials for the treatment of antimicrobial-resistant sexually acquired pathogens. However, due to the rapid development of resistance to antimicrobials demonstrated by these pathogens in the past, further research and development of effective prevention strategies should be prioritized.

Impact of the COVID-19 pandemic on the surveillance, prevention and control of antimicrobial resistance: a global survey.

ObjectivesThe COVID-19 pandemic has had a substantial impact on health systems. The WHO Antimicrobial Resistance (AMR) Surveillance and Quality Assessment Collaborating Centres Network conducted a survey to assess the effects of COVID-19 on AMR surveillance, prevention and control.MethodsFrom October to December 2020, WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) national focal points completed a questionnaire, including Likert scales and open-ended questions. Data were descriptively analysed, income/regional differences were assessed and free-text questions were thematically analysed.ResultsSeventy-three countries across income levels participated. During the COVID-19 pandemic, 67% reported limited ability to work with AMR partnerships; decreases in funding were frequently reported by low- and middle-income countries (LMICs; P < 0.01). Reduced availability of nursing, medical and public health staff for AMR was reported by 71%, 69% and 64%, respectively, whereas 67% reported stable cleaning staff availability. The majority (58%) reported reduced reagents/consumables, particularly LMICs (P < 0.01). Decreased numbers of cultures, elective procedures, chronically ill admissions and outpatients and increased ICU admissions reported could bias AMR data. Reported overall infection prevention and control (IPC) improvement could decrease AMR rates, whereas increases in selected inappropriate IPC practices and antimicrobial prescribing could increase rates. Most did not yet have complete data on changing AMR rates due to COVID-19.ConclusionsThis was the first survey to explore the global impact of COVID-19 on AMR among GLASS countries. Responses highlight important actions to help ensure that AMR remains a global health priority, including engaging with GLASS to facilitate reliable AMR surveillance data, seizing the opportunity to develop more sustainable IPC programmes, promoting integrated antibiotic stewardship guidance, leveraging increased laboratory capabilities and other system-strengthening efforts.

Educational antimicrobial stewardship programs in medical schools: a scoping review.

The objective of this scoping review was to identify the available evidence on antimicrobial stewardship programs for teaching medical students about rational antimicrobial use, including the content taught and the method of instruction used. Antibiotics are a precious resource whose discovery have saved millions of lives. They are used extensively in surgical procedures, cancer chemotherapy, and in the treatment of infectious diseases. However, the development of antimicrobial resistance and the slow rate of discovery of new agents with novel mechanisms of actions represent a threat to modern medicine. This scoping review considered papers that described medical school curricula that focused on the teaching and learning of the prescription of antimicrobial medication. Studies that described this concept in the curricula of other health profession students, such as nursing, pharmacy, or dentistry students, were excluded. The JBI three-step process was followed and conducted by two reviewers. The scoping review followed an a priori published protocol. Eight databases were searched for both published and unpublished literature and gray literature. Only studies published in English from 1996 onwards were included. Full texts of selected citations were assessed against the inclusion criteria by two independent reviewers. Data were independently extracted by two reviewers. Disagreements were resolved through discussion, and the need for a third reviewer was not required. Data extraction was undertaken using a modified charting table developed for the review objectives. The findings are presented using the narrative synthesis. Thirteen studies were included in the review, with most of the papers originating from the United States of America and Europe, with one from developing countries. Didactic lectures and web-based distance learning were the most common modes of instruction used in the included papers. Six of the included papers presented the outcomes of their interventions; different methods of assessment were used to evaluate students, which included baseline and post-instruction assessment or a series of short exams. Some of the concepts in the teaching material included the use of antimicrobial agents, prevention of antimicrobial resistance, antimicrobial stewardship, and infection prevention control. The programs (ranging from 75 minutes to 100 hours) were implemented from second to fourth year of study. A wide range of interventions were used to teach the principles of antimicrobial stewardship to medical students. There is a need to further evaluate these programs through follow-up of students after graduation to determine whether the skills learned are retained.

High incidence of multi-drug resistance and heterogeneity of mobile genetic elements in Escherichia coli isolates from diseased ducks in Sichuan province of China

Harmonious ecological environment is a major concern with rising feeding and consumption of ducks, as these waterfowl birds can promote the spread of antibiotic resistant genes (ARGs). Therefore, this study was conducted to know diversity of antimicrobial resistance (AMR), integrons, and mobile genetic elements (MGEs) in Escherichia coli (E. coli) isolated from intestinal contents or pericardial effusion of diseased ducks from 2018 to 2020 in Sichuan, China. The AMR phenotype was determined via disk diffusion test in 165 E. coli isolates. Further, the integrase genes of integron (intI1, intI2 and intI3 genes), gene cassettes (GCs) and MGEs were screened by PCR and sequencing. The results indicated 100% isolates were resistant to at least one antibiotic and 98.8% were multidrug-resistant strains. Highest AMR phenotype was recorded to rifampin (97.0%) followed by ampicillin (95.8%), chloramphenicol (89.7%), trimethoprim-sulfamethoxazole (84.2%), ciprofloxacin (83.0%), cefotaxime (80.0%), streptomycin (75.8%), doxycycline (49.7%), amikacin (10.3%), amoxicillin/clavulanic acid (3.6%), polymyxin B (1.2%) and ertapenem (0.6%). Further, class 1 and 2 integrons were found in 87.3% and 17.6% isolates, respectively. All isolates were negative for intI3 gene. The variable region of class 1 and 2 integrons contained total 13 different GCs, including arr-3+dfrA27, dfrA1+aadA1, dfrA17+aadA5, dfrA12, dfrA1+sat2+aadA1, dfrA12+aadA2, dfrA5, aadA2+ere(A)+dfrA32, aac(6’)-Ib-cr, aadA22, aadA5, dfrA17, and dfrA27. Moreover, 13 MGEs in 69 different combinations were observed with predominance of IS26 followed by tnpA/Tn21, trbC, ISEcp1, merA, ISAba1, tnsA, tnsB, tnsC, IS1133, tnsD, ISCR3/14, and tnsE. Thus, the monitoring of integrons, MGEs and ARGs is important to understand the complex mechanism of AMR, which might help to introduce interventions for prevention and control of AMR in duck farms in China.

Automated Nationwide Benchmarking Dashboard for Antimicrobial Stewardship Programs within the Veterans’ Health Administration

Group Name: VHA Center for Antimicrobial Stewardship and Prevention of Antimicrobial Resistance (CASPAR) Background: Antimicrobial stewardship programs (ASPs) are advised to measure antimicrobial consumption as a metric for audit and feedback. However, most ASPs lack the tools necessary for appropriate risk adjustment and standardized data collection, which are critical for peer-program benchmarking. We created a system that automatically extracts antimicrobial use data and patient-level factors for risk-adjustment and a dashboard to present risk-adjusted benchmarking metrics for ASP within the Veterans’ Health Administration (VHA). Methods: We built a system to extract patient-level data for antimicrobial use, procedures, demographics, and comorbidities for acute inpatient and long-term care units at all VHA hospitals utilizing the VHA’s Corporate Data Warehouse (CDW). We built baseline negative binomial regression models to perform risk-adjustments based on patient- and unit-level factors using records dated between October 2016 and September 2018. These models were then leveraged both retrospectively and prospectively to calculate observed-to-expected ratios of antimicrobial use for each hospital and for specific units within each hospital. Data transformation and applications of risk-adjustment models were automatically performed within the CDW database server, followed by monthly scheduled data transfer from the CDW to the Microsoft Power BI server for interactive data visualization. Frontline antimicrobial stewards at 10 VHA hospitals participated in the project as pilot users. Results: Separate baseline risk-adjustment models to predict days of therapy (DOT) for all antibacterial agents were created for acute-care and long-term care units based on 15,941,972 patient days and 3,011,788 DOT between October 2016 and September 2018 at 134 VHA hospitals. Risk adjustment models include month, unit types (eg, intensive care unit [ICU] vs non-ICU for acute care), specialty, age, gender, comorbidities (50 and 30 factors for acute care and long-term care, respectively), and preceding procedures (45 and 24 procedures for acute care and long-term care, respectively). We created additional models for each antimicrobial category based on National Healthcare Safety Network definitions. For each hospital, risk-adjusted benchmarking metrics and a monthly ranking within the VHA system were visualized and presented to end users through the dashboard (an example screenshot in Figure 1). Conclusions: Developing an automated surveillance system for antimicrobial consumption and risk-adjustment benchmarking using an electronic medical record data warehouse is feasible and can potentially provide valuable tools for ASPs, especially at hospitals with no or limited local informatics expertise. Future efforts will evaluate the effectiveness of dashboards in these settings.Funding: NoDisclosures: None

Validation of neonatal and paediatric antimicrobial stewardship treatment algorithms in rapid diagnostic-detected bacteraemia.

Blood culture rapid diagnostic testing (RDT) aids in early organism identification and resistance gene detection. This information allows quicker transition to tailored antimicrobial therapy, improved patient outcomes and prevention of antimicrobial resistance. An antimicrobial treatment algorithm based on RDT results and local antibiograms can serve as a valuable clinical decision-support tool. This study assessed the proportion of appropriate antibiotic therapy recommendations using a novel paediatric RDT-guided treatment algorithm compared with standard care (SC) in paediatric bacteraemia. This was a retrospective, observational study of admitted paediatric patients who received antibiotics for RDT-confirmed bacteraemia. Appropriateness of SC was compared with algorithm-recommended treatment. Antimicrobial appropriateness was defined as in vitro susceptibility to the organism identified through traditional microbiology. Clinical appropriateness took into consideration the ability to tailor therapy within 12 h of RDT results. Appropriateness was evaluated by two blinded, independent reviewers. Eighty-six blood cultures were included with 15 unique Gram-positive and Gram-negative species or genus identified. Comparative antimicrobial appropriateness of SC and algorithm-recommended treatment was 94.2% (81/86) and 100% (86/86), respectively (P = 0.06). Clinical assessment determined 39.5% (34/86) of SC patients were on appropriate therapy within 12 h of RDT result. Algorithm-recommended therapy was clinically appropriate in 97.7% (84/86) of patients (P < 0.001). There was a median time savings of 42.7 h (IQR 40.6, 49.4) for the patients able to be de-escalated as compared with waiting on final sensitivities. Algorithm-guided treatment may allow most patients to be de-escalated to organism-tailored therapy earlier in their therapeutic course.

Optimizing antimicrobial use: challenges, advances and opportunities.

An optimal antimicrobial dose provides enough drug to achieve a clinical response while minimizing toxicity and development of drug resistance. There can be considerable variability in pharmacokinetics, for example, owing to comorbidities or other medications, which affects antimicrobial pharmacodynamics and, thus, treatment success. Although current approaches to antimicrobial dose optimization address fixed variability, better methods to monitor and rapidly adjust antimicrobial dosing are required to understand and react to residual variability that occurs within and between individuals. We review current challenges to the wider implementation of antimicrobial dose optimization and highlight novel solutions, including biosensor-based, real-time therapeutic drug monitoring and computer-controlled, closed-loop control systems. Precision antimicrobial dosing promises to improve patient outcome and is important for antimicrobial stewardship and the prevention of antimicrobial resistance.

Knowledge and attitude among samples from community members, pharmacists and health care providers about antibiotic resistance in Al- Suwaria city/Wassit province/Iraq

Antimicrobial resistance (AMR) is one of the greatest public health challenges of our time, primarily due to inappropriate antimicrobial use. Addressing this threat is a public health priority that requires a collaborative global approach in all areas. The rational use of antimicrobials is the main strategy for the prevention of antimicrobial resistance, which can be achieved by changing the behavior and knowledge of the prescribers. So, for the success of any problem management program, the most important prerequisite is community participation. Therefore, this study aimed to assess the knowledge and attitude of the samples of community members, pharmacists and health professionals in the city of Al-Suwaria, in the province of Wasit, in the Middle East of Iraq, with respect to antimicrobial resistance, which helps to rationalize the use of antimicrobials. In this survey, a cross-sectional study of 102 random contributing samples was performed. From January to March 2020. Knowledge and attitudes were assessed using a typical self-administered questionnaire. Descriptive analyzes were used to express the results. A total of 102 participants answered the questionnaire. Overall, collaborators have established good knowledge and positive attitudes toward antimicrobial resistance based on 13 knowledge questions and nine attitude statements. Gaps were identified in the knowledge of the possibility of addressing resistance through the discovery of a new drug (21.6%), the possibility of using antibiotics as an effective drug against viral diseases (36.3%) and the possibility of accelerate the treatment of diseases with antibiotics (38.2%). The majority of respondents (72.5%) agreed that antibiotic resistance induces serious global problems that affect public health. Furthermore, the majority of those interviewed (69.6%) believe that this phenomenon affects our health and that of our families. Similarly, (13.7%) of the participants totally agreed, while (65.7%) agreed that pharmacists played an important role in the appearance of this problem, and (37, 3%) of the participants fully agreed, while (58.8%) agreed that it is necessary to follow the recommendations and guidelines for life-saving antibiotics in the hospital. In contrast, 27.5% of the participants expressed a weak attitude towards the possibility of fighting antimicrobial resistance in their region through infection control practices by health professionals. Contributors in this study had good knowledge and positive attitudes toward antimicrobial resistance. Although the data is indicative of gaps in the knowledge of residents of the city of Al-Suwaria/Wasit province.

ED1 Antimicrobial Resistance in US Hospitals: Burden and VALUE of Investment in Developing New Treatments

This research aims to quantify the burden of antimicrobial resistance (AMR) from the perspective of hospital stakeholders and the value of continued investment in developing new treatments. A dataset representative of the US population demographics and health characteristics was constructed by merging the American Community Survey, Behavioral Risk Factor Surveillance System and data on nursing home residents. Prediction equations linking patient demographics and health characteristics to likelihood of hospitalization within hospital service lines were generated using the Medical Expenditure Panel Survey and applied to the population file. Data from the National Healthcare Safety Network were used to calculate state-specific rates of AMR in hospitalized patients experiencing an infection. Peer-reviewed published research provided estimates for AMR-attributable outcomes, including mortality, inpatient days, and direct & indirect costs. Results were calculated under a base case scenario reflecting current rates of infection continuing into the future, and alternative scenarios reflecting changes in future rates of infection and resistance. Base case results suggested approximately 4,100 AMR-attributable deaths would occur in the base modeling year, resulting in over $700 million in direct costs, increasing to 5,300 deaths and $907 million in direct costs by 2035. Under a scenario in which rates of resistance increase to 100%, reflecting a hypothetical scenario where alternative antimicrobial treatments are no longer effective, projected 2035 AMR-attributable deaths increase to 30,700 (480% increase from base case) and direct costs of $8.4 billion (826% increase from base case). Infections are projected be highest in general surgery and thoracic surgery service lines, where high infection risk could potentially make surgeries too risky to perform. Though its current burden is substantial, AMR’s potential future burden is significantly more concerning. Investing in AMR prevention strategies will be necessary to reverse course with respect to increasing resistance.

The burden and etiology of lower respiratory tract infections in children under five years of age in Indonesia.

Lower respiratory tract infections (LRTI) are a substantial threat for children worldwide. Currently, there is a lack of knowledge about the burden and etiology of LRTI in children under five years of age in Indonesia. We have systematically searched the available English and Indonesian scientific literature to review and summarize data on LRTI and LRTI-associated invasive disease, and bacterial carriage in the upper respiratory tract in children under five years of age in Indonesia. Overall, data on the burden and etiology of LRTI in children under five years of age in Indonesia is very limited. The data are primarily collected in Java. Data from other parts of Indonesia, including Sumatra, Kalimantan, and Sulawesi, are scarce. The case fatality rate (CFR) of LRTI in children under five years of age in Indonesia was 0.11%. Influenza was the most commonly reported viral etiological agent of LRTI in children under five years of age in Indonesia. Klebsiella pneumoniae was the most frequently reported bacterial agent of LRTI. Streptococcus pneumoniae showed the highest carriage rates. Surveillance and diagnostic studies are urgently needed and should be conducted in different parts of Indonesia to improve insight in the burden and etiology of LRTI in Indonesia. These data are pivotal to increase the effectiveness of public health strategies, including vaccination and prevention of antimicrobial resistance.

Promoting cross-regional collaboration in antimicrobial stewardship: Findings of an infectious diseases working group survey in Arab countries of the Middle East

BackgroundAntimicrobial resistance is a significant global issue that presents an increasing threat to patients’ wellbeing. Although a global concern, the emergence of multi-drug resistant organisms is of particular significance in the Middle East. In recent years, this region has seen an alarming increase in antimicrobial resistance presenting a major challenge to physicians managing various infectious diseases. MethodsA Working Group comprising experts in infectious diseases from Arab countries of Middle East assembled to review similarities and differences in antimicrobial practices and management of multi-drug resistant organisms across the region and assess the barriers to achieving cross-regional collaboration. The Working Group conducted an anonymous online survey to evaluate current practice and understanding of management of multi-drug resistant organisms across the region. ResultsA total of 122 physicians from Arab countries of the Middle East responded to the survey. Their responses demonstrated heterogeneity between countries in awareness of local epidemiology, management of multi-drug resistant organisms and antimicrobial stewardship practices. The Working Group recognized similarities and differences in the management of multi-drug resistant organisms across the region, and these were validated by the data collected in the survey. Overall, the similarities across the region reflect several key issues that can have an impact on the management of multi-drug resistant organisms and the prevention of antimicrobial resistance. ConclusionsThis paper highlights the urgency of addressing antimicrobial resistance in Arab countries of the Middle East. The Working Group identified key barriers to effective management which may guide the development of future coherent strategies to promote effective antimicrobial stewardship in the region. Here, we outline a call to action for the region, with a need to focus on training and education, capacity building, infrastructure, regional research, and regional surveillance.

The Impact of Educational Intervention on Knowledge and Attitude Regarding Antibiotic Resistance Among Medical Doctors in A Tertiary Care Hospital

Background and objectives: The important component of all antibiotic stewardship program is education of clinicians about the antimicrobial usage. The objective of the study was to evaluate the knowledge and attitudes regarding antibiotic resistance among medical doctors in a tertiary care hospital. The other objective was to evaluate the usefulness of the interactive educational intervention in improving the knowledge about antibiotic resistance Methodology: This was a cross sectional questionnaire based study involving residents and postgraduates from various departments. Questionnaire had three categories of assessment, namely, knowledge about the development of antimicrobial resistance (fifteen questions), treatment of resistant microbial conditions (five questions) and prevention of antimicrobial resistance (five questions). Questionnaire was pre-tested and pilot run. After the filling up of the questionnaire, each participant or a group of three or four participants were provided with interactive educational intervention. In each such session, three components were discussed using a custom designed course module using a learning management system. The modes of development of antimicrobial resistance, methods of rationale antimicrobial prescription and interventions to prevent development of antimicrobial resistance were the main components in the online module. After the online course, each participant filled post-test. The long-term retention of the concepts was tested with one-month follow-up post-test. Results: 120 participants have taken up the pre-test and undergone the study. Pre-test average score was 11.1(± 3.44) out of 25. Of these participants 114, have taken immediate post-test and average score was 20.9 (± 2.67). The improvement of pre-test scores to post-test scores was statistically significant. 94 participants have answered the one-month post-test, the average score was 16 (± 4.79). The results were statistically significantly more than the pre-test score, however statistically lower than post-test score. Conclusion: Use of the interactive online learning material has resulted in significant improvement in the knowledge and attitude regarding antibiotic resistance among post-graduates and interns in a tertiary care hospital.

Animal-Food-Human Antimicrobial Resistance Fundamentals, Prevention Mechanisms and Global Surveillance Trends: A Terse Review

Background and objective: Food-producing animals can potentially transmit resistant bacterial pathogens to humans with various rates in various microbial species. Confronting the global antimicrobial resistance challenges needs collaboratively collective efforts by countries. Published literatures regarding antimicrobial resistance challenges and surveillance continually increase worldwide. Furthermore, understanding of antimicrobial resistance challenges and surveillance must be improved. Therefore, this brief review included antimicrobial resistance fundamentals and prevention mechanisms and its global surveillance trends specific to animal-food-human pathways. Results and Conclusions: The capacity of antimicrobial resistance to include economic and health effects on various regions of the world must not be underestimated. The nature of antimicrobial resistance mechanisms contributes to its complicated spread mechanisms. Hence, there is the need for effective and efficient methods or strategies to challenge antimicrobial resistance. In addition to the concerns of antimicrobial agents with the developed understanding of the antimicrobial resistance prevention mechanisms, key facts of surveillance, specifically in microbiological contexts, are demonstrated in this review. In recent decades, global surveillance trends have been urged to overcome antimicrobial resistance problems. Due to its complexities, antimicrobial resistance remains a major public health concern with no single strategy to thoroughly prevent emergence or spread of infectious microorganisms.

Methods for prevention and constraint of antimicrobial resistance: a review

A variety of multidrug-resistant bacteria is blamed for severe infections worldwide. The emergence of antimicrobial resistance constitutes a serious problem for healthcare systems around the world. Here we review techniques for the prevention and constraint of antimicrobial resistance, the risk factors, and the ways by which antimicrobial resistance spreads. We discuss strategies for containment of widespread infections caused by antibacterial drug-resistant bacteria, including internationally recognized guidelines of antibiotic stewardship, educational programs, and behavioral changes. Recent discoveries of novel therapeutic drugs that can be used against antimicrobial resistance are very promising. For instance, antisense oligonucleotides are novel drugs that can be used successfully against resistant bacteria. This technology has many advantages in the development of antibacterial drugs.

Successful Prevention of Antimicrobial Resistance in Animals-A Retrospective Country Case Study of Sweden.

The misuse and overuse of antibiotics have resulted in an alarmingly high prevalence of antimicrobial resistance (AMR) in human and animal bacteria. European monitoring programmes show that AMR occurrence in food animals is lower in Sweden than in most other EU Member States and that the use of antibiotics for animals is among the lowest in Europe. In this retrospective country case study, we analysed published documents to identify factors contributing to this favourable situation. A fundamental factor identified was early insight into and sustained awareness of the risks of AMR and the need for the prudent use of antibiotics. Early and continuous access to data on antibiotic use and AMR made it possible to focus activities on areas of concern. Another factor identified was the long-term control and eradication of infectious animal diseases, including coordinated activities against endemic diseases, which reduced the need to use antibiotics. Structures and strategies for that purpose established at the national level have since proven useful in counteracting AMR as an integral part of disease prevention and control, guided by a “prevention is better than cure” approach. A third factor identified was consensus among stakeholders on the need to address AMR and their cooperation in the design and implementation of measures.

ICMR's Antimicrobial Resistance Surveillance system (i-AMRSS): a promising tool for global antimicrobial resistance surveillance.

BackgroundGrowing resistance to antimicrobials has become an important health issue of the 21st century. Many international, national and local approaches are being employed for the control and prevention of antimicrobial resistance (AMR). Among them, surveillance is reported to be the best method to reduce the spread of infection and thereby AMR. An integral component of AMR surveillance is the informatics suite for collection, storage and analysis of surveillance data.MethodsConsidering the traits of an optimal surveillance tool and constraints with existing tools, Indian Council of Medical Research (ICMR) initiated the design and development of ICMR’s Antimicrobial Resistance Surveillance system (i-AMRSS). i-AMRSS is a web-based tool built using modular architecture. It is capable of collecting standardized data from small laboratories to generate local and nationwide reports.Results i-AMRSS is a robust, comprehensive, modular, extensible and intelligent open-source tool piloted in ICMR’s AMR Network (31 hospitals and laboratories across India) since 2016. The developed tool has collected more than 280 000 patient records to date.ConclusionsThe standardized data collected through i-AMRSS would be valuable for various collaborators to monitor outbreaks and infection control practices, evaluate transmission dynamics and formulate antibiotic use and selling policies. The tool is presently being used to capture human testing and consumption data, however, it can be extended for AMR surveillance using a ‘One Health’ approach.