Suchergebnisse

Background The international community strongly advocates the implementation of multi-sectoral surveillance policies for an effective approach to antibiotic resistance, in line with the One Health concept. To comply with these international recommendations, the Vietnamese government has issued an inter-ministerial surveillance strategy for antibiotic resistance, including an integrated surveillance system. However, one may question the ability and willingness of surveillance stakeholders to implement the collaborations required. To assess the feasibility of operationalising this strategy within the national context, we explored the role of key stakeholders in the strategy, as well as their abilities to comply with it. Methods We conducted a qualitative approach based on an iterative stakeholder mapping and analysis, in three distinct steps: (1) a description of the structure of the national surveillance strategy (literature review, key informant interviews); (2) an analysis of the key stakeholders' positions regarding the strategy (semi-structured interviews); (3) the identification of factors influencing the operationalisation of the collaborative surveillance strategy (comparison of data collected at the first and second steps). Results The mapping of the surveillance system, as well as the characterisation of key stakeholders according to organisational and functional attributes, underlined that inter-sectoral surveillance initiatives do exist, but that the organisation of the national surveillance system remains highly silo-oriented. Based on stakeholder perspectives, we identified seven factors that may influence the implementation of the One Health strategy at national level: governance and operational frameworks, divergence of institutional cultures, level of knowledge, technical capacities, allocation of resources, conflicting commercial interests and influence of international partners. Conclusions The study suggests that the operationalisation of the collaborative surveillance strategy requires the full adhesion of stakeholders and the provision of appropriate resources. Based on these findings, we have proposed a guidance framework together with recommendations to move towards a more suitable governance and operational model for One Health surveillance of antibiotic resistance in Vietnam. To lever and promote successful inter-sectoral collaboration, a participatory "learning by doing" process could be applied to guide, frame and mentor stakeholders through the identification of appropriate levels of collaboration, depending on the expected positive impacts on the value of surveillance.

Background The international community strongly advocates the implementation of multi-sectoral surveillance policies for an effective approach to antibiotic resistance, in line with the One Health concept. To comply with these international recommendations, the Vietnamese government has issued an inter-ministerial surveillance strategy for antibiotic resistance, including an integrated surveillance system. However, one may question the ability and willingness of surveillance stakeholders to implement the collaborations required. To assess the feasibility of operationalising this strategy within the national context, we explored the role of key stakeholders in the strategy, as well as their abilities to comply with it. Methods We conducted a qualitative approach based on an iterative stakeholder mapping and analysis, in three distinct steps: (1) a description of the structure of the national surveillance strategy (literature review, key informant interviews); (2) an analysis of the key stakeholders' positions regarding the strategy (semi-structured interviews); (3) the identification of factors influencing the operationalisation of the collaborative surveillance strategy (comparison of data collected at the first and second steps). Results The mapping of the surveillance system, as well as the characterisation of key stakeholders according to organisational and functional attributes, underlined that inter-sectoral surveillance initiatives do exist, but that the organisation of the national surveillance system remains highly silo-oriented. Based on stakeholder perspectives, we identified seven factors that may influence the implementation of the One Health strategy at national level: governance and operational frameworks, divergence of institutional cultures, level of knowledge, technical capacities, allocation of resources, conflicting commercial interests and influence of international partners. Conclusions The study suggests that the operationalisation of the collaborative surveillance strategy requires the ...

Background The international community strongly advocates the implementation of multi-sectoral surveillance policies for an effective approach to antibiotic resistance, in line with the One Health concept. To comply with these international recommendations, the Vietnamese government has issued an inter-ministerial surveillance strategy for antibiotic resistance, including an integrated surveillance system. However, one may question the ability and willingness of surveillance stakeholders to implement the collaborations required. To assess the feasibility of operationalising this strategy within the national context, we explored the role of key stakeholders in the strategy, as well as their abilities to comply with it. Methods We conducted a qualitative approach based on an iterative stakeholder mapping and analysis, in three distinct steps: (1) a description of the structure of the national surveillance strategy (literature review, key informant interviews); (2) an analysis of the key stakeholders' positions regarding the strategy (semi-structured interviews); (3) the identification of factors influencing the operationalisation of the collaborative surveillance strategy (comparison of data collected at the first and second steps). Results The mapping of the surveillance system, as well as the characterisation of key stakeholders according to organisational and functional attributes, underlined that inter-sectoral surveillance initiatives do exist, but that the organisation of the national surveillance system remains highly silo-oriented. Based on stakeholder perspectives, we identified seven factors that may influence the implementation of the One Health strategy at national level: governance and operational frameworks, divergence of institutional cultures, level of knowledge, technical capacities, allocation of resources, conflicting commercial interests and influence of international partners. Conclusions The study suggests that the operationalisation of the collaborative surveillance strategy requires the ...

AbstractThe development of alternative animal health products is one way to reduce antibiotic use in agriculture. However, little economic research is directed at animal pharma. While programs to incentivize research and development (R&D) for human drugs have been adopted, analogous programs in veterinary pharma are only at the proposal stage. We describe the broad "push" and "pull" incentive mechanisms for human pharma, and analyze the differences in employing these in veterinary pharma. Using newly compiled data on veterinary drug approvals and firm‐level R&D, we also present data on trends in drug development for veterinary pharma.

Bacterial multidrug efflux pumps are antibiotic resistance determinants present in all microorganisms. With few exceptions, they are chromosomally encoded and present a conserved organization both at the genetic and at the protein levels. In addition, most, if not all, strains of a given bacterial species present the same chromosomally-encoded efflux pumps. Altogether this indicates that multidrug efflux pumps are ancient elements encoded in bacterial genomes long before the recent use of antibiotics for human and animal therapy. In this regard, it is worth mentioning that efflux pumps can extrude a wide range of substrates that include, besides antibiotics, heavy metals, organic pollutants, plant-produced compounds, quorum sensing signals or bacterial metabolites, among others. In the current review, we present information on the different functions that multidrug efflux pumps may have for the bacterial behaviour in different habitats as well as on their regulation by specific signals. Since, in addition to their function in non-clinical ecosystems, multidrug efflux pumps contribute to intrinsic, acquired, and phenotypic resistance of bacterial pathogens, the review also presents information on the search for inhibitors of multidrug efflux pumps, which are currently under development, in the aim of increasing the susceptibility of bacterial pathogens to antibiotics. ; We acknowledge support by the CSIC Open Access Publication Initiative through its Unit of Information Resources for Research (URICI). ; Work in our laboratory is supported by grants from the Spanish Ministry of Economy and Competitiveness (BIO2014-54507-R and JPI Water StARE JPIW2013-089-C02-01); from Madrid Autonomous Community (S2010/BMD2414 (PROMPT); from the Instituto de Salud Carlos III (Spanish Network for Research on Infectious Diseases (REIPI RD12/0015)); and from the European Union (HEALTH-F3-2011-282004 (EVOTAR)). FC is a recipient of a JAE fellowship financed by European Social Fund. MAR and PB are recipients of FPI fellowships from MINECO. ; Peer reviewed

Background: The rise of antibiotic resistant bacteria is a major challenge to global public health. The environment has a significant impact on health and infectious diseases; however, there is a lacuna of information on the relationship between the environment and antibiotic resistance. Aim: The overall aim of this thesis was to explore the relationship between antibiotic resistance and environmental components. Methods: This study was conducted in Odisha, India. In Paper I, eight focus group discussions and ten individual interviews among community members without any healthcare background, and in Paper II, 24 interviews among healthcare professionals: allopathic doctors, veterinarians and drug dispensers from two different environmental settings were conducted. In Paper III, studies were conducted to investigate the antibiotic resistance pattern of Escherichia coli isolated from samples of children's stool, cow-dung and drinking water from two geographical regions: non-coastal (230 households) and coastal (187 households). Paper IV investigated the association of temperature and relative humidity with occurrence of skin and soft-tissue infections (SSTIs, n=590), Staphylococcus aureus associated skin infections (SA-SSTIs, n=387) and methicillin-resistant S. aureus (MRSA, n=251) during a period of 18 months in case of outpatients in a tertiary care hospital in Bhubaneswar. Findings: Participants perceived a relationship between environmental factors, infectious diseases and antibiotic use and resistance. It was perceived that behavioural and social environmental factors, i.e. patients' non-compliance with antibiotic use, irrational prescription by informal as well as trained healthcare providers and overthe- counter availability of antibiotics are the major contributors for antibiotic resistance development. It was also perceived that natural and physical environmental factors are associated with the occurrence and prevalence of infectious diseases and antibiotic resistance (Paper I & II). When quantitative studies were conducted, it was found that the overall prevalence of antibiotic resistance in E. coli isolated from children's stool, cow-dung and drinking water was higher in the non-coastal than the coastal environment (Paper III). In Paper IV it was revealed that the maximum temperature above 33°C and minimum temperature above 24°C coinciding with relative humidity between 55% to 78% is a favourable combination for the occurrence of SSTIs, SA-SSTIs and MRSA infections; this combination of temperature and relative humidity is observed during late summer in Odisha. Conclusions: Although behavioural and social environmental factors are major contributors to resistance development; natural and physical environmental factors also influence antibiotic resistance development. There was geographical variation in antibiotic resistance. It was also evident that climatic factors have influence on skin and soft-tissue infections and resistant bacteria. There is a need for further research on the influence of natural and physical factors on antibiotic resistance development and for education, information dissemination and proper implementation and enforcement of legislation at all levels of the drug delivery and disposal system in order to improve antibiotic use and minimise resistance development.

Background: The international community strongly advocates the implementation of multi-sectoral surveillance policies for an effective approach to antibiotic resistance, in line with the One Health concept. To comply with these international recommendations, the Vietnamese government has issued an inter-ministerial surveillance strategy for antibiotic resistance, including an integrated surveillance system. However, one may question the ability and willingness of surveillance stakeholders to implement the collaborations required. To assess the feasibility of operationalising this strategy within the national context, we explored the role of key stakeholders in the strategy, as well as their abilities to comply with it. Methods: We conducted a qualitative approach based on an iterative stakeholder mapping and analysis, in three distinct steps: (1) a description of the structure of the national surveillance strategy (literature review, key informant interviews); (2) an analysis of the key stakeholders' positions regarding the strategy (semi-structured interviews); (3) the identification of factors influencing the operationalisation of the collaborative surveillance strategy (comparison of data collected at the first and second steps). Results: The mapping of the surveillance system, as well as the characterisation of key stakeholders according to organisational and functional attributes, underlined that inter-sectoral surveillance initiatives do exist, but that the organisation of the national surveillance system remains highly silo-oriented. Based on stakeholder perspectives, we identified seven factors that may influence the implementation of the One Health strategy at national level: governance and operational frameworks, divergence of institutional cultures, level of knowledge, technical capacities, allocation of resources, conflicting commercial interests and influence of international partners. Conclusions: The study suggests that the operationalisation of the collaborative surveillance strategy requires the full adhesion of stakeholders and the provision of appropriate resources. Based on these findings, we have proposed a guidance framework together with recommendations to move towards a more suitable governance and operational model for One Health surveillance of antibiotic resistance in Vietnam. To lever and promote successful inter-sectoral collaboration, a participatory "learning by doing" process could be applied to guide, frame and mentor stakeholders through the identification of appropriate levels of collaboration, depending on the expected positive impacts on the value of surveillance.

For an American in the 21st century, it is hard to imagine the world before antibiotics. At the beginning of the 20th century, as many as nine women out of every 1,000 who gave birth died, 40 percent from sepsis. In some cities as many as 30 percent of children died before their first birthday. One of every nine people who developed a serious skin infection died, even from something as simple as a scrape or an insect bite. Pneumonia killed 30 percent of those who contracted it; meningitis killed 70 percent. Ear infections caused deafness; sore throats were not infrequently followed by rheumati

Salmonella spp. are bacteria that cause salmonellosis, a common form of foodborne illness with major impact on human health and huge financial losses in poultry industry. The incidence of notified cases of salmonellosis has declined from a peak of 24 per 100,000 in 2009 to 20.4 reported cases per 100,000 population in 2013, with S. enteritidis and S. typhimurium being the most commonly reported serovar in EU. Salmonella spp. has been detected in a range of foods, and outbreaks have predominantly been associated with animal products such as eggs, poultry and dairy products, but also with plant origin food such as salad dressing, fruit juice and sesame. At the time of slaughter, Salmonella-infected poultry may have high numbers of organisms in their intestines as well as on the outside of the bird and are therefore an important source of contamination. Nowadays, food safety has become an important concern for the European society and governments; therefore, more strict and harmonized regulations are being implemented throughout the poultry production chain with the aim to guarantee and increase the consumer confidence in foodstuffs of animal origin. Furthermore, increasing antimicrobial resistance in non-typhoid Salmonella species has been a serious problem for public health worldwide.

AbstractThe evolution of resistance to antibiotics in disease causing pathogens is a major world‐wide threat to human health. This paper explores why regulatory, funding and institutional structures have inadequately addressed this issue, focusing on data from the US, but emphasizing that these issues are of global scope and applicability. There is an increasing call for serious acceptance of evolutionary biology by the medical community, but the failure to apply evolutionary ideas to the problem of antibiotic resistance continues. These ideas are deceptively simple in their basic formulation, but require sophisticated expertise when it comes to applying them in practice and to human health. The divergent histories of evolutionary biology and medical research have self‐referential constituencies in each field. The field of evolutionary biology does not see the applied issues associated with antibiotic resistance as part of its remit. At the biomedical research level, funding for research on evolution of antibiotic resistance is paltry compared to its importance as a health threat, regulatory requirements do not address evolutionary issues, institutional structures dealing with the issue are undeveloped, and there is even avoidance of the word 'evolution' in the context of antibiotic resistance. Current approaches to antibiotic resistance invoke evolutionary principles at a such a naive level that what is put forward are ineffective seat‐of‐the‐pants rules that have no strong theoretical basis and are almost always in desperate need of justification through evidence‐based research. Clear solutions exist but their implementation remains problematic.