Suchergebnisse

The Korean government established an antimicrobial resistance (AMR) surveillance system, compatible with the Global AMR Surveillance System (GLASS): Kor-GLASS. We describe results from the first year of operation of the Kor-GLASS from May 2016 to April 2017, comprising all non-duplicated clinical isolates of major pathogens from blood, urine, faeces and urethral and cervical swabs from six sentinel hospitals. Antimicrobial susceptibility tests were carried out by disk diffusion, Etest, broth microdilution and agar dilution methods. Among 67,803 blood cultures, 3,523 target pathogens were recovered. The predominant bacterial species were Escherichia coli (n = 1,536), Klebsiella pneumoniae (n = 597) and Staphylococcus aureus (n = 584). From 57,477 urine cultures, 6,394 E. coli and 1,097 K. pneumoniae were recovered. Bloodstream infections in inpatients per 10,000 patient-days (10TPD) were highest for cefotaxime-resistant E. coli with 2.1, followed by 1.6 for meticillin-resistant Sta. aureus, 1.1 for imipenem-resistant Acinetobacter baumannii, 0.8 for cefotaxime-resistant K. pneumoniae and 0.4 for vancomycin-resistant Enterococcus faecium. Urinary tract infections in inpatients were 7.7 and 2.1 per 10TPD for cefotaxime-resistant E. coli and K. pneumoniae, respectively. Kor-GLASS generated well-curated surveillance data devoid of collection bias or isolate duplication. A bacterial bank and a database for the collections are under development. ; open

The definition of antibiotic resistance in bacteria differs if it is seen from the viewpoint of the bacteriologist and the epidemiologist, or of the clinician and the pharmacologist. The standardization by the European Union Committee on antimicrobial susceptibility testing (EUCAST) led to more accurate definitions. This committee defined critical concentrations based on pharmacological approaches and clinical outcomes, and on the variability of exposure of the treated subjects. In France, the values used for veterinary antibiograms are based on epidemiological data. New funding is necessary to move to the next stage and use all available data to define clinical resistance in veterinary medicine. ; Les définitions de la résistance des bactéries aux antibiotiques dépendent des points de vue du bactériologiste et de l'épidémiologiste ou du clinicien et du pharmacologue. Les travaux de standardisation du comité de l'Union Européenne des tests de sensibilité aux antimicrobiens (EUCAST) les ont rendues plus précises. Aujourd'hui, ce comité définit des concentrations critiques pour les catégories cliniques de résistance, en intégrant les approches pharmacologiques et les résultats cliniques et en tenant compte de la variabilité de l'exposition des sujets traités. En France, la définition retenue pour les antibiogrammes vétérinaires est uniquement de nature épidémiologique. Une mobilisation de moyens est nécessaire pour passer au stade suivant et intégrer l'ensemble des informations dans la définition de la résistance clinique applicable à la médecine vétérinaire.

Nowadays, bacterial antimicrobial resistance constitutes a challenge in public health. In the European Union surveillance systems monitor antimicrobial resistance in terrestrial food animals: bovine, pigs and poultry. No monitoring system currently exists for seafood even if the consumption of seafood is important (34.5 kg/inh/year consumed in France and 20 kg/inh/year worldwide). In this study we developed a high-throughput qPCR chip to detect antimicrobial resistance genes with a critical importance in human health. We validated qPCR tests targeting 40 antimicrobial resistance genes for Gram-negative bacteria. This method allowed us to detect four antimicrobial resistance genes and one plasmid-associated gene in a collection of 159 Gram-negative bacterial strains isolated from seafood products. This tool will be useful to follow the introduction and dissemination of antimicrobial resistance genes in the food chain. ; L'antibiorésistance bactérienne est actuellement un enjeu majeur de santé publique. Il existe des systèmes de surveillance concernant les animaux terrestres : bovins, porcins et volaille. Aucun système de surveillance n'est cependant actuellement mis en place pour les produits de la mer alors que la consommation des produits de la mer constitue une part importante de la consommation française (34,5 kg/habitant/an) et mondiale (20 kg/habitant/an). Cette étude propose le développement d'une puce de qPCR très haut débit (Fluidigm) afin de détecter les gènes d'antibiorésistance d'importance critique en santé humaine. L'étude a permis de valider 40 marqueurs de gènes de résistance pour les bactéries Gram négatives. Nous avons ainsi détecté quatre gènes d'antibiorésistance et un gène signature de plasmide dans une collection de 159 souches Gram négatives isolées des produits de la mer principalement consommés en France. Cet outil pourra être utilisé afin de suivre l'introduction de gènes de résistance aux antibiotiques dans la chaîne alimentaire.

The growing concern of the selection of bacteria resistant to antimicrobials and their possible transmissions to humans lead French Authorities to implement several legislative measures to decrease antimicrobial use in livestock production. This context leads to question whether the demand of antimicrobials could be regarded as a simple demand of agricultural input, or rather as a demand of an input with distinctive effects, submitted to regulatory prescription. In this paper, the accuracy of the regulatory measures implemented by the Authorities are assessed, regarding the whole factors gathered in a conceptual framework enlightening the decision-making process of antimicrobial use. Lastly, other alternative policies are described. ; La sélection de bactéries résistantes aux antibiotiques transmissibles à l'homme, induite par l'usage des antibiotiques en productions animales, pousse les pouvoirs publics à réduire leur utilisation, dans le cadre du Plan Ecoantibio 2012-2017 et de la Loi d'Avenir pour l'Agriculture. Cet article questionne la pertinence des mesures en cours d'implémentation par les administrations françaises au regard d'un cadre d'analyse, regroupant dans un modèle conceptuel l'ensemble des facteurs sanitaires, économiques et institutionnels déterminant la demande d'antibiotiques. La compréhension des clés d'usage des antibiotiques, produit banal et substituable, ou au contraire ressource particulière, soumise à prescription, permet également d'envisager d'autres politiques de réduction.

The growing concern of the selection of bacteria resistant to antimicrobials and their possible transmissions to humans lead French Authorities to implement several legislative measures to decrease antimicrobial use in livestock production. This context leads to question whether the demand of antimicrobials could be regarded as a simple demand of agricultural input, or rather as a demand of an input with distinctive effects, submitted to regulatory prescription. In this paper, the accuracy of the regulatory measures implemented by the Authorities are assessed, regarding the whole factors gathered in a conceptual framework enlightening the decision-making process of antimicrobial use. Lastly, other alternative policies are described. ; La sélection de bactéries résistantes aux antibiotiques transmissibles à l'homme, induite par l'usage des antibiotiques en productions animales, pousse les pouvoirs publics à réduire leur utilisation, dans le cadre du Plan Ecoantibio 2012-2017 et de la Loi d'Avenir pour l'Agriculture. Cet article questionne la pertinence des mesures en cours d'implémentation par les administrations françaises au regard d'un cadre d'analyse, regroupant dans un modèle conceptuel l'ensemble des facteurs sanitaires, économiques et institutionnels déterminant la demande d'antibiotiques. La compréhension des clés d'usage des antibiotiques, produit banal et substituable, ou au contraire ressource particulière, soumise à prescription, permet également d'envisager d'autres politiques de réduction.

In the moving context of research on animal health, a collective discussion has been carried out on its issues, special features and synergism with biomedical research. Strongly enhanced by WHO, FAO and OIE, the issues of animal health are important and deal with food security, agriculture economics and all economical activities that follow from it. Others are related to public health (zoonoses, xenobiotics, antimicrobial resistance), environment and animal welfare. Research on animal health has got special features concerning methodology and scientific questions, among others the particular biological nature of domestic species and breeding practices. Scientific questions are not similar to those of biomedical research, even if dealing with the same pathogens; connected to the other animal sciences (genetics, physiology, animal breeding), research on animal health takes root in a very specific agricultural and economical reality. Nevertheless, generic and methodological synergies do exist with biomedical research, particularly concerning biological tools and models. Some domestic species like pig have functional similarities with Humans, better than with mouse or rat. Thus, the peculiarity of research on animal health compared to biomedical research should be considered in its organisation, evaluation and funding, through a political recognition of specific issues. Simultaneously, the one health approach should facilitate a thorough collaboration between biomedical research and research on animal health, at the levels of research teams and research programmes. ; Dans le contexte très évolutif de la recherche en santé animale, une réflexion sur ses enjeux, ses spécificités et ses synergies avec la recherche biomédicale, a été conduite à l'initiative de l'INRA. Affirmés au premier chef par l'OMS, la FAO et l'OIE, les enjeux en santé animale, hors des maladies transmissibles à l'Homme, sont énormes et touchent à la sécurité alimentaire, l'économie de l'agriculture et l'ensemble des activités économiques qui en ...

In the moving context of research on animal health, a collective discussion has been carried out on its issues, special features and synergism with biomedical research. Strongly enhanced by WHO, FAO and OIE, the issues of animal health are important and deal with food security, agriculture economics and all economical activities that follow from it. Others are related to public health (zoonoses, xenobiotics, antimicrobial resistance), environment and animal welfare. Research on animal health has got special features concerning methodology and scientific questions, among others the particular biological nature of domestic species and breeding practices. Scientific questions are not similar to those of biomedical research, even if dealing with the same pathogens; connected to the other animal sciences (genetics, physiology, animal breeding), research on animal health takes root in a very specific agricultural and economical reality. Nevertheless, generic and methodological synergies do exist with biomedical research, particularly concerning biological tools and models. Some domestic species like pig have functional similarities with Humans, better than with mouse or rat. Thus, the peculiarity of research on animal health compared to biomedical research should be considered in its organisation, evaluation and funding, through a political recognition of specific issues. Simultaneously, the one health approach should facilitate a thorough collaboration between biomedical research and research on animal health, at the levels of research teams and research programmes. ; Dans le contexte très évolutif de la recherche en santé animale, une réflexion sur ses enjeux, ses spécificités et ses synergies avec la recherche biomédicale, a été conduite à l'initiative de l'INRA. Affirmés au premier chef par l'OMS, la FAO et l'OIE, les enjeux en santé animale, hors des maladies transmissibles à l'Homme, sont énormes et touchent à la sécurité alimentaire, l'économie de l'agriculture et l'ensemble des activités économiques qui en ...

In the moving context of research on animal health, a collective discussion has been carried out on its issues, special features and synergism with biomedical research. Strongly enhanced by WHO, FAO and OIE, the issues of animal health are important and deal with food security, agriculture economics and all economical activities that follow from it. Others are related to public health (zoonoses, xenobiotics, antimicrobial resistance), environment and animal welfare. Research on animal health has got special features concerning methodology and scientific questions, among others the particular biological nature of domestic species and breeding practices. Scientific questions are not similar to those of biomedical research, even if dealing with the same pathogens; connected to the other animal sciences (genetics, physiology, animal breeding), research on animal health takes root in a very specific agricultural and economical reality. Nevertheless, generic and methodological synergies do exist with biomedical research, particularly concerning biological tools and models. Some domestic species like pig have functional similarities with Humans, better than with mouse or rat. Thus, the peculiarity of research on animal health compared to biomedical research should be considered in its organisation, evaluation and funding, through a political recognition of specific issues. Simultaneously, the one health approach should facilitate a thorough collaboration between biomedical research and research on animal health, at the levels of research teams and research programmes. ; Dans le contexte très évolutif de la recherche en santé animale, une réflexion sur ses enjeux, ses spécificités et ses synergies avec la recherche biomédicale, a été conduite à l'initiative de l'INRA. Affirmés au premier chef par l'OMS, la FAO et l'OIE, les enjeux en santé animale, hors des maladies transmissibles à l'Homme, sont énormes et touchent à la sécurité alimentaire, l'économie de l'agriculture et l'ensemble des activités économiques qui en ...

In the moving context of research on animal health, a collective discussion has been carried out on its issues, special features and synergism with biomedical research. Strongly enhanced by WHO, FAO and OIE, the issues of animal health are important and deal with food security, agriculture economics and all economical activities that follow from it. Others are related to public health (zoonoses, xenobiotics, antimicrobial resistance), environment and animal welfare. Research on animal health has got special features concerning methodology and scientific questions, among others the particular biological nature of domestic species and breeding practices. Scientific questions are not similar to those of biomedical research, even if dealing with the same pathogens; connected to the other animal sciences (genetics, physiology, animal breeding), research on animal health takes root in a very specific agricultural and economical reality. Nevertheless, generic and methodological synergies do exist with biomedical research, particularly concerning biological tools and models. Some domestic species like pig have functional similarities with Humans, better than with mouse or rat. Thus, the peculiarity of research on animal health compared to biomedical research should be considered in its organisation, evaluation and funding, through a political recognition of specific issues. Simultaneously, the one health approach should facilitate a thorough collaboration between biomedical research and research on animal health, at the levels of research teams and research programmes. ; Dans le contexte très évolutif de la recherche en santé animale, une réflexion sur ses enjeux, ses spécificités et ses synergies avec la recherche biomédicale, a été conduite à l'initiative de l'INRA. Affirmés au premier chef par l'OMS, la FAO et l'OIE, les enjeux en santé animale, hors des maladies transmissibles à l'Homme, sont énormes et touchent à la sécurité alimentaire, l'économie de l'agriculture et l'ensemble des activités économiques qui en ...

In the moving context of research on animal health, a collective discussion has been carried out on its issues, special features and synergism with biomedical research. Strongly enhanced by WHO, FAO and OIE, the issues of animal health are important and deal with food security, agriculture economics and all economical activities that follow from it. Others are related to public health (zoonoses, xenobiotics, antimicrobial resistance), environment and animal welfare. Research on animal health has got special features concerning methodology and scientific questions, among others the particular biological nature of domestic species and breeding practices. Scientific questions are not similar to those of biomedical research, even if dealing with the same pathogens; connected to the other animal sciences (genetics, physiology, animal breeding), research on animal health takes root in a very specific agricultural and economical reality. Nevertheless, generic and methodological synergies do exist with biomedical research, particularly concerning biological tools and models. Some domestic species like pig have functional similarities with Humans, better than with mouse or rat. Thus, the peculiarity of research on animal health compared to biomedical research should be considered in its organisation, evaluation and funding, through a political recognition of specific issues. Simultaneously, the one health approach should facilitate a thorough collaboration between biomedical research and research on animal health, at the levels of research teams and research programmes. ; Dans le contexte très évolutif de la recherche en santé animale, une réflexion sur ses enjeux, ses spécificités et ses synergies avec la recherche biomédicale, a été conduite à l'initiative de l'INRA. Affirmés au premier chef par l'OMS, la FAO et l'OIE, les enjeux en santé animale, hors des maladies transmissibles à l'Homme, sont énormes et touchent à la sécurité alimentaire, l'économie de l'agriculture et l'ensemble des activités économiques qui en ...

In the moving context of research on animal health, a collective discussion has been carried out on its issues, special features and synergism with biomedical research. Strongly enhanced by WHO, FAO and OIE, the issues of animal health are important and deal with food security, agriculture economics and all economical activities that follow from it. Others are related to public health (zoonoses, xenobiotics, antimicrobial resistance), environment and animal welfare. Research on animal health has got special features concerning methodology and scientific questions, among others the particular biological nature of domestic species and breeding practices. Scientific questions are not similar to those of biomedical research, even if dealing with the same pathogens; connected to the other animal sciences (genetics, physiology, animal breeding), research on animal health takes root in a very specific agricultural and economical reality. Nevertheless, generic and methodological synergies do exist with biomedical research, particularly concerning biological tools and models. Some domestic species like pig have functional similarities with Humans, better than with mouse or rat. Thus, the peculiarity of research on animal health compared to biomedical research should be considered in its organisation, evaluation and funding, through a political recognition of specific issues. Simultaneously, the one health approach should facilitate a thorough collaboration between biomedical research and research on animal health, at the levels of research teams and research programmes. ; Dans le contexte très évolutif de la recherche en santé animale, une réflexion sur ses enjeux, ses spécificités et ses synergies avec la recherche biomédicale, a été conduite à l'initiative de l'INRA. Affirmés au premier chef par l'OMS, la FAO et l'OIE, les enjeux en santé animale, hors des maladies transmissibles à l'Homme, sont énormes et touchent à la sécurité alimentaire, l'économie de l'agriculture et l'ensemble des activités économiques qui en ...

In the moving context of research on animal health, a collective discussion has been carried out on its issues, special features and synergism with biomedical research. Strongly enhanced by WHO, FAO and OIE, the issues of animal health are important and deal with food security, agriculture economics and all economical activities that follow from it. Others are related to public health (zoonoses, xenobiotics, antimicrobial resistance), environment and animal welfare. Research on animal health has got special features concerning methodology and scientific questions, among others the particular biological nature of domestic species and breeding practices. Scientific questions are not similar to those of biomedical research, even if dealing with the same pathogens; connected to the other animal sciences (genetics, physiology, animal breeding), research on animal health takes root in a very specific agricultural and economical reality. Nevertheless, generic and methodological synergies do exist with biomedical research, particularly concerning biological tools and models. Some domestic species like pig have functional similarities with Humans, better than with mouse or rat. Thus, the peculiarity of research on animal health compared to biomedical research should be considered in its organisation, evaluation and funding, through a political recognition of specific issues. Simultaneously, the one health approach should facilitate a thorough collaboration between biomedical research and research on animal health, at the levels of research teams and research programmes. ; Dans le contexte très évolutif de la recherche en santé animale, une réflexion sur ses enjeux, ses spécificités et ses synergies avec la recherche biomédicale, a été conduite à l'initiative de l'INRA. Affirmés au premier chef par l'OMS, la FAO et l'OIE, les enjeux en santé animale, hors des maladies transmissibles à l'Homme, sont énormes et touchent à la sécurité alimentaire, l'économie de l'agriculture et l'ensemble des activités économiques qui en ...

Dans le contexte très évolutif de la recherche en santé animale, une réflexion sur ses enjeux, ses spécificités et ses synergies avec la recherche biomédicale, a été conduite à l'initiative de l'INRA. Affirmés au premier chef par l'OMS, la FAO et l'OIE, les enjeux en santé animale, hors des maladies transmissibles à l'Homme, sont énormes et touchent à la sécurité alimentaire, l'économie de l'agriculture et l'ensemble des activités économiques qui en découlent. S'y ajoutent les enjeux de santé publique (zoonoses, xénobiotiques, antibiorésistance), environnementaux et de bien-être animal. La recherche en santé animale présente des spécificités d'ordre méthodologique et scientifique, liées notamment aux particularités biologiques des espèces domestiques et aux pratiques d'élevage. Elle n'a pas les mêmes questionnements scientifiques qu'en biologie humaine même lorsqu'elle traite des mêmes agents pathogènes et, connectée aux autres sciences animales (génétique, physiologie, zootechnie), elle s'enracine dans une réalité agricole et économique très spécifique. Des synergies génériques et méthodologiques existent néanmoins avec la recherche biomédicale, en particulier autour des outils et des modèles biologiques. Certaines espèces domestiques (tel le porc) présentent en outre des similitudes fonctionnelles avec l'Homme, plus que le rongeur de laboratoire. Ainsi la singularité de la recherche en santé animale par rapport à la recherche en biologie humaine devrait être prise en compte dans son organisation, son évaluation et son financement, via une politique de reconnaissance des enjeux spécifiques. Simultanément, l'approche one health devrait faciliter une collaboration approfondie entre recherche en biologie humaine et recherche en santé animale, à l'échelle des équipes ou des programmes. ; In the moving context of research on animal health, a collective discussion has been carried out on its issues, special features and synergism with biomedical research. Strongly enhanced by WHO, FAO and OIE, the issues of animal health are important and deal with food security, agriculture economics and all economical activities that follow from it. Others are related to public health (zoonoses, xenobiotics, antimicrobial resistance), environment and animal welfare. Research on animal health has got special features concerning methodology and scientific questions, among others the particular biological nature of domestic species and breeding practices. Scientific questions are not similar to those of biomedical research, even if dealing with the same pathogens; connected to the other animal sciences (genetics, physiology, animal breeding), research on animal health takes root in a very specific agricultural and economical reality. Nevertheless, generic and methodological synergies do exist with biomedical research, particularly concerning biological tools and models. Some domestic species like pig have functional similarities with Humans, better than with mouse or rat. Thus, the peculiarity of research on animal health compared to biomedical research should be considered in its organisation, evaluation and funding, through a political recognition of specific issues. Simultaneously, the one health approach should facilitate a thorough collaboration between biomedical research and research on animal health, at the levels of research teams and research programmes.

Overuse and inappropriate use of antibiotics has been described worldwide for about 25 years, in both community and hospital settings. In addition to its deleterious effect on patients, antibiotic misuse can lead to the emergence of bacterial resistance and increased the cost of hospitalization. Indeed, during the 1990s several organizations published plans to control the costs of antibiotics and limit selective pressure on microorganisms through surveillance and interventions promoting rational use. An antimicrobial policy has been implemented at the University Hospitals of Nancy since the mid-1990s. This antibiotic policy was therefore reinforced the beginning of 2006, changes included complete reorganization of the methods of prescribing and delivering antibiotics in all wards of the University hospitals of Nancy. In addition, an Operational Multidisciplinary Antibiotic Team (OMAT) including an infectious disease physician and a clinical pharmacist was established in some wards. To evaluate the effectiveness of this OMAT, in reducing the hospital antimicrobial consumption and costs a cluster controlled "before-after" study was performed. We compared consumption of antibiotics overall and by therapeutic class and cost savings between "before" and "after" in both groups (control and intervention). The results of this study have shown that overall consumption of antibiotics decreased after implementation of the OMAT by 34% in the intervention group and by 3% in the control group (p = 0.003). For the same activity, the total cost savings were 14-fold higher in the intervention group. Establishment of an operational multidisciplinary team may be an effective way to reduce hospital antibiotic use and cost. ; L'usage excessif et inapproprié des antibiotiques a été décrit dans le monde entier depuis 25ans, tant en ville qu'à l'hôpital. En plus des effets délétères sur les patients l'utilisation abusive des antibiotiques contribue à l'émergence de résistances bactériennes et à l'augmentation des dépenses ...

Overuse and inappropriate use of antibiotics has been described worldwide for about 25 years, in both community and hospital settings. In addition to its deleterious effect on patients, antibiotic misuse can lead to the emergence of bacterial resistance and increased the cost of hospitalization. Indeed, during the 1990s several organizations published plans to control the costs of antibiotics and limit selective pressure on microorganisms through surveillance and interventions promoting rational use. An antimicrobial policy has been implemented at the University Hospitals of Nancy since the mid-1990s. This antibiotic policy was therefore reinforced the beginning of 2006, changes included complete reorganization of the methods of prescribing and delivering antibiotics in all wards of the University hospitals of Nancy. In addition, an Operational Multidisciplinary Antibiotic Team (OMAT) including an infectious disease physician and a clinical pharmacist was established in some wards. To evaluate the effectiveness of this OMAT, in reducing the hospital antimicrobial consumption and costs a cluster controlled "before-after" study was performed. We compared consumption of antibiotics overall and by therapeutic class and cost savings between "before" and "after" in both groups (control and intervention). The results of this study have shown that overall consumption of antibiotics decreased after implementation of the OMAT by 34% in the intervention group and by 3% in the control group (p = 0.003). For the same activity, the total cost savings were 14-fold higher in the intervention group. Establishment of an operational multidisciplinary team may be an effective way to reduce hospital antibiotic use and cost. ; L'usage excessif et inapproprié des antibiotiques a été décrit dans le monde entier depuis 25ans, tant en ville qu'à l'hôpital. En plus des effets délétères sur les patients l'utilisation abusive des antibiotiques contribue à l'émergence de résistances bactériennes et à l'augmentation des dépenses ...