Suchergebnisse

Antimicrobial resistance (AMR) has emerged as a global health threat, which has elicited a high-level political declaration at the United Nations General Assembly, 2016. In response, member countries agreed to pay greater attention to the surveillance and implementation of antimicrobial stewardship. TheNigeria Centre forDisease Control called for a reviewofAMR inNigeria using a "OneHealth approach". As anecdotal evidence suggests that food animal health and production rely heavily on antimicrobials, it becomes imperative to understand AMR trends in food animals and the environment. We reviewed previous studies to curate data and evaluate the contributions of food animals and the environment (2000–2016) to the AMR burden in Nigeria using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart focused on three areas: Antimicrobial resistance, residues, and antiseptics studies. Only one of the 48 antimicrobial studies did not reportmultidrug resistance. At least 18 bacterial spp. were found to be resistant to various locally available antimicrobials. All 16 residue studies reported high levels of drug residues either in the form of prevalence or concentration above the recommended international limit. Fourteen different "resistotypes"were found in some commonly used antiseptics. High levels of residues and AMRwere found in food animals destined for the human food chain. High levels of residues and antimicrobials discharged into environments sustain the AMR pool. These had evolved into potential public health challenges that need attention. These findings constitute public health threats forNigeria's teeming population and require attention. ; Supplementary Materials Figure S1: Flow chart of the methodological strategy (PRISMA 2009 Flow Diagram), Figure S2: Nigeria geopolitical zonal spread of the AMRS reports, Figure S3: Geopolitical zonal spread of the Antimicrobial Residue reports, Figure S4a: Level of resistance within generation of antimicrobials tested, Figure S4b: Proportional ...

Abstract International infectious disease surveillance has been conducted by the United States (U.S.) Department of Defense (DoD) for many years and has been consolidated within the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) since 1998. This includes activities that monitor the presence of antimicrobial resistance among pathogens. AFHSC-GEIS partners work within DoD military treatment facilities and collaborate with host-nation civilian and military clinics, hospitals and university systems. The goals of these activities are to foster military force health protection and medical diplomacy. Surveillance activities include both community-acquired and health care-associated infections and have promoted the development of surveillance networks, centers of excellence and referral laboratories. Information technology applications have been utilized increasingly to aid in DoD-wide global surveillance for diseases significant to force health protection and global public health. This section documents the accomplishments and activities of the network through AFHSC-GEIS partners in 2009.

Antimicrobial-resistant infections are becoming more frequent and increasingly difficult to treat, and this situation is exacerbated by the widespread use of antimicrobials in both human and veterinary medicine and by the agriculture industry. As part of Canada's coordinated response to addressing antimicrobial resistance (AMR), Tackling Antimicrobial Resistance and Antimicrobial Use: A Pan-Canadian Framework for Action, was released in September 2017. The Framework is a high-level policy document that outlines the strategic objectives, outcomes and opportunities to guide collaborative action on AMR and antimicrobial use (AMU). It is grounded in a One Health approach, and was developed in collaboration with federal, provincial and territorial governments and external stakeholders in the human and animal health sectors. The Framework is based on four components: surveillance; infection prevention and control; stewardship; and research and innovation. It builds upon existing AMR activities already underway in the human and animal health sectors and strives to connect these activities together to strengthen Canada's approach to AMR.

Antimicrobial resistance (AMR) is widely recognised as a global health threat, which is projected to account for more deaths than cancer by 2050. The Government of India has formulated a National Action Plan to tackle AMR (NAP-AMR), largely modelled on the World Health Organization's Global Action Plan on AMR. While the NAP-AMR successfully mirrors the Global Action Plan and lays out ambitious goals, we find that the lack of financial allocation across states, poor enforcement and inadequate multisectoral co-ordination have hampered progress. A broader focus on improving infrastructure for water and sanitation, linking the issue of AMR to existing vertical health programmes for human immunodeficiency virus (HIV) and tuberculosis (TB), prioritising infection prevention and control, strengthening the frontline healthcare workforce in rural and peri-urban settings to reduce reliance on antibiotics, leveraging pointof-care testing and mobile app-based health interventions for diagnosis and surveillance, and adopting a socioecological approach to health and development would help to create an enabling environment for concrete action on AMR in India. (c) 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )

AbstractThe article investigates isomorphic dynamics in the development and implementation of national action plans (NAPs) on antimicrobial resistance (AMR) following the World Health Assembly's adoption of a Global Action Plan on AMR in 2015. Through a nested approach, we conduct a quantitative cross‐country analysis of this policy process with particular emphasis on form (the NAP design) and function (their implementation). The qualitative component consists of three illustrative examples from Japan, Myanmar, and Denmark, which represent different types of responses to this internationally driven policy process. The analysis reveals tendencies of isomorphic mimicry characterized by a clear rift between the drafting of NAPs and their implementation, particularly in low‐income and lower‐middle‐income countries. Interestingly, there is also evidence of typically high‐income member states with substantial leverage deviating from global guidelines when compiling their NAPs—a trend we term "isomorphic posturing." We argue that both types of isomorphic behaviors inhibit global harmonization around best practices and conclude that the mismatch between policy design and policy implementation in the AMR field can best be solved by establishing international, legally binding agreements that adhere to the benefit principle and individualized responsibilities.

Antimicrobial resistant bacteria represent a global health issue due to their dissemination through different stages of livestock production and acquisition of resistance mechanisms towards critical antimicrobials for human and veterinary medicine. Italy is one of the largest producers of livestock, meat, and meat-based products in the European Union. However, antibiotic resistant bacteria are repeatedly detected in pig farms and slaughterhouse environment. Some bacterial populations disseminated among livestock displaying a multi-drug resistant phenotype represent a cause of concern due to their transmission to humans. Therefore, this work was aimed to improve the knowledge of antimicrobial resistance properties of bacterial isolates from different stages of livestock farming, as well as their distribution among pigs. The first objective was thus to evaluate the molecular characteristics of Methicillin resistant Staphylococcus aureus (MRSA) isolated from 50 finishing units located in Lombardy, a region of northern Italy. A total of 400 samples originating from cutaneous samples at slaughter and environmental samples at farm was collected. Isolates were identified as MRSA by phenotypical (enrichment, growth on selective media, and Gram staining) and biochemical (miniaturized system Api Staph, coagulase, and urease fermentation) tests, and confirmed as such by multiplex-PCR with three set of primers (nuc, mecA, and mecC). In addition, molecular characterization was carried out by means of MLST (targeting seven housekeeping genes) and sub-typing of the staphylococcal protein A. Finally, phylogenetic and neighbour-joining tree analyses were performed on confirmed MRSA isolates. MRSA was detected in 25 out of 400 samples analysed (6.25 %), whereas 17 finishing units were positive for MRSA (34 %). In particular, MRSA was detected in 12 samples from farms and 13 samples at slaughter. MLST analysis assigned most of the MRSA isolates to ST398, followed on less extent by ST97 and ST30. In addition, a new ST, namely ...

Effective antimicrobials are essential for adequate healthcare, but unfortunately, worldwide antimicrobial resistance (AMR) threatens this effectiveness, caused by antimicrobial use (AMU). The possibilities for development of antimicrobials are limited, and new antimicrobials will not become widely available. This leaves prudent AMU and other interventions to limit existing AMR as an important strategy and therefore, AMR must be monitored. Production animals are a relevant reservoir to monitor, because AMR may be transmitted to humans directly, or indirectly via food or the environment. This thesis is about monitoring of AMR in livestock as public health hazard in indicator organism Escherichia coli. In the European Union, monitoring of AMR in animals as public health hazard is performed by European legislation in commensal E. coli and food-borne pathogens Salmonella and Campylobacter. The international legislation has led to harmonisation and standardisation of the sampling and the microbiological methods. Elements not prescribed create room for improvement. The evaluation and interpretation by statistical analysis of AMR monitoring results is not prescribed, but is challenging and will be more complex when the amount of data increases. The updated EU legislation in 2020 has allowed whole-genome sequencing (WGS) as alternative method to culture-based antimicrobial susceptibility testing in AMR monitoring. So far, no statistical approaches were described to evaluate WGS versus culture-based methods. Analyses can be improved for optimal evaluation and interpretation of AMR monitoring data. Therefore, the first aim of this thesis is to evaluate AMR monitoring results with statistical methods. The second aim is to improve the interpretation of AMR monitoring in commensal E. coli. The third aim is to assess WGS versus culture-based methods to monitor AMR. The conclusions from this thesis are that E. coli is a useful indicator to monitor AMR in livestock, provided that bias in the sampling is prevented, and that proper statistical methods are used for the evaluation and interpretation. As we show, the randomized sample from healthy animals is well suited to analyse AMR trends over time. Other types of samples such as risk-based sampling (for example from diseased animals) are useful to detect rare or emerging resistance, but should be used next to a random sample to ensure representativeness for the whole animal population. To improve interpretation of AMR monitoring data, quantitative analyses should be incorporated in routine monitoring, because in the future the amount and complexity of data will further increase. The validity of the statistical approaches in this thesis should be further investigated in data with more variation, from different countries. We promote further evaluation of AMR surveillance systems, and the analysis of AMR monitoring outcomes should be harmonized, next to already existing harmonization of laboratory methods.

The antimicrobial resistance (AMR) crisis is the increasing global incidence of infectious diseases affecting the human population, which are untreatable with any known antimicrobial agent. This crisis will have a devastating cost on human society as both debilitating and lethal diseases increase in frequency and scope. Three major factors determine this crisis: (1) the increasing frequency of AMR phenotypes among microbes is an evolutionary response to the widespread use of antimicrobials; (2) the large and globally connected human population allows pathogens in any environment access to all of humanity; and (3) the extensive and often unnecessary use of antimicrobials by humanity provides the strong selective pressure that is driving the evolutionary response in the microbial world. Of these factors, the size of the human population is least amenable to rapid change. In contrast, the remaining two factors may be affected, so offering a means of managing the crisis: the rate at which AMR, as well as virulence factors evolve in microbial world may be slowed by reducing the applied selective pressure. This may be accomplished by radically reducing the global use of current and prospective antimicrobials. Current management measures to legislate the use of antimicrobials and to educate the healthcare world in the issues, while useful, have not comprehensively addressed the problem of achieving an overall reduction in the human use of antimicrobials. We propose that in addition to current measures and increased research into new antimicrobials and diagnostics, a comprehensive education program will be required to change the public paradigm of antimicrobial usage from that of a first line treatment to that of a last resort when all other therapeutic options have failed.

The use of antimicrobials, primarily antibiotics, but also antivirals, antiparasitics, and antiseptics is rapidly rising around the world - and with it, antimicrobial resistance (AMR). The current COVID-19 pandemic illustrates both the burden on the health system and the economic costs a pathogen can pose when no medication is available. Concerning resistance, the crux of the matter lies in balancing the need to reduce overall antibiotic consumption while at the same time expanding access in countries where such antibiotics are not easily accessible.
The rising use of antibiotics in health and agricultural sectors are driving the increase in antimicrobial resistance. The quick expansion of access and use along with ineffective stewardship have led to alarming resistance rates, particularly in fast-growing middle-income economies - a problem these countries must urgently address.
If AMR is not tackled more efficiently, it is estimated that by 2050 ten million people will die each year from common infections that will then no longer be treatable. Concomitant with this will be substantial economic losses predicted to total 2.5 to 3 per cent of global GDP. Hence, the pressure is mounting to secure more international commitment to combat AMR.
Lowering antibiotic consumption might slow the pace of the spread of resistance, as every dose raises the risk of resistance building. Hence, the continuous development of new medicines is crucial and requires market intervention to take place.
An oft-neglected aspect of the debate over AMR is that especially in low- and middle--income countries many life-saving antibiotics are not or not sufficiently available. This situation undermines controlled distribution and promotes a vicious cycle of poverty and antimicrobial resistance.
Antimicrobial resistance is a serious concern and, particularly given the presence of COVID-19, one where action should not be delayed. Policies need to address three issues: First, emerging economies must implement effective policy measures to combat resistance. Second, public funding is required to remedy market failure. Third, international cooperation, particularly in research on diagnostics and prevalence as well as interventions, is necessary to better assess the societal impact of antimicrobial resistance and identify efficient ways to actively address the problem.

Antimicrobial Resistance (AMR) is already affecting human and animal health sectors negatively. The UN General Assembly has listed AMR among issues that need urgent address; subsequently FAO/OIE/WHO tripartite took lead and jointly developed Global Action Plan (GAP) to tackle the problem. States and Governments have developed AMR National Action Plans (NAP), Policies and Communication Strategies. In health communication realms AMR is a distinctive and novel phenomenon. Consequently, communication theories and principles on this issue have not been tested adequately; even as literature around AMR is growing. While there are lessons that can be learned from previous and ongoing health communication campaigns targeting various audiences and coined around behavior change strategies; AMR is certainly a unique and maiden case. Kenya developed and is implementing its AMR - NAP. Kenya is among few countries that have developed and implemented an AMR Communication Strategy with the goal to create awareness and subsequently change audience behavior. This paper presents a review of available literature, reports, Kenya experiences and theories that can be applied to AMR communications. It illustrates the gaps, opportunities and challenges and proposes strategies that can be applied at the moment as more literature on AMR communication is collected through research and documentation of country experiences.