Antimicrobial Use and Resistance in Australia (AURA) surveillance system: coordinating national data on antimicrobial use and resistance for Australia

Objective The aim of the present study was to describe the process of establishment and coordination of the national Antimicrobial Use and Resistance in Australia (AURA) surveillance system. Methods Existing surveillance programs conducted by health organisations at state or multi-jurisdictional levels were reviewed, and gaps and opportunities identified for the development of a national system. In view of the time frame available as part of the Australian Government Department of Health funding agreement, the strategy used by the Australian Commission on Safety and Quality in Health Care was to commence work with existing surveillance programs, expanding and enhancing them and developing new systems where gaps were identified. Using the specifications of the AURA national system, the data from each of these elements were then analysed and reported. The system provides coverage for the acute and community sectors for antimicrobial use and antimicrobial resistance. Results The AURA surveillance system integrates eight streams of surveillance activities, including passive and targeted surveillance of antimicrobial use and resistance from hospitals (public and private) and the community (general practitioners and aged care homes). A gap was identified in timely surveillance of critical antimicrobial resistances (CARs), which resulted in the development of the national CARAlert system. The first comprehensive analyses of data across the surveillance programs was published in June 2016, providing baseline data for future reports to build on. Conclusion The AURA surveillance system has established the framework and foundation systems for an integrated and comprehensive picture of both antimicrobial use and resistance in Australia over time. National coordination and support will improve data collection, standardisation and analysis, and will facilitate collaboration across the states and territories, the Australian Government and the private sector. AURA publications will inform policy development and clinical decision making and improve consumer awareness of antimicrobial use and resistance. The system will continue to develop as a comprehensive system, with additional data over time, and appropriate clinical and epidemiological review. What is known about this topic? Surveillance of antimicrobial use and resistance is critical to inform effective policy development and public health responses to the growing problem of antimicrobial resistance. Until now, surveillance of antimicrobial use and resistance in Australia has been fragmented, with state and territory and professional group differences in data collection, analysis and reporting. What does this paper add? This paper profiles the development of the AURA surveillance system, the first nationally coordinated surveillance system for antimicrobial use and resistance, and its use of a partnership approach with contributing programs in order to promote participation and to obtain data to inform strategies to prevent and contain antimicrobial resistance. This paper highlights the establishment phase, noting that the system continues to be improved with growing participation from all sectors. What are the implications for practitioners? National surveillance data from the AURA surveillance system provides evidence for action to guide improvements in infection control, antimicrobial prescribing and the prevention and control of antimicrobial resistance across all healthcare sectors. It will also enable trends to be identified and reported on, and have the capability of determining the effect of interventions to improve and rationalise antimicrobial prescribing.

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One Health Evaluation of Antimicrobial Use and Resistance Surveillance: A Novel Tool for Evaluating Integrated, One Health Antimicrobial Resistance and Antimicrobial Use Surveillance Programs

Frontiers in Public Health ◽

10.3389/fpubh.2021.693703 ◽

2021 ◽

Vol 9 ◽

Author(s):

Margaret Haworth-Brockman ◽

Lynora M. Saxinger ◽

Misha Miazga-Rodriguez ◽

Aleksandra Wierzbowski ◽

Simon J. G. Otto

Keyword(s):

Antimicrobial Resistance ◽

Surveillance System ◽

One Health ◽

Health Surveillance ◽

Qualitative Inquiry ◽

Antimicrobial Use ◽

Health Evaluation ◽

The Matrix ◽

Surveillance Programs ◽

Canadian Council

We describe the development, application and utility of our novel, One Health Evaluation of Antimicrobial Use and Resistance Surveillance (OHE-AMURS) tool that we created to evaluate progress toward integrated, One Health surveillance of antimicrobial resistance (AMR) and antimicrobial use (AMU) as a complex system in Canada. We conducted a qualitative inquiry into the current state of policy and programs for integrated AMR/AMU surveillance using explicit and tacit knowledge. To assess the “messy” state of public health surveillance program development, we synthesized recommendations from previous reports by the National Collaborating Centre for Infectious Diseases and the Canadian Council of Chief Veterinary Officers; conducted an environmental scan to find all federal, provincial, and territorial AMR/AMU surveillance programs in Canada; and conducted semi-structured interviews with Canadian subject matter experts. To integrate evidence from these different sources we adapted two published tools to create a new evaluation matrix, deriving 36 components of the ideal integrated AMR/AMU surveillance system. Our two-way matrix tool allowed us to examine seven common, foundational elements of sustainable programs for each component, and assign a stage of development/sustainability ranking for each component according to the matrix definitions. Our adaptable novel tool allowed for granular and repeatable assessment of the many components of a complex surveillance system. The assessment proved robust and exacting to ensure transparency in our methods and results. The matrix allows flexible assignment of program components based on program principles, and stages can be adapted to evaluate any aspect of an AMR/AMU surveillance or other multi-faceted, multi-jurisdictional system. Future refinement should include an assessment of the scope of surveillance components.

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Evaluation of the impact of antimicrobial use protocols in PRRS virus infected swine on phenotypic antimicrobial resistance patterns

Applied and Environmental Microbiology ◽

10.1128/aem.00970-21 ◽

2021 ◽

Author(s):

Carissa A. Odland ◽

Roy Edler ◽

Noelle R. Noyes ◽

Scott A. Dee ◽

Joel Nerem ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Longitudinal Studies ◽

Bacterial Infections ◽

Population Level ◽

Control Group ◽

Antimicrobial Use ◽

Treatment Groups ◽

Resistance Patterns ◽

The Impact ◽

Over Time

A longitudinal study was conducted to assess the impact of different antimicrobial exposures of nursery-phase pigs on patterns of phenotypic antimicrobial resistance in fecal indicator organisms throughout the growing phase. Based on practical approaches used to treat moderate to severe PRRSV-associated secondary bacterial infections, two antimicrobial protocols of differing intensity of exposure [44.1 and 181.5 animal-treatment days per 1000 animal days at risk (ATD)] were compared with a control group with minimal antimicrobial exposure (2.1 ATD). Litter-matched pigs (n = 108) with no prior antimicrobial exposure were assigned randomly to the treatment groups. Pen fecal samples were collected nine times during the wean-to-finish period and cultured for Escherichia coli and Enterococcus spp. Antimicrobial susceptibility testing was conducted using NARMS gram-negative and gram-positive antibiotic panels. Despite up to 65-fold difference in ATD, few and modest differences were observed between groups and over time. Resistant patterns at marketing overall remained similar to those observed at weaning, prior to any antimicrobial exposures. Those differences observed could not readily be reconciled with the patterns of antimicrobial exposure. Resistance of E. coli to streptomycin was higher in the group exposed to 44.1 ATD, but no aminoglycosides were used. In all instances where resistance differed between time points, the higher resistance occurred early in the trial prior to any antimicrobial exposures. These minimal impacts on AMR despite substantially different antimicrobial exposures point to the lack of understanding of the drivers of AMR at the population level and the likely importance of factors other than antimicrobial exposure. IMPORTANCE Despite a recognized need for more longitudinal studies to assess the effects of antimicrobial use on resistance in food animals, they remain sparse in the literature, and most longitudinal studies of pigs have been observational. The current experimental study had the advantages of greater control of potential confounding, precise measurement of antimicrobial exposures which varied markedly between groups and tracking of pigs until market age. Overall, resistance patterns were remarkably stable between the treatment groups over time, and the differences observed could not be readily reconciled with the antimicrobial exposures, indicating the likely importance of other determinants of AMR at the population level.

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Evaluating Integrated Surveillance for Antimicrobial Use and Resistance in England: A Qualitative Study

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.743857 ◽

2021 ◽

Vol 8 ◽

Author(s):

Houda Bennani ◽

Laura Cornelsen ◽

Katharina D. C. Stärk ◽

Barbara Häsler

Keyword(s):

Data Collection ◽

Qualitative Study ◽

Surveillance System ◽

Companion Animals ◽

Mitigation Measures ◽

Antimicrobial Use ◽

Surveillance Systems ◽

Structured Interviews ◽

A Value ◽

The Uk

Integrated surveillance systems for antimicrobial use (AMU) and antimicrobial resistance (AMR) require regular evaluation to ensure the effectiveness and efficiency of the system. An important step in the evaluation is to choose an appropriate tool for the purpose of the evaluation. The “Integrated Surveillance System Evaluation” (ISSE) framework is a conceptual framework that was developed to evaluate One Health (OH) integration in surveillance system for AMU/AMR. This study aimed to evaluate the performance and value of integrated surveillance system for AMU/AMR in England by applying the ISSE framework, which was used to develop data collection protocols and define the study design. A qualitative study using semi-structured interviews was conducted to collect the data and analyse it thematically. Eighteen stakeholders from human, animal, food and environment sectors that are involved in AMU/AMR surveillance were interviewed. Four main themes emerged from the analysis: (1) Cross-sectoral integration in the surveillance system for AMU/AMR; (2) Production of OH outputs and outcomes; (3) Drivers and barriers to cross-sectoral collaboration; and 4) Need for more cross-sectoral collaboration. The findings showed that there were links between integrated surveillance information, decision making and interventions. However, there were only few OH examples, such as the UK AMR contingency plan, where the potential of cross-sectoral collaboration was fully exploited. A lot of the benefits described were related to the generation of information and increase in knowledge and understanding without links to how the information generated was used. While these intangible benefits have a value on their own, being able to link surveillance information and mitigation measures would help to enhance the value of integrated surveillance. In terms of improvement, the main areas identified were the development of more harmonised methods for data collection and analysis, provision of resources dedicated to cross-sectoral collaboration, improved coordination, and collection of surveillance data from the environment and from companion animals. By identifying links between OH surveillance information produced and various outputs and outcomes; this study helped to understand the wider benefits of integrated surveillance for AMU/AMR in England and provided insights on how the system could be improved and efficiency increased.

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P33 Antimicrobial prescribing point prevalence study at a paediatric tertiary/quaternary centre

Archives of Disease in Childhood ◽

10.1136/archdischild-2020-nppg.42 ◽

2020 ◽

Vol 105 (9) ◽

pp. e23.2-e24

Author(s):

Orlagh McGarrity ◽

Coralie Robson

Keyword(s):

Antimicrobial Resistance ◽

Data Collection ◽

Point Prevalence ◽

Prevalence Study ◽

List Type ◽

Antibiotic Resistant ◽

Inappropriate Use ◽

Antimicrobial Prescribing ◽

Electronic Chart ◽

Tract Infections

AimsIncreasing antibiotic resistant organisms combined with frequent, inappropriate use of antibiotics is giving rise to infections which may no longer be able to be treated1. The aim of this prevalence study was to audit antimicrobial prescribing at a Hospital against Trust antimicrobial policies to determine whether the rising trend in antimicrobial prescribing is appropriate.MethodsThe data was collected in a point prevalence manner; prescriptions that were active at the time of auditing were included and those which were discontinued or prescribed and not yet administered were excluded. A data collection template was designed and distributed to ward pharmacists with education on how to complete. The following parameters were audited; allergy status, antibiotic name, route, indication, duration, review date as well as the ward and speciality. Ward pharmacists assessed whether the prescription was in line with Trust guidelines/ID/Micro recommendations. Data was collected into a central database, as well time taken to audit.The audit standards were90% of patients prescribed an antimicrobial for an indication in line with Trust policy or ID/Micro90% of patients prescribed an antimicrobial for a duration in line with Trust policy or ID/Micro90% of patients have an allergy status documentedResults272 inpatient charts were reviewed. 153 of these patients (56%) were prescribed an antimicrobial.398 antibiotic prescriptions were included for audit. 38% of prescriptions were for medical/surgical prophylaxis. Prophylactic prescriptions were not included for further analysis. 85% of prescriptions had an indication documented either on the electronic chart (JAC) or written in the paper medical notes. 98% of prescriptions were as per policy or in line with recommendations from ID/Micro. 61% of prescriptions had a review date documented. 100% of patients had an allergy status documented. Average duration of antibiotic prescription was 8 days, range 1–50 days, median 5. 80% of prescriptions were IV. 70% of antimicrobial prescribing takes place in the ICU/cancer/transplant setting. Respiratory tract infections were the most common indication for antimicrobial prescribing, 35%. Amikacin was the most commonly prescribed antibiotic (15%), followed by piperacillin/tazobactam (14%). The audit cost in terms of pharmacist time was £763, at a total of 33 hours.ConclusionsPolicy compliant prescribing was very high at 98%; this figure is surprisingly high and poses questions as to the accuracy of data collection and whether bias was present. As a Trust we are now interested and will focus on improving intravenous to oral switches and reviewing and documenting patients’ antimicrobial therapy regularly. As a tertiary/quaternary centre we treat complicated immunocompromised patients; we are unlikely to lower the burden of infection. Approximately 75% of antimicrobial prescribing was in the ICU and cancer and transplant setting, however we must optimise the use of antimicrobials and demonstrate good antimicrobial stewardship. This data will act as a baseline for a subsequent audits which will be carried out using the newly implemented EPIC® patient management system.ReferenceGOV.UK. 2019. Antimicrobial Resistance (AMR). [ONLINE]Available at: https://www.gov.uk/government/collections/antimicrobial-resistance-amr-information-and-resources [Accessed 2 July 2019].

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Letters to the Editor

PEDIATRICS ◽

10.1542/peds.69.4.505 ◽

1982 ◽

Vol 69 (4) ◽

pp. 505-505

Author(s):

James K. Todd

Keyword(s):

Disease Control ◽

Surveillance System ◽

Toxic Shock Syndrome ◽

Personal Communication ◽

Passive Surveillance ◽

Toxic Shock ◽

Letters To The Editor ◽

Passive Surveillance System ◽

Surveillance Programs ◽

Over Time

The above letter suggests that some women are prompted to change their tampon use practices based upon knowledge of toxic shock syndrome. The general trends recited here are commensurate with other observations across the country. Others have observed that over time some of these women will revert back to the use of tampons as publicity about toxic shock syndrome wanes. Although the Center for Disease Control (CDC) has claimed that the incidence of toxic shock syndrome has decreased,1 they have a passive surveillance system and data from other, more complete, active surveillance programs (Michael Osterholm, personal communication) suggest that no decrease has occurred.

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Letters to the Editor

PEDIATRICS ◽

10.1542/peds.69.2.251a ◽

1982 ◽

Vol 69 (2) ◽

pp. 251-252

Author(s):

Robert White ◽

Timothy R. Townsend ◽

E. Richard Moxon

Keyword(s):

Antimicrobial Resistance ◽

Surveillance System ◽

Resistance Pattern ◽

Letters To The Editor ◽

Apparent Relationship ◽

Surveillance Programs

As Weber and Marks emphasize, our study found no apparent relationship between colonization and the occurrence of sepsis caused by enteric bacilli of a defined antimicrobial resistance pattern. Obviously, we did not wish to suggest that all similar surveillance programs be discontinued, but we do feel there is a need to examine components of such regimens in a critical fashion. If the objective of a surveillance system is not realized, its discontinuation may be justified.

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Therapy-related issues: infections

10.1093/med/9780199603640.003.0020 ◽

2012 ◽

Author(s):

Philip Wiffen ◽

Marc Mitchell ◽

Melanie Snelling ◽

Nicola Stoner

Keyword(s):

Antimicrobial Resistance ◽

Infection Control ◽

Antimicrobial Prophylaxis ◽

Antimicrobial Use ◽

Antimicrobial Prescribing ◽

Modes Of Action ◽

Micro Organisms

Basic microbiology 412Modes of action of antibacterials 416Selection and use of antimicrobials 418Antimicrobial prophylaxis 428Optimizing antimicrobial use 430Antimicrobial prescribing guidelines 432Antimicrobial resistance 436Infection control 440Micro-organisms are classified in many ways. The most important classifications are as follows. ...

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Trends and correlates of antimicrobial use in broiler and turkey farms: a poultry company registry-based study in Italy

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz212 ◽

2019 ◽

Vol 74 (9) ◽

pp. 2784-2787 ◽

Cited By ~ 3

Author(s):

Claudia Caucci ◽

Guido Di Martino ◽

Alessandro Dalla Costa ◽

Manuel Santagiuliana ◽

Monica Lorenzetto ◽

...

Keyword(s):

Public Health ◽

Risk Factors ◽

Antimicrobial Resistance ◽

Geographical Area ◽

Antimicrobial Use ◽

Poultry Production ◽

Structural Interventions ◽

Antimicrobial Prescribing ◽

Prescribing Behaviour ◽

Antimicrobial Treatments

Abstract Background Antimicrobial usage (AMU) in livestock plays a key role in the emergence and spread of antimicrobial resistance. Analysis of AMU data in livestock is therefore relevant for both animal and public health. Objectives To assess AMU in 470 broiler and 252 turkey farms of one of Italy’s largest poultry companies, accounting for around 30% of national poultry production, to identify trends and risk factors for AMU. Methods Antimicrobial treatments administered to 5827 broiler and 1264 turkey grow-out cycles in 2015–17 were expressed as DDDs for animals per population correction unit (DDDvet/PCU). A retrospective analysis was conducted to examine the effect of geographical area, season and prescribing veterinarian on AMU. Management and structural interventions implemented by the company were also assessed. Results AMU showed a 71% reduction in broilers (from 14 to 4 DDDvet/PCU) and a 56% reduction in turkeys (from 41 to 18 DDDvet/PCU) during the study period. Quinolones, macrolides and polymyxins decreased from 33% to 6% of total AMU in broilers, and from 56% to 32% in turkeys. Broiler cycles during spring and winter showed significantly higher AMU, as well as those in densely populated poultry areas. Different antimicrobial prescribing behaviour was identified among veterinarians. Conclusions This study evidenced a decreasing trend in AMU and identified several correlates of AMU in broilers and turkeys. These factors will inform the design of interventions to further reduce AMU and therefore counteract antimicrobial resistance in these poultry sectors.

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Antimicrobial resistance in commensal Escherichia coli and Enterococcus spp. is influenced by production system, antimicrobial use, and biosecurity measures on Spanish pig farms

Porcine Health Management ◽

10.1186/s40813-021-00206-1 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Oscar Mencía-Ares ◽

Héctor Argüello ◽

Héctor Puente ◽

Manuel Gómez-García ◽

Edgar G. Manzanilla ◽

...

Keyword(s):

Escherichia Coli ◽

Antimicrobial Resistance ◽

Production System ◽

Production Systems ◽

Multidrug Resistant ◽

Antimicrobial Use ◽

Global Public Health ◽

E Coli ◽

Pig Farms ◽

Surveillance Programs

Abstract Background Antimicrobial resistance (AMR) is a global public health threat consequence of antimicrobial use (AMU) in human and animal medicine. In food-producing animals factors such as management, husbandry or biosecurity may impact AMU. Organic and extensive Iberian swine productions are based on a more sustainable and eco-friendly management system, providing an excellent opportunity to evaluate how sustained differences in AMU impact the AMR in indicator bacteria. Here, we evaluate the usefulness of commensal Escherichia coli and Enterococcus spp. isolates as AMR bioindicators when comparing 37 Spanish pig farms from both intensive and organic-extensive production systems, considering the effect of AMU and biosecurity measures, the last only on intensive farms. Results The production system was the main factor contributing to explain the AMR differences in E. coli and Enterococcus spp. In both bacteria, the pansusceptible phenotype was more common (p < 0.001) on organic-extensive farms when compared to intensive herds. The microbiological resistance in commensal E. coli was, for most of the antimicrobials evaluated, significantly higher (p < 0.05) on intensive farms. In enterococci, the lincosamides usage revealed the association between AMR and AMU, with an increase in the AMR for erythromycin (p < 0.01), quinupristin-dalfopristin (p < 0.01) and the multidrug-resistant (MDR) phenotype (p < 0.05). The biosecurity measures implemented on intensive farms influenced the AMR of these bioindicators, with a slightly lower resistance to sulfamethoxazole (p < 0.01) and the MDR phenotype (p < 0.05) in E. coli isolated from farms with better cleaning and disinfection protocols. On these intensive farms, we also observed that larger herds had a higher biosecurity when compared to smaller farms (p < 0.01), with no significant associations between AMU and the biosecurity scores. Conclusions Overall, this study evidences that the production system and, to a lesser extent, the biosecurity measures, contribute to the AMR development in commensal E. coli and Enterococcus spp., with antimicrobial usage as the main differential factor, and demonstrates the potential value of these bacteria as bioindicators on pig farms in AMR surveillance programs.

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Evaluating the Integration of One Health in Surveillance Systems for Antimicrobial Use and Resistance: A Conceptual Framework

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.611931 ◽

2021 ◽

Vol 8 ◽

Author(s):

Cécile Aenishaenslin ◽

Barbara Häsler ◽

André Ravel ◽

E. Jane Parmley ◽

Sarah Mediouni ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Conceptual Framework ◽

Surveillance System ◽

One Health ◽

Specific Aspect ◽

Evaluation Framework ◽

Public Health Issue ◽

Antimicrobial Use ◽

Surveillance Systems ◽

Global Public Health

It is now widely acknowledged that surveillance of antimicrobial resistance (AMR) must adopt a “One Health” (OH) approach to successfully address the significant threats this global public health issue poses to humans, animals, and the environment. While many protocols exist for the evaluation of surveillance, the specific aspect of the integration of a OH approach into surveillance systems for AMR and antimicrobial Use (AMU), suffers from a lack of common and accepted guidelines and metrics for its monitoring and evaluation functions. This article presents a conceptual framework to evaluate the integration of OH in surveillance systems for AMR and AMU, named the Integrated Surveillance System Evaluation framework (ISSE framework). The ISSE framework aims to assist stakeholders and researchers who design an overall evaluation plan to select the relevant evaluation questions and tools. The framework was developed in partnership with the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS). It consists of five evaluation components, which consider the capacity of the system to: [1] integrate a OH approach, [2] produce OH information and expertise, [3] generate actionable knowledge, [4] influence decision-making, and [5] positively impact outcomes. For each component, a set of evaluation questions is defined, and links to other available evaluation tools are shown. The ISSE framework helps evaluators to systematically assess the different OH aspects of a surveillance system, to gain comprehensive information on the performance and value of these integrated efforts, and to use the evaluation results to refine and improve the surveillance of AMR and AMU globally.

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