scholarly journals 733. Carbapenem-Resistant Enterobacterales (CRE) Colonization Prevalence in Botswana: an Antibiotic Resistance in Communities and Hospitals (ARCH) Study

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S464-S465
Author(s):  
Naledi Mannathoko ◽  
Mosepele Mosepele ◽  
Rachel Smith ◽  
Robert Gross ◽  
Laurel Glaser ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Temporal Trends ◽  
Middle Income ◽  
Material Support ◽  
Middle Income Countries ◽  
Preliminary Identification ◽  
Carbapenem Resistant ◽  
Study Sites ◽  
Global Threat ◽  
Multiple Strains

Abstract Background Although CRE are a global threat, data in low- and middle-income countries are scarce. Colonization data are vital for informing antibiotic resistance strategies. We characterized the colonization prevalence of CRE in various settings in Botswana. Methods This study was conducted in 3 districts in Botswana (1 hospital and 2 clinics per district). Adult inpatients and clinic patients were randomly selected for enrollment. Community subjects were enrolled by inviting each enrolled clinic subject to refer up to 3 adults. Each adult clinic or community subject was also asked to refer their children. All subjects had rectal swabs obtained and inoculated on selective chromogenic media for preliminary identification of CRE. Final identification and susceptibility testing were performed using MALDI-TOF MS and VITEK-2, respectively. CRE underwent genotyping for carbapenemase genes. Results Subjects were enrolled from 1/15/20-9/4/20 with a pause from 4/2/20-5/21/20 due to a countrywide COVID lockdown. Of 5,088 subjects approached, 2,469 (49%) participated. Enrollment by subject type was: hospital – 469 (19%); clinic – 959 (39%); community adult – 477 (19%); and community child – 564 (23%). Of 2,469 subjects, the median (interquartile range) age was 32 years (19-44) and 1,783 (72%) were female. 42 (1.7%) subjects were colonized with at least one CRE; 10 subjects were colonized with multiple strains. E. coli (n=17), K. pneumoniae (n=20), and E. cloacae complex (n=11) were most common. CRE colonization prevalence was 6.8% for hospital subjects, 0.7% for clinic subjects, 0.2% for adult community subjects, and 0.5% for child community subjects (p< 0.001)). CRE prevalence varied across regions (Figure 1) and was significantly higher pre- vs post-lockdown (Figure 2). VIM and NDM were the most common carbapenemase genes (Figure 3). Figure 1. CRE Colonization - Study Sites Figure 2. CRE Colonization - Temporal Trends FIgure 3. CRE Genotypic Analyses Conclusion CRE colonization was significantly higher in hospital vs community settings in Botswana. CRE prevalence varied by region and decreased significantly following a countrywide lockdown. With CRE prevalence still modest, elucidating risk factors for CRE colonization holds promise in developing strategies to curb further emergence of CRE. Additional investigation of the CRE isolates without identified resistance genes is warranted. Disclosures Robert Gross, MD, MSCE, Pfizer (Other Financial or Material Support, Serve on DSMB for drug unrelated to HIV) Ebbing Lautenbach, MD, MPH, MSCE, Merck (Other Financial or Material Support, Member of Data and Safety Monitoring Board (DSMB))

scholarly journals 743. Colonization with Extended-Spectrum Cephalosporin-Resistant Enterobacterales (ESCrE) in Healthcare and Community Settings in Botswana: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S469-S470
Author(s):  
Naledi Mannathoko ◽  
Mosepele Mosepele ◽  
Robert Gross ◽  
Rachel Smith ◽  
Kevin Alby ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Temporal Trends ◽  
Community Settings ◽  
Middle Income ◽  
Material Support ◽  
Extended Spectrum Beta Lactamase ◽  
Global Challenge ◽  
Preliminary Identification ◽  
Extended Spectrum ◽  
Multiple Strains

Abstract Background Although ESCrE are a global challenge, data on ESCrE in low- and middle-income countries are limited. In particular, colonization data are critical for larger antibiotic resistance efforts. We characterized the colonization prevalence of ESCrE in various settings in Botswana. Methods This study was conducted in 3 hospitals and 6 clinics located in 3 districts in Botswana. In each hospital, we conducted surveillance of adult patients. Adult clinic patients were also randomly selected for participation. Finally, we enrolled community subjects by inviting each enrolled clinic subject to refer up to 3 adults. Each adult clinic or community subject was also allowed to refer their children. All subjects had rectal swabs obtained which were inoculated onto chromogenic media for preliminary identification of ESCrE. Final identification and susceptibility testing were performed using MALDI-TOF MS and VITEK-2, respectively. Genotyping was done for identification of extended-spectrum beta-lactamase (ESBL) genes. Results Enrollment occurred from 1/15/20-9/4/20 but paused from 4/2/20-5/21/20 due to a countrywide COVID lockdown. Of 5,088 subjects approached, 2,469 (49%) participated. Enrollment by subject type was: hospital – 469 (19%); clinic – 959 (39%); community adult – 477 (19%); and community child – 564 (23%). Of 2,469 subjects, the median (interquartile range) age was 32 years (19-44) and 1,783 (72%) were female. 759 (31%) subjects were colonized with at least one ESCrE; 130 subjects were colonized with multiple strains. E. coli (n=663) and K. pneumoniae (n=121) were most common. ESCrE colonization prevalence was 43% for hospital subjects, 31% for clinic subjects, 24% for adult community subjects, and 26% for child community subjects (p< 0.001)). ESCrE prevalence varied significantly across regions (Figure 1) and was significantly higher pre-lockdown vs post-lockdown (Figure 2). CTX-M was the most common ESBL gene (Figure 3). Figure 1. ESCrE Colonization - Study Sites Figure 2. ESCrE Colonization - Temporal Trends Figure 3. ESCrE Genotypic Analyses Conclusion ESCrE colonization was common in both healthcare and community settings in Botswana. Colonization prevalence varies by region and clinical setting and decreased following a countrywide lockdown. These findings provide important clues regarding potential drivers of ESCrE that might serve as targets for intervention. Disclosures Robert Gross, MD, MSCE, Pfizer (Other Financial or Material Support, Serve on DSMB for drug unrelated to HIV) Ebbing Lautenbach, MD, MPH, MSCE, Merck (Other Financial or Material Support, Member of Data and Safety Monitoring Board (DSMB))

scholarly journals Characteristics of a Nationwide Voluntary Antibiotic Resistance Awareness Campaign in India; Future Paths and Pointers for Resource Limited Settings/Low and Middle Income Countries

2019 ◽  
Vol 16 (24) ◽  
pp. 5141
Author(s):  
Ashok J. Tamhankar ◽  
Ramesh Nachimuthu ◽  
Ravikant Singh ◽  
Jyoti Harindran ◽  
Gautam Kumar Meghwanshi ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Use ◽  
World Health ◽  
Awareness Campaign ◽  
Resource Limited Settings ◽  
Middle Income ◽  
Middle Income Countries ◽  
Awareness Campaigns ◽  
Resource Limited ◽  
Low And Middle Income

Antibiotic resistance has reached alarming proportions globally, prompting the World Health Organization to advise nations to take up antibiotic awareness campaigns. Several campaigns have been taken up worldwide, mostly by governments. The government of India asked manufacturers to append a ‘redline’ to packages of antibiotics as identification marks and conducted a campaign to inform the general public about it and appropriate antibiotic use. We investigated whether an antibiotic resistance awareness campaign could be organized voluntarily in India and determined the characteristics of the voluntarily organized campaign by administering a questionnaire to the coordinators, who participated in organizing the voluntary campaign India. The campaign characteristics were: multiple electro–physical pedagogical and participatory techniques were used, 49 physical events were organized in various parts of India that included lectures, posters, booklet/pamphlet distribution, audio and video messages, competitions, and mass contact rallies along with broadcast of messages in 11 local languages using community radio stations (CRS) spread all over India. The median values for campaign events were: expenditure—3000 Indian Rupees/day (US$~47), time for planning—1 day, program spread—4 days, program time—4 h, direct and indirect reach of the message—respectively 250 and 500 persons/event. A 2 min play entitled ‘Take antibiotics as prescribed by the doctor’ was broadcast 10 times/day for 5 days on CRS with listener reach of ~5 million persons. More than 85%ofcoordinators thought that the campaign created adequate awareness about appropriate antibiotic use and antibiotic resistance. The voluntary campaign has implications for resource limited settings/low and middle income countries.

scholarly journals Oral Morphine Use in South India: A Population-Based Study

2017 ◽  
Vol 3 (6) ◽  
pp. 720-727 ◽  
Author(s):  
M.R. Rajagopal ◽  
Safiya Karim ◽  
Christopher M. Booth
Keyword(s):  
Temporal Trends ◽  
Oral Morphine ◽  
Population Based ◽  
Private Institutions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Provider Characteristics ◽  
Regional Trends ◽  
Per Capita ◽  
Over Time

Purpose Access to opioids for pain control is recognized as an urgent issue in low- and middle-income countries. Here we report temporal and regional trends in morphine use in Kerala, India. Methods Oral morphine use data for the State of Kerala (2012 to 2015) was used to describe temporal trends, regional variation, and provider characteristics. Total morphine use was calculated for each district of Kerala to derive an annual per capita use rate (milligrams per capita). Each provider was classified as government, private, nongovernment organization (NGO), or NGO partnership. Results Oral morphine use for Kerala was 1.32 mg/capita and increased over the study period 27% (from 1.23 mg/capita to 1.56 mg/capita). There was substantial variation in morphine use across districts (range, 0.49 mg/capita to 2.97 mg/capita; six-fold difference). This variation increased over time (19-fold difference in 2015). In 2015, 31% of morphine providers (51 of 167) were government institutions; they delivered 48% of total morphine in Kerala. Corresponding data for other providers are private institutions, 23% of centers and 13% of morphine; NGOs, 41% of centers and 34% of morphine; and NGO partnerships, 5% of centers and 4% of morphine. From 2012 to 2015, the total number of centers increased by 35%, from 124 to 167. Conclusion Oral morphine use has increased over time in Kerala but remains substantially lower than estimated need. There is significant geographic variation of use. Efforts are needed to improve palliative care in Kerala and to reduce regional disparities in access to opioids.

scholarly journals Strategic Approach for Prioritising Local and Regional Sanitation Interventions for Reducing Global Antibiotic Resistance

Water ◽  
2018 ◽  
Vol 11 (1) ◽  
pp. 27 ◽  
Author(s):  
David Graham ◽  
Myra Giesen ◽  
Joshua Bunce
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Use ◽  
Middle Income ◽  
Middle Income Countries ◽  
National Priority ◽  
Strategic Approach ◽  
Starting Point ◽  
Improved Sanitation ◽  
Intervention Costs

Globally increasing antibiotic resistance (AR) will only be reversed through a suite of multidisciplinary actions (One Health), including more prudent antibiotic use and improved sanitation on international scales. Relative to sanitation, advanced technologies exist that reduce AR in waste releases, but such technologies are expensive, and a strategic approach is needed to prioritize more affordable mitigation options, especially for Low- and Middle-Income Countries (LMICs). Such an approach is proposed here, which overlays the incremental cost of different sanitation options and their relative benefit in reducing AR, ultimately suggesting the “next-most-economic” options for different locations. When considering AR gene fate versus intervention costs, reducing open defecation (OD) and increasing decentralized secondary wastewater treatment, with condominial sewers, will probably have the greatest impact on reducing AR, for the least expense. However, the best option for a given country depends on the existing sewerage infrastructure. Using Southeast Asia as a case study and World Bank/WHO/UNICEF data, the approach suggests that Cambodia and East Timor should target reducing OD as a national priority. In contrast, increasing decentralized secondary treatment is well suited to Thailand, Vietnam and rural Malaysia. Our approach provides a science-informed starting point for decision-makers, for prioritising AR mitigation interventions; an approach that will evolve and refine as more data become available.

scholarly journals Temporal trends in the cardiorespiratory fitness of children and adolescents representing 19 high-income and upper middle-income countries between 1981 and 2014

2017 ◽  
Vol 53 (8) ◽  
pp. 478-486 ◽  
Author(s):  
Grant R Tomkinson ◽  
Justin J Lang ◽  
Mark S Tremblay
Keyword(s):  
Children And Adolescents ◽  
Cardiorespiratory Fitness ◽  
Low Income ◽  
Polynomial Regression ◽  
Temporal Trends ◽  
High Income ◽  
Middle Income ◽  
Middle Income Countries ◽  
International Trends ◽  
Health Related

ObjectiveTo estimate international and national temporal trends in the cardiorespiratory fitness (CRF) of children and adolescents and to examine relationships between temporal trends in CRF and temporal trends in broad socioeconomic and health-related indicators across countries.MethodsData were obtained from a systematic search of studies that explicitly reported 20 m shuttle run test (a validated measure of CRF) descriptive data on apparently healthy individuals aged 9–17 years. Following the estimation of relative peak oxygen uptake (mL/kg/min) as a measure of CRF, sample-weighted temporal trends were estimated at the country–sex–age level using best-fitting linear or polynomial regression models relating the year of testing to mean CRF. Poststratified population-weighted mean changes in absolute and per cent CRF were estimated. Pearson’s correlations were used to describe the association between linear temporal trends in CRF and linear temporal trends in broad socioeconomic and health-related indicators.ResultsTemporal trends were estimated from 965 264 children and adolescents from 19 high-income and upper middle-income countries between 1981 and 2014, using data from 137 studies. Collectively, there was a moderate decline in CRF of 3.3 mL/kg/min (95% CI −3.5 to −3.1), equivalent to a decline of 7.3% (95% CI −7.8% to −6.7%) over the 33-year time period. This international decline diminished with each decade and stabilised near zero around 2000. The decline was larger for boys than girls and was similar for children and adolescents. Trends also differed in magnitude and direction between countries, with most showing declines. There was a strong negative association between country-specific trends in income inequality (Gini index) and trends in CRF across 18 countries; meaning, countries approaching income equality had more favourable trends in CRF.ConclusionsThere has been a substantial decline in CRF since 1981, which is suggestive of a meaningful decline in population health. However, the international trend in CRF has not followed the anticipated trajectory, diminishing and stabilising with negligible change since 2000. CRF data are needed from children in low-income and middle-income countries to more confidently determine true international trends and determine whether temporal trends are similar to those observed in high-income and upper middle-income countries.

scholarly journals Metagenome-Wide Analysis of Rural and Urban Surface Waters and Sediments in Bangladesh Identifies Human Waste as a Driver of Antibiotic Resistance

mSystems ◽  
2021 ◽  
Author(s):  
Ross Stuart McInnes ◽  
Md Hassan uz-Zaman ◽  
Imam Taskin Alam ◽  
Siu Fung Stanley Ho ◽  
Robert A. Moran ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Surface Waters ◽  
Antibiotic Resistance Genes ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Middle Income ◽  
Antibiotic Resistant ◽  
Human Waste ◽  
Middle Income Countries ◽  
Rural And Urban

Low- and middle-income countries (LMICs) have higher burdens of multidrug-resistant infections than high-income countries, and there is thus an urgent need to elucidate the drivers of the spread of antibiotic-resistant bacteria in LMICs. Here, we study the diversity and abundance of antibiotic resistance genes in surface water and sediments from rural and urban settings in Bangladesh.

scholarly journals Active School Transport among Children from Canada, Colombia, Finland, South Africa, and the United States: A Tale of Two Journeys

2020 ◽  
Vol 17 (11) ◽  
pp. 3847
Author(s):  
Silvia A. González ◽  
Olga L. Sarmiento ◽  
Pablo D. Lemoine ◽  
Richard Larouche ◽  
Jose D. Meisel ◽  
...  
Keyword(s):  
Mixed Models ◽  
International Study ◽  
The United States ◽  
High Income ◽  
Vehicle Ownership ◽  
School Crime ◽  
Middle Income ◽  
Socioeconomic Variables ◽  
Middle Income Countries ◽  
Study Sites

Walking and biking to school represent a source of regular daily physical activity (PA). The objectives of this paper are to determine the associations of distance to school, crime safety, and socioeconomic variables with active school transport (AST) among children from five culturally and socioeconomically different country sites and to describe the main policies related to AST in those country sites. The analytical sample included 2845 children aged 9–11 years from the International Study of Childhood Obesity, Lifestyle and the Environment. Multilevel generalized linear mixed models were used to estimate the associations between distance, safety and socioeconomic variables, and the odds of engaging in AST. Greater distance to school and vehicle ownership were associated with a lower likelihood of engaging in AST in sites in upper-middle- and high-income countries. Crime perception was negatively associated to AST only in sites in high-income countries. Our results suggest that distance to school is a consistent correlate of AST in different contexts. Our findings regarding crime perception support a need vs. choice framework, indicating that AST may be the only commuting choice for many children from the study sites in upper-middle-income countries, despite the high perception of crime.

Linking Participatory Action Research on Health Systems to Justice in Global Health: A Case Study of the Maternal and Neonatal Implementation for Equitable Health Systems Project in Rural Uganda

2017 ◽  
Vol 13 (1) ◽  
pp. 74-87 ◽  
Author(s):  
Bridget Pratt ◽  
Adnan A. Hyder
Keyword(s):  
Health Systems ◽  
Ethical Framework ◽  
Participatory Action ◽  
Middle Income ◽  
Makerere University ◽  
Middle Income Countries ◽  
Systems Research ◽  
Study Sites ◽  
Health Justice

An ethical framework called “research for health justice” provides initial guidance on how to link health systems research in low- and middle-income countries to health equity. To further develop the largely conceptual framework, we tested its guidance against the experience of the Maternal and Neonatal Implementation for Equitable Health Systems (Manifest) project, which was performed in rural Uganda by researchers from Makerere University. We conducted 21 in-depth interviews with investigators and research implementers, directly observed study sites, and reviewed study-related documents. Our analysis identifies where alignment exists between the framework’s guidance and the Manifest project, providing initial lessons on how that was achieved. It also identifies where nonalignment occurred and gaps in the framework’s guidance. Suggestions are then made for revising and expanding “research for health justice.”

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