scholarly journals Antimicrobial resistance surveillance: can we estimate resistance in bloodstream infections from other types of specimen?

2020 ◽  
Author(s):  
Karina-Doris Vihta ◽  
Nicola Claire Gordon ◽  
Nicole Stoesser ◽  
T. Phuong Quan ◽  
Carina SB Tyrrell ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
Bloodstream Infections ◽  
Cost Effective ◽  
Middle Income ◽  
E Coli ◽  
Middle Income Countries ◽  
Invasive Infections ◽  
Tract Infections ◽  
Over Time

SynopsisBackgroundAntimicrobial resistance (AMR) surveillance of bloodstream infections is challenging in low- and middle-income countries (LMICs), limited laboratory capacity preventing routine patient-level susceptibility testing. Other specimen types could provide an effective approach to surveillance.ObjectivesOur study aims to systematically evaluate the relationship between resistance prevalence in non-sterile sites and bloodstream infections.MethodsAssociations between resistance rates in Escherichia coli and Staphylococcus aureus isolates from blood and other specimens were estimated in Oxfordshire, UK, 1998-2018, comparing proportions resistant in each calendar year using time series cross-correlations and across drug-years. We repeated analysis across publicly-available data from four high-income and 12 middle-income countries, and in three hospitals/programmes in LMICs.Results8102 E. coli bloodstream infections, 322087 E. coli urinary tract infections, 6952 S. aureus bloodstream infections and 112074 S. aureus non-sterile site cultures were included from Oxfordshire. Resistance trends over time in blood versus other specimens were strongly correlated (maximum cross-correlation 0.51-0.99, strongest associations in the same year for 18/27 pathogen-drug combinations). Resistance prevalence was broadly congruent across drug-years for each species. 276/312 (88%) species-drug-years had resistance prevalence in other specimen types within ±10% of that blood isolates. Results were similar across multiple countries and hospitals/programmes in high/middle/low income-settings.ConclusionsResistance in bloodstream and less invasive infections are strongly related over time, suggesting the latter could be a surveillance tool for AMR in LMICs. These infection sites are easier to sample and cheaper to obtain the necessary numbers of susceptibility tests, providing more cost-effective evidence for decisions including empiric antibiotic recommendations.

scholarly journals Antimicrobial resistance in commensal opportunistic pathogens isolated from non-sterile sites can be an effective proxy for surveillance in bloodstream infections

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Karina-Doris Vihta ◽  
Nicola Claire Gordon ◽  
Nicole Stoesser ◽  
T. Phuong Quan ◽  
Carina S. B. Tyrrell ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
Bloodstream Infections ◽  
Opportunistic Pathogens ◽  
Calendar Time ◽  
Middle Income ◽  
E Coli ◽  
Laboratory Capacity ◽  
Low Middle Income Countries ◽  
Tract Infections

AbstractAntimicrobial resistance (AMR) surveillance in bloodstream infections (BSIs) is challenging in low/middle-income countries (LMICs) given limited laboratory capacity. Other specimens are easier to collect and process and are more likely to be culture-positive. In 8102 E. coli BSIs, 322,087 E. coli urinary tract infections, 6952 S. aureus BSIs and 112,074 S. aureus non-sterile site cultures from Oxfordshire (1998–2018), and other (55,296 isolates) rarer commensal opportunistic pathogens, antibiotic resistance trends over time in blood were strongly associated with those in other specimens (maximum cross-correlation per drug 0.51–0.99). Resistance prevalence was congruent across drug-years for each species (276/312 (88%) species-drug-years with prevalence within ± 10% between blood/other isolates). Results were similar across multiple countries in high/middle/low income-settings in the independent ATLAS dataset (103,559 isolates, 2004–2017) and three further LMIC hospitals/programmes (6154 isolates, 2008–2019). AMR in commensal opportunistic pathogens cultured from BSIs is strongly associated with AMR in commensal opportunistic pathogens cultured from non-sterile sites over calendar time, suggesting the latter could be used as an effective proxy for AMR surveillance in BSIs.

scholarly journals Policies to prevent non-communicable disease: implementation trends in 194 countries 2015–2020

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
H Holmer ◽  
L Allen
Keyword(s):  
Low Income ◽  
Communicable Disease ◽  
Cost Effective ◽  
Low Income Countries ◽  
Middle Income ◽  
Global Trends ◽  
Alcohol Policies ◽  
Middle Income Countries ◽  
Alcohol Interventions ◽  
Over Time

Abstract Background Non-communicable diseases (NCDs) are the leading cause of death and disability worldwide. The WHO proposed 19 “Best Buy” policies to prevent NCDs, mainly addressing four leading risk factors: tobacco, alcohol, unhealthy diets and insufficient physical exercise. Yet, little is known about how implementation has changed over time and the role of geopolitical factors. This study addresses that crucial gap. Methods We calculated policy implementation scores for all 194 WHO member states from the 2015, 2017 and 2020 WHO NCD Progress Monitor Reports. We analyzed global trends across the three years for all countries and by geopolitical group and used linear regression to assess association with health, economic and political indicators. Results The global average implementation score in 2020 was 47.0% (SD 19.8%), compared to 44.9% (SD 19.1%) in 2017 and 39.0% (SD 19.3%) in 2015. Implementation scores varied by income level (p < 0.001), with high-income countries' average implementation score over twice that of low-income countries (59.7% vs. 28.9%). Implementation improved for all policies in 2015-2020 except the three alcohol policies which decreased. Implementation scores were associated with the proportion of deaths due to NCDs (β 0.8, 95% confidence interval 0.7-0.9, p < 0.001); however, on average, countries with a greater increase in the proportion of deaths due to NCDs were less likely to implement NCD policies (p < 0.001). Conclusions Implementation of policies to prevent NCDs is improving over time, but the average implementation score remains below 50% and progress is uneven. Our findings suggest the need to increase implementation of recommended interventions, particularly in low- and middle-income countries and where the proportion of NCD deaths is growing fastest, and to urgently address the decreasing level of implementation of alcohol interventions. Key messages Implementation of recommended, cost-effective policies to prevent NCDs is improving but remains low, and alcohol policies are decreasing. Low-income countries, and countries where the proportion of deaths due to NCDs is growing the fastest, are least likely to have recommended policies in place to prevent NCDs.

scholarly journals Immunisation financing and programme performance in the Middle East and North Africa, 2010 to 2017

2019 ◽  
Vol 4 (2) ◽  
pp. e001248
Author(s):  
Helen Saxenian ◽  
Nahad Sadr-Azodi ◽  
Miloud Kaddar ◽  
Kamel Senouci
Keyword(s):  
Economic Growth ◽  
Middle East ◽  
North Africa ◽  
Low Income ◽  
Health Sector ◽  
Cost Effective ◽  
Middle Income ◽  
Middle Income Countries ◽  
Life Saving ◽  
Fiscal Space

Immunisation is a cornerstone to primary health care and is an exceptionally good value. The 14 low-income and middle-income countries in the Middle East and North Africa region make up 88% of the region’s population and 92% of its births. Many of these countries have maintained high immunisation coverage even during periods of low or negative economic growth. However, coverage has sharply deteriorated in countries directly impacted by conflict and political unrest. Approximately 1.3 million children were not completely vaccinated in 2017, as measured by third dose of diphtheria–pertussis–tetanus vaccine. Most of the countries have been slow to adopt the newer, more expensive life-saving vaccines mainly because of financial constraints and the socioeconomic context. Apart from the three countries that have had long-standing assistance from Gavi, the Vaccine Alliance, most countries have not benefited appreciably from donor and partner activities in supporting their health sector and in achieving their national and subnational immunisation targets. Looking forward, development partners will have an important role in helping reconstruct health systems in conflict-affected countries. They can also help with generating evidence and strategic advocacy for high-priority and cost-effective services, including immunisation. Governments and ministries of health would ensure important benefits to their populations by investing further in their immunisation programmes. Where possible, the health system can create and expand fiscal space from efficiency gains in harmonising vaccine procurement mechanisms and service integration; broader revenue generation from economic growth; and reallocation of government budgets to health, and from within health, to immunization.

scholarly journals Antiparasitic phytotherapy perspectives, scope and current development

Infectio ◽  
2019 ◽  
Vol 23 (2) ◽  
pp. 189 ◽  
Author(s):  
Jhon Carlos Castaño Osorio ◽  
Alejandra María Giraldo García
Keyword(s):  
Low Income ◽  
Public Health Problem ◽  
Cost Effective ◽  
Prolonged Treatment ◽  
Major Public Health Problem ◽  
Middle Income ◽  
Middle Income Countries ◽  
Commercial Markets ◽  
Health And Economic Development ◽  
New Treatments

Tropical protozoan diseases are currently a major public health problem throughout the world and are strongly linked with poverty, this combined with a lack of commercial markets for potential drugs has created a large burden on the health and economic development of low-income and middle-income countries in Africa, Asia, and the Americas. Due to the low research interest and the high increase of resistance against the existing treatments, as well as increasing inefficiency, toxicity, prolonged treatment schedules and costs, there is an urgent need for cost-effective, safe and easy-to-administer, new effective compounds with novel mechanisms of action. Several studies of crude plant extracts have already identified potential compounds to treat Chagas’ disease, Leishmaniasis, Toxoplasmosis, Giardiasis, and Malaria among other protozoan parasites. Natural compounds of medicinal plants have shown lower toxicity together with higher specificity, creating an optimistic view of new treatments for diseases. Out of 1010 new active substances approved as drugs for medical conditions by regulatory agencies during the past 25 years, 490(48.5%) were from a natural origin.

scholarly journals Using ‘smart regulation’ to tackle antimicrobial resistance in low-income and middle-income countries

2020 ◽  
Vol 5 (1) ◽  
pp. e001864 ◽  
Author(s):  
Gerard Porter ◽  
Jyoti Joshi ◽  
Lovleen Bhullar ◽  
Anita Kotwani
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
Middle Income ◽  
Middle Income Countries ◽  
Smart Regulation

scholarly journals Out-of-pocket health expenditures and antimicrobial resistance in low-income and middle-income countries: an economic analysis

2015 ◽  
Vol 15 (10) ◽  
pp. 1203-1210 ◽  
Author(s):  
Marcella Alsan ◽  
Lena Schoemaker ◽  
Karen Eggleston ◽  
Nagamani Kammili ◽  
Prasanthi Kolli ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Economic Analysis ◽  
Low Income ◽  
Health Expenditures ◽  
Middle Income ◽  
Middle Income Countries

scholarly journals Opening up ‘fever’, closing down medicines

2019 ◽  
Vol 6 (4) ◽  
Author(s):  
Clare Chandler ◽  
Justin Dixon
Keyword(s):  
Antimicrobial Resistance ◽  
Global Health ◽  
Integrated Management ◽  
Childhood Illness ◽  
High Tech ◽  
Middle Income ◽  
Middle Income Countries ◽  
Opening Up ◽  
Over Time ◽  
Global Algorithm

Rising concerns about antimicrobial resistance have sparked a renewed push to rationalise and ration the use of medicines. This article explores the case of the Integrated Management of Childhood Illness (IMCI) guideline, a periodically updated ‘global’ algorithm that shapes and normalises the centrality of medicines to care in low- and middle-income countries and, increasingly, the imperative to ration them. Using ‘classification work’ as analytic frame, we firstly consider the IMCI algorithm as a blueprint for global health that classifies illnesses, patients, and care in particular ways relative to available medicines. Zooming in on this blueprint, we then offer a classificatory reading of ‘fever’ over time, tracing ‘nonmalarial fever’ from being malaria’s residual ‘other’ category to becoming increasingly legible through attention to diagnostics and antibiotic (over)use. Our reading suggests that an apparent refinement of the ‘fever’ category may concurrently entail the closing down of medicine options. This raises the possibility that an increasingly high-tech but ‘empty’ form of pharmaceuticalised care is being incidentally worked into the infrastructure of weak health systems.

scholarly journals High Burden of Bloodstream Infections Associated With Antimicrobial Resistance and Mortality in the Neonatal Intensive Care Unit in Pune, India

2020 ◽  
Author(s):  
Julia Johnson ◽  
Matthew L Robinson ◽  
Uday C Rajput ◽  
Chhaya Valvi ◽  
Aarti Kinikar ◽  
...  
Keyword(s):  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Early Onset ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Bloodstream Infections ◽  
Middle Income ◽  
Middle Income Countries ◽  
Effective Interventions ◽  
High Prevalence

Abstract Background Antimicrobial resistance (AMR) is a growing threat to newborns in low- and middle-income countries (LMIC). Methods We performed a prospective cohort study in 3 tertiary neonatal intensive care units (NICUs) in Pune, India, to describe the epidemiology of neonatal bloodstream infections (BSIs). All neonates admitted to the NICU were enrolled. The primary outcome was BSI, defined as positive blood culture. Early-onset BSI was defined as BSI on day of life (DOL) 0–2 and late-onset BSI on DOL 3 or later. Results From 1 May 2017 until 30 April 2018, 4073 neonates were enrolled. Among at-risk neonates, 55 (1.6%) developed early-onset BSI and 176 (5.5%) developed late-onset BSI. The majority of BSIs were caused by gram-negative bacteria (GNB; 58%); among GNB, 61 (45%) were resistant to carbapenems. Klebsiella spp. (n = 53, 23%) were the most common cause of BSI. Compared with neonates without BSI, all-cause mortality was higher among neonates with early-onset BSI (31% vs 10%, P < .001) and late-onset BSI (24% vs 7%, P < .001). Non–low-birth-weight neonates with late-onset BSI had the greatest excess in mortality (22% vs 3%, P < .001). Conclusions In our cohort, neonatal BSIs were most commonly caused by GNB, with a high prevalence of AMR, and were associated with high mortality, even in term neonates. Effective interventions are urgently needed to reduce the burden of BSI and death due to AMR GNB in hospitalized neonates in LMIC.

scholarly journals 1698. Trends in antimicrobial resistance among outpatient urine E. coli isolates in US females ≥12 years of age: A multicenter evaluation from 2011 to 2019

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S831-S832
Author(s):  
Keith S Kaye ◽  
Vikas Gupta ◽  
Aruni Mulgirigama ◽  
Ashish V Joshi ◽  
Nicole Scangarella-Oman ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Outpatient Setting ◽  
Research Database ◽  
Becton Dickinson ◽  
Multicenter Cohort Study ◽  
Material Support ◽  
E Coli ◽  
Using Data ◽  
Tract Infections ◽  
Over Time

Abstract Background E. coli is the predominant uropathogen isolated in uncomplicated urinary tract infections (UTI). Surveillance data suggest increasing antimicrobial resistance (AMR), although recent data from the outpatient setting are limited. Treatment is typically empiric and should be guided by local resistance rates; however, this is challenging in the absence of routine culture and assessment of regional AMR. We characterized AMR trends for E. coli isolated from females with outpatient UTI in the US, from 2011 to 2019. Methods A retrospective multicenter cohort study of antimicrobial susceptibility using data from the BD Insights Research Database (Franklin Lakes, NJ) was conducted. The first E. coli urine culture isolates representing each distinct susceptibility pattern within 30 days of index urine from 2011–2019 were included from females ≥ 12 years old. E. coli isolates were identified as not-susceptible (NS) if intermediate or resistant to trimethoprim-sulfamethoxazole (TMP-SMX NS), fluoroquinolone (FQ NS), nitrofurantoin (NFT NS), ESBL+ (by commercial panels or intermediate/resistant to ceftriaxone, cefotaxime, ceftazidime or cefepime), and multi-drug resistant (MDR), defined as NS to ≥ 2 or ≥ 3 of FQ, TMP-SMX, NFT or ESBL+. Descriptive analyses characterized AMR (%) over time and generalized estimating equations were used to statistically assess AMR trends over time. Results A total of 1,513,882 E. coli isolates were tested at 106 to 295 US centers between 2011 and 2019. Over the study period, AMR remained persistently high (> 20%) for FQ and TMP-SMX and increased for the MDR (≥ 3 drugs) phenotype (from 3.1% to 4.0%) (Table). Prevalence of the ESBL+ phenotype increased year-on-year (from 4.1% to 7.3%). Modeling confirmed a significant increasing trend for the ESBL+ (7.7%/year) and MDR (≥ 3 drugs) phenotypes (2.7%/year) (P< 0.001), with decreasing or no trend change for NFT NS and other AMR phenotypes (Table). Table. Descriptive Statistics and Model-estimated Annual Change of AMR (count and % not-susceptible out of isolates tested) in E. coli among US Females (≥12 years of age) with Outpatient UTI Conclusion Characterization of AMR trends for E. coli over the last decade, in outpatient E. coli isolates in US females, shows persistently high AMR to FQ and TMP-SMX, and increasing AMR trends for the ESBL+ and MDR (≥ 3 drugs) phenotypes. Disclosures Vikas Gupta, PharmD, BCPS, Becton, Dickinson and Company (Employee, Shareholder)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Aruni Mulgirigama, MBBS, GlaxoSmithKline plc. (Employee, Shareholder) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder) Nicole Scangarella-Oman, MS, GlaxoSmithKline plc. (Employee, Shareholder) Kalvin Yu, MD, Becton, Dickinson and Company (Employee)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Gang Ye, PhD, Becton, Dickinson and Company (Employee)GlaxoSmithKline plc. (Other Financial or Material Support, Funding) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder)

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