scholarly journals Harmonized One Health Trans-Species and Community Surveillance for Tackling Antibacterial Resistance in India: Protocol for a Mixed Methods Study

10.2196/23241 ◽  
2020 ◽  
Vol 9 (10) ◽  
pp. e23241
Author(s):  
◽  
Manoja Kumar Das ◽  
Ashoka Mahapatra ◽  
Basanti Pathi ◽  
Rajashree Panigrahy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Data Analysis ◽  
Data Collection ◽  
One Health ◽  
Antibiotic Use ◽  
Resistant Bacteria ◽  
Drug Resistant ◽  
Care Seeking ◽  
Resistance Patterns ◽  
The One

Background India has the largest burden of drug‑resistant organisms compared with other countries around the world, including multiresistant and extremely drug‑resistant tuberculosis and resistant Gram‑negative and Gram‑positive bacteria. Antibiotic resistant bacteria are found in all living hosts and in the environment and move between hosts and ecosystems. An intricate interplay of infections, exposure to antibiotics, and disinfectants at individual and community levels among humans, animals, birds, and fishes triggers evolution and spread of resistance. The One Health framework proposes addressing antibiotic resistance as a complex multidisciplinary problem. However, the evidence base in the Indian context is limited. Objective This multisectoral, trans-species surveillance project aims to document the infection and resistance patterns of 7 resistant-priority bacteria and the risk factors for resistance following the One Health framework and geospatial epidemiology. Methods This hospital- and community-based surveillance adopts a cross-sectional design with mixed methodology (quantitative, qualitative, and spatial) data collection. This study is being conducted at 6 microbiology laboratories and communities in Khurda district, Odisha, India. The laboratory surveillance collects data on bacteria isolates from different hosts and their resistance patterns. The hosts for infection surveillance include humans, animals (livestock, food chain, and pet animals), birds (poultry), and freshwater fishes (not crustaceans). For eligible patients, animals, birds and fishes, detailed data from their households or farms on health care seeking (for animals, birds and fishes, the illness, and care seeking of the caretakers), antibiotic use, disinfection practices, and neighborhood exposure to infection risks will be collected. Antibiotic prescription and use patterns at hospitals and clinics, and therapeutic and nontherapeutic antibiotic and disinfectant use in farms will also be collected. Interviews with key informants from animal breeding, agriculture, and food processing will explore the perceptions, attitudes, and practices related to antibiotic use. The data analysis will follow quantitative (descriptive and analytical), qualitative, and geospatial epidemiology principles. Results The study was funded in May 2019 and approved by Institute Ethics Committees in March 2019. The data collection started in September 2019 and shall continue till March 2021. As of June 2020, data for 56 humans, 30 animals and birds, and fishes from 10 ponds have been collected. Data analysis is yet to be done. Conclusions This study will inform about the bacterial infection and resistance epidemiology among different hosts, the risk factors for infection, and resistance transmission. In addition, it will identify the potential triggers and levers for further exploration and action. International Registered Report Identifier (IRRID) DERR1-10.2196/23241

scholarly journals Harmonized One Health Trans-Species and Community Surveillance for Tackling Antibacterial Resistance in India: Protocol for a Mixed Methods Study (Preprint)

2020 ◽  
Author(s):  
◽  
Manoja Kumar Das ◽  
Ashoka Mahapatra ◽  
Basanti Pathi ◽  
Rajashree Panigrahy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Data Analysis ◽  
Data Collection ◽  
One Health ◽  
Antibiotic Use ◽  
Resistant Bacteria ◽  
Drug Resistant ◽  
Care Seeking ◽  
Attitudes And Practices ◽  
Resistance Patterns

BACKGROUND India has the largest burden of drug‑resistant organisms compared with other countries around the world, including multiresistant and extremely drug‑resistant tuberculosis and resistant Gram‑negative and Gram‑positive bacteria. Antibiotic resistant bacteria are found in all living hosts and in the environment and move between hosts and ecosystems. An intricate interplay of infections, exposure to antibiotics, and disinfectants at individual and community levels among humans, animals, birds, and fishes triggers evolution and spread of resistance. The <i>One Health</i> framework proposes addressing antibiotic resistance as a complex multidisciplinary problem. However, the evidence base in the Indian context is limited. OBJECTIVE This multisectoral, trans-species surveillance project aims to document the infection and resistance patterns of 7 resistant-priority bacteria and the risk factors for resistance following the One Health framework and geospatial epidemiology. METHODS This hospital- and community-based surveillance adopts a cross-sectional design with mixed methodology (quantitative, qualitative, and spatial) data collection. This study is being conducted at 6 microbiology laboratories and communities in Khurda district, Odisha, India. The laboratory surveillance collects data on bacteria isolates from different hosts and their resistance patterns. The hosts for infection surveillance include humans, animals (livestock, food chain, and pet animals), birds (poultry), and freshwater fishes (not crustaceans). For eligible patients, animals, birds and fishes, detailed data from their households or farms on health care seeking (for animals, birds and fishes, the illness, and care seeking of the caretakers), antibiotic use, disinfection practices, and neighborhood exposure to infection risks will be collected. Antibiotic prescription and use patterns at hospitals and clinics, and therapeutic and nontherapeutic antibiotic and disinfectant use in farms will also be collected. Interviews with key informants from animal breeding, agriculture, and food processing will explore the perceptions, attitudes, and practices related to antibiotic use. The data analysis will follow quantitative (descriptive and analytical), qualitative, and geospatial epidemiology principles. RESULTS The study was funded in May 2019 and approved by Institute Ethics Committees in March 2019. The data collection started in September 2019 and shall continue till March 2021. As of June 2020, data for 56 humans, 30 animals and birds, and fishes from 10 ponds have been collected. Data analysis is yet to be done. CONCLUSIONS This study will inform about the bacterial infection and resistance epidemiology among different hosts, the risk factors for infection, and resistance transmission. In addition, it will identify the potential triggers and levers for further exploration and action. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/23241

Antimicrobial stewardship through a one health lens

2016 ◽  
Vol 21 (3) ◽  
pp. 114-130 ◽  
Author(s):  
Marisa Anne D'Angeli ◽  
Joe B. Baker ◽  
Douglas R. Call ◽  
Margaret A. Davis ◽  
Kelly J. Kauber ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
One Health ◽  
Work Group ◽  
Animal Health ◽  
Antibiotic Use ◽  
Washington State ◽  
Resistant Bacteria ◽  
Health Crisis ◽  
Content Type ◽  
The One

Purpose – Antibiotic resistance (AR) is a global health crisis that is attracting focussed attention from healthcare, public health, governmental agencies, the public, and food producers. The purpose of this paper is to describe the work in Washington State to combat resistance and promote antimicrobial stewardship from a one health perspective. Design/methodology/approach – In 2014, the Washington State Department of Health convened a One Health Steering Committee and two workgroups to focus on AR, the One Health Antimicrobial Stewardship work group and the One Health Antimicrobial Resistance Surveillance work group. The group organized educational sessions to establish a basic understanding of epidemiological factors that contribute to resistance, including antibiotic use, transmission of resistant bacteria, and environmental contamination with resistant bacteria and antibiotic residues. Findings – The authors describe the varied uses of antibiotics; efforts to promote stewardship in human, and animal health, including examples from the USA and Europe; economic factors that promote use of antibiotics in animal agriculture; and efforts, products and next steps of the workgroups. Originality/value – In Washington, human, animal and environmental health experts are working collaboratively to address resistance from a one health perspective. The authors are establishing a multi-species resistance database that will allow tracking resistance trends in the region. Gaps include measurement of antibiotic use in humans and animals; integrated resistance surveillance information; and funding for AR and animal health research.

Leptospirosis prevalence and risk factors in India: Evidence gap maps

2021 ◽  
pp. 004947552110052
Author(s):  
Sandeep Moola ◽  
Deepti Beri ◽  
Abdul Salam ◽  
Jagnoor Jagnoor ◽  
Arun Teja ◽  
...  
Keyword(s):  
Risk Factors ◽  
One Health ◽  
Data Extraction ◽  
Research Priorities ◽  
Risk Groups ◽  
Public Health Importance ◽  
Country Level ◽  
Disease Condition ◽  
Extraction Parameters ◽  
The One

Leptospirosis is a zoonotic disease of public health importance in India. A country-level evidence gap map was developed to identify gaps on epidemiology of leptospirosis. It is the first such on leptospirosis globally and on any single disease condition in India. The steps for development of evidence gap map were development of a framework to map evidence, retrieval of evidence, data extraction parameters and mapping of available evidence in evidence gap map framework. The prevalence evidence gap map consisted of 157 studies (102 in humans, 55 in animals, and 12 in both). The evidence gap map on risk factors had 120 studies (102 in humans, 11 in animals and 7 in both). There were inter-state differences in availability of research and disparity between animal and human research. Research on high-risk groups was limited and studies did not use the One Health approach to identify epidemiology, which can help understand the issue more comprehensively. The study demonstrates the potential of evidence gap maps to inform research priorities.

scholarly journals Antimicrobial multidrug resistance in the era of COVID-19: a forgotten plight?

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Eric Pelfrene ◽  
Radu Botgros ◽  
Marco Cavaleri
Keyword(s):  
Public Health ◽  
Multidrug Resistance ◽  
Regulatory Network ◽  
One Health ◽  
Animal Health ◽  
Antibiotic Use ◽  
Economic Conditions ◽  
Main Body ◽  
The One ◽  
The Relationship

Abstract Background Antimicrobial resistance (AMR) is a growing global problem to which the ongoing COVID-19 pandemic may further contribute. With resources deployed away from antimicrobial stewardship, evidence of substantial pre-emptive antibiotic use in COVID-19 patients and indirectly, with deteriorating economic conditions fuelling poverty potentially impacting on levels of resistance, AMR threat remains significant. Main body In this paper, main AMR countermeasures are revisited and priorities to tackle the issue are re-iterated. The need for collaboration is stressed, acknowledging the relationship between human health, animal health and environment (“One Health” approach). Among the stated priorities, the initiative by the European Medicines Regulatory Network to further strengthen the measures in combatting AMR is highlighted. Likewise, it is asserted that other emerging health threats require global collaboration with the One Health approach offering a valuable blueprint for action. Conclusion The authors stress the importance of an integrated preparedness strategy to tackle this public health peril.

scholarly journals Aquatic environments in the One Health context: modulating the antimicrobial resistance phenomenon

2020 ◽  
Vol 32 ◽  
Author(s):  
Juliana Alves Resende ◽  
Vânia Lúcia da Silva ◽  
Claudio Galuppo Diniz
Keyword(s):  
Antimicrobial Resistance ◽  
One Health ◽  
Anthropogenic Activities ◽  
Treatment Strategies ◽  
Chemical Pollution ◽  
Resistant Bacteria ◽  
Aquatic Environments ◽  
Antimicrobial Substances ◽  
Antimicrobial Resistance Genes ◽  
The One

Abstract: From an anthropocentric perspective, aquatic environments are important to maintain health and survival, however, as they are sometimes managed based on misconception, they are considered a convergent pathway for anthropogenic residues and sanitation. Thus, it is observed that these ecosystems have been threatened by chemical pollution due to xenobiotics, especially from a more contemporary approach, by the selective pressure associated with antimicrobials. There are several studies that report the enrichment of antimicrobial resistant bacteria and mobilizable antimicrobial resistance genes in aquatic and adjacent ecosystems. From the perspective of the emerging and reemerging number of diseases related to the interplay of human, animal, and environmental factors, a new conception arose to address these issues holistically, which is known as the One Health approach. Scientific and political discourse on this conception should lead to effective action plans for preventing and controlling the spread of infectious diseases in open environment, including those impacted by anthropogenic activities. Therefore, nowadays, discussions on antimicrobial resistance are becoming broader and are requiring a multi-disciplinary view to address health and environmental challenges, which includes aquatic environment management. Water may represent one of the most important ecosystems for the in antimicrobial resistance phenomenon that arises when a dynamic and singular microbial community may be influenced by several characteristics. As antimicrobial substances do not all degrade at the same time under the same treatment, strategies concerning their removal from the environment should consider their individualized chemical characteristics.

Article Commentary: Strategies in the Prevention and Management of Ventilator-Associated Pneumonia

2007 ◽  
Vol 73 (5) ◽  
pp. 419-432 ◽  
Author(s):  
Fredric M. Pieracci ◽  
Philip S. Barie
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Lower Respiratory Tract ◽  
Antibiotic Use ◽  
Current Data ◽  
Evidence Based ◽  
Ventilator Associated Pneumonia ◽  
Drug Resistant ◽  
Duration Of Therapy ◽  
Risk Of Aspiration

Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality in the intensive care unit. Prevention of VAP is possible through the use of several evidence-based strategies intended to minimize intubation, the duration of mechanical ventilation, and the risk of aspiration of oropharyngeal pathogens. Current data favor the quantitative analysis of lower respiratory tract cultures for the diagnosis of VAP, accompanied by the initiation of broad-spectrum empiric antimicrobial therapy based on patient risk factors for infection with multi-drug-resistant pathogens and data from unit-specific antibiograms. Eventual choice of antibiotic and duration of therapy are selected based on culture results and patient stability, with an emphasis on minimization of unnecessary antibiotic use.

Multi- and Extensive-Drug Resistant Acinetobacter baumannii in ICUs: Risk Factors, Antimicrobial Resistance Profiles and co-harboring of gyrA and parC mutations

2020 ◽  
Vol EJMM29 (4) ◽  
pp. 109-116
Author(s):  
Enas A. Tantawy ◽  
Hanan M. El-Sayed ◽  
Heba M. Matar ◽  
Basma A. El-Azhary
Keyword(s):  
Risk Factors ◽  
Antimicrobial Resistance ◽  
Acinetobacter Baumannii ◽  
High Resistance ◽  
Respiratory Infections ◽  
Gene Mutations ◽  
Antibiotic Use ◽  
Quinolone Resistance ◽  
Diffusion Method ◽  
Drug Resistant

Background: Acinetobacter baumannii is a gram-negative organism that is implicated in hospital acquired infections. It confers high resistance to many classes of antibiotics. Objectives: To assess the prevalence of multi and extensive drug-resistant (MDR & XDR) Acinetobacter baumannii, their risk factors, antimicrobial resistance patterns and the presence of gyrA and parC gene mutations of quinolone resistance. Methodology: The study included 106 ICU patients (56 males & 50 females), samples were collected according to sites of infections, Acinetobacter baumannii was identified by morphology, biochemical reactions &API 20NE. Antimicrobial susceptibility testing was performed by disc diffusion method. The E-test was used to detect MIC of Ciprofloxacin & Levofloxacin, then a polymerase chain reaction- restriction fragment length polymorphism was performed to detect the occurence of gyrA and parC gene mutations of Quinolone resistance. Results: Thirty isolates were identified as Acinetobacter baumannii, most of which from respiratory infections (P=0.005) prolonged hospitalization, antibiotic use, urinary catheters & ventilator supports were found to be risk factors of infections. Acinetobacter baumannii isolates showed high resistance to most of the tested antibiotics (29 MDR & 28 XDR). All isolates were resistant to Ciprofloxacin & Levofloxacin with the co-presence of gyrA and parC mutations in all isolates (P<0.001). Conclusions: There is an increased prevalence of MDR & XDR Acinetobacter baumannii among ICU infections. The co-occurrence of gyrA and parC mutations is associated with high resistance to Quinolones.

Risk Factors for Drug-resistant Bloodstream Infections in Patients with Systemic Lupus Erythematosus

2014 ◽  
Vol 41 (7) ◽  
pp. 1311-1316 ◽  
Author(s):  
Ana Barrera-Vargas ◽  
Diana Gómez-Martín ◽  
Javier Merayo-Chalico ◽  
Alfredo Ponce-de-León ◽  
Jorge Alcocer-Varela
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Bloodstream Infection ◽  
Lupus Erythematosus ◽  
Resistant Bacteria ◽  
Drug Resistant ◽  
Systemic Lupus ◽  
Prednisone Dose ◽  
Drug Resistant Bacteria ◽  
Time Of Infection

Objective.To identify risk factors for developing drug-resistant bacterial infections in patients with systemic lupus erythematosus (SLE).Methods.A retrospective, case-control study was performed. Patients fulfilled American College of Rheumatology criteria for SLE and had an episode of bloodstream infection between 2001 and 2012. Cases were defined as those with bloodstream infection caused by drug-resistant bacteria (Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, or extended-spectrum-β-lactalamase-producing Escherichia coli); while controls had susceptible strains of S. aureus or E. coli. Differences between groups were analyzed by Student t test or Mann-Whitney U test. Association between variables was assessed by OR (CI 95%). Multivariate analysis was performed by binary logistic regression model.Results.Forty-four patients were included in each group. Variables associated with drug-resistant bloodstream infection were history of central nervous system activity; hematological activity, immunosuppressive treatment and prednisone dose at the time of the infection; and low C3 levels, antibiotic use, or hospitalization in the previous 3 months. In multivariate analysis, variables that remained significant were low C3 previous to infection (OR 3.12, CI 95% 1.91–8.22), previous hospitalization (OR 2.22, CI 95% 1.42–4.10), and prednisone dose at the time of infection (OR 1.10, CI 95% 1.04–1.22).Conclusion.Low C3 levels, recent hospitalization, and prednisone dose at time of infection are independent risk factors for acquiring drug-resistant bacteria in patients with SLE. Although the present data do not fully support a change in initial treatment-decision strategies, this information could lead to prospective studies designed to address this issue, which could determine the best approach in clinical practice.

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