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

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

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.

scholarly journals Risk factors for fecal carriage of multidrug-resistant Escherichia coli in a college community: a penalized regression model

2020 ◽  
Author(s):  
Yuan Hu ◽  
Julia Rubin ◽  
Kaitlyn Mussio ◽  
Lee W. Riley
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Logistic Regression ◽  
Penalized Regression ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Drug Resistant ◽  
E Coli ◽  
College Community ◽  
Fecal Carriage

AbstractBackgroundBacterial antimicrobial resistance is a serious global public health threat. Intestinal commensal drug-resistant bacteria have been suggested as an important reservoir of antimicrobial resistant genes (ARGs), which may be acquired via food. We aimed to identify risk factors associated with fecal carriage of drug-resistant commensal Escherichia coli (E. coli) among healthy adults focused on their dietary habit.MethodsWe conducted a cross-sectional study targeting healthy adult volunteers in a college community. Fecal samples and questionnaires were obtained from 113 volunteers. We conducted backward elimination logistic regression and least absolute shrinkage and selection (LASSO) methods to identify risk factors.ResultsWe analyzed responses from 81 of 113 volunteers who completed the questionnaire. The logistic regression and LASSO methods identified red meat consumption to be associated with increased risk (OR = 6.13 [1.83-24.2] and 1.82, respectively) and fish consumption with reduced risk (OR = 0.27 [0.08-0.85] and 0.82) for the carriage of multidrug-resistant E. coli, adjusted for gender, employment status, frequently-used supermarket, and previous travel.ConclusionsDietary habits are associated with the risk of fecal carriage of multidrug-resistant E. coli. This study supports the growing evidence that food may be an important source of ARGs present in human commensal E. coli.

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.

scholarly journals 1420. A One Health Approach Examining the Potential Linkage between Agricultural Livestock and Human Antibiotic Resistance at the Watershed Level

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S716-S717
Author(s):  
Linsey M Donner ◽  
Xu Li ◽  
Daniel D Snow ◽  
Jodi L Sangster ◽  
Zachery R Staley ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
One Health ◽  
Bacterial Species ◽  
Antibiotic Resistance Gene ◽  
Agricultural Watershed ◽  
Resistant Bacteria ◽  
Organic Chemical ◽  
Drug Resistant ◽  
Antibiotic Resistant Bacteria ◽  
Antibiotic Resistant

Abstract Background Antibiotic resistance is a significant public health threat and widespread use of antibiotics in agriculture is increasing the concern about agricultural contributions to the dissemination of antibiotic resistant bacteria. Of concern is the level of exposure to antibiotics and antibiotic-resistant bacteria in the watershed. Consequently, adopting a One Health approach to measure antibiotic levels and identify antibiotic resistance gene (ARG) transfer at the human, animal and environmental interfaces is essential to better understand how antibiotic resistance is spread. Methods In this project, antibiotic levels were measured using passive organic chemical integrative samplers (POCIS) for 30-day periods from August – November 2018 from Elkhorn River and Shell Creek watersheds in Nebraska (Figure 1). In addition, whole genome sequences of bacterial isolates cultured from the watersheds were assessed to identify ARGs present on mobile genetic elements (MGE) that had &gt;95% similarity to mobile ARG present in isolates recorded in the NCBI GenBank database was identified using ResFinder. Figure 1. Sampling locations within the two watersheds. Results The study demonstrated significant antibiotic levels present throughout the watershed, with five of them associated with human usage (Table 1). In addition, seasonally based drug-resistant bacterial species was associated with specific antibiotic levels in the watershed (Figure 2). Mobile ARGs were detected in 87.5% of isolates collected from the Elkhorn River and 80.0% within Shell Creek (Figure 3). Table 1. Pharmaceutical levels in the watershed Figure 2. Antibiotic levels and drug-resistant bacteria in the watershed Figure 3. Antibiotic resistance observed from each isolate at every sampling date and site. A colored bar denotes that resistance to that antibiotic was observed. Conclusion These results present evidence of transfer of highly mobile ARGs between environment, clinical, and animal-associated bacteria and highlight the need for a One Health perspective in assessing the spread of antibiotic resistance. The presence of significant levels of antibiotics persisting in this agricultural watershed points out the need for ongoing monitoring of compliance with the Food and Drug Administration (FDA) recommendation of veterinarian oversight of the use of antibiotics in the use of veterinary feed directive applications. Disclosures All Authors: No reported disclosures

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