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One Health: Opportunities and Challenges of Antibiotic Resistance and Stewardship

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A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Mechanism and Evolution of Antibiotic Resistance".

Deadline for manuscript submissions: closed (30 September 2022) | Viewed by 35502

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Special Issue Editors

Dr. Nichola R. Naylor

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Guest Editor

London School of Hygiene and Tropical Medicine, London, UK United Kingdom Health Security Agency, London, UK
Interests: antibiotic resistance; One Health; public health; infectious diseases; economics

Dr. Chris Pinto J.

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Guest Editor

London School of Hygiene and Tropical Medicine, London, UK
Interests: antibiotic resistance; One Health; veterinary sciences; microbiology; infectious diseases; zoonoses

Special Issue Information

Dear Colleagues,

Antibiotic resistance (ABR) is a worldwide problem with a significant impact on human health, animal health, and the environment. It is currently affecting our ability to treat infections, putting at risk public health, especially the health of those living in perilous conditions. Moreover, the impact of ABR goes beyond public health, as a greater burden of infections negatively affects global and local economies.

The application of a One Health approach to research and policy on antibiotic resistance has become an imperative. Currently, the tripartite WHO–FAO–OIE is actively advocating for the integration of human, animal and environmental health when searching for solutions to the ABR problem that could be applicable to various settings. ABR researchers, policymakers and stakeholders face various challenges when applying One Health to their ABR research, as innovative methods are required in order to account for interactions within and across humans, animals and the environment. Exploring past, present, and future challenges in tackling antibiotic resistance across One Health from different perspectives is key in building successful policies to tackle this global issue.

In this Special Issue, we would like to collate evidence from interdisciplinary ABR research performed across the human–animal–environment interface. We welcome research that describes the current challenges of antibiotic resistance and antibiotic stewardship (theoretical, empirical, qualitative and/or quantitative) and discusses how they can be overcome. We particularly welcome research that covers the following, preferably examining more than one sector of the One Health triad:

Uses of antibiotics, including on animals and in agriculture;
Antibiotic resistance surveillance;
Epidemiology of antibiotic use and ABR;
Antibiotic stewardship;
ABR-sensitive and ABR-specific interventions tackling antibiotic resistance in the human–animal–environment interface;
Observational studies and trials evaluating interventions related to antibiotic use and/or antibiotic resistance;
Policy and economic evaluations ABR-associated interventions;
Qualitative and quantitative research exploring the determinants of antibiotic use and/or antibiotic resistance;
Gaps and current challenges of ABR research.

Dr. Nichola R. Naylor
Dr. Chris Pinto J.
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

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Keywords

antibiotic resistance
One Health
antibiotic usage
stewardship
drug-resistant infections
interventions
human–animal–environmental health
surveillance
burden
policy

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Published Papers (11 papers)

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22 pages, 614 KiB

Open AccessArticle

“If You Do Not Take the Medicine and Complete the Dose…It Could Cause You More Trouble”: Bringing Awareness, Local Knowledge and Experience into Antimicrobial Stewardship in Tanzania

by Jennika Virhia, Molly Gilmour, Cairistiona Russell, Edna Mutua, Fortunata Nasuwa, Blandina T. Mmbaga, Stephen E. Mshana, Torre Dunlea, Gabriel Shirima, Jeremiah Seni, Tiziana Lembo and Alicia Davis

Antibiotics 2023, 12(2), 243; https://doi.org/10.3390/antibiotics12020243 - 25 Jan 2023

Cited by 7 | Viewed by 3062

Abstract

Antimicrobial resistance (AMR) is a global health issue disproportionately affecting low- and middle-income countries. In Tanzania, multi-drug-resistant bacteria (MDR) are highly prevalent in clinical and community settings, inhibiting effective treatment and recovery from infection. The burden of AMR can be alleviated if antimicrobial stewardship (AMS) programs are coordinated and incorporate local knowledge and systemic factors. AMS includes the education of health providers to optimise antimicrobial use to improve patient outcomes while minimising AMR risks. For programmes to succeed, it is essential to understand not just the awareness of and receptiveness to AMR education, but also the opportunities and challenges facing health professionals. We conducted in-depth interviews (n = 44) with animal and human health providers in rural northern Tanzania in order to understand their experiences around AMR. In doing so, we aimed to assess the contextual factors surrounding their practices that might enable or impede the translation of knowledge into action. Specifically, we explored their motivations, training, understanding of infections and AMR, and constraints in daily practice. While providers were motivated in supporting their communities, clear issues emerged regarding training and understanding of AMR. Community health workers and retail drug dispensers exhibited the most variation in training. Inconsistencies in understandings of AMR and its drivers were apparent. Providers cited the actions of patients and other providers as contributing to AMR, perpetuating narratives of blame. Challenges related to AMR included infrastructural constraints, such as a lack of diagnostic testing. While health and AMR-specific training would be beneficial to address awareness, equally important, if not more critical, is tackling the challenges providers face in turning knowledge into action. Full article

(This article belongs to the Special Issue One Health: Opportunities and Challenges of Antibiotic Resistance and Stewardship)

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13 pages, 436 KiB

Open AccessArticle

Antimicrobial Resistance Policy Protagonists and Processes—A Qualitative Study of Policy Advocacy and Implementation

by Olivia S. K. Chan, Wendy W. T. Lam, Keiji Fukuda, Hein Min Tun, Norio Ohmagari, Jasper Littmann, Xu Dong Zhou, Yonghong Xiao, Ping Liu and Didier Wernli

Antibiotics 2022, 11(10), 1434; https://doi.org/10.3390/antibiotics11101434 - 18 Oct 2022

Cited by 4 | Viewed by 2123

Abstract

Antimicrobial resistance (AMR) fundamentally weakens societal foundations economically and in health care. The development of well-considered policies against AMR is important. However, in many places, AMR policy implementation remains elusive. This study aims to identify enablers and deterrents as well as processes and conditions in AMR policy advocacy. It also aims to identify AMR implementation conditions where AMR national policies are adopted and, to a certain extent, formulated and implemented. This study adopts qualitative research methodology and applies the Grounded Theory Framework to identify thematic findings from interviews conducted in China, Japan, Norway, the United Kingdom (UK), and the United States of America (US). It was identified that AMR policy protagonists are critical to filtering AMR issues and identifying policies “fit to prioritize” and “fit to implement”. They have helped move policy prioritization needles in the UK and the US and engaged in diplomatic efforts in the UK. In these cases, no clientelism was considered. In the US, protagonists who talked to the right decision-makers in the right office at the right time both moved AMR issues from individuals to institutional agenda and from social norms to policy agenda. To conclude, there are three thematic policy conditions that are significant to AMR policy advocacy and implementation: committed personal championship, institutionalization of policies, and social norms facilitate AMR policy advocacy and implementation. Full article

(This article belongs to the Special Issue One Health: Opportunities and Challenges of Antibiotic Resistance and Stewardship)

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15 pages, 1332 KiB

Open AccessArticle

A Meta-Analysis to Estimate Prevalence of Resistance to Tetracyclines and Third Generation Cephalosporins in Enterobacteriaceae Isolated from Food Crops

by Ariel A. Brunn, Manon Roustit, Zaharat Kadri-Alabi, Luca Guardabassi and Jeff Waage

Antibiotics 2022, 11(10), 1424; https://doi.org/10.3390/antibiotics11101424 - 17 Oct 2022

Cited by 1 | Viewed by 2360

Abstract

Application of human and animal waste to fields and water sources and on-farm antimicrobial usage are documented contributors to the occurrence of antimicrobial resistance (AMR) in agricultural domains. This meta-analysis aimed to determine the prevalence of resistance to tetracycline (TET) and third generation cephalosporins (3GC) in Enterobacteriaceae isolated from food crops. TET was selected in view of its wide use in agriculture, whereas 3GC were selected because of the public health concerns of reported resistance to these critically important antibiotics in the environment. Forty-two studies from all six world regions published between 2010 and 2022 met the eligibility criteria. A random effects model estimated that 4.63% (95% CI: 2.57%, 7.18%; p-value: <0.0001) and 3.75% (95%CI: 2.13%, 5.74%; p-value: <0.0001) of surveyed food crops harboured Enterobacteriaceae resistant to TET and 3GC, respectively. No significant differences were observed between pre- and post-harvest stages of the value chain. 3GC resistance prevalence estimates in food crops were highest for the African region (6.59%; 95% CI: 2.41%, 12.40%; p-value: <0.0001) and lowest for Europe (1.84%; 95% CI: 0.00%, 6.02%; p-value: <0.0001). Considering the rare use of 3GC in agriculture, these results support its inclusion for AMR surveillance in food crops. Integrating food crops into One Health AMR surveillance using harmonized sampling methods could confirm trends highlighted here. Full article

(This article belongs to the Special Issue One Health: Opportunities and Challenges of Antibiotic Resistance and Stewardship)

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14 pages, 1918 KiB

Open AccessArticle

The Role of the Environment in Dynamics of Antibiotic Resistance in Humans and Animals: A Modelling Study

by Hannah C. Lepper, Mark E. J. Woolhouse and Bram A. D. van Bunnik

Antibiotics 2022, 11(10), 1361; https://doi.org/10.3390/antibiotics11101361 - 5 Oct 2022

Cited by 9 | Viewed by 2057

Abstract

Antibiotic resistance is transmitted between animals and humans either directly or indirectly, through transmission via the environment. However, little is known about the contribution of the environment to resistance epidemiology. Here, we use a mathematical model to study the effect of the environment on human resistance levels and the impact of interventions to reduce antibiotic consumption in animals. We developed a model of resistance transmission with human, animal, and environmental compartments. We compared the model outcomes under different transmission scenarios, conducted a sensitivity analysis, and investigated the impacts of curtailing antibiotic usage in animals. Human resistance levels were most sensitive to parameters associated with the human compartment (rate of loss of resistance from humans) and with the environmental compartment (rate of loss of environmental resistance and rate of environment-to-human transmission). Increasing environmental transmission could lead to increased or reduced impact of curtailing antibiotic consumption in animals on resistance in humans. We highlight that environment–human sharing of resistance can influence the epidemiology of resistant bacterial infections in humans and reduce the impact of interventions that curtail antibiotic consumption in animals. More data on resistance in the environment and frequency of human–environment transmission is crucial to understanding antibiotic resistance dynamics. Full article

(This article belongs to the Special Issue One Health: Opportunities and Challenges of Antibiotic Resistance and Stewardship)

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21 pages, 925 KiB

Open AccessArticle

Towards a One Health Food Safety Strategy for Palestine: A Mixed-Method Study

by Said Abukhattab, Miriam Kull, Niveen M. E. Abu-Rmeileh, Guéladio Cissé, Lisa Crump, Jan Hattendorf and Jakob Zinsstag

Antibiotics 2022, 11(10), 1359; https://doi.org/10.3390/antibiotics11101359 - 5 Oct 2022

Cited by 3 | Viewed by 3008

Abstract

Introduction: Foodborne diseases, together with increasing antimicrobial resistance (AMR), pose a threat to public health in an era of huge challenges with climate change and the risks of zoonotic epidemics. A One Health approach to foster food safety is a key for improvement, particularly in complex socio-ecological systems such as in Palestine, to examine human–animal-environment interfaces and promote intersectoral action. Objectives: This study aimed to assess food safety from farm to public health toward an operational One Health strategy for Palestine. This study evaluates the food production (broiler production) and monitoring system to better understanding the zoonotic foodborne illnesses transmission and their resistance to antimicrobials. Methods: The transdisciplinary approach included multi-stakeholder discussion groups and field visits to broiler farms, slaughterhouses, and meat stores in the Ramallah and Al-Bireh and Jerusalem districts using a semi-structured observational tool. A survey with 337 poultry producers and workers in slaughterhouses and meat stores was conducted to assess hygiene knowledge, attitudes, and practices during broiler meat production. Results: The stakeholders point out various challenges along the food production chain in Palestine, such as a striking scarcity of public slaughterhouses, insufficient coordination between authorities, a gap between public and private sectors, and inconsistent application of the law. From observations, it appears that, unlike traditional broiler production, the public slaughterhouses and meat markets have effective hygiene, while large-scale farms implement biosecurity measures. Overall, surveyed participants reported that they are aware of zoonotic disease transmission routes and value hygiene standards. Semi-structured observations and survey results are contradictory. Observations indicate poor hygiene practices; however, the vast majority of broiler meat production chain workers claim that hygiene standards are met. Discussion and Conclusions: Our study found that the overuse of antimicrobials, system fragmentation, insufficient infrastructure, a lack of regulations and controls, and poor hygiene practices are among the main obstacles to improving food safety in Palestine. Considering the risk of an important human health burden of food-related illnesses, enhancing food safety in Palestine is required using an integrated One Health approach. It is crucial to develop an integrated quality control system for food production along with promoting on-farm biosecurity and antimicrobial stewardship. Infrastructure, especially slaughterhouses and laboratories, must be built, training and education provided, and consumer awareness raised. As an important added value within a One Health strategy for better food safety in Palestine, research should be reinforced and accompany any future development of the food production monitoring system. Full article

(This article belongs to the Special Issue One Health: Opportunities and Challenges of Antibiotic Resistance and Stewardship)

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24 pages, 781 KiB

Open AccessArticle

Crossover-Use of Human Antibiotics in Livestock in Agricultural Communities: A Qualitative Cross-Country Comparison between Uganda, Tanzania and India

by Jessica Myers, Mathew Hennessey, Jean-Christophe Arnold, Kayley D. McCubbin, Tiziana Lembo, Ana Mateus, Freddy Eric Kitutu, Indranil Samanta, Eleanor Hutchinson, Alicia Davis, Blandina T. Mmbaga, Fortunata Nasuwa, Meenakshi Gautham and Siân E. Clarke

Antibiotics 2022, 11(10), 1342; https://doi.org/10.3390/antibiotics11101342 - 30 Sep 2022

Cited by 16 | Viewed by 4692

Abstract

Antibiotic use in animal agriculture contributes significantly to antibiotic use globally and is a key driver of the rising threat of antibiotic resistance. It is becoming increasingly important to better understand antibiotic use in livestock in low-and-middle income countries where antibiotic use is predicted to increase considerably as a consequence of the growing demand for animal-derived products. Antibiotic crossover-use refers to the practice of using antibiotic formulations licensed for humans in animals and vice versa. This practice has the potential to cause adverse drug reactions and contribute to the development and spread of antibiotic resistance between humans and animals. We performed secondary data analysis of in-depth interview and focus-group discussion transcripts from independent studies investigating antibiotic use in agricultural communities in Uganda, Tanzania and India to understand the practice of antibiotic crossover-use by medicine-providers and livestock-keepers in these settings. Thematic analysis was conducted to explore driving factors of reported antibiotic crossover-use in the three countries. Similarities were found between countries regarding both the accounts of antibiotic crossover-use and its drivers. In all three countries, chickens and goats were treated with human antibiotics, and among the total range of human antibiotics reported, amoxicillin, tetracycline and penicillin were stated as used in animals in all three countries. The key themes identified to be driving crossover-use were: (1) medicine-providers’ and livestock-keepers’ perceptions of the effectiveness and safety of antibiotics, (2) livestock-keepers’ sources of information, (3) differences in availability of human and veterinary services and antibiotics, (4) economic incentives and pressures. Antibiotic crossover-use occurs in low-intensity production agricultural settings in geographically distinct low-and-middle income countries, influenced by a similar set of interconnected contextual drivers. Improving accessibility and affordability of veterinary medicines to both livestock-keepers and medicine-providers is required alongside interventions to address understanding of the differences between human and animal antibiotics, and potential dangers of antibiotic crossover-use in order to reduce the practice. A One Health approach to studying antibiotic use is necessary to understand the implications of antibiotic accessibility and use in one sector upon antibiotic use in other sectors. Full article

(This article belongs to the Special Issue One Health: Opportunities and Challenges of Antibiotic Resistance and Stewardship)

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9 pages, 790 KiB

Open AccessArticle

Advances in Integrated Antimicrobial Resistance Surveillance and Control Strategies in Asia-Pacific Economic Cooperation Economies: Assessment of a Multiyear Building Capacity Project

by Javiera Cornejo, Gabriela Asenjo, Sebastian Zavala, Lucas Venegas, Nicolás Galarce, Juan Carlos Hormazábal, Constanza Vergara-E and Lisette Lapierre

Antibiotics 2022, 11(8), 1022; https://doi.org/10.3390/antibiotics11081022 - 29 Jul 2022

Cited by 2 | Viewed by 1823

Abstract

Antimicrobial resistance (AMR) is a growing global health concern for both animal and public health, and collaborative strategies are needed to combat the threat. The level of awareness and funding for policies focused on reducing AMR varies between countries. The aim of this study was to compare the integrated surveillance systems for AMR in high and low–middle economies of the Asia-Pacific Economic Cooperation and determine whether there was any improvement from 2015 to 2018. We conducted a survey with a group of 21 countries at different development levels. Associations between the economic development level and the questions of AMR awareness and funding were established using Fisher’s exact test. Improvements were identified where countries established public policies for integrated surveillance of AMR. High economies showed greater advancement in several topics related to AMR than low–middle economies. The survey revealed that there is a better understanding surrounding the implications of the emergence of AMR in human medicine than in veterinary medicine, agriculture, and food production. Our results show that countries enhanced overall AMR surveillance over the 4-year-period; however, more research is needed concerning these advances, especially in low–middle economies and the food production sector. Full article

(This article belongs to the Special Issue One Health: Opportunities and Challenges of Antibiotic Resistance and Stewardship)

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14 pages, 1236 KiB

Open AccessArticle

Mec-Positive Staphylococcus Healthcare-Associated Infections Presenting High Transmission Risks for Antimicrobial-Resistant Strains in an Equine Hospital

by Paula Soza-Ossandón, Dácil Rivera, Kasim Allel, Gerardo González-Rocha, Mario Quezada-Aguiluz, Ivan San Martin, Patricia García and Andrea I. Moreno-Switt

Antibiotics 2022, 11(5), 621; https://doi.org/10.3390/antibiotics11050621 - 4 May 2022

Cited by 1 | Viewed by 2762

Abstract

Healthcare-associated infections caused by Staphylococcus, particularly Staphylococcus aureus, represent a high risk for human and animal health. Staphylococcus can be easily transmitted through direct contact with individual carriers or fomites, such as medical and non-medical equipment. The risk increases if S. aureus strains carry antibiotic resistance genes and show a phenotypic multidrug resistance behavior. The aim of the study was to identify and characterize methicillin resistant coagulase-positive staphylococci (MRSA) and coagulase-negative staphylococci (MRCoNS) in equine patients and environmental sources in an equine hospital to evaluate the genetic presence of multidrug resistance and to understand the dissemination risks within the hospital setting. We explored 978 samples for MRSA and MRCoNS using Oxacillin Screen Agar in an equine hospital for racehorses in Chile, which included monthly samples (n = 61–70) from equine patients (246) and hospital environments (732) in a one-year period. All isolates were PCR-assessed for the presence of methicillin resistance gene mecA and/or mecC. Additionally, we explored the epidemiological relatedness by Pulsed Field Gel Electrophoresis (PFGE) in MRSA isolates. Phenotypic antibiotic resistance was evaluated using the Kirby-Bauer disk diffusion method. We estimated the unadjusted and adjusted risk of acquiring drug-resistant Staphylococcus strains by employing logistic regression analyses. We identified 16 MRSA isolates and 36 MRCoNS isolates. For MRSA, we detected mecA and mecC in 100% and 87.5 % of the isolates, respectively. For MRCoNS, mecA was detected among 94% of the isolates and mecC among 86%. MRSA and MRCoNS were isolated from eight and 13 equine patients, respectively, either from colonized areas or compromised wounds. MRSA strains showed six different pulse types (i.e., A1–A3, B1–B2, C) isolated from different highly transited areas of the hospital, suggesting potential transmission risks for other patients and hospital staff. The risk of acquiring drug-resistant Staphylococcus species is considerably greater for patients from the surgery, equipment, and exterior areas posing higher transmission risks. Tackling antimicrobial resistance (AMR) using a One Health perspective should be advocated, including a wider control over antimicrobial consumption and reducing the exposure to AMR reservoirs in animals, to avoid cross-transmission of AMR Staphylococcus within equine hospitals. Full article

(This article belongs to the Special Issue One Health: Opportunities and Challenges of Antibiotic Resistance and Stewardship)

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25 pages, 1515 KiB

Open AccessArticle

Assessing Knowledge, Beliefs, and Behaviors around Antibiotic Usage and Antibiotic Resistance among UK Veterinary Students: A Multi-Site, Cross-Sectional Survey

by Sarah E. Golding, Helen M. Higgins and Jane Ogden

Antibiotics 2022, 11(2), 256; https://doi.org/10.3390/antibiotics11020256 - 16 Feb 2022

Cited by 5 | Viewed by 3057

Abstract

Antimicrobial resistance (AMR) is a profound threat to human and animal health. Antimicrobial prescribing behaviours are influenced by psychological factors such as knowledge, beliefs, and emotions. As future antimicrobial prescribers, it is important to understand beliefs about AMR and stewardship among veterinary (vet) students. This cross-sectional online survey assessed vet students’ self-reported behavior, knowledge, and beliefs in specific relation to antibiotic resistance (ABR) and antibiotic usage. Participants were early years (first- and second-year; n = 460) and later-years (third- and fourth-year; n = 113) undergraduate vet students from three UK universities. Self-reported antibiotic-related behaviors were responsible among most students. Knowledge about ABR and stewardship was moderate among early years students and good among later years students. Vet students typically believed that vets had less responsibility for both causing and preventing ABR than other groups (animal owners, human medics, and the public). This study offers evidence that vet students (along with other groups) tend to lay greater responsibility for ABR/AMR outside of their own profession, which may impact their future prescribing behaviors. It is vital that AMR and antimicrobial stewardship are embedded across veterinary curricula, and that the One Health nature of the challenge posed by AMR is emphasized to encourage shared responsibility across all stakeholder groups, thereby helping to reduce ‘other-blaming’ for AMR. Full article

(This article belongs to the Special Issue One Health: Opportunities and Challenges of Antibiotic Resistance and Stewardship)

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14 pages, 1198 KiB

Open AccessArticle

Quantifying the Relationship between Antibiotic Use in Food-Producing Animals and Antibiotic Resistance in Humans

by David Emes, Nichola Naylor, Jeff Waage and Gwenan Knight

Antibiotics 2022, 11(1), 66; https://doi.org/10.3390/antibiotics11010066 - 6 Jan 2022

Cited by 15 | Viewed by 4974

Abstract

It is commonly asserted that agricultural production systems must use fewer antibiotics in food-producing animals in order to mitigate the global spread of antimicrobial resistance (AMR). In order to assess the cost-effectiveness of such interventions, especially given the potential trade-off with rural livelihoods, we must quantify more precisely the relationship between food-producing animal antimicrobial use and AMR in humans. Here, we outline and compare methods that can be used to estimate this relationship, calling on key literature in this area. Mechanistic mathematical models have the advantage of being rooted in epidemiological theory, but may struggle to capture relevant non-epidemiological covariates which have an uncertain relationship with human AMR. We advocate greater use of panel regression models which can incorporate these factors in a flexible way, capturing both shape and scale variation. We provide recommendations for future panel regression studies to follow in order to inform cost-effectiveness analyses of AMR containment interventions across the One Health spectrum, which will be key in the age of increasing AMR. Full article

(This article belongs to the Special Issue One Health: Opportunities and Challenges of Antibiotic Resistance and Stewardship)

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19 pages, 3591 KiB

Open AccessSystematic Review

State of Knowledge on the Acquisition, Diversity, Interspecies Attribution and Spread of Antimicrobial Resistance between Humans, Animals and the Environment: A Systematic Review

by Hélène Meier, Keira Spinner, Lisa Crump, Esther Kuenzli, Gertraud Schuepbach and Jakob Zinsstag

Antibiotics 2023, 12(1), 73; https://doi.org/10.3390/antibiotics12010073 - 31 Dec 2022

Cited by 12 | Viewed by 3201

Abstract

Resistance to antibiotics is considered one of the most urgent global public health concerns. It has considerable impacts on health and the economy, being responsible for the failure to treat infectious diseases, higher morbidity and mortality rates, and rising health costs. In spite of the joint research efforts between different humans, animals and the environment, the key directions and dynamics of the spread of antimicrobial resistance (AMR) still remain unclear. The aim of this systematic review is to examine the current knowledge of AMR acquisition, diversity and the interspecies spread of disease between humans, animals and the environment. Using a systematic literature review, based on a One Health approach, we examined articles investigating AMR bacteria acquisition, diversity, and the interspecies spread between humans, animals and the environment. Water was the environmental sector most often represented. Samples were derived from 51 defined animal species and/or their products A large majority of studies investigated clinical samples of the human population. A large variety of 15 different bacteria genera in three phyla (Proteobacteria, Firmicutes and Actinobacteria) were investigated. The majority of the publications compared the prevalence of pheno- and/or genotypic antibiotic resistance within the different compartments. There is evidence for a certain host or compartment specificity, regarding the occurrence of ARGs/AMR bacteria. This could indicate the rather limited AMR spread between different compartments. Altogether, there remains a very fragmented and incomplete understanding of AMR acquisition, diversity, and the interspecies spread between humans, animals and the environment. Stringent One Health epidemiological study designs are necessary for elucidating the principal routes and dynamics of the spread of AMR bacteria between humans, animals and the environment. This knowledge is an important prerequisite to develop effective public health measures to tackle the alarming AMR situation. Full article

(This article belongs to the Special Issue One Health: Opportunities and Challenges of Antibiotic Resistance and Stewardship)

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