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11 pages, 236 KiB

Open AccessArticle

Antimicrobial Resistance in Fecal Escherichia coli from Humans and Pigs at Farms at Different Levels of Intensification

by Kamonwan Lunha, Thongpan Leangapichart, Jatesada Jiwakanon, Sunpetch Angkititrakul, Marianne Sunde, Josef D. Järhult, Gunilla Ström Hallenberg, Rachel A. Hickman, Thomas Van Boeckel and Ulf Magnusson

Antibiotics 2020, 9(10), 662; https://doi.org/10.3390/antibiotics9100662 - 30 Sep 2020

Cited by 18 | Viewed by 3711

Abstract

The overall aim of the current study was to test the hypotheses that (i) antibiotic resistance in bacteria were more frequent in clinically health pigs in intensified company owned, medium-scale farms (MSFs) (100–500 sows) than in pigs in family-owned, small-scale farms (SSFs) (1–50 [...] Read more.

The overall aim of the current study was to test the hypotheses that (i) antibiotic resistance in bacteria were more frequent in clinically health pigs in intensified company owned, medium-scale farms (MSFs) (100–500 sows) than in pigs in family-owned, small-scale farms (SSFs) (1–50 sows) and (ii) that farmers working at the MSFs were more prone to attain antibiotic resistant bacteria than farmers working at SSFs. The study was conducted in North-Eastern Thailand, comprising fecal Escherichia coli isolates from pigs, farmers working with the pigs (contact humans) and persons living in the same household as the farmer (non-contact humans) at 51 MSFs and 113 SSFs. Samples from all farms were also screened for methicillin-resistant staphylococcus aureus (MRSA), which was not detected in pig samples, but was found in one human sample. Susceptibility was tested by disc-diffusion for seven antibiotics commonly used in the study area. Resistance in pig isolates from MSFs were more frequent for chloramphenicol which (P < 0.001), trimethoprim/sulfamethoxazole (P < 0.001) and gentamicin (P < 0.05) compared with isolates from SSFs, whereas the opposite was true for tetracycline (P < 0.01). Resistance in the human isolates was lower than those in the isolates from pigs for tetracycline, trimethoprim/sulfamethoxazole and chloramphenicol (P < 0.001). The frequency of resistance in the contact human samples from SSFs and MSFs did not differ. There was no difference between isolates from contact and non-contact humans for any of the tested antibiotics. Multidrug resistance in isolates from pigs was 26%, significantly higher (P < 0.01) than the 13% from humans. The data indicate that (i) resistance to antibiotics, including those critical and highly important for human medicine, were more common in fecal E. coli from pigs at the MSFs than at the SSFs, whereas (ii) the resistance in fecal E. coli from pig farmers seemed not to be influenced by the level of intensification of the farm they were working at. Full article

(This article belongs to the Special Issue Antibiotics Use and Antimicrobial Stewardship in Remote Areas – an One Health Perspective)

12 pages, 544 KiB

Open AccessArticle

Longitudinal Point Prevalence Survey of Antimicrobial Consumption in Russian Hospitals: Results of the Global-PPS Project

by Svetlana Rachina, Yuliya Belkova, Roman Kozlov, Ann Versporten, Ines Pauwels, Herman Goossens, Elena Bochanova, Olga Domanskaya, Elena Elokhina, Ludmila Ezhova, Vladimir Mishchenko, Oksana Ni, Dmitry Popov, Ulyana Portnjagina, Evgeny Shchetinin, Vera Shegimova, Yulia Strezh, Vera Vityazeva, Nadezhda Zubareva and Russian Global-PPS Project Study Group

Antibiotics 2020, 9(8), 446; https://doi.org/10.3390/antibiotics9080446 - 25 Jul 2020

Cited by 12 | Viewed by 4026

Abstract

Antimicrobial resistance is one of the key issues limiting the successful treatment of infectious diseases and associated with adverse medical, social and economic consequences on a global scale. The present study aims to evaluate antimicrobials prescribing patterns and assess progress in quality indicators [...] Read more.

Antimicrobial resistance is one of the key issues limiting the successful treatment of infectious diseases and associated with adverse medical, social and economic consequences on a global scale. The present study aims to evaluate antimicrobials prescribing patterns and assess progress in quality indicators in Russian multidisciplinary hospitals using three repetitive point prevalence studies (PPSs) over 4 years (Global-PPS 2015, 2017 and 2018). Out of 13,595 patients from 21 hospitals surveyed over the three time points, 3542 (26.14%) received antimicrobials, predominantly third-generation cephalosporins (44.7% in 2015, 34.1% in 2017 and 41.8% in 2018). Compliance with the hospital antibiotic guidelines was 74.8%, 66.8% and 74.3%, respectively. Indication for treatment was recorded in 72.6%, 84.1% and 82.6%, while stop/review date was documented only in 40.5%, 46.5% and 61.1% of cases. Perioperative antibiotic prophylaxis exceeded 1 day in 92%, 84% and 81% of cases. Targeted therapy rate at all time points did not exceed 15.1%, treatment based on the biomarkers rate—19.9%. For the part of PPS-2017 and 2018 analyzed in dynamics, no prominent trends were noted. The results of the project provide the basis for the development of appropriate antimicrobial stewardship programs tailored according to local practices for each hospital in the project. Full article

(This article belongs to the Special Issue Antibiotics Use and Antimicrobial Stewardship in Remote Areas – an One Health Perspective)

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10 pages, 370 KiB

Open AccessArticle

Prescription of Levofloxacin and Moxifloxacin in Select Hospitals in Uganda: A Pilot Study to Assess Guideline Concordance

by Victoria Nambasa, Helen B. Ndagije, Allan Serwanga, Leonard Manirakiza, Joanitah Atuhaire, Diana Nakitto, Ronald Kiguba and Albert Figueras

Antibiotics 2020, 9(8), 439; https://doi.org/10.3390/antibiotics9080439 - 23 Jul 2020

Cited by 8 | Viewed by 4121

Abstract

Background: In Uganda, national tuberculosis (TB) treatment guidelines were revised to include the newer generation fluoroquinolones among the second-line treatment options for multidrug-resistant TB. This study was designed to analyze if the prescription of these quinolones is compliant with country recommendations. Methods [...] Read more.

Background: In Uganda, national tuberculosis (TB) treatment guidelines were revised to include the newer generation fluoroquinolones among the second-line treatment options for multidrug-resistant TB. This study was designed to analyze if the prescription of these quinolones is compliant with country recommendations. Methods: This was an observational retrospective study of consumption data for 2017 and 2018 across four selected regional referral hospitals. The sources of consumption data were hospital pharmacy stock cards and the dispensing register. The medical files of patients who had been prescribed fluoroquinolones were also assessed to study compliance with the Uganda Clinical Guidelines and the British National Formulary (BNF). Results: None of the 371 levofloxacin prescriptions analyzed complied with the Uganda Clinical Guidelines, although 250 (67.3%) were prescribed for indications included in the BNF. According to WHO prescription indicators, only 220 (59.3%) prescriptions were appropriate. Conclusion: The prescription of levofloxacin and moxifloxacin increased in the hospitals studied, but in a high proportion of cases, they were not compliant with country recommendations. The findings call for the strengthening of national antimicrobial stewardship programs. Full article

(This article belongs to the Special Issue Antibiotics Use and Antimicrobial Stewardship in Remote Areas – an One Health Perspective)

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12 pages, 590 KiB

Open AccessArticle

Day 10 Post-Prescription Audit Optimizes Antibiotic Therapy in Patients with Bloodstream Infections

by Rita Murri, Claudia Palazzolo, Francesca Giovannenze, Francesco Taccari, Marta Camici, Teresa Spanu, Brunella Posteraro, Maurizio Sanguinetti, Roberto Cauda and Massimo Fantoni

Antibiotics 2020, 9(8), 437; https://doi.org/10.3390/antibiotics9080437 - 23 Jul 2020

Cited by 1 | Viewed by 2209

Abstract

This study aimed to investigate the clinical and organizational impact of an active re-evaluation (on day 10) of patients on antibiotic treatment diagnosed with bloodstream infections (BSIs). A prospective, single center, pre-post quasi-experimental study was performed. Patients were enrolled at the time of [...] Read more.

This study aimed to investigate the clinical and organizational impact of an active re-evaluation (on day 10) of patients on antibiotic treatment diagnosed with bloodstream infections (BSIs). A prospective, single center, pre-post quasi-experimental study was performed. Patients were enrolled at the time of microbial BSI confirmation. In the pre-intervention phase (August 2014–August 2015), clinical status and antibiotic regimen were re-evaluated at day 3. In the intervention phase (January 2016–January 2017), clinical status and antibiotic regimen were re-evaluated at day 3 and day 10. Primary outcomes were rate of optimal therapy, duration of antibiotic therapy, length of hospitalization, and 30-day mortality. A total of 632 patients were enrolled (pre-intervention period, n = 303; intervention period, n = 329). Average duration of therapy reduced from 18.1 days (standard deviation (SD), 11.4) in the pre-intervention period to 16.8 days (SD, 12.7) in the intervention period (p < 0.001). Similarly, average length of hospitalization decreased from 24.1 days (SD, 20.8) to 20.6 days (SD, 17.7) (p = 0.001). No inter-group difference was found for the rate of 30-day mortality. In patients with BSI, re-evaluation of clinical status and antibiotic regimen at day 3 and 10 after microbiological diagnosis was correlated with a reduction in the duration of antibiotic therapy and hospital stay. The intervention is simple and has a low impact on overall costs. Full article

(This article belongs to the Special Issue Antibiotics Use and Antimicrobial Stewardship in Remote Areas – an One Health Perspective)

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8 pages, 240 KiB

Open AccessArticle

Substandard Quality of the Antimicrobials Sold in the Street Markets in Haiti

by Théodule Jean-Baptiste, John F. Carpenter, Kevin Dahl, Wellington Derameau, Rosemela Veillard, John Redford Jacquet, Pierre Ludens Osselyn and Albert Figueras

Antibiotics 2020, 9(7), 407; https://doi.org/10.3390/antibiotics9070407 - 14 Jul 2020

Cited by 7 | Viewed by 6517

Abstract

This pilot study was conducted to analyze the quality of the antimicrobials sold in the street markets in Port-au-Prince, Haiti. A total of 258 packs containing antimicrobials were bought in 28 street markets in Port-au-Prince (Haiti). Tablets and contents of capsules included in [...] Read more.

This pilot study was conducted to analyze the quality of the antimicrobials sold in the street markets in Port-au-Prince, Haiti. A total of 258 packs containing antimicrobials were bought in 28 street markets in Port-au-Prince (Haiti). Tablets and contents of capsules included in 196 packs were analyzed using a Raman handheld spectrometer (NanoRAM of BWTEK, Model: BWS456-785) during the first quarter of 2019. Three out of 11 antimicrobials (Amoxicillin, Metronidazole, and Cotrimoxazole) had a high spectral match with an HQI ≥ 90 to the respective authentic medicine for more than 95% of their tablets/capsules. For six antimicrobials (Tetracycline, Erythromycin, Cloxacillin, Azithromycin, Clarithromycin, and the combination Amoxicillin + Clavulanic Acid) none of their tablets/capsules showed a sufficient spectral match with the authentic medicine. This finding indicates that these products sold in the markets did not contain the labeled drug and/or contained a degraded drug. In addition to the fact that prescription antimicrobials can be purchased in street markets, the present field study found that for most of them (including “Watch” antimicrobials according to the AWaRe classification) were substandard, which contributes to the present antimicrobials resistance epidemic. Full article

(This article belongs to the Special Issue Antibiotics Use and Antimicrobial Stewardship in Remote Areas – an One Health Perspective)

14 pages, 263 KiB

Open AccessArticle

Patterns of Antibiotic Prescription in Colombia: Are There Differences between Capital Cities and Municipalities?

by Jorge Enrique Machado-Alba, Luis Fernando Valladales-Restrepo, Andrés Gaviria-Mendoza, Manuel Enrique Machado-Duque and Albert Figueras

Antibiotics 2020, 9(7), 389; https://doi.org/10.3390/antibiotics9070389 - 8 Jul 2020

Cited by 22 | Viewed by 4031

Abstract

The use of antibiotics is the most important modifiable risk factor for the development of microorganism resistance. A cross-sectional study of outpatients receiving antibiotic prescriptions registered in a population database in Colombia was conducted. The characteristics of the consumption in capital cities and [...] Read more.

The use of antibiotics is the most important modifiable risk factor for the development of microorganism resistance. A cross-sectional study of outpatients receiving antibiotic prescriptions registered in a population database in Colombia was conducted. The characteristics of the consumption in capital cities and small municipalities was studied and the AWaRe classification was used. AWaRe classifies antibiotics into three stewardship groups: Access, Watch and Reserve, to emphasize the importance of their optimal use and potential harms of antimicrobial resistance. A total of 182,397 patients were prescribed an antibiotic; the most common were penicillins (38.6%), cephalosporins (30.2%) and fluoroquinolones (10.9%). ‘Access’ antibiotics (86.4%) were the most frequently prescribed, followed by ‘Watch’ antibiotics (17.0%). Being 18 or older, being male, living in a municipality, having one or more comorbidities and urinary, respiratory or gastrointestinal disorders increased the probability of receiving ‘Watch’ or ‘Reserve’ antibiotics. Penicillin and urinary antiseptic prescriptions predominated in cities, while cephalosporin and fluoroquinolone prescriptions predominated in municipalities. This analysis showed that the goal set by the WHO Access of mainly using Access antibiotics is being met, although the high use of Watch antibiotics in municipalities should be carefully studied to determine if it is necessary to design specific campaigns to improve antibiotics use. Full article

(This article belongs to the Special Issue Antibiotics Use and Antimicrobial Stewardship in Remote Areas – an One Health Perspective)

9 pages, 250 KiB

Open AccessArticle

Prevalence of Multi-Resistant Microorganisms and Antibiotic Stewardship among Hospitalized Patients Living in Residential Care Homes in Spain: A Cross-Sectional Study

by Mario Rivera-Izquierdo, Alberto Benavente-Fernández, Jairo López-Gómez, Antonio Jesús Láinez-Ramos-Bossini, Marta Rodríguez-Camacho, María del Carmen Valero-Ubierna, Luis Miguel Martín-delosReyes, Eladio Jiménez-Mejías, Elena Moreno-Roldán, Pablo Lardelli-Claret and Virginia Martínez-Ruiz

Antibiotics 2020, 9(6), 324; https://doi.org/10.3390/antibiotics9060324 - 13 Jun 2020

Cited by 8 | Viewed by 3526

Abstract

Antimicrobial resistance is a growing global health problem. Patients living in care homes are a vulnerable high-risk population colonized by multidrug-resistant organisms (MDRO). We identified a case series of 116 residents of care homes from a cohort of 540 consecutive patients admitted to [...] Read more.

Antimicrobial resistance is a growing global health problem. Patients living in care homes are a vulnerable high-risk population colonized by multidrug-resistant organisms (MDRO). We identified a case series of 116 residents of care homes from a cohort of 540 consecutive patients admitted to the internal medicine service of our hospital. We performed early diagnostic tests of MDRO through anal exudates in our sample. The prevalence of MDRO colonization was 34.5% of residents and 70% of them had not been previously identified in the clinical records. Previous hospitalizations and in-hospital antibiotic administration were significantly associated with the presence of MDRO. Our results emphasize the need to consider care homes in the planning of regional and national infection control measures and for implementing surveillance systems that monitor the spread of antimicrobial resistance in Spain. Systematic early testing upon admission to hospital services with a high prevalence of patients with MDRO colonization (e.g., internal medicine) could contribute to the adoption of adequate prevention measures. Specific educational programs for care home staff should also be implemented to address this increasing problem. Full article

(This article belongs to the Special Issue Antibiotics Use and Antimicrobial Stewardship in Remote Areas – an One Health Perspective)

11 pages, 510 KiB

Open AccessArticle

Development of Antimicrobial Stewardship Programmes in Low and Middle-Income Countries: A Mixed-Methods Study in Nigerian Hospitals

by Eneyi E. Kpokiri, David G. Taylor and Felicity J. Smith

Antibiotics 2020, 9(4), 204; https://doi.org/10.3390/antibiotics9040204 - 23 Apr 2020

Cited by 27 | Viewed by 4923

Abstract

Antimicrobial resistance (AMR) is a major concern facing global health today, with the greatest impact in developing countries where the burden of infectious diseases is much higher. The inappropriate prescribing and use of antibiotics are contributory factors to increasing antibiotic resistance. Antimicrobial stewardship [...] Read more.

Antimicrobial resistance (AMR) is a major concern facing global health today, with the greatest impact in developing countries where the burden of infectious diseases is much higher. The inappropriate prescribing and use of antibiotics are contributory factors to increasing antibiotic resistance. Antimicrobial stewardship programmes (AMS) are implemented to optimise use and promote behavioural change in the use of antimicrobials. AMS programmes have been widely employed and proven to improve antibiotic use in many high-income settings. However, strategies to contain antimicrobial resistance have yet to be successfully implemented in low-resource settings. A recent toolkit for AMS in low- and middle-income countries by the World Health Organisation (WHO) recognizes the importance of local context in the development of AMS programmes. This study employed a bottom-up approach to identify important local determinants of antimicrobial prescribing practices in a low-middle income setting, to inform the development of a local AMS programme. Analysis of prescribing practices and interviews with prescribers highlighted priorities for AMS, which include increasing awareness of antibiotic resistance, development and maintenance of guidelines for antibiotic use, monitoring and surveillance of antibiotic use, ensuring the quality of low-cost generic medicines, and improved laboratory services. The application of an established theoretical model for behaviour change guided the development of specific proposals for AMS. Finally, in a consultation with stakeholders, the feasibility of the plan was explored along with strategies for its implementation. This project provides an example of the design, and proposal for implementation of an AMS plan to improve antibiotic use in hospitals in low-middle income settings. Full article

(This article belongs to the Special Issue Antibiotics Use and Antimicrobial Stewardship in Remote Areas – an One Health Perspective)

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16 pages, 932 KiB

Open AccessArticle

Dispensing Antibiotics without a Prescription for Acute Cough Associated with Common Cold at Community Pharmacies in Shenyang, Northeastern China: A Cross-Sectional Study

by Li Shi, Jie Chang, Xiaoxi Liu, Panpan Zhai, Shuchen Hu, Pengchao Li, Khezar Hayat, John Alimamy Kabba, Zhitong Feng, Caijun Yang, Minghuan Jiang, Mingyue Zhao, Hao Hu and Yu Fang

Antibiotics 2020, 9(4), 163; https://doi.org/10.3390/antibiotics9040163 - 6 Apr 2020

Cited by 21 | Viewed by 5259

Abstract

The inappropriate use of antibiotics is a major health issue in China. We aimed to assess nonprescription antibiotic dispensing and assess pharmacy service practice at community pharmacies in Shenyang, northeastern China, and to compare these practices between pediatric and adult cases. A cross-sectional [...] Read more.

The inappropriate use of antibiotics is a major health issue in China. We aimed to assess nonprescription antibiotic dispensing and assess pharmacy service practice at community pharmacies in Shenyang, northeastern China, and to compare these practices between pediatric and adult cases. A cross-sectional study was performed from March to May 2018 using the standardized client method. Two different simulated scenarios were presented at pharmacies, namely, pediatric and adult acute cough associated with a common cold. Of 150 pharmacy visits, 147 visits were completed (pediatric case: 73, adult case: 74). A total of 130 (88.4%) community pharmacies dispensed antibiotics without a prescription, with a significant difference between pediatric and adult cases (pediatric case, 79.5% versus adult case, 97.3%, p = 0.005). Symptoms were asked in most visits (pediatric case: 82.2%, adult case 82.4%). Patients’ previous treatment and history of allergies were both inquired more frequently in the pediatric cases than in the adult cases. Medication advice was provided more often in the adult cases than in pediatric cases. Antibiotics were easily obtained without a prescription in Shenyang, especially for adult patients. Adequate inquiries and counseling had not occurred in most pharmacies. Full article

(This article belongs to the Special Issue Antibiotics Use and Antimicrobial Stewardship in Remote Areas – an One Health Perspective)

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Review

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12 pages, 912 KiB

Open AccessReview

Antibiotic Use in Low and Middle-Income Countries and the Challenges of Antimicrobial Resistance in Surgery

by Massimo Sartelli, Timothy C. Hardcastle, Fausto Catena, Alain Chichom-Mefire, Federico Coccolini, Sameer Dhingra, Mainul Haque, Adrien Hodonou, Katia Iskandar, Francesco M. Labricciosa, Cristina Marmorale, Ibrahima Sall and Leonardo Pagani

Antibiotics 2020, 9(8), 497; https://doi.org/10.3390/antibiotics9080497 - 9 Aug 2020

Cited by 77 | Viewed by 8834

Abstract

Antimicrobial resistance (AMR) is a phenomenon resulting from the natural evolution of microbes. Nonetheless, human activities accelerate the pace at which microorganisms develop and spread resistance. AMR is a complex and multidimensional problem, threatening not only human and animal health, but also regional, [...] Read more.

Antimicrobial resistance (AMR) is a phenomenon resulting from the natural evolution of microbes. Nonetheless, human activities accelerate the pace at which microorganisms develop and spread resistance. AMR is a complex and multidimensional problem, threatening not only human and animal health, but also regional, national, and global security, and the economy. Inappropriate use of antibiotics, and poor infection prevention and control strategies are contributing to the emergence and dissemination of AMR. All healthcare providers play an important role in preventing the occurrence and spread of AMR. The organization of healthcare systems, availability of diagnostic testing and appropriate antibiotics, infection prevention and control practices, along with prescribing practices (such as over-the-counter availability of antibiotics) differs markedly between high-income countries and low and middle-income countries (LMICs). These differences may affect the implementation of antibiotic prescribing practices in these settings. The strategy to reduce the global burden of AMR includes, among other aspects, an in-depth modification of the use of existing and future antibiotics in all aspects of medical practice. The Global Alliance for Infections in Surgery has instituted an interdisciplinary working group including healthcare professionals from different countries with different backgrounds to assess the need for implementing education and increasing awareness about correct antibiotic prescribing practices across the surgical pathways. This article discusses aspects specific to LMICs, where pre-existing factors make surgeons’ compliance with best practices even more important. Full article

(This article belongs to the Special Issue Antibiotics Use and Antimicrobial Stewardship in Remote Areas – an One Health Perspective)

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13 pages, 293 KiB

Open AccessReview

Country Income Is Only One of the Tiles: The Global Journey of Antimicrobial Resistance among Humans, Animals, and Environment

by Angela Pieri, Richard Aschbacher, Giada Fasani, Jole Mariella, Lorenzo Brusetti, Elisabetta Pagani, Massimo Sartelli and Leonardo Pagani

Antibiotics 2020, 9(8), 473; https://doi.org/10.3390/antibiotics9080473 - 1 Aug 2020

Cited by 22 | Viewed by 4881

Abstract

Antimicrobial resistance (AMR) is one of the most complex global health challenges today: decades of overuse and misuse in human medicine, animal health, agriculture, and dispersion into the environment have produced the dire consequence of infections to become progressively untreatable. Infection control and [...] Read more.

Antimicrobial resistance (AMR) is one of the most complex global health challenges today: decades of overuse and misuse in human medicine, animal health, agriculture, and dispersion into the environment have produced the dire consequence of infections to become progressively untreatable. Infection control and prevention (IPC) procedures, the reduction of overuse, and the misuse of antimicrobials in human and veterinary medicine are the cornerstones required to prevent the spreading of resistant bacteria. Purified drinking water and strongly improved sanitation even in remote areas would prevent the pollution from inadequate treatment of industrial, residential, and farm waste, as all these situations are expanding the resistome in the environment. The One Health concept addresses the interconnected relationships between human, animal, and environmental health as a whole: several countries and international agencies have now included a One Health Approach within their action plans to address AMR. Improved antimicrobial usage, coupled with regulation and policy, as well as integrated surveillance, infection control and prevention, along with antimicrobial stewardship, sanitation, and animal husbandry should all be integrated parts of any new action plan targeted to tackle AMR on the Earth. Since AMR is found in bacteria from humans, animals, and in the environment, we briefly summarize herein the current concepts of One Health as a global challenge to enable the continued use of antibiotics. Full article

(This article belongs to the Special Issue Antibiotics Use and Antimicrobial Stewardship in Remote Areas – an One Health Perspective)

15 pages, 1372 KiB

Open AccessReview

Antimicrobial Stewardship: From Bedside to Theory. Thirteen Examples of Old and More Recent Strategies from Everyday Clinical Practice

by Stefano Di Bella, Bojana Beović, Massimiliano Fabbiani, Michael Valentini and Roberto Luzzati

Antibiotics 2020, 9(7), 398; https://doi.org/10.3390/antibiotics9070398 - 10 Jul 2020

Cited by 7 | Viewed by 5620

Abstract

“Antimicrobial stewardship” is a strategy that promotes the responsible use of antimicrobials. The objective of this paper is to focus on consolidated and more recent improvements in clinical strategies that should be adopted in hospitalized patients to ameliorate their infectious diseases’ outcome and [...] Read more.

“Antimicrobial stewardship” is a strategy that promotes the responsible use of antimicrobials. The objective of this paper is to focus on consolidated and more recent improvements in clinical strategies that should be adopted in hospitalized patients to ameliorate their infectious diseases’ outcome and to reduce the antibiotic resistance risk through judicious use of antibiotics. We present 13 common clinical scenarios, the respective suggested interventions and the explanations of the supporting evidence, in order to help clinicians in their decision-making process. Strategies including the choice of antibiotic and dose optimization, antibiotic spectrum narrowing (de-escalation), shortening of duration, shift to oral route or outpatient parenteral antibiotic (including elastomeric pumps), and biomarkers are described and discussed. Full article

(This article belongs to the Special Issue Antibiotics Use and Antimicrobial Stewardship in Remote Areas – an One Health Perspective)

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23 pages, 929 KiB

Open AccessReview

Drivers of Antibiotic Resistance Transmission in Low- and Middle-Income Countries from a “One Health” Perspective—A Review

by Katia Iskandar, Laurent Molinier, Souheil Hallit, Massimo Sartelli, Fausto Catena, Federico Coccolini, Timothy Craig Hardcastle, Christine Roques and Pascale Salameh

Antibiotics 2020, 9(7), 372; https://doi.org/10.3390/antibiotics9070372 - 1 Jul 2020

Cited by 74 | Viewed by 9502

Abstract

Antibiotic resistance is an ecosystem problem threatening the interrelated human-animal-environment health under the “One Health” framework. Resistant bacteria arising in one geographical area can spread via cross-reservoir transmission to other areas worldwide either by direct exposure or through the food chain and the [...] Read more.

Antibiotic resistance is an ecosystem problem threatening the interrelated human-animal-environment health under the “One Health” framework. Resistant bacteria arising in one geographical area can spread via cross-reservoir transmission to other areas worldwide either by direct exposure or through the food chain and the environment. Drivers of antibiotic resistance are complex and multi-sectoral particularly in Lower- and Middle-income countries. These include inappropriate socio-ecological behaviors; poverty; overcrowding; lack of surveillance systems; food supply chain safety issues; highly contaminated waste effluents; and loose rules and regulations. In order to examine the drivers of antibiotic resistance from a “one health” perspective, a literature review was conducted on three databases including PubMed, Medline and Google Scholar. A total of 485 studies of potential relevance were selected, out of which 182 were included in this review. Results have shown that the aforementioned market failures are the leading cause for the negative externality of antibiotic resistance that extends in scope from the individual to the global ecosystem. Incremental and sustainable global actions can make the change, however, the problem will continue to prevail if governments do not prioritize the “One health” approach and if individual’s accountability is still denied in a world struggling with profound socio-economic problems. Full article

(This article belongs to the Special Issue Antibiotics Use and Antimicrobial Stewardship in Remote Areas – an One Health Perspective)

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