Introduction: The inappropriate antimicrobial usage (AMU) in chicken production has led to an increase in the prevalence of antimicrobial resistance (AMR). In Zambia, there is little information documented regarding t...Introduction: The inappropriate antimicrobial usage (AMU) in chicken production has led to an increase in the prevalence of antimicrobial resistance (AMR). In Zambia, there is little information documented regarding the knowledge, attitude, and practices of poultry farmers on AMU and AMR. Therefore, this study assessed the knowledge, attitude and practices regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Methods: This was a cross-sectional study conducted among 106 poultry farmers from November to December 2021 using a structured questionnaire. Data analysis was done using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: Overall, of the 106 participants, 90.6% knew what antimicrobials were, but only 29.2% were aware of AMR. The study showed that 46.2% of the participants had low knowledge, 71.7% had negative attitudes, and 61.3% had poor practices regarding AMR. The prevalence of antibiotic use in poultry production was 83%. The most used antimicrobials were tetracycline (84%) and gentamicin (35.2%). The commonly reported reason for the use of antimicrobials was for the treatment (93.2%) and prevention (89.8%) of diseases. Further, 76.9% of the administered antimicrobials were usually done without veterinarian consultation or prescription. Conclusion: The study shows that there was high AMU in poultry farms in Kitwe. However, there was low knowledge, negative attitude, and poor practices towards AMU and AMR. Therefore, there is a need for educational and sensitisation programmes regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Alongside this, antimicrobial stewardship and surveillance systems should be strengthened in the livestock production sector. This will ensure food safety and public health.展开更多
Background: One of the key drivers for the emergence and spread of antimicrobial resistance (AMR) is non-prudent antibiotic use, which results in selection pressure toward relevant bacteria. Pharmacy staffs have pivot...Background: One of the key drivers for the emergence and spread of antimicrobial resistance (AMR) is non-prudent antibiotic use, which results in selection pressure toward relevant bacteria. Pharmacy staffs have pivotal roles in facilitating the prudent use of antibiotics through antimicrobial stewardship programs. Due to limited information in Benin, this study assessed the knowledge and attitudes of pharmacy staffs on antibiotic use and resistance. Materials and Methods: This cross-sectional study was conducted among 159 pharmacy staffs using a structured questionnaire from August 2018 to December 2018 in Benin. Data analysis was done by using Stata version 13.0. Results: Of the 159 participants, 54.8% knew the definition of antibiotic therapy and 66.9% knew the definition of probabilistic antibiotic therapy. The majority (88.1%) of the participants thought that the choice of antibiotics was made according to the pathology, while 60.4% thought that it depended on the pathology and the germ involved. 49.02% of dispensers in pharmacies stated that half of the patients had requested treatment without providing a prescription at the pharmacy. The top three antibiotics that were dispensed without a prescription include amoxicillin (98.1%), cloxacillin (76.7%) and metronidazole (57.2%), all from the Access group of antibiotics. Conclusion: These results underscore the need for educational and training interventions targeting specific professional groups. There is an urgent need for regulatory measures and public awareness through improved antimicrobial stewardship to limit this practice.展开更多
Background: Antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity and this burden is borne largely by low and middle-income countries. As part of efforts to combat AMR, the W...Background: Antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity and this burden is borne largely by low and middle-income countries. As part of efforts to combat AMR, the World Health Organization has identified Antimicrobial Stewardship as one of the strategic objectives of its global action plan on antimicrobial resistance. This survey aimed to observe antimicrobial prescribing and usage patterns in the Rivers State University Teaching Hospital with the purpose of identifying gaps to inform the specific antimicrobial stewardship interventions necessary to address our specific needs. Methodology: A point prevalence survey was conducted using the protocol and web-based automated data management system designed by the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance, University of Antwerp, Belgium, in November 2021. Results: A total of 69 adult medical and surgical patients were surveyed;27 males and 18 females. Antimicrobial prevalence was 65.2%. Third generation cephalosporins (24.4%;33.3%), fluoroquinolones (17.8%;22.2%) and imidazole derivatives (20%;36.1%) were most prescribed on the medical and surgical wards. Antimicrobial guidelines were completely unavailable, most antimicrobials (93.8%) were prescribed empirically and 64.4% of these remained empirical after 72 hours of commencement. Conclusion: Antimicrobial stewardship interventions are necessary to minimize sub-optimal antimicrobial prescribing practices in our facility. Most critical are education on appropriate use of antimicrobials, support for development of antimicrobial guidelines, diagnostic stewardship, and the drive for improved use of the laboratory to guide antimicrobial prescriptions. The antimicrobial stewardship committee and team must drive this, having the requisite support from the management and prescribers, with the primary outcomes being reduced antimicrobial prevalence and improved antimicrobial prescription patterns.展开更多
ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hos...ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).展开更多
Objective To evaluate the effect of pharmacist-driven antimicrobial stewardship based on value-based healthcare in a tertiary hospital in China.Methods The application of plan-do-check-action(PDCA)cycle and antimicrob...Objective To evaluate the effect of pharmacist-driven antimicrobial stewardship based on value-based healthcare in a tertiary hospital in China.Methods The application of plan-do-check-action(PDCA)cycle and antimicrobial stewardship(AMS)were respectively used to improve the rational use of antimicrobial agents in prophylactic and therapeutic.Data were collected and the effect was assessed during the management period(2016-2019).Results and Conclusion From 2016(before implementation)to 2019(after implementation),the rational use of antibiotics were obviously enhanced in outpatients,inpatients,and emergency department.For instance,the utilization rate in type I incision operation was decreased from 26.42%to 14.60%(P=0.000),the daily doses of antibiotic per 100 patient-days decreased from 49.34±2.97 to 35.89±4.96(P=0.000),and the average antibiotic expenditures dropped from 948.53 yuan to 526.30 yuan(P=0.000).There was no significant change in infection rate,nosocomial mortality rate,and the length of hospital stay.After the implementation of clinical pharmacist-driven antimicrobial stewardship based on value-based healthcare,the consumption and cost of antibacterial have been greatly reduced.Therefore,the pharmacist-driven antimicrobial stewardship increases its value。展开更多
High resistance rates to antimicrobials continue to be a global health threat.The incidence of multidrug-resistant(MDR)microorganisms in intensive care units(ICUs)is quite high compared to in the community and other u...High resistance rates to antimicrobials continue to be a global health threat.The incidence of multidrug-resistant(MDR)microorganisms in intensive care units(ICUs)is quite high compared to in the community and other unitsin the hospital because ICU patients are generally older,have higher numbers of co-morbidities and immunesuppressed;moreover,the typically high rates of invasive procedures performed in the ICU increase the risk ofinfection by MDR microorganisms.Antimicrobial stewardship(AMS)refers to the implementation of coordinatedinterventions to improve and track the appropriate use of antibiotics while offering the best possible antibioticprescription(according to dose,duration,and route of administration).Broad-spectrum antibiotics are frequentlypreferred in ICUs because of greater infection severity and colonization and infection by MDR microorganisms.For this reason,a number of studies on AMS in ICUs have increased in recent years.Reducing the use of broadspectrum antibiotics forms the basis of AMS.For this purpose,parameters such as establishing an AMS team,limiting the use of broad-spectrum antimicrobials,terminating treatments early,using early warning systems,pursuing infection control,and providing education and feedback are used.In this review,current AMS practicesin ICUs are discussed.展开更多
The rising threats from antimicrobial resistance due to inappropriate utilization of antimicrobial agents in health care including the pediatric population has been a topic of concern at the global level for the last ...The rising threats from antimicrobial resistance due to inappropriate utilization of antimicrobial agents in health care including the pediatric population has been a topic of concern at the global level for the last several decades.The antimicrobial stewardship program(ASP)is a multidisciplinary institutional initiative focusing primarily on the improvement of antimicrobial prescribing practices and limiting inappropriate use.ASPs play an important role in the implementation of healthcare strategies in pediatrics worldwide to reduce antimicrobial resistance.Many published reports demonstrate how adapted ASPs in pediatrics result in improvement of unnecessary antimicrobial utilization,decreasing drug resistance and treatment failure,minimization of adverse clinical outcomes,decreasing healthcare costs and hospital length of stay,and optimization of diagnostic strategies.However,some barriers in pediatric ASP still exist.This narrative review describes core elements of ASP,the impact of implemented ASPs on pediatric healthcare,and challenges of pediatric ASP as seen by the authors.展开更多
Background: Antimicrobial resistance (AMR) is a global health challenge that has escalated due to the inappropriate use of antimicrobials in humans, animals, and the environment. Developing and implementing strategies...Background: Antimicrobial resistance (AMR) is a global health challenge that has escalated due to the inappropriate use of antimicrobials in humans, animals, and the environment. Developing and implementing strategies to reduce and combat AMR is critical. Purpose: This study aimed to highlight some global strategies that can be implemented to address AMR using a One Health approach. Methods: This study employed a narrative review design that included studies published from January 2002 to July 2023. The study searched for literature on AMR and antimicrobial stewardship (AMS) in PubMed and Google Scholar using the 2020 PRISMA guidelines. Results: This study reveals that AMR remains a significant global public health problem. Its severity has been markedly exacerbated by inappropriate use of antimicrobials in humans, animals, and the broader ecological environment. Several strategies have been developed to address AMR, including the Global Action Plan (GAP), National Action Plans (NAPs), AMS programs, and implementation of the AWaRe classification of antimicrobials. These strategies also involve strengthening surveillance of antimicrobial consumption and resistance, encouraging the development of new antimicrobials, and enhancing regulations around antimicrobial prescribing, dispensing, and usage. Additional measures include promoting global partnerships, combating substandard and falsified antimicrobials, advocating for vaccinations, sanitation, hygiene and biosecurity, as well as exploring alternatives to antimicrobials. However, the implementation of these strategies faces various challenges. These challenges include low awareness and knowledge of AMR, a shortage of human resources and capacity building for AMR and AMS, in adequate funding for AMR and AMS initiatives, limited laboratory capacities for surveillance, behavioural change issues, and ineffective leadership and multidisciplinary teams. Conclusion: In conclusion, this study established that AMR is prevalent among humans, animals, and the environment. Successfully addressing AMR calls for a collaborative, multifaceted One Health approach. Despite this, some gaps remain effectively implementing strategies currently recommended to combat AMR. As a result, it is essential to reinforce the strategies that are deployed to counter AMR across the human, animal, and environmental sectors.展开更多
A noteworthy public health problem,antimicrobial resistance(AMR)has been impeded in many ways by the coronavirus disease 2019(COVID-19)pandemic.This narrative review discusses the two-sided impact of COVID-19 on the m...A noteworthy public health problem,antimicrobial resistance(AMR)has been impeded in many ways by the coronavirus disease 2019(COVID-19)pandemic.This narrative review discusses the two-sided impact of COVID-19 on the magnitude of AMR.The pandemic has put tremendous strain on healthcare systems,diverting resources,personnel,and attention away from AMR diagnosis and management toward COVID-19 diagnosis and contact tracking and tracing.AMR research has been severely hampered,and surveillance and antimicrobial stewardship(AMS)programs have been de-emphasized,delayed,or halted.Antibiotics,particularly broad-spectrum,were prescribed more frequently without diagnostic confirmation of bacterial infection than before the pandemic.Nonetheless,the COVID-19 pandemic has highlighted the vulnerability of healthcare systems in controlling infectious disease threats and raised awareness of the importance of infection prevention and control.Yet,the pandemic has created opportunities to capitalize on positive effects on AMR management.The review concludes that it is now more important than ever to focus on AMR and strengthen AMS programs to ensure appropriate antibiotic use and other AMR prevention measures in healthcare.We must ensure that one of the COVID-19 legacies is increased support for AMR research,diagnostic implementation,appropriate diagnostic stewardship,and the strengthening of our health systems.The COVID-19 pandemic has demonstrated that prevention is better than cure.Countries will need to step up their efforts to combat AMR as a multidisciplinary community.We must prepare our public health systems to combat multiple threats at the same time.展开更多
BACKGROUND With the widespread use of antimicrobial drugs,bacterial resistance has become a significant problem,posing a serious threat to public health.The prevalence of clinical infection strains in hospitals and th...BACKGROUND With the widespread use of antimicrobial drugs,bacterial resistance has become a significant problem,posing a serious threat to public health.The prevalence of clinical infection strains in hospitals and their drug sensitivities are key to the appropriate use of antibiotics in clinical practice.AIM To identify prevalent bacteria and their antibiotic resistance profiles in a hospital setting,thereby guiding effective antibiotic usage by clinicians.METHODS Specimens from across the institution were collected by the microbiology laboratory.The VITEK 2 compact fully automatic analyzer was used for bacterial identification and antibiotic sensitivity testing,and the WHONET5.6 software was utilized for statistical analysis.RESULTS A total of 12062 bacterial strains of key monitoring significance were detected.Staphylococcus aureus demonstrated widespread resistance to penicillin,but none of the strains were resistant to vancomycin or linezolid.Moreover,219 strains of methicillin-resistant coagulase-negative staphylococci and 110 strains of methicillin-resistant Staphylococcus aureus were detected.Enterococcus faecalis showed moderate resistance to the third-generation quinolones ciprofloxacin and levofloxacin,but its resistance to nitrofurantoin and tetracycline was low.Enterococcus faecium displayed significantly lower resistance to third-and fourthgeneration quinolones than Enterococcus faecalis.The resistance of two key monitoring strains,Escherichia coli and Klebsiella pneumoniae,to piperacillin/tazobactam was 5%-8%.However,none of the Escherichia coli and Klebsiella pneumoniae strains were resistant to meropenem.The resistance of Acinetobacter baumannii to piperacillin/sulbactam was nearly 90%.Nonetheless,the resistance to tigecycline was low,and Pseudomonas aeruginosa demonstrated minimal resistance in the antibiotic sensitivity test,maintaining a resistance of<10%to the cephalosporin antibiotics cefotetan and cefoperazone over the last 6 years.The resistance to amikacin remained at 0.2%over the past 3 years.CONCLUSION Our hospital’s overall antibiotic resistance rate was relatively stable from 2017 to 2022.The detection rates of key monitoring strains are reported quarterly and their resistance dynamics are monitored and communicated to the entire hospital,which can guide clinical antibiotic selection.展开更多
Mortality, morbidity, early recognition, and treatment of sepsis remain a diagnostic dilemma for clinicians, in addition, the timely diagnosis of sepsis represents an ongoing clinical challenge. This review looks at t...Mortality, morbidity, early recognition, and treatment of sepsis remain a diagnostic dilemma for clinicians, in addition, the timely diagnosis of sepsis represents an ongoing clinical challenge. This review looks at the challenges of early recognition, the scope of the problem, the immunologic basis of the sepsis cascade, new frontiers related to interventions, and the role of antibiotics in an era of antimicrobial resistance. In Figure 1, once a patient is on the slippery slope of sepsis, the ability to reverse the momentum is challenging;hoping antibiotics, fluid resuscitation, vasopressors may buy time for the immunologic cascade to equilibrate to its homeostatic balance. While the development of septic shock is much more complex than pathogen proliferation, our understanding of the pathogenesis and ability to therapeutically intervene is in its infancy. Patients with sepsis frequently present for urgent medical care with undifferentiated infection and nonspecific symptoms. As 80% of patients with sepsis are initially treated in an Emergency Department, the burden of early recognition and intervention falls squarely on the shoulders of Emergency Department Clinicians. [1] This is an entity that occurs in all age groups, without regard to race, geography, or health status. Survival and mortality related to this clinical entity are poorly understood. Our understanding of sepsis needs to expand beyond the downstream effects and collateral damage of multiorgan dysfunction and failure. Immunologically, the antigenic triggers, be it invasive infection, severe injury, and systemic inflammation without concomitant infection, elicit similar pattern recognition receptors and innate host responses. If you are lucky enough to have survived an acute episode of sepsis, patients with sepsis often develop new adverse sequelae after treatment, a concept called persistent critical illness or post sepsis syndrome, characterized by long-term disability, and worsening chronic health conditions requiring re-hospitalization. [2]展开更多
Introduction: Indiscriminate prescribing and using of antibiotics have led to the development of antimicrobial resistance (AMR). To reduce this problem, the World Health Organization (WHO) developed the “Access”, “...Introduction: Indiscriminate prescribing and using of antibiotics have led to the development of antimicrobial resistance (AMR). To reduce this problem, the World Health Organization (WHO) developed the “Access”, “Watch”, and “Reserve” (AWaRe) classification of antibiotics that promotes antimicrobial stewardship (AMS). In Zambia, there are gaps in practice regarding prescribing of antibiotics based on the AWaRe protocol. This study assessed antibiotic prescribing patterns in adult in-patients in selected primary healthcare hospitals in Lusaka, Zambia. Materials and Methods: This retrospective cross-sectional study was conducted using 388 patient medical files from September 2021 to November 2021, five primary healthcare hospitals namely;Chawama, Matero, Chilenje, Kanyama, and Chipata. Data analysis was performed using the Statistical Package for Social Sciences version 23. Results: Of the selected medical files, 52.3% (n = 203) were for male patients. Overall, the prevalence of antibiotic use was 82.5% (n = 320) which was higher than the WHO recommendation of a less than 30% threshold. The most prescribed antibiotic was ceftriaxone (20.3%), a Watch group antibiotic, followed by metronidazole (17.8%) and sulfamethoxazole/trimethoprim (16.3%), both belonging to the Access group. Furthermore, of the total antibiotics prescribed, 41.9% were prescribed without adhering to the standard treatment guidelines. Conclusion: This study found a high prescription of antibiotics (82.5%) that can be linked to non-adherence to the standard treatment guidelines in primary healthcare hospitals. The most prescribed antibiotic was ceftriaxone which belongs to the Watch group, raising a lot of concerns. There is a need for rational prescribing of antibiotics and implementation of AMS programs in healthcare facilities in Zambia, and this may promote surveillance of irrational prescribing and help reduce AMR in the future.展开更多
Antimicrobial resistance(AMR)is a growing global threat,especially in low-and middle-income countries(LMICs),causing prolonged illnesses,heightened antimicrobial use,increased healthcare expenses,and avoidable deaths....Antimicrobial resistance(AMR)is a growing global threat,especially in low-and middle-income countries(LMICs),causing prolonged illnesses,heightened antimicrobial use,increased healthcare expenses,and avoidable deaths.If not tackled,AMR could force 24 million people into severe poverty by 2030 and hinder progress on Sustainable Development Goals(SDGs).AMR spreads through interconnected ecosystems,with humans,animals,and the environment serving as reservoirs.Pharmaceutical wastewater,loaded with antibiotics and resistance genes,poses a significant environmental risk,mainly due to inadequate treatment and irresponsible disposal.The pharmaceutical industry is a notable contributor to environmental antibiotic pollution,with varying effluent management practices.Contaminated pharmaceutical wastewater discharge harms water sources and ecosystems.Urgent collaborative efforts are needed across policymakers,regulators,manufacturers,researchers,civil society,and communities,adopting a One Health approach to curb AMR's spread.Developing global standards for pharmaceutical effluent antibiotic residues,effective treatment methods,and improved diagnostics are vital in addressing AMR's environmental impact while safeguarding public health and the environment.National action plans should encompass comprehensive strategies to combat AMR.Preserving antibiotic efficacy and ensuring sustainable production require a united front from all stakeholders.展开更多
Background:Studies have demonstrated improved clinical outcomes with extended infusion(EI)piperacillin/tazobactam(TZP)compared to standard infusion(SI).However,there is less evidence on its benefits in noncritically-i...Background:Studies have demonstrated improved clinical outcomes with extended infusion(EI)piperacillin/tazobactam(TZP)compared to standard infusion(SI).However,there is less evidence on its benefits in noncritically-ill patients.Hospital-wide EI TZP was implemented at our site on February 21,2012.Our objectives were to compare clinical,safety and economic outcomes between EI and SI TZP.Methods:A retrospective cohort study of all adult patients who received EI TZP(3.375 g IV q8h infused over 4 hours and SI TZP for≥48 hours during 3 years pre-and postimplementation was conducted.The primary study outcome was 14-day mortality while secondary outcomes included length of hospital stay(LOS),nursing plus pharmacy cost,occurrence of Clostridioides difficile infection,readmission within 30 days and change in Pseudomonas aeruginosa minimum inhibitory concentration(MIC)distribution for TZP.The primary outcome and binary secondary outcomes were analyzed using a logistic regression model.LOS was examined using time to event analysis.Cost was examined using linear regression modelling.Results:Overall,2034 patients received EI TZP and 1364 patients received SI TZP.EI TZP was associated with lower odds of mortality(OR 0.76,95%CI 0.63-0.91),lower odds of C.difficile infection(OR 0.59,95%CI 0.41-0.84)and 8%lower cost(estimate 0.92,95%CI 0.87-0.98)compared to SI TZP.Conclusions:Hospital-wide implementation of EI TZP was associated with lower odds of 14-day mortality and incidence of C.difficile infection with cost savings at our institution.展开更多
Background:Poverty increases the risk of contracting infectious diseases and therefore exposure to antibiotics.Yet there is lacking evidence on the relationship between income and non-income dimensions of poverty and ...Background:Poverty increases the risk of contracting infectious diseases and therefore exposure to antibiotics.Yet there is lacking evidence on the relationship between income and non-income dimensions of poverty and antimicrobial resistance.Investigating such relationship would strengthen antimicrobial stewardship interventions.Methods:A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.PubMed,Ovid,MEDLINE,EMBASE,Scopus,CINAHL,PsychINFO,EBSCO,HMIC,and Web of Science databases were searched in October 2016.Prospective and retrospective studies reporting on income or non-income dimensions of poverty and their influence on colonisation or infection with antimicrobial-resistant organisms were retrieved.Study quality was assessed with the Integrated quality criteria for review of multiple study designs(ICROMS)tool.Results:Nineteen articles were reviewed.Crowding and homelessness were associated with antimicrobial resistance in community and hospital patients.In high-income countries,low income was associated with Streptococcus pneumoniae and Acinetobacter baumannii resistance and a seven-fold higher infection rate.In low-income countries the findings on this relation were contradictory.Lack of education was linked to resistant S.pneumoniae and Escherichia coli.Two papers explored the relation between water and sanitation and antimicrobial resistance in low-income settings.Conclusions:Despite methodological limitations,the results suggest that addressing social determinants of poverty worldwide remains a crucial yet neglected step towards preventing antimicrobial resistance.展开更多
文摘Introduction: The inappropriate antimicrobial usage (AMU) in chicken production has led to an increase in the prevalence of antimicrobial resistance (AMR). In Zambia, there is little information documented regarding the knowledge, attitude, and practices of poultry farmers on AMU and AMR. Therefore, this study assessed the knowledge, attitude and practices regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Methods: This was a cross-sectional study conducted among 106 poultry farmers from November to December 2021 using a structured questionnaire. Data analysis was done using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: Overall, of the 106 participants, 90.6% knew what antimicrobials were, but only 29.2% were aware of AMR. The study showed that 46.2% of the participants had low knowledge, 71.7% had negative attitudes, and 61.3% had poor practices regarding AMR. The prevalence of antibiotic use in poultry production was 83%. The most used antimicrobials were tetracycline (84%) and gentamicin (35.2%). The commonly reported reason for the use of antimicrobials was for the treatment (93.2%) and prevention (89.8%) of diseases. Further, 76.9% of the administered antimicrobials were usually done without veterinarian consultation or prescription. Conclusion: The study shows that there was high AMU in poultry farms in Kitwe. However, there was low knowledge, negative attitude, and poor practices towards AMU and AMR. Therefore, there is a need for educational and sensitisation programmes regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Alongside this, antimicrobial stewardship and surveillance systems should be strengthened in the livestock production sector. This will ensure food safety and public health.
文摘Background: One of the key drivers for the emergence and spread of antimicrobial resistance (AMR) is non-prudent antibiotic use, which results in selection pressure toward relevant bacteria. Pharmacy staffs have pivotal roles in facilitating the prudent use of antibiotics through antimicrobial stewardship programs. Due to limited information in Benin, this study assessed the knowledge and attitudes of pharmacy staffs on antibiotic use and resistance. Materials and Methods: This cross-sectional study was conducted among 159 pharmacy staffs using a structured questionnaire from August 2018 to December 2018 in Benin. Data analysis was done by using Stata version 13.0. Results: Of the 159 participants, 54.8% knew the definition of antibiotic therapy and 66.9% knew the definition of probabilistic antibiotic therapy. The majority (88.1%) of the participants thought that the choice of antibiotics was made according to the pathology, while 60.4% thought that it depended on the pathology and the germ involved. 49.02% of dispensers in pharmacies stated that half of the patients had requested treatment without providing a prescription at the pharmacy. The top three antibiotics that were dispensed without a prescription include amoxicillin (98.1%), cloxacillin (76.7%) and metronidazole (57.2%), all from the Access group of antibiotics. Conclusion: These results underscore the need for educational and training interventions targeting specific professional groups. There is an urgent need for regulatory measures and public awareness through improved antimicrobial stewardship to limit this practice.
文摘Background: Antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity and this burden is borne largely by low and middle-income countries. As part of efforts to combat AMR, the World Health Organization has identified Antimicrobial Stewardship as one of the strategic objectives of its global action plan on antimicrobial resistance. This survey aimed to observe antimicrobial prescribing and usage patterns in the Rivers State University Teaching Hospital with the purpose of identifying gaps to inform the specific antimicrobial stewardship interventions necessary to address our specific needs. Methodology: A point prevalence survey was conducted using the protocol and web-based automated data management system designed by the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance, University of Antwerp, Belgium, in November 2021. Results: A total of 69 adult medical and surgical patients were surveyed;27 males and 18 females. Antimicrobial prevalence was 65.2%. Third generation cephalosporins (24.4%;33.3%), fluoroquinolones (17.8%;22.2%) and imidazole derivatives (20%;36.1%) were most prescribed on the medical and surgical wards. Antimicrobial guidelines were completely unavailable, most antimicrobials (93.8%) were prescribed empirically and 64.4% of these remained empirical after 72 hours of commencement. Conclusion: Antimicrobial stewardship interventions are necessary to minimize sub-optimal antimicrobial prescribing practices in our facility. Most critical are education on appropriate use of antimicrobials, support for development of antimicrobial guidelines, diagnostic stewardship, and the drive for improved use of the laboratory to guide antimicrobial prescriptions. The antimicrobial stewardship committee and team must drive this, having the requisite support from the management and prescribers, with the primary outcomes being reduced antimicrobial prevalence and improved antimicrobial prescription patterns.
基金supported by the Natural Science Foundation of Hubei Province(No.2021CFB348).
文摘ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).
基金the project:the Science and Technology Planning Project of Zhuhai City of China(No.20191206F060001)。
文摘Objective To evaluate the effect of pharmacist-driven antimicrobial stewardship based on value-based healthcare in a tertiary hospital in China.Methods The application of plan-do-check-action(PDCA)cycle and antimicrobial stewardship(AMS)were respectively used to improve the rational use of antimicrobial agents in prophylactic and therapeutic.Data were collected and the effect was assessed during the management period(2016-2019).Results and Conclusion From 2016(before implementation)to 2019(after implementation),the rational use of antibiotics were obviously enhanced in outpatients,inpatients,and emergency department.For instance,the utilization rate in type I incision operation was decreased from 26.42%to 14.60%(P=0.000),the daily doses of antibiotic per 100 patient-days decreased from 49.34±2.97 to 35.89±4.96(P=0.000),and the average antibiotic expenditures dropped from 948.53 yuan to 526.30 yuan(P=0.000).There was no significant change in infection rate,nosocomial mortality rate,and the length of hospital stay.After the implementation of clinical pharmacist-driven antimicrobial stewardship based on value-based healthcare,the consumption and cost of antibacterial have been greatly reduced.Therefore,the pharmacist-driven antimicrobial stewardship increases its value。
文摘High resistance rates to antimicrobials continue to be a global health threat.The incidence of multidrug-resistant(MDR)microorganisms in intensive care units(ICUs)is quite high compared to in the community and other unitsin the hospital because ICU patients are generally older,have higher numbers of co-morbidities and immunesuppressed;moreover,the typically high rates of invasive procedures performed in the ICU increase the risk ofinfection by MDR microorganisms.Antimicrobial stewardship(AMS)refers to the implementation of coordinatedinterventions to improve and track the appropriate use of antibiotics while offering the best possible antibioticprescription(according to dose,duration,and route of administration).Broad-spectrum antibiotics are frequentlypreferred in ICUs because of greater infection severity and colonization and infection by MDR microorganisms.For this reason,a number of studies on AMS in ICUs have increased in recent years.Reducing the use of broadspectrum antibiotics forms the basis of AMS.For this purpose,parameters such as establishing an AMS team,limiting the use of broad-spectrum antimicrobials,terminating treatments early,using early warning systems,pursuing infection control,and providing education and feedback are used.In this review,current AMS practicesin ICUs are discussed.
文摘The rising threats from antimicrobial resistance due to inappropriate utilization of antimicrobial agents in health care including the pediatric population has been a topic of concern at the global level for the last several decades.The antimicrobial stewardship program(ASP)is a multidisciplinary institutional initiative focusing primarily on the improvement of antimicrobial prescribing practices and limiting inappropriate use.ASPs play an important role in the implementation of healthcare strategies in pediatrics worldwide to reduce antimicrobial resistance.Many published reports demonstrate how adapted ASPs in pediatrics result in improvement of unnecessary antimicrobial utilization,decreasing drug resistance and treatment failure,minimization of adverse clinical outcomes,decreasing healthcare costs and hospital length of stay,and optimization of diagnostic strategies.However,some barriers in pediatric ASP still exist.This narrative review describes core elements of ASP,the impact of implemented ASPs on pediatric healthcare,and challenges of pediatric ASP as seen by the authors.
文摘Background: Antimicrobial resistance (AMR) is a global health challenge that has escalated due to the inappropriate use of antimicrobials in humans, animals, and the environment. Developing and implementing strategies to reduce and combat AMR is critical. Purpose: This study aimed to highlight some global strategies that can be implemented to address AMR using a One Health approach. Methods: This study employed a narrative review design that included studies published from January 2002 to July 2023. The study searched for literature on AMR and antimicrobial stewardship (AMS) in PubMed and Google Scholar using the 2020 PRISMA guidelines. Results: This study reveals that AMR remains a significant global public health problem. Its severity has been markedly exacerbated by inappropriate use of antimicrobials in humans, animals, and the broader ecological environment. Several strategies have been developed to address AMR, including the Global Action Plan (GAP), National Action Plans (NAPs), AMS programs, and implementation of the AWaRe classification of antimicrobials. These strategies also involve strengthening surveillance of antimicrobial consumption and resistance, encouraging the development of new antimicrobials, and enhancing regulations around antimicrobial prescribing, dispensing, and usage. Additional measures include promoting global partnerships, combating substandard and falsified antimicrobials, advocating for vaccinations, sanitation, hygiene and biosecurity, as well as exploring alternatives to antimicrobials. However, the implementation of these strategies faces various challenges. These challenges include low awareness and knowledge of AMR, a shortage of human resources and capacity building for AMR and AMS, in adequate funding for AMR and AMS initiatives, limited laboratory capacities for surveillance, behavioural change issues, and ineffective leadership and multidisciplinary teams. Conclusion: In conclusion, this study established that AMR is prevalent among humans, animals, and the environment. Successfully addressing AMR calls for a collaborative, multifaceted One Health approach. Despite this, some gaps remain effectively implementing strategies currently recommended to combat AMR. As a result, it is essential to reinforce the strategies that are deployed to counter AMR across the human, animal, and environmental sectors.
文摘A noteworthy public health problem,antimicrobial resistance(AMR)has been impeded in many ways by the coronavirus disease 2019(COVID-19)pandemic.This narrative review discusses the two-sided impact of COVID-19 on the magnitude of AMR.The pandemic has put tremendous strain on healthcare systems,diverting resources,personnel,and attention away from AMR diagnosis and management toward COVID-19 diagnosis and contact tracking and tracing.AMR research has been severely hampered,and surveillance and antimicrobial stewardship(AMS)programs have been de-emphasized,delayed,or halted.Antibiotics,particularly broad-spectrum,were prescribed more frequently without diagnostic confirmation of bacterial infection than before the pandemic.Nonetheless,the COVID-19 pandemic has highlighted the vulnerability of healthcare systems in controlling infectious disease threats and raised awareness of the importance of infection prevention and control.Yet,the pandemic has created opportunities to capitalize on positive effects on AMR management.The review concludes that it is now more important than ever to focus on AMR and strengthen AMS programs to ensure appropriate antibiotic use and other AMR prevention measures in healthcare.We must ensure that one of the COVID-19 legacies is increased support for AMR research,diagnostic implementation,appropriate diagnostic stewardship,and the strengthening of our health systems.The COVID-19 pandemic has demonstrated that prevention is better than cure.Countries will need to step up their efforts to combat AMR as a multidisciplinary community.We must prepare our public health systems to combat multiple threats at the same time.
文摘BACKGROUND With the widespread use of antimicrobial drugs,bacterial resistance has become a significant problem,posing a serious threat to public health.The prevalence of clinical infection strains in hospitals and their drug sensitivities are key to the appropriate use of antibiotics in clinical practice.AIM To identify prevalent bacteria and their antibiotic resistance profiles in a hospital setting,thereby guiding effective antibiotic usage by clinicians.METHODS Specimens from across the institution were collected by the microbiology laboratory.The VITEK 2 compact fully automatic analyzer was used for bacterial identification and antibiotic sensitivity testing,and the WHONET5.6 software was utilized for statistical analysis.RESULTS A total of 12062 bacterial strains of key monitoring significance were detected.Staphylococcus aureus demonstrated widespread resistance to penicillin,but none of the strains were resistant to vancomycin or linezolid.Moreover,219 strains of methicillin-resistant coagulase-negative staphylococci and 110 strains of methicillin-resistant Staphylococcus aureus were detected.Enterococcus faecalis showed moderate resistance to the third-generation quinolones ciprofloxacin and levofloxacin,but its resistance to nitrofurantoin and tetracycline was low.Enterococcus faecium displayed significantly lower resistance to third-and fourthgeneration quinolones than Enterococcus faecalis.The resistance of two key monitoring strains,Escherichia coli and Klebsiella pneumoniae,to piperacillin/tazobactam was 5%-8%.However,none of the Escherichia coli and Klebsiella pneumoniae strains were resistant to meropenem.The resistance of Acinetobacter baumannii to piperacillin/sulbactam was nearly 90%.Nonetheless,the resistance to tigecycline was low,and Pseudomonas aeruginosa demonstrated minimal resistance in the antibiotic sensitivity test,maintaining a resistance of<10%to the cephalosporin antibiotics cefotetan and cefoperazone over the last 6 years.The resistance to amikacin remained at 0.2%over the past 3 years.CONCLUSION Our hospital’s overall antibiotic resistance rate was relatively stable from 2017 to 2022.The detection rates of key monitoring strains are reported quarterly and their resistance dynamics are monitored and communicated to the entire hospital,which can guide clinical antibiotic selection.
文摘Mortality, morbidity, early recognition, and treatment of sepsis remain a diagnostic dilemma for clinicians, in addition, the timely diagnosis of sepsis represents an ongoing clinical challenge. This review looks at the challenges of early recognition, the scope of the problem, the immunologic basis of the sepsis cascade, new frontiers related to interventions, and the role of antibiotics in an era of antimicrobial resistance. In Figure 1, once a patient is on the slippery slope of sepsis, the ability to reverse the momentum is challenging;hoping antibiotics, fluid resuscitation, vasopressors may buy time for the immunologic cascade to equilibrate to its homeostatic balance. While the development of septic shock is much more complex than pathogen proliferation, our understanding of the pathogenesis and ability to therapeutically intervene is in its infancy. Patients with sepsis frequently present for urgent medical care with undifferentiated infection and nonspecific symptoms. As 80% of patients with sepsis are initially treated in an Emergency Department, the burden of early recognition and intervention falls squarely on the shoulders of Emergency Department Clinicians. [1] This is an entity that occurs in all age groups, without regard to race, geography, or health status. Survival and mortality related to this clinical entity are poorly understood. Our understanding of sepsis needs to expand beyond the downstream effects and collateral damage of multiorgan dysfunction and failure. Immunologically, the antigenic triggers, be it invasive infection, severe injury, and systemic inflammation without concomitant infection, elicit similar pattern recognition receptors and innate host responses. If you are lucky enough to have survived an acute episode of sepsis, patients with sepsis often develop new adverse sequelae after treatment, a concept called persistent critical illness or post sepsis syndrome, characterized by long-term disability, and worsening chronic health conditions requiring re-hospitalization. [2]
文摘Introduction: Indiscriminate prescribing and using of antibiotics have led to the development of antimicrobial resistance (AMR). To reduce this problem, the World Health Organization (WHO) developed the “Access”, “Watch”, and “Reserve” (AWaRe) classification of antibiotics that promotes antimicrobial stewardship (AMS). In Zambia, there are gaps in practice regarding prescribing of antibiotics based on the AWaRe protocol. This study assessed antibiotic prescribing patterns in adult in-patients in selected primary healthcare hospitals in Lusaka, Zambia. Materials and Methods: This retrospective cross-sectional study was conducted using 388 patient medical files from September 2021 to November 2021, five primary healthcare hospitals namely;Chawama, Matero, Chilenje, Kanyama, and Chipata. Data analysis was performed using the Statistical Package for Social Sciences version 23. Results: Of the selected medical files, 52.3% (n = 203) were for male patients. Overall, the prevalence of antibiotic use was 82.5% (n = 320) which was higher than the WHO recommendation of a less than 30% threshold. The most prescribed antibiotic was ceftriaxone (20.3%), a Watch group antibiotic, followed by metronidazole (17.8%) and sulfamethoxazole/trimethoprim (16.3%), both belonging to the Access group. Furthermore, of the total antibiotics prescribed, 41.9% were prescribed without adhering to the standard treatment guidelines. Conclusion: This study found a high prescription of antibiotics (82.5%) that can be linked to non-adherence to the standard treatment guidelines in primary healthcare hospitals. The most prescribed antibiotic was ceftriaxone which belongs to the Watch group, raising a lot of concerns. There is a need for rational prescribing of antibiotics and implementation of AMS programs in healthcare facilities in Zambia, and this may promote surveillance of irrational prescribing and help reduce AMR in the future.
文摘Antimicrobial resistance(AMR)is a growing global threat,especially in low-and middle-income countries(LMICs),causing prolonged illnesses,heightened antimicrobial use,increased healthcare expenses,and avoidable deaths.If not tackled,AMR could force 24 million people into severe poverty by 2030 and hinder progress on Sustainable Development Goals(SDGs).AMR spreads through interconnected ecosystems,with humans,animals,and the environment serving as reservoirs.Pharmaceutical wastewater,loaded with antibiotics and resistance genes,poses a significant environmental risk,mainly due to inadequate treatment and irresponsible disposal.The pharmaceutical industry is a notable contributor to environmental antibiotic pollution,with varying effluent management practices.Contaminated pharmaceutical wastewater discharge harms water sources and ecosystems.Urgent collaborative efforts are needed across policymakers,regulators,manufacturers,researchers,civil society,and communities,adopting a One Health approach to curb AMR's spread.Developing global standards for pharmaceutical effluent antibiotic residues,effective treatment methods,and improved diagnostics are vital in addressing AMR's environmental impact while safeguarding public health and the environment.National action plans should encompass comprehensive strategies to combat AMR.Preserving antibiotic efficacy and ensuring sustainable production require a united front from all stakeholders.
文摘Background:Studies have demonstrated improved clinical outcomes with extended infusion(EI)piperacillin/tazobactam(TZP)compared to standard infusion(SI).However,there is less evidence on its benefits in noncritically-ill patients.Hospital-wide EI TZP was implemented at our site on February 21,2012.Our objectives were to compare clinical,safety and economic outcomes between EI and SI TZP.Methods:A retrospective cohort study of all adult patients who received EI TZP(3.375 g IV q8h infused over 4 hours and SI TZP for≥48 hours during 3 years pre-and postimplementation was conducted.The primary study outcome was 14-day mortality while secondary outcomes included length of hospital stay(LOS),nursing plus pharmacy cost,occurrence of Clostridioides difficile infection,readmission within 30 days and change in Pseudomonas aeruginosa minimum inhibitory concentration(MIC)distribution for TZP.The primary outcome and binary secondary outcomes were analyzed using a logistic regression model.LOS was examined using time to event analysis.Cost was examined using linear regression modelling.Results:Overall,2034 patients received EI TZP and 1364 patients received SI TZP.EI TZP was associated with lower odds of mortality(OR 0.76,95%CI 0.63-0.91),lower odds of C.difficile infection(OR 0.59,95%CI 0.41-0.84)and 8%lower cost(estimate 0.92,95%CI 0.87-0.98)compared to SI TZP.Conclusions:Hospital-wide implementation of EI TZP was associated with lower odds of 14-day mortality and incidence of C.difficile infection with cost savings at our institution.
基金This work was supported by the National Institute for Health Research Health Protection Research Unit(NIHR HPRU)[grant No.HPRU-2012-10047]in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London in partnership with Public Health England(PHE)ECS has received a Wellcome Trust ISFF Faculty postdoctoral fellowship,an Early Career Research Fellowship from the Antimicrobial Research Collaborative at Imperial College London,and acknowledges the support of the Florence Nightingale Foundation+2 种基金The views expressed are those of the author(s)and not necessarily those of the NHS,the NIHR,the Department of Health or Public Health EnglandThe funder of the study had no role in the study design,data collection,data analysis,data interpretation,or writing of the reportThe corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
文摘Background:Poverty increases the risk of contracting infectious diseases and therefore exposure to antibiotics.Yet there is lacking evidence on the relationship between income and non-income dimensions of poverty and antimicrobial resistance.Investigating such relationship would strengthen antimicrobial stewardship interventions.Methods:A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)guidelines.PubMed,Ovid,MEDLINE,EMBASE,Scopus,CINAHL,PsychINFO,EBSCO,HMIC,and Web of Science databases were searched in October 2016.Prospective and retrospective studies reporting on income or non-income dimensions of poverty and their influence on colonisation or infection with antimicrobial-resistant organisms were retrieved.Study quality was assessed with the Integrated quality criteria for review of multiple study designs(ICROMS)tool.Results:Nineteen articles were reviewed.Crowding and homelessness were associated with antimicrobial resistance in community and hospital patients.In high-income countries,low income was associated with Streptococcus pneumoniae and Acinetobacter baumannii resistance and a seven-fold higher infection rate.In low-income countries the findings on this relation were contradictory.Lack of education was linked to resistant S.pneumoniae and Escherichia coli.Two papers explored the relation between water and sanitation and antimicrobial resistance in low-income settings.Conclusions:Despite methodological limitations,the results suggest that addressing social determinants of poverty worldwide remains a crucial yet neglected step towards preventing antimicrobial resistance.
