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Comelli A, Zanforlini M, Mazzone A, Pedroni P, De Castro U, Scarioni S, D’Amelio AC, Renisi G, Bandera A, Gori A, Schiatti S, Cereda D. How a laboratory-based antimicrobial resistance (AMR) regional surveillance system can address large-scale and local AMR epidemiology: the MICRO-BIO experience. Front Public Health 2024; 12:1341482. [PMID: 38410663 PMCID: PMC10895007 DOI: 10.3389/fpubh.2024.1341482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/30/2024] [Indexed: 02/28/2024] Open
Abstract
Antimicrobial resistance is a significant threat to public health, with Italy experiencing substantial challenges in terms of AMR rate, surveillance system and activities to combat AMR. In response, the MICRO-BIO project was initiated as part of the National Plan to Combat Antibiotic Resistance by Region Lombardy health department. It was launched in 2018 with the aim of creating a surveillance tool by integrating data on bacterial isolates from microbiology laboratories. The participating laboratories were directly involved in reviewing and addressing discrepancies in the transmission data quality assessment. Despite the disruptions caused by COVID-19, 30 out of 33 laboratories in the Lombardy Region were successfully integrated by October 2023, with 1,201,000 microbiological data collected in the first nine months of 2023. In 2022 the analysis yielded 15,037 blood culture results from 20 labs passing validation. Data regarding the antimicrobial resistance profile of high-priority pathogens was analyzed at regional and single-hospital levels. The MICRO-BIO project represents a significant step toward strengthening AMR surveillance in a highly populated region. As a multi-disciplinary tool encompassing the fields of public health and IT (information technology), this tool has the potential to inform regional and local AMR epidemiology.
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Affiliation(s)
- Agnese Comelli
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- External Consultant, Lombardy Region, Milan, Italy
| | - Martina Zanforlini
- Regional Company for Innovation and Purchasing Aria S.p.A., Milan, Italy
| | - Arianna Mazzone
- Regional Company for Innovation and Purchasing Aria S.p.A., Milan, Italy
| | | | - Umberto De Castro
- Regional Company for Innovation and Purchasing Aria S.p.A., Milan, Italy
| | - Simona Scarioni
- Department of Biomedical Sciences for Health, School of Public Health, University of Milan, Milan, Italy
| | | | - Giulia Renisi
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandra Bandera
- Infectious Diseases Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical Sciences for Health, School of Public Health, University of Milan, Milan, Italy
| | - Andrea Gori
- Department of Biomedical Sciences for Health, School of Public Health, University of Milan, Milan, Italy
- ASST Fatebenefratelli Sacco, Ospedale Luigi Sacco, Milan, Italy
| | - Simone Schiatti
- Regional Company for Innovation and Purchasing Aria S.p.A., Milan, Italy
| | - Danilo Cereda
- General Directorate for Health, Lombardy Region, Milan, Italy
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Zongo E, Dama E, Yenyetou D, Muhigwa M, Nikiema A, Dahourou GA, Ouedraogo AS. On-site evaluation as external quality assessment of microbiology laboratories involved in sentinel laboratory-based antimicrobial resistance surveillance network in Burkina Faso. Antimicrob Resist Infect Control 2024; 13:3. [PMID: 38191470 PMCID: PMC10775656 DOI: 10.1186/s13756-023-01362-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/29/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The laboratory-based surveillance of antimicrobial resistance (AMR) is a priority component of the multisectoral national action plan to combat AMR in Burkina Faso. This study aimed to assess the QMS of microbiology laboratories involved in the Sentinel laboratory-based antimicrobial resistance surveillance network in Burkina Faso. METHODS A cross-sectional study was conducted from September 1st to November 30th, 2022. The external quality assessment (EQA) method used was on-site evaluation using a checklist that was developed and validated by a technical committee of experts. Teams of two, including an antimicrobial susceptibility test (AST) specialist and a QMS specialist, were trained on this checklist to conduct the assessment. Satisfactory performance was defined as any on-site evaluation score 80% and above with the aim of developing action plans to address gaps. RESULTS All 18 laboratories were evaluated. The overall average performance score of the participating laboratories was 40%. The highest overall performance score was 58%, and the lowest overall performance score was 26%. The average overall scores were not significantly different between private and public laboratories (p value = 0.78). The only section of the checklist with the satisfactory performance concerned the "Analytical step of AST", with 76.5% (13/17) of the sentinel laboratories having a score ≥ 80%. CONCLUSION The performance of the QMS of the sentinel laboratories in Burkina Faso for AMR surveillance was unsatisfactory, and a corrective action plan was proposed to support these laboratories in improving their QMS over the next 3 years.
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Affiliation(s)
- Emmanuel Zongo
- Higher Institute of Health Sciences, Nazi BONI University, Bobo-Dioulasso, Burkina Faso.
- National Reference Laboratory for Antimicrobial Resistance, Souro SANOU University Hospital Center, Bobo-Dioulasso, Burkina Faso.
- Laboratory of Emerging and Re-emerging Pathogens (LaPathER), Doctoral School of Health Sciences, Nazi BONI University, Bobo-Dioulasso, Burkina Faso.
- Health Sciences Research Institute, Ouagadougou, Burkina Faso.
| | - Emilie Dama
- US Centers for Disease Control and Prevention, Ouagadougou, Burkina Faso
| | - Dame Yenyetou
- Higher Institute of Health Sciences, Nazi BONI University, Bobo-Dioulasso, Burkina Faso
- National Reference Laboratory for Antimicrobial Resistance, Souro SANOU University Hospital Center, Bobo-Dioulasso, Burkina Faso
- Laboratory of Emerging and Re-emerging Pathogens (LaPathER), Doctoral School of Health Sciences, Nazi BONI University, Bobo-Dioulasso, Burkina Faso
| | - Merci Muhigwa
- Higher Institute of Health Sciences, Nazi BONI University, Bobo-Dioulasso, Burkina Faso
- National Reference Laboratory for Antimicrobial Resistance, Souro SANOU University Hospital Center, Bobo-Dioulasso, Burkina Faso
- Laboratory of Emerging and Re-emerging Pathogens (LaPathER), Doctoral School of Health Sciences, Nazi BONI University, Bobo-Dioulasso, Burkina Faso
| | | | | | - Abdoul-Salam Ouedraogo
- Higher Institute of Health Sciences, Nazi BONI University, Bobo-Dioulasso, Burkina Faso
- National Reference Laboratory for Antimicrobial Resistance, Souro SANOU University Hospital Center, Bobo-Dioulasso, Burkina Faso
- Laboratory of Emerging and Re-emerging Pathogens (LaPathER), Doctoral School of Health Sciences, Nazi BONI University, Bobo-Dioulasso, Burkina Faso
- MURAZ Center, Bobo-Dioulasso, Burkina Faso
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Asaduzzaman M, Mekonnen Z, Rødland EK, Sahay S, Winkler AS, Gradmann C. District health information system (DHIS2) as integrated antimicrobial resistance surveillance platform: An exploratory qualitative investigation of the one health stakeholders' viewpoints in Ethiopia. Int J Med Inform 2024; 181:105268. [PMID: 37972481 DOI: 10.1016/j.ijmedinf.2023.105268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION There is an unmet need for One Health (OH) surveillance and reporting systems for antimicrobial resistance (AMR) in resource poor settings. District health information system, version 2 (DHIS2), is a globally recognized digital surveillance platform which has not been widely utilized for AMR data yet. Our study aimed to understand the local stakeholders' viewpoints on DHIS2 as OH-AMR surveillance platform in Jimma, Ethiopia which will aid its further context specific establishment. METHODS We performed an exploratory qualitative study using semi-structured key informant interviews (KIIs) in Jimma Zone at Southwest Ethiopia. We interviewed 42 OH professionals between November 2020 and February 2021. Following verbatim transcription of the audio recordings of KIIs, we conducted thematic analysis. RESULTS We identified five major themes which are important for understanding the trajectory of OH-AMR surveillance in DHIS2 platform. The themes were: (1) Stakeholders' current knowledge on digital surveillance platforms including DHIS2. (2) Stakeholders' perception on digital surveillance platform including DHIS2. (3) Features suggested by stakeholders to be included in the surveillance platform. (4) Comments from stakeholders on system implementation challenges. (5) Stakeholders' perceived role in the process of implementation. Despite several barriers and challenges, most of the participants perceived and suggested DHIS2 as a suitable OH-AMR surveillance platform and were willing to contribute at their current professional roles. CONCLUSIONS Our study demonstrates the potential of the DHIS2 as a user friendly and acceptable interoperable platform for OH-AMR surveillance if the technology designers accommodate the stakeholders' concerns. Piloting at local level and using performance appraisal tool in all OH disciplines should be the next step before proceeding to workable format.
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Affiliation(s)
- Muhammad Asaduzzaman
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Ernst Kristian Rødland
- Department of Climate and Environmental Health, Norwegian Institute of Public Health, Norway
| | - Sundeep Sahay
- Department of Informatics, University of Oslo, Norway
| | - Andrea Sylvia Winkler
- Centre for Global Health, Faculty of Medicine, University of Oslo, Norway; Center for Global Health, Department of Neurology, Faculty of Medicine, Technical University of Munich, Germany
| | - Christoph Gradmann
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
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Abayneh M, Zeynudin A, Tamrat R, Tadesse M, Tamirat A. Drug resistance and extended-spectrum β-lactamase (ESBLs) - producing Enterobacteriaceae, Acinetobacter and Pseudomonas species from the views of one-health approach in Ethiopia: a systematic review and meta-analysis. ONE HEALTH OUTLOOK 2023; 5:12. [PMID: 37697359 PMCID: PMC10496308 DOI: 10.1186/s42522-023-00088-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/10/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Although antimicrobial resistance (AMR) bacteria present a significant and ongoing public health challenge, its magnitude remains poorly understood, especially in many parts of the developing countries. Hence, this review was conducted to describe the current pooled prevalence of drug resistance, multidrug- resistance (MDR), and Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, Acinetobacter, and Pseudomonas species in humans, the environment, and animals or food of animal origin in Ethiopia. METHODS PubMed, Google Scholar, and other sources were searched for relevant articles as per the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A critical appraisal for screening, eligibility, and inclusion in the meta-analysis was made based on the Joanna Briggs Institute's (JBI) essential appraisal tools. The meta-analysis was done on Statistical Software Package (STATA) version 17.0. RESULTS A total of 33 research articles were included in this systematic review and meta-analysis. Escherichia coli, Klebsiella species, Acinetobacter, and Pseudomonas species were the most frequently reported bacteria from two or more sources. More than 50% of Klebsiella species and 25% to 89% of Escherichia coli from two or more sources were resistant to all analysed antibiotics, except carbapenems. Fifty-five percent (55%) to 84% of Acinetobacter species and 33% to 79% of Pseudomonas species from human and environmental sources were resistant to all analyzed antibiotics. Carbapenem resistance was common in Acinetobacter and Pseudomonas species (38% to 64%) but uncommon in Enterobacteriaceae (19% to 44%). Acinetobacter species (92%), Klebsiella species (86%), and Pseudomonas species (79%) from human sources, and Proteus species (92%), and Acinetobacter species (83%), from environmental sources, were the common multidrug-resistant isolates. About 45% to 67% of E. coli, Klebsiella, Acinetobacter, and Pseudomonas species from human and environmental sources were ESBL producers. CONCLUSION Our review report concluded that there was a significant pooled prevalence of drug resistance, MDR, and ESBL-producing Enterobacteriaceae, Acinetobacter, and Pseudomonas species from two or more sources. Hence, our finding underlines the need for the implementation of integrated intervention approaches to address the gaps in reducing the emergence and spread of antibiotic- resistant bacteria.
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Affiliation(s)
- Mengistu Abayneh
- College of Medical and Health Science, Department of Medical Laboratory Sciences, Mizan-Tepi University, PO Box 260, Mizan-Aman, Ethiopia.
| | - Ahmed Zeynudin
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Rahel Tamrat
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Mulualem Tadesse
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abraham Tamirat
- Faculity of Public Health, Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
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Do PC, Assefa YA, Batikawai SM, Reid SA. Strengthening antimicrobial resistance surveillance systems: a scoping review. BMC Infect Dis 2023; 23:593. [PMID: 37697310 PMCID: PMC10496311 DOI: 10.1186/s12879-023-08585-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is an emerging global public health crisis. Surveillance is a fundamental component in the monitoring and evaluation of AMR mitigation endeavours. The primary aim of the scoping review is to identify successes, barriers, and gaps in implementing AMR surveillance systems and utilising data from them. METHODS PubMed, Web of Science, SCOPUS, and EMBASE databases were searched systematically to identify literature pertaining to implementation, monitoring, and evaluation of AMR surveillance systems. A thematic analysis was conducted where themes within the literature were inductively grouped based on the described content. RESULTS The systematic search yielded 639 journal articles for screening. Following deduplication and screening, 46 articles were determined to be appropriate for inclusion. Generally, most studies focused on human AMR surveillance (n = 38, 82.6%). Regionally, there was equal focus on low- and middle-income countries (n = 7, 15.2%) and trans-national contexts (n = 7, 14.5%). All included articles (n = 46, 100.0%) discussed barriers to either implementing or utilising AMR surveillance systems. From the scoping review, 6 themes emerged: capacity for surveillance, data infrastructure, policy, representativeness, stakeholder engagement, and sustainability. Data infrastructure was most frequently discussed as problematic in evaluation of surveillance systems (n = 36, 75.0%). The most frequent success to surveillance system implementation was stakeholder engagement (n = 30, 65.2%). CONCLUSIONS Experiences of AMR surveillance systems are diverse across contexts. There is a distinct separation of experiences between systems with emerging surveillance systems and those with established systems. Surveillance systems require extensive refinement to become representative and meet surveillance objectives.
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Affiliation(s)
- Phu Cong Do
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Australia.
| | - Yibeltal Alemu Assefa
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Australia
| | | | - Simon Andrew Reid
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Australia
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Validation of Three MicroScan® Antimicrobial Susceptibility Testing Plates Designed for Low-Resource Settings. Diagnostics (Basel) 2022; 12:diagnostics12092106. [PMID: 36140507 PMCID: PMC9497938 DOI: 10.3390/diagnostics12092106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/17/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022] Open
Abstract
Easy and robust antimicrobial susceptibility testing (AST) methods are essential in clinical bacteriology laboratories (CBL) in low-resource settings (LRS). We evaluated the Beckman Coulter MicroScan lyophilized broth microdilution panel designed to support Médecins Sans Frontières (MSF) CBL activity in difficult settings, in particular with the Mini-Lab. We evaluated the custom-designed MSF MicroScan Gram-pos microplate (MICPOS1) for Staphylococcus and Enterococcus species, MSF MicroScan Gram-neg microplate (MICNEG1) for Gram-negative bacilli, and MSF MicroScan Fastidious microplate (MICFAST1) for Streptococci and Haemophilus species using 387 isolates from routine CBLs from LRS against the reference methods. Results showed that, for all selected antibiotics on the three panels, the proportion of the category agreement was above 90% and the proportion of major and very major errors was below 3%, as per ISO standards. The use of the Prompt inoculation system was found to increase the MIC and the major error rate for some antibiotics when testing Staphylococci. The readability of the manufacturer’s user manual was considered challenging for low-skilled staff. The inoculations and readings of the panels were estimated as easy to use. In conclusion, the three MSF MicroScan MIC panels performed well against clinical isolates from LRS and provided a convenient, robust, and standardized AST method for use in CBL in LRS.
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Teni FS, Wubishet BL, Yimenu DK. Assessment of medicine use among outpatients at healthcare facilities in Ethiopia using the WHO's prescribing indicators with a focus on antibiotics: a systematic review and meta-analysis. J Antimicrob Chemother 2021; 75:2044-2058. [PMID: 32437516 DOI: 10.1093/jac/dkaa124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/18/2020] [Accepted: 03/09/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To summarize studies on prescribing medicine to general outpatients through the WHO/International Network for Rational Use of Drugs (INRUD) prescribing indicators with a focus on antibiotic prescription. METHODS A systematic review and random-effects meta-analysis of studies on the WHO prescribing indicators with a focus on the percentage of encounters with antibiotics prescribed (PEAP) was performed. The databases PubMed, Web of Science, EMBASE and Global Index Medicus were searched. RESULTS Twenty-six studies with a total of over 34 000 prescription encounters were included in the systematic review, showing a mean of two medicines per encounter. In each meta-analysis, a range of 19 to 25 studies was included. The percentages of medicines prescribed with an international non-proprietary name (INN) and from the essential medicines list (EML) were 91% and 96% of the total number of medicines, respectively, while 19% of encounters contained injections. Studies with over 25 000 prescription encounters reported an average PEAP of 58% and PEAP showed an increasing trend over the years included in this review. Multivariable meta-regression showed that PEAP increased with the average number of medicines per encounter (estimate = 0.83, P value = 0.0005). The number of medicines, study design and year of prescription explained over 40% of the variation in PEAP across studies. CONCLUSIONS Patterns of medicine use within and close to the WHO reference values were reported for the number of medicines, INN prescribing, prescription of injections and compliance with the EML, on average. Prescription of antibiotics requires attention as amounts much higher than the reference values were prescribed, which were even higher with polypharmacy and increasing over the years included in this review.
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Affiliation(s)
- Fitsum Sebsibe Teni
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Dawit Kumilachew Yimenu
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Ronat JB, Natale A, Kesteman T, Andremont A, Elamin W, Hardy L, Kanapathipillai R, Michel J, Langendorf C, Vandenberg O, Naas T, Kouassi F. AMR in low-resource settings: Médecins Sans Frontières bridges surveillance gaps by developing a turnkey solution, the Mini-Lab. Clin Microbiol Infect 2021; 27:1414-1421. [PMID: 33932617 DOI: 10.1016/j.cmi.2021.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/26/2021] [Accepted: 04/13/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND In low- and middle-income countries (LMICs), data related to antimicrobial resistance (AMR) are often inconsistently collected. Humanitarian, private and non-governmental medical organizations (NGOs), working with or in parallel to public medical systems, are sometimes present in these contexts. Yet, what is the role of NGOs in the fight against AMR, and how can they contribute to AMR data collection in contexts where reporting is scarce? How can context-adapted, high-quality clinical bacteriology be implemented in remote, challenging and underserved areas of the world? OBJECTIVES The aim was to provide an overview of AMR data collection challenges in LMICs and describe one initiative, the Mini-Lab project developed by Médecins Sans Frontières (MSF), that attempts to partially address them. SOURCES We conducted a literature review using PubMed and Google scholar databases to identify peer-reviewed research and grey literature from publicly available reports and websites. CONTENT We address the necessity of and difficulties related to obtaining AMR data in LMICs, as well as the role that actors outside of public medical systems can play in the collection of this information. We then describe how the Mini-Lab can provide simplified bacteriological diagnosis and AMR surveillance in challenging settings. IMPLICATIONS NGOs are responsible for a large amount of healthcare provision in some very low-resourced contexts. As a result, they also have a role in AMR control, including bacteriological diagnosis and the collection of AMR-related data. Actors outside the public medical system can actively contribute to implementing and adapting clinical bacteriology in LMICs and can help improve AMR surveillance and data collection.
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Affiliation(s)
- Jean-Baptiste Ronat
- Médecins Sans Frontières, Paris, France; Team ReSIST, INSERM U1184, School of Medicine University Paris-Saclay, France; Bacteriology-Hygiene Unit, Assistance Publique - Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France.
| | | | | | | | - Wael Elamin
- Clinical Microbiology Department, Queen Mary University, London, UK; Clinical Microbiology Department, Elrazi University, Khartoum, Sudan
| | - Liselotte Hardy
- Unit Tropical Bacteriology, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | - Olivier Vandenberg
- Center for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium; Innovation and Business Development Unit, Laboratoire Hospitalier Universitaire de Bruxelles, Brussels, Belgium; Division of Infection and Immunity, University College London, London, UK
| | - Thierry Naas
- Team ReSIST, INSERM U1184, School of Medicine University Paris-Saclay, France; Bacteriology-Hygiene Unit, Assistance Publique - Hôpitaux de Paris, Bicêtre Hospital, Le Kremlin-Bicêtre, France
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Acharya J, Zolfo M, Enbiale W, Kyaw KWY, Bhattachan M, Rijal N, Shrestha A, Shrestha B, Madhup SK, Raghubanshi BR, Kattel HP, Rajbhandari P, Bhandari P, Thakur S, Sharma S, Singh DR, Jha R. Quality Assessment of an Antimicrobial Resistance Surveillance System in a Province of Nepal. Trop Med Infect Dis 2021; 6:60. [PMID: 33922405 PMCID: PMC8167624 DOI: 10.3390/tropicalmed6020060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/28/2021] [Accepted: 04/08/2021] [Indexed: 11/17/2022] Open
Abstract
Antimicrobial resistance (AMR) is a global problem, and Nepal is no exception. Countries are expected to report annually to the World Health Organization on their AMR surveillance progress through a Global Antimicrobial Resistance Surveillance System, in which Nepal enrolled in 2017. We assessed the quality of AMR surveillance data during 2019-2020 at nine surveillance sites in Province 3 of Nepal for completeness, consistency, and timeliness and examined barriers for non-reporting sites. Here, we present the results of this cross-sectional descriptive study of secondary AMR data from five reporting sites and barriers identified through a structured questionnaire completed by representatives at the five reporting and four non-reporting sites. Among the 1584 records from the reporting sites assessed for consistency and completeness, 77-92% were consistent and 88-100% were complete, with inter-site variation. Data from two sites were received by the 15th day of the following month, whereas receipt was delayed by a mean of 175 days at three other sites. All four non-reporting sites lacked dedicated data personnel, and two lacked computers. The AMR surveillance data collection process needs improvement in completeness, consistency, and timeliness. Non-reporting sites need support to meet the specific requirements for data compilation and sharing.
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Affiliation(s)
- Jyoti Acharya
- National Public Health Laboratory, Kathmandu 44600, Nepal; (N.R.); (A.S.); (R.J.)
| | - Maria Zolfo
- Institute of Tropical Medicine, 2000 Antwerp, Belgium;
| | - Wendemagegn Enbiale
- Department of Dermatology and Venereology, BahirDar University, 1996 Bahir Dar, Ethiopia;
- Amsterdam UMC, Academic Medical Centre, Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&I), University of Amsterdam, 7057 Amsterdam, The Netherlands
| | - Khine Wut Yee Kyaw
- International Union against Tuberculosis and Lung Disease, Paris, France and International Union against Tuberculosis and Lung Disease, Mandalay 11061, Myanmar;
| | - Meika Bhattachan
- World Health Organization, Health Emergencies Unit, Kathmandu 44700, Nepal;
| | - Nisha Rijal
- National Public Health Laboratory, Kathmandu 44600, Nepal; (N.R.); (A.S.); (R.J.)
| | - Anjana Shrestha
- National Public Health Laboratory, Kathmandu 44600, Nepal; (N.R.); (A.S.); (R.J.)
| | | | | | | | | | - Piyush Rajbhandari
- Patan Hospital, Patan Academy of Health Sciences, Lalitpur 44700, Nepal;
| | | | - Subhash Thakur
- Paropakar Maternity and Women’s Hospital, Kathmandu 44600, Nepal;
| | - Saroj Sharma
- Kanti Children’s Hospital, Kathmandu 44600, Nepal;
| | - Dipendra Raman Singh
- Quality Standard and Regulation Division, Ministry of Health and Population, Kathmandu 44600, Nepal;
| | - Runa Jha
- National Public Health Laboratory, Kathmandu 44600, Nepal; (N.R.); (A.S.); (R.J.)
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Gandra S, Alvarez-Uria G, Turner P, Joshi J, Limmathurotsakul D, van Doorn HR. Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries. Clin Microbiol Rev 2020; 33:e00048-19. [PMID: 32522747 PMCID: PMC7289787 DOI: 10.1128/cmr.00048-19] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Antimicrobial resistance (AMR) is a serious global health threat and is predicted to cause significant health and economic impacts, particularly in low- and middle-income countries (LMICs). AMR surveillance is critical in LMICs due to high burden of bacterial infections; however, conducting AMR surveillance in resource-limited settings is constrained by poorly functioning health systems, scarce financial resources, and lack of skilled personnel. In 2015, the United Nations World Health Assembly endorsed the World Health Organization's Global Action Plan to tackle AMR; thus, several countries are striving to improve their AMR surveillance capacity, including making significant investments and establishing and expanding surveillance networks. Initial data generated from AMR surveillance networks in LMICs suggest the high prevalence of resistance, but these data exhibit several shortcomings, such as a lack of representativeness, lack of standardized laboratory practices, and underutilization of microbiology services. Despite significant progress, AMR surveillance networks in LMICs face several challenges in expansion and sustainability due to limited financial resources and technical capacity. This review summarizes the existing health infrastructure affecting the establishment of AMR surveillance programs, the burden of bacterial infections demonstrating the need for AMR surveillance, and current progress and challenges in AMR surveillance efforts in eight South and Southeast Asian countries.
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Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gerardo Alvarez-Uria
- Department of Infectious Diseases, Rural Development Trust Hospital, Bathalapalli, Anantapur, Andhra Pradesh, India
| | - Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jyoti Joshi
- Center for Disease Dynamics, Economics and Policy, New Delhi, India
| | - Direk Limmathurotsakul
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - H Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Vietnam
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11
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Arega B, Agunie A, Minda A, Mersha A, Sitotaw A, Weldeyohhans G, Teshome A, Adane K, Mengistu G. Guideline Recommendations for Empirical Antimicrobial Therapy: An Appraisal of Research Evidence for Clinical Decision-Making in Ethiopia. Infect Dis Ther 2020; 9:451-465. [PMID: 32572787 PMCID: PMC7452993 DOI: 10.1007/s40121-020-00308-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The rapid spread of drug resistance is forcing standard treatment guidelines (STGs) to become more appropriate with due consideration of the evidence on the antimicrobial resistance (AMR) situation in Ethiopia. Therefore, we aimed to assess the local AMR recommendations in the STGs for empirical antibacterial prescriptions for the five common infectious syndromes. We also determined the quality of AMR reviews conducted in the country. METHODS We conducted a review of the STGs used in the health centers, general hospitals, and primary hospitals in Ethiopia and assessed the AMR recommendations in STGs for empirical antibacterial prescriptions for community-acquired pneumonia (CAP), urinary tract infection (UTI), tonsillopharyngitis, acute otitis media (AOM), and bacterial dysentery. Next, we performed an overview of AMR reviews published in Ethiopia. We used the MEDLINE/PubMed, Embase, Cochrane Library, and Google Scholar databases to identify AMR reviews. The review characteristics were extracted. We also evaluated the quality of each included AMR review using a measurement tool to assess the systematic review scale (AMSTAR 2). RESULTS A total of 6 STGs and 12 AMR reviews conducted in the country were included. The choice of empirical antibacterials for similar infectious syndromes (and editions) was comparable across the three levels of the health care system. None of the STGs evaluated included the local AMR recommendations for empirical antibacterial prescriptions for five common infectious syndromes. Of all the AMR reviews included, 75% had low and below methodologic quality, and none had a high-quality score using the AMSTAR 2 tool. CONCLUSION Standard treatment guidelines did not consider local AMR recommendations for empirically prescribing antibacterials for common infectious syndromes. The AMR reviews published in the country produced poor methodologic quality evidence for clinical applications. This highlights the need to improve the methodologic quality to provide the best available evidence for clinical decision-making and curb the ongoing AMR in Ethiopia. TRIAL REGISTRATION Retrospectively registered (15/07/2020).
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Affiliation(s)
- Balew Arega
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia.
| | - Asnake Agunie
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Abraham Minda
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | | | - Alazar Sitotaw
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | | | - Ayele Teshome
- Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | | | - Getachew Mengistu
- Debere Markos University, College of Health Science, Debre Markos, Ethiopia
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12
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Hall JW, Bouchard J, Bookstaver PB, Haldeman MS, Kishimbo P, Mbwanji G, Mwakyula I, Mwasomola D, Seddon M, Shaffer M, Shealy SC, Nsojo A. The Mbeya Antimicrobial Stewardship Team: Implementing Antimicrobial Stewardship at a Zonal-Level Hospital in Southern Tanzania. PHARMACY 2020; 8:pharmacy8020107. [PMID: 32599699 PMCID: PMC7356184 DOI: 10.3390/pharmacy8020107] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/11/2020] [Accepted: 06/18/2020] [Indexed: 01/14/2023] Open
Abstract
Background: In 2017, Mbeya Zonal Referral Hospital (MZRH) and the University of South Carolina (UofSC) agreed to collaboratively strengthen antimicrobial prescribing in the southern highlands of Tanzania and train a new generation of clinicians in responsible antimicrobial use. Methods: Key stakeholders and participants were identified and the Mbeya Antimicrobial Stewardship Team (MAST) was created. The team identified assets brought by the collaborators, and four investigations of baseline needs were developed. These investigations included (a) a baseline clinician survey regarding antimicrobial resistance and stewardship, (b) a serial chart review of inpatient antimicrobial prescribing practices, (c) an investigation of antimicrobial resistance rates using existing isolates at the MZRH laboratory, and (d) a survey of antimicrobial availability at community pharmacies in the city. Results: 91% of physicians believe antimicrobial resistance is problem in Tanzania, although only 29% of physicians were familiar with the term “antimicrobial stewardship”. Escherichia coli isolates had resistance rates of over 60% to the commonly used agents ciprofloxacin, trimethoprim-sulfamethoxazole, and ceftriaxone. Thirteen out of 14 community pharmacies offered over-the-counter antibiotics for upper respiratory symptoms. Conclusions: International antimicrobial stewardship collaborations can successfully identify opportunities and needs. Evaluating the team’s efforts to improve patient outcomes will be essential.
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Affiliation(s)
- Jeffrey W. Hall
- School of Medicine, University of South Carolina, Columbia, SC 29209 USA; (M.S.H.); (M.S.)
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA; (J.B.); (P.B.B.); (S.C.S.)
- Correspondence:
| | - Jeannette Bouchard
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA; (J.B.); (P.B.B.); (S.C.S.)
| | - P. Brandon Bookstaver
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA; (J.B.); (P.B.B.); (S.C.S.)
| | - Matthew S. Haldeman
- School of Medicine, University of South Carolina, Columbia, SC 29209 USA; (M.S.H.); (M.S.)
| | - Peter Kishimbo
- Mbeya Zonal Referral Hospital, Mbeya PO Box 419, Tanzania; (P.K.); (G.M.); (I.M.); (D.M.); (A.N.)
| | - Godlove Mbwanji
- Mbeya Zonal Referral Hospital, Mbeya PO Box 419, Tanzania; (P.K.); (G.M.); (I.M.); (D.M.); (A.N.)
| | - Issakwisa Mwakyula
- Mbeya Zonal Referral Hospital, Mbeya PO Box 419, Tanzania; (P.K.); (G.M.); (I.M.); (D.M.); (A.N.)
| | - Davance Mwasomola
- Mbeya Zonal Referral Hospital, Mbeya PO Box 419, Tanzania; (P.K.); (G.M.); (I.M.); (D.M.); (A.N.)
| | - Megan Seddon
- Sarasota Memorial Health Care System, Sarasota, FL 34239, USA;
| | - Mark Shaffer
- School of Medicine, University of South Carolina, Columbia, SC 29209 USA; (M.S.H.); (M.S.)
| | - Stephanie C. Shealy
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA; (J.B.); (P.B.B.); (S.C.S.)
| | - Anthony Nsojo
- Mbeya Zonal Referral Hospital, Mbeya PO Box 419, Tanzania; (P.K.); (G.M.); (I.M.); (D.M.); (A.N.)
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13
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Haldeman MS, Kishimbo P, Seddon M, Sangare A, Mwasomola D, Hall J, Shaffer M, Leclair R, Caulder C, Bookstaver PB, Nsojo A. Evaluation of Antimicrobial Utilization and Concordance with National Guidelines at a Tertiary Hospital in the Southern Highlands Zone of Tanzania. Am J Trop Med Hyg 2020; 102:370-376. [PMID: 31802729 PMCID: PMC7008321 DOI: 10.4269/ajtmh.19-0231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 10/26/2019] [Indexed: 11/07/2022] Open
Abstract
Antimicrobial resistance is a growing concern in sub-Saharan Africa, and antimicrobial stewardship (AMS) programs have not been widely implemented in this region. We evaluated antibiotic prescribing patterns and concordance with national guidelines at Mbeya Zonal Referral Hospital (MZRH) in Tanzania. Adult inpatient medical records were chronologically reviewed from January 1, 2018 until 100 records documenting antibiotic therapy were evaluated. The primary endpoint was concordance with national guidelines for indication-based antibiotic selection and duration. Data were summarized using descriptive statistics. Overall, 155 records with sufficient data were reviewed. The 100 records which involved antibiotic therapy represented 171 unique antibiotic courses. The most common indication for antibiotics was bacterial pneumonia. Ceftriaxone and metronidazole, the most commonly used antibiotics, were administered in 40% and 24% of courses, respectively. Indication-based antibiotic selection was concordant with national guidelines in 63% of courses, but this fell to 15% when course duration was taken into account. Antibiotic courses were completed as prescribed 28% of the time among evaluable courses. A microbiologic culture of any kind was obtained in 17% of patients. In conclusion, antibiotic therapy was often incomplete, was generally guideline discordant, exhibited limited diversity of selection, and frequently lacked diagnostic confirmation. These data, combined with local susceptibility patterns, may be used to foster AMS efforts for improved compliance with guidelines at MZRH in the future.
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Affiliation(s)
- Matthew S. Haldeman
- Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina
| | - Peter Kishimbo
- Mbeya College of Health and Allied Sciences, University of Dar Es Salaam, Mbeya, Tanzania
| | - Megan Seddon
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Anthony Sangare
- Mbeya College of Health and Allied Sciences, University of Dar Es Salaam, Mbeya, Tanzania
| | - Davance Mwasomola
- Mbeya College of Health and Allied Sciences, University of Dar Es Salaam, Mbeya, Tanzania
| | - Jeff Hall
- Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina
| | - Mark Shaffer
- Department of Family and Preventive Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina
| | - Rachel Leclair
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | - Celeste Caulder
- College of Pharmacy, University of South Carolina, Columbia, South Carolina
| | | | - Anthony Nsojo
- Mbeya College of Health and Allied Sciences, University of Dar Es Salaam, Mbeya, Tanzania
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14
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Kennedy ED, Morgan J, Knight NW. Global Health Security Implementation: Expanding the Evidence Base. Health Secur 2019; 16:S1-S4. [PMID: 30480503 DOI: 10.1089/hs.2018.0120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Erin D Kennedy
- Erin D. Kennedy, DVM, MS, MPH, is Associate Director for Science, Epidemiology, Informatics, Surveillance, and Laboratory Branch, Division of Global Health Protection, Center for Global Health, the Centers for Disease Control and Prevention , Atlanta, GA
| | - Juliette Morgan
- Juliette Morgan, MD, was Associate Director for Science, Division of Global Health Protection, Center for Global Health, the Centers for Disease Control and Prevention , Atlanta, GA
| | - Nancy W Knight
- Nancy W. Knight, MD, is a captain in the US Public Health Service and Director, Division of Global Health Protection, Center for Global Health, the Centers for Disease Control and Prevention , Atlanta, GA
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