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Saxena S, Aggarwal P, Mitra S, Singh S, Kaim M, Sharma A. In vitro assessment of newer colistin-sparing antimicrobial agents for clinical isolates of carbapenem-resistant organisms. J Infect Chemother 2024:S1341-321X(24)00149-1. [PMID: 38839032 DOI: 10.1016/j.jiac.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/24/2024] [Accepted: 05/31/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES Carbapenem-resistant organisms (CROs) are a significant public health threat globally, particularly in countries like India with high antibiotic resistance rates. The current study investigates the prevalence of CROs, detects resistance mechanisms using phenotypic methods and assesses the efficacy of newer antibiotics against CROs. METHODS A prospective study conducted at a tertiary care hospital in India during 2021-23. Clinical specimens were processed and bacterial identification was performed using MALDI-TOF mass spectrometry followed by antimicrobial susceptibility testing using CLSI guidelines against a plethora of newer antibiotics for CROs. Carbapenemase production was detected using phenotypic methods, and the presence of the mcr-1 gene was assessed by real-time PCR. RESULTS During the study period, predominantly (70 %) Gram-negative bacteria were isolated; amongst which 5692 strains were carbapenem-resistant, wherein resistance to different carbapenems ranged from 34.1% to 79 %. Majority of the carbapenemase producers were metallo-β-lactamases (MBL) producers (75 %). Colistin resistance was noted in 5.4 % of selected carbapenem-resistant isolates. Among newer antibiotics, cefiderocol demonstrated the lowest resistance rates (0-14 %), while resistance to newer β-lactam/β-lactamase inhibitor combinations was very high in carbapenem-resistant isolates. Fosfomycin, minocycline and tigecycline, each showing variable efficacy depending on the site of infection. Moreover, newer β-lactam/β-lactamase inhibitor combinations offer restricted benefits due to widespread prevalence of MBL in the region. CONCLUSION The escalating prevalence of CROs in India underscores the urgency for alternative treatment options beyond colistin. Hence, highlighting the critical importance of developing effective strategies to combat carbapenem resistance.
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Affiliation(s)
- Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Prabhav Aggarwal
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Srestha Mitra
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India.
| | - Shweta Singh
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Manisha Kaim
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
| | - Anju Sharma
- Department of Microbiology, Maulana Azad Medical College, New Delhi, India
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Sajwan RK, Kumar Himanshu J, Solanki PR. Polyvinyl alcohol-derived-carbon quantum dots based fluorometric "On-Off" probe for moxifloxacin detection in milk and egg samples. Food Chem 2024; 439:138038. [PMID: 38041884 DOI: 10.1016/j.foodchem.2023.138038] [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: 09/08/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 12/04/2023]
Abstract
Unconditional use of antibiotics triggered the process of bacterial resistance and causes major health problems. Nowadays, antibiotics majorly used in animals not only for infection treatment but also as mass promotor. The excess amount of antibiotics residue in animal derived foods which accelerate antibiotic resistance (ABR). So, here, a simple and quick carbon quantum dots(CQDs) based fluorometric "On-Off" probe was developed for detection of moxifloxacin (MOXI) in milk and egg samples. The CQDs emits blue emission and are uniformly distributed with average particle size 5.9 ± 0.22 nm. With MOXI, fluorescence intensity of CQDs at 372 nm decreased due to inner filter effect (IFE) and a new peak appeared at 508 nm correspondence to MOXI. The probe shows linear response with MOXI concentration varies as 0.025 µM - 15.0 µM with lower detection limit (LOD) of 6.34 nM. The real sample applicability test proved that the sensors have excellent efficacy for food applications.
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Affiliation(s)
- Reena K Sajwan
- Nano-bio Laboratory, Special Center for Nanoscience, Jawaharlal Nehru University, New Delhi 110067, India
| | - Jayendra Kumar Himanshu
- Nano-bio Laboratory, Special Center for Nanoscience, Jawaharlal Nehru University, New Delhi 110067, India; Department of Biotechnology, School of Life Sciences, Mahatma Gandhi Central University, Motihari, Bihar 845401, India
| | - Pratima R Solanki
- Nano-bio Laboratory, Special Center for Nanoscience, Jawaharlal Nehru University, New Delhi 110067, India.
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Abejew AA, Wubetu GY, Fenta TG. A six years trend analysis of systemic antibiotic consumption in Northwest Ethiopia. PLoS One 2024; 19:e0290391. [PMID: 38295126 PMCID: PMC10830007 DOI: 10.1371/journal.pone.0290391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/08/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Consumption of antibiotics, a major global threat to public health, is perhaps the key driver of antibiotic resistance. Monitoring antibiotic consumption is crucial to tackling antimicrobial resistance. This study assessed antibiotic consumption trends during the last six years in the Bahir Dar branch of the Ethiopian pharmaceutical supply agency (EPSA), Northwest Ethiopia, in 2022. METHODS Retrospective data were collected in August 2022 based on antibiotic distribution data from the Bahir Dar Brach of EPSA from July 2016 to June 2022. Data were analyzed according to the Anatomic Therapeutic Classification (ATC) developed by the World Health Organization (WHO). We measured antibiotic consumption using a defined daily dose per 1000 inhabitants per day (DIDs) based on the Agency's catchment population. Descriptive statistics and trend analyses were conducted. RESULTS About 30.34 DIDs of antibiotics were consumed during the six years. The consumption of antibiotics decreased by 87.4%, from 6.9 DIDs in 2016/17 to 0.9 DIDs in 2021/22. Based on the WHO AWaRe classification, 23.39 DIDs (77.1%) of the consumed antibiotics were from the Access category. Consumption of Access category antibiotics was decreased by 72.7% (from 5 to 0.5 DIDs) but Watch antibiotics decreased by 54.3% (from 1.8 to 0.4 DIDs). Oral antibiotics accounted for 29.19 DIDs (96.2%) of all consumed systemic antibiotics. The average cost expenditure per DDD for all antibiotics was 54.1 birr/DDD (0.4-482.3 birr/DDD). Only seven antibiotics accounted for DU90% and the cost expenditure per DDD for the DU90% antibiotics ranged from 0.4/DDD for Doxycycline to 232.8 birr/DDD for Piperacillin/tazobactam. Overall, during the last six years, the most commonly used antibiotic was Amoxicillin (10.1 DIDs), followed by Doxycycline (5.3 DIDs) and Ciprofloxacin (3.4 DIDs). CONCLUSION In this study, we found that antibiotic usage was low and continuously declining over time. Minimizing unnecessary antibiotic usage is one possible approach to reduced AMR. However, a shortage of access to important medicines can compromise the quality of treatment and patient outcomes. A prospective study is needed to evaluate the balance of patient outcomes and reduce AMR by optimizing the community consumption of systemic antibiotics.
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Affiliation(s)
- Asrat Agalu Abejew
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Teferi Gedif Fenta
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Jayaprasad N, Borhade P, LeBoa C, Date K, Joshi S, Shimpi R, Andrews JR, Luby SP, Hoffman SA. Retrospective Review of Blood Culture-Confirmed Cases of Enteric Fever in Navi Mumbai, India: 2014-2018. Am J Trop Med Hyg 2023; 109:571-574. [PMID: 37549903 PMCID: PMC10484249 DOI: 10.4269/ajtmh.23-0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/03/2023] [Indexed: 08/09/2023] Open
Abstract
India has one of the highest estimated burdens of enteric fever globally. Prior to the implementation of Typbar-TCV typhoid conjugate vaccine (TCV) in a public sector pediatric immunization campaign in Navi Mumbai, India, we conducted a retrospective review of blood culture-confirmed cases of typhoid and paratyphoid fevers to estimate the local burden of disease. This review included all blood cultures processed at a central microbiology laboratory, serving multiple hospitals, in Navi Mumbai (January 2014-May 2018) that tested positive for either Salmonella Typhi or Salmonella Paratyphi A. Of 40,670 blood cultures analyzed, 1,309 (3.2%) were positive for S. Typhi (1,201 [92%]) or S. Paratyphi A (108 [8%]). Culture positivity was highest in the last months of the dry season (April-June). Our findings indicate a substantial burden of enteric fever in Navi Mumbai and support the importance of TCV immunization campaigns and improved water, sanitation, and hygiene.
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Affiliation(s)
- Niniya Jayaprasad
- National Public Health Surveillance Project, World Health Organization–Country Office for India, New Delhi, India
| | - Priyanka Borhade
- National Public Health Surveillance Project, World Health Organization–Country Office for India, New Delhi, India
| | - Christopher LeBoa
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Kashmira Date
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shrikrishna Joshi
- Dr. Joshi’s Central Clinical Microbiology Laboratory, Navi Mumbai, India
| | - Rahul Shimpi
- National Public Health Surveillance Project, World Health Organization–Country Office for India, New Delhi, India
| | - Jason R. Andrews
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Stephen P. Luby
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Seth A. Hoffman
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
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Avatsingh AU, Sharma S, Kour S, Arora Y, Sharma S, Joshi D, Chaudhary PP, Perveen K, Kamal MA, Singh N. Prevalence of antibiotic-resistant Gram-negative bacteria having extended-spectrum β-lactamase phenotypes in polluted irrigation-purpose wastewaters from Indian agro-ecosystems. Front Microbiol 2023; 14:1227132. [PMID: 37608947 PMCID: PMC10440439 DOI: 10.3389/fmicb.2023.1227132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023] Open
Abstract
Antibiotic resistance in bacteria has emerged as a serious public health threat worldwide. Aquatic environments including irrigation-purpose wastewaters facilitate the emergence and transmission of antibiotic-resistant bacteria and antibiotic resistance genes leading to detrimental effects on human health and environment sustainability. Considering the paramount threat of ever-increasing antibiotic resistance to human health, there is an urgent need for continuous environmental monitoring of antibiotic-resistant bacteria and antibiotic resistance genes in wastewater being used for irrigation in Indian agro-ecosystems. In this study, the prevalence of antibiotic resistance in Gram-negative bacteria isolated from irrigation-purpose wastewater samples from Sirmaur and Solan districts of Himachal Pradesh was determined. Bacterial isolates of genera Escherichia, Enterobacter, Hafnia, Shigella, Citrobacter, and Klebsiella obtained from 11 different geographical locations were found to exhibit resistance against ampicillin, amoxyclav, cefotaxime, co-trimoxazole, tobramycin, cefpodoxime and ceftazidime. However, all the isolates were sensitive to aminoglycoside antibiotic gentamicin. Enterobacter spp. and Escherichia coli showed predominance among all the isolates. Multidrug-resistance phenotype was observed with isolate AUK-06 (Enterobacter sp.) which exhibited resistant to five antibiotics. Isolate AUK-02 and AUK-09, both E. coli strains showed resistant phenotypes to four antibiotics each. Phenotypic detection revealed that six isolates were positive for extended-spectrum β-lactamases which includes two isolates from Enterobacter spp. and E. coli each and one each from Shigella sp. and Citrobacter sp. Overall, the findings revealed the occurrence of antibiotic resistant and ESBL-positive bacterial isolates in wastewaters utilized for irrigation purpose in the study area and necessitate continuous monitoring and precautionary interventions. The outcomes of the study would be of significant clinical, epidemiological, and agro-environmental importance in designing effective wastewater management and environmental pollution control strategies.
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Affiliation(s)
- Achhada Ujalkaur Avatsingh
- Department of Microbiology, Akal College of Basic Sciences, Eternal University, Baru Sahib, Sirmaur, Himachal Pradesh, India
| | - Shilpa Sharma
- Department of Microbiology, Akal College of Basic Sciences, Eternal University, Baru Sahib, Sirmaur, Himachal Pradesh, India
| | - Shilippreet Kour
- Department of Microbiology, Akal College of Basic Sciences, Eternal University, Baru Sahib, Sirmaur, Himachal Pradesh, India
| | - Yukta Arora
- Department of Microbiology, Akal College of Basic Sciences, Eternal University, Baru Sahib, Sirmaur, Himachal Pradesh, India
| | - Sheetal Sharma
- Department of Microbiology, Akal College of Basic Sciences, Eternal University, Baru Sahib, Sirmaur, Himachal Pradesh, India
| | - Divya Joshi
- Department of Microbiology, College of Basic Sciences and Humanities, GBPUA&T, Pantnagar, Uttarakhand, India
| | - Prem Prashant Chaudhary
- Epithelial Therapeutics Unit, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Kahkashan Perveen
- Department of Botany & Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Mohab Amin Kamal
- Environmental Engineering, Civil Engineering Department, College of Engineering, King Saud University, Riyadh, Saudi Arabia
| | - Nasib Singh
- Department of Microbiology, Akal College of Basic Sciences, Eternal University, Baru Sahib, Sirmaur, Himachal Pradesh, India
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Chen X, Jiang Y, Liu Y, Yao C. Y 3+@CdTe quantum dot nanoprobe as a fluorescence signal enhancement sensing platform for the visualization of norfloxacin. Analyst 2023. [PMID: 37455634 DOI: 10.1039/d3an00921a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Quinolone antibiotics (norfloxacin) pose a serious threat to animal and human health due to their misuse and difficulty in being broken down in surface water and food. Rapid and effective detection of norfloxacin (NOR) is essential for environmental testing and ecosystems. In this study, yttrium was coordinated with mercaptopropionic acid (MPA)-modified CdTe quantum dots (QDs) to obtain a novel fluorescence sensor Y3+@CdTe QDs for the sensitive detection of NOR. NOR can bind to Y3+ to form a complex (NOR-Y3+). This complex enhances the luminescence of NOR and blue-shifts to 423 nm. The fluorescence intensity of NOR-Y3+ at 423 nm (I423) gradually increased with increasing NOR concentration; meanwhile, the fluorescence intensity of CdTe QDs at 634 nm (I634) gradually decreased due to aggregation induction. The ratio of I423 to I634 was used for the quantitative determination of NOR. The linear range of the constructed fluorescent probes was from 1.0 to 150.0 μM, with a detection limit of 31.8 nM. CdTe QDs act as a red fluorescent background, and with the addition of NOR, the color of the system transitions from red to purple and finally blue. This method was rapid (immediate) and visual, providing a simple analysis of various actual samples (tap water, lake water, honey, milk and human serum) for NOR.
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Affiliation(s)
- Xiong Chen
- College of Chemistry and Molecular Engineering, Nanjing Tech University, Nanjing 211816, P. R. China.
| | - Yuanhang Jiang
- College of Chemistry and Molecular Engineering, Nanjing Tech University, Nanjing 211816, P. R. China.
| | - Ying Liu
- College of Chemistry and Molecular Engineering, Nanjing Tech University, Nanjing 211816, P. R. China.
| | - Cheng Yao
- College of Chemistry and Molecular Engineering, Nanjing Tech University, Nanjing 211816, P. R. China.
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Sharma A, Thakur N, Thakur A, Chauhan A, Babrah H. The Challenge of Antimicrobial Resistance in the Indian Healthcare System. Cureus 2023; 15:e42231. [PMID: 37605711 PMCID: PMC10440008 DOI: 10.7759/cureus.42231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/23/2023] Open
Abstract
The emergence and rapid spread of antimicrobial resistance (AMR) pose a grave threat to public health globally, and particularly so in India. With its unique combination of a dense population, a significant disease burden, and diverse healthcare practices, India stands at a critical juncture in the global battle against AMR. The implications of this escalating crisis are far-reaching, threatening decades of medical progress, undermining healthcare delivery, and posing potential roadblocks to the realization of several Sustainable Development Goals. AMR is a crisis within the Indian healthcare system as it severely hampers the effective treatment of infectious diseases, leading to higher mortality rates, longer hospital stays, and increased healthcare costs. Its rise could mark the return of the pre-antibiotic era, where common infections and minor surgeries could once again become life-threatening. Addressing the challenge of AMR in India requires a comprehensive, multifaceted, and well-coordinated response. From creating strong regulatory frameworks for antibiotic usage and improving diagnostic capabilities to fostering greater public awareness and promoting research into new antimicrobials, the strategies need to be as diverse and interconnected as the problem itself. This editorial will delve into the specificities of the AMR challenge within the Indian healthcare system, discuss potential strategies for mitigating the crisis, and evaluate the broader implications for public health and national policy. It will also highlight why India's response to this global health threat is crucial not only for the country but for the world at large.
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Affiliation(s)
- Abhishek Sharma
- Anaesthesia, Sri Guru Ram Das Institute of Medical Sciences & Research, Amritsar, IND
| | - Niketa Thakur
- Radiation Oncology, Government Medical College and Hospital, Amritsar, IND
| | | | - Ankit Chauhan
- Cardiac Anaesthesia, UN Mehta Institute of Cardiology and Research Centre, Ahmedabad, IND
| | - Harpreet Babrah
- Anaesthesia, Sri Guru Ram Das Institute of Medical Sciences & Research, Amritsar, IND
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Nair M, Engel N, Zeegers MP, Burza S. Perceptions of effective policy interventions and strategies to address antibiotic misuse within primary healthcare in India: A qualitative study. J Infect Prev 2023; 24:113-118. [PMID: 37065277 PMCID: PMC10090571 DOI: 10.1177/17571774231158778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Abstract
Objectives Antimicrobial resistance poses a major public health threat. Despite Indian retail sector antibiotic consumption per capita increasing by approximately 22% between 2008 and 2016, empirical studies that examine policy or behavioural interventions addressing antibiotic misuse in primary healthcare are scarce. Our study aimed to assess perceptions of interventions and gaps in policy and practice with respect to outpatient antibiotic misuse in India. Methods We conducted 23 semi-structured, in-depth interviews with a variety of key informants with diverse backgrounds in academia, non-government organisations, policy, advocacy, pharmacy, medicine and others. Data were charted into a framework matrix and analysed using a hybrid, inductive and deductive thematic analysis. Themes were analysed and organised according to the socio-ecological model at various levels ranging from the individual to the enabling environment. Results Key informants largely focused on the importance of adopting a structural perspective to addressing socio-ecological drivers of antibiotic misuse. There was a recognition that educational interventions targeting individual or interpersonal interactions were largely ineffective, and policy interventions should incorporate behavioural nudge interventions, improve the healthcare infrastructure and embrace task shifting to rectify staffing disparities in rural areas. Conclusions Prescription behaviour is perceived to be governed by structural issues of access and limitations in public health infrastructure that create an enabling environment for antibiotic overuse. Interventions should move beyond a clinical and individual focus on behaviour change with respect to antimicrobial resistance and aim for structural alignment between existing disease specific programs and between the informal and formal sector of healthcare delivery in India.
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Affiliation(s)
- Mohit Nair
- Maastricht University, Maastricht, Netherlands
| | - Nora Engel
- Maastricht University, Maastricht, Netherlands
| | | | - Sakib Burza
- London School of Hygiene & Tropical Medicine, London, UK
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Talat A, Blake KS, Dantas G, Khan AU. Metagenomic Insight into Microbiome and Antibiotic Resistance Genes of High Clinical Concern in Urban and Rural Hospital Wastewater of Northern India Origin: a Major Reservoir of Antimicrobial Resistance. Microbiol Spectr 2023; 11:e0410222. [PMID: 36786639 PMCID: PMC10100738 DOI: 10.1128/spectrum.04102-22] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/30/2023] [Indexed: 02/15/2023] Open
Abstract
India is one of the largest consumers and producers of antibiotics and a hot spot for the emergence and proliferation of antimicrobial resistance genes (ARGs). Indian hospital wastewater (HWW) accumulates ARGs from source hospitals and often merges with urban wastewater, with the potential for environmental and human contamination. Despite its putative clinical importance, there is a lack of high-resolution resistome profiling of Indian hospital wastewater, with most studies either relying on conventional PCR-biased techniques or being limited to one city. In this study, we comprehensively analyzed antibiotic resistomes of wastewater from six Indian hospitals distributed in rural and urban areas of northern India through shotgun metagenomics. Our study revealed the predominance of ARGs against aminoglycoside, macrolide, carbapenem, trimethoprim, and sulfonamide antibiotics in all the samples through both read-based analysis and assembly-based analysis. We detected the mobile colistin resistance gene mcr-5.1 for the first time in Indian hospital sewage. blaNDM-1 was present in 4 out of 6 samples and was carried by Pseudomonas aeruginosa in HWW-2, Klebsiella pneumoniae in HWW-4 and HWW-6, and Acinetobacter baumanii in HWW-5. Most ARGs were plasmid-mediated and hosted by Proteobacteria. We identified virulence factors and transposable elements flanking the ARGs, highlighting the role of horizontal gene transmission of ARGs. IMPORTANCE There is a paucity of research on detailed antibiotic resistome and microbiome diversity of Indian hospital wastewater. This study reports the predominance of clinically concerning ARGs such as the beta-lactamases blaNDM and blaOXA and the colistin resistance gene mcr and their association with the microbiome in six different Indian hospital wastewaters of both urban and rural origin. The abundance of plasmid-mediated ARGs and virulence factors calls for urgent AMR crisis management. The lack of proper wastewater management strategies meeting international standards and open drainage systems further complicates the problem of containing the ARGs at these hospitals. This metagenomic study presents the current AMR profile propagating in hospital settings in India and can be used as a reference for future surveillance and risk management of ARGs in Indian hospitals.
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Affiliation(s)
- Absar Talat
- Medical Microbiology and Molecular Biology Laboratory, Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, India
| | - Kevin S. Blake
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gautam Dantas
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Asad U. Khan
- Medical Microbiology and Molecular Biology Laboratory, Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, India
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Dubey M, Vellanki BP, Kazmi AA. Removal of emerging contaminants in conventional and advanced biological wastewater treatment plants in India-a comparison of treatment technologies. ENVIRONMENTAL RESEARCH 2023; 218:115012. [PMID: 36502902 DOI: 10.1016/j.envres.2022.115012] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/07/2022] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
Abstract
Emerging contaminants (ECs) are a growing concern for the environment and human health. The study investigates 20 commonly reported ECs in 10 wastewater treatment plants (WWTPs) in urban to semi-urban settlements of north India over two years in the summer and winter. The selected plants were based on waste stabilization pond (WSP), up-flow anaerobic sludge blanket (UASB), activated sludge process (ASP), anoxic-aerobic process (AO), anaerobic-anoxic-oxic process, biodenipho process, sequencing batch reactor, and densadeg-biofor process. Of the 20 ECs, all 20 were identified in the influent and effluent, and 13 were identified in the final sludge on at least one occasion. The concentration in the influent, effluent, and sludge varied in the range from 2.5 ng/L to 77.4 μg/L, below limit of detection (LOD) to 1.984 μg/L, and < LOD to 1.41 μg/g, respectively. Acetaminophen and caffeine were predominately detected in the influent, whereas naproxen, ciprofloxacin, and carbamazepine were predominant in the effluent. The total removal in the plants was found in the range of 40.3-68.6%, mainly attributed to biodegradation/biotransformation. Removal of ECs by WWTPs, ranked by a relative removal criterion, followed the order: Biological nutrient removal based plants > WSP > UASB > densadeg-biofor > AO > ASP > combitreat-SBR. The risk assessment showed the risk to algae from antibiotics and triclosan, daphnia from triclosan, and fish from triclosan and hormones.
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Affiliation(s)
- Monika Dubey
- Department of Civil Engineering, Indian Institute of Technology, Roorkee, Roorkee, Uttarakhand, India
| | - Bhanu Prakash Vellanki
- Department of Civil Engineering, Indian Institute of Technology, Roorkee, Roorkee, Uttarakhand, India.
| | - Absar Ahmad Kazmi
- Department of Civil Engineering, Indian Institute of Technology, Roorkee, Roorkee, Uttarakhand, India
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11
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Chatterjee N, Nirwan PK, Srivastava S, Rati R, Sharma L, Sharma P, Dwivedi P, Jaggi N. Trends in carbapenem resistance in Pre-COVID and COVID times in a tertiary care hospital in North India. Ann Clin Microbiol Antimicrob 2023; 22:1. [PMID: 36597098 PMCID: PMC9808733 DOI: 10.1186/s12941-022-00549-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 12/09/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Carbapenem resistance is endemic in the Indian sub-continent. In this study, carbapenem resistance rates and the prevalence of different carbapenemases were determined in Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa during two periods; Pre-COVID (August to October 2019) and COVID (January to February 2021) in a north-Indian tertiary care hospital. METHODS Details of patient demographics and clinical condition was collated from the Hospital Information System and detection of carbapenemases NDM, OXA-48, VIM, IMP and KPC was done by Polymerase chain reaction (PCR) in 152 and 138 non-consecutive carbapenem resistant isolates during the two study periods respectively. Conjugation assay and sequencing of NDM and OXA-48 gene was done on a few selected isolates. RESULTS As compared to Pre-COVID period, co-morbidities and the mortality rates were higher in patients harbouring carbapenem resistant organisms during the COVID period. The overall carbapenem resistance rate for all the four organisms increased from 23 to 41% between the two periods of study; with Pseudomonas aeruginosa and Klebsiella pneumoniae showing significant increase (p < 0.05). OXA-48, NDM and co-expression of NDM and OXA-48 were the most common genotypes detected. NDM-5 and OXA-232 were most common variants of NDM and OXA-48 family respectively during both the study periods. CONCLUSION Higher rate of carbapenem resistance in COVID times could be attributed to increase in number of patients with co-morbidities. However, genetic elements of carbapenem resistance largely remained the same in the two time periods.
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Affiliation(s)
- Nirupama Chatterjee
- grid.464746.30000 0004 1761 4703Education and Research, Artemis Hospitals, Sector-51, Gurugram, Haryana India
| | - Pushpa K. Nirwan
- grid.464746.30000 0004 1761 4703Education and Research, Artemis Hospitals, Sector-51, Gurugram, Haryana India
| | - Shruti Srivastava
- grid.464746.30000 0004 1761 4703Education and Research, Artemis Hospitals, Sector-51, Gurugram, Haryana India
| | - Ruchi Rati
- grid.464746.30000 0004 1761 4703Department of Microbiology, Artemis Hospitals, Sector-51, Gurugram, Haryana India
| | - Lalit Sharma
- grid.464746.30000 0004 1761 4703Department of Microbiology, Artemis Hospitals, Sector-51, Gurugram, Haryana India
| | - Priyanka Sharma
- grid.464746.30000 0004 1761 4703Education and Research, Artemis Hospitals, Sector-51, Gurugram, Haryana India
| | - Priyambada Dwivedi
- grid.464746.30000 0004 1761 4703Education and Research, Artemis Hospitals, Sector-51, Gurugram, Haryana India
| | - Namita Jaggi
- grid.464746.30000 0004 1761 4703Education and Research, Artemis Hospitals, Sector-51, Gurugram, Haryana India
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Bhatt S, Chatterjee S. Fluoroquinolone antibiotics: Occurrence, mode of action, resistance, environmental detection, and remediation - A comprehensive review. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2022; 315:120440. [PMID: 36265724 DOI: 10.1016/j.envpol.2022.120440] [Citation(s) in RCA: 47] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/19/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Antibiotics play an essential role in the medical healthcare world, but their widespread usage and high prevalence have posed negative environmental consequences. During the past few decades, various antibiotic drugs have been detected in aquatic and terrestrial ecosystems. Among them, the Fluoroquinolones (FQ) group is ubiquitous in the environment and has emerged as a major environmental pollutant. FQs are very significant, broad-spectrum antibiotics used in treating various pathogenic diseases of humans and animals. The most known and used FQs are ciprofloxacin, norfloxacin, ofloxacin, levofloxacin, enrofloxacin, danofloxacin, and moxifloxacin. After human and animal administration, about 70% of these drugs are excreted out in unaltered form into the environment. Besides, wastewater discharge from pharmaceutical industries, hospitals, and agriculture runoff is the major contributor to the accumulation of FQs into the ecosystem. Their long-term presence in the environment creates selection pressure on microorganisms and contributes to the emergence of multi-drug-resistant bacteria. In addition to the resistance, these antibiotics also impose ecotoxicological effects on various animals and plant species. The presence of the fluorine atom in Fluoroquinolones makes them highly electronegative, strong, recalcitrant, and less compatible with microbial degradation. Many biological and chemical processes have been invented and successfully implemented during the past few decades for the elimination of these pollutants from the environment. This review provides a detailed overview of the classification, occurrence, distribution, and ecotoxicological effects of Fluoroquinolones. Their modes of action, resistance mechanism, detection and analysis methods, and remediation strategies have also been discussed in detail.
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Affiliation(s)
- Sunidhi Bhatt
- Bioremediation and Metabolomics Research Group, Department of Environmental Sciences, Central University of Himachal Pradesh, Academic Block, Shahpur District, Kangra, Himachal Pradesh, 176206, India
| | - Subhankar Chatterjee
- Bioremediation and Metabolomics Research Group, Department of Environmental Sciences, Central University of Himachal Pradesh, Academic Block, Shahpur District, Kangra, Himachal Pradesh, 176206, India; Bioremediation and Metabolomics Research Group, Dept. of Ecology & Environmental Sciences, School of Life Sciences, Pondicherry University, R.V. Nagar, Kalapet, Puducherry, 605 014, India.
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Muacevic A, Adler JR. Antibiotic Prescription Audits Among Pediatric Outpatients With Acute Ailments in a Secondary Care Hospital During the COVID-19 Omicron Wave in Northern India. Cureus 2022; 14:e32017. [PMID: 36589166 PMCID: PMC9797871 DOI: 10.7759/cureus.32017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background Antibiotics, as defined by the World Health Organization (WHO), are pharmaceuticals used to treat bacterial infections. There is growing recognition that inappropriate antibiotic prescription in children is linked to increasing rates of severe adverse drug events and higher medical expenditures. There are a few prescriptions audit studies from smaller cities in Northern India, especially those conducted during the COVID-19 pandemic when the unregulated private sector accounted for 90% of antibiotic sales and 75% of healthcare requirements. The study objectives were to determine the rate of outpatient antibiotic prescription and adherence to WHO drug indicators in prescriptions to pediatric outpatients in private healthcare facilities in India. Methodology This cross-sectional survey was conducted over three months (January to March 2022) in the outpatient setting of a private pediatric hospital in Kanpur, a city having a population of nearly three million population located in the state of Uttar Pradesh in India. Prescriptions of children aged <10 years with a history of onset of complaint <14 days were included in this audit. Prescriptions were numbered; data were collected using a specially designed semistructured, pretested prescription audit checklist; and the recommended WHO indicators were also calculated. Data were entered using CSPro (U.S. Census Bureau, Washington, DC, USA) and analyzed using STATA 15 (StataCorp LLC, College Station, TX, USA). Results This study observed an antibiotic prescription rate of 65.75%, which was higher than the WHO-recommended value, which might indicate indiscriminate usage of antibiotics in the setting. Out of the 144 antibiotic medications prescribed, none were generic and all the antibiotics were prescribed presumptively. The most commonly prescribed medicines were cefpodoxime, azithromycin, and ofloxacin, which were primarily used to treat cough and stomach infections. Conclusions This antibiotic audit conducted in a private hospital outpatient setting in a city in Northern India during the Omicron wave of the COVID-19 pandemic found nongeneric, predominantly oral, presumptive antibiotic prescriptions in nearly two out of three young pediatric patients. Improvement in prescribing practices through regulation, monitoring, and antibiotic stewardship in low-resource settings is urgently warranted to curb the impending global pandemic of antimicrobial resistance.
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Fazaludeen Koya S, Ganesh S, Selvaraj S, Wirtz VJ, Galea S, Rockers PC. Antibiotic consumption in India: geographical variations and temporal changes between 2011 and 2019. JAC Antimicrob Resist 2022; 4:dlac112. [PMID: 36320447 PMCID: PMC9596537 DOI: 10.1093/jacamr/dlac112] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To describe and compare private sector systemic (J01) antibiotic consumption across Indian states from 2011 to 2019. METHODS We used the nationally representative PharmaTrac dataset to describe the consumption rates in DDD across national, state and state-group [high focus (HF) and non-high focus (nHF)] levels. We used median and IQRs to describe and compare across states and state groups, and relative change and compound annual growth rate (CAGR) to examine temporal changes. RESULTS The annual consumption rate decreased by 3.6% between 2011 and 2019. The share of Access antibiotics decreased (13.1%) and the Access/Watch ratio declined from 0.59 to 0.49. State consumption rates varied widely (HF states reported lower rates) and the inappropriate use increased over the years, especially among HF states. The HF and nHF states showed convergence in the share of the Access and the Access/Watch ratio, while they showed divergence in the use of Discouraged fixed-dose combinations. CONCLUSIONS AND IMPLICATIONS India's private-sector antibiotic consumption rate was lower than global rates. The rates varied across states and appropriateness of use decreased in most states over the years. States with an increase in appropriate use over time could serve as best practice examples. Studies to understand the factors affecting inappropriate use are required alongside improved data systems to monitor the public-sector provision of antibiotics to understand the total consumption.
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Affiliation(s)
| | - Senthil Ganesh
- Public Health Foundation of India, New Delhi, Delhi, India
| | | | | | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
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Koya SF, Ganesh S, Selvaraj S, Wirtz VJ, Galea S, Rockers PC. Consumption of systemic antibiotics in India in 2019. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2022; 4:100025. [PMID: 37383993 PMCID: PMC10305917 DOI: 10.1016/j.lansea.2022.100025] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND Inappropriate use of antibiotics is a significant driver of antibiotic resistance in India. Largely unrestricted over-the-counter sales of most antibiotics, manufacturing and marketing of many fixed-dose combinations (FDC) and overlap in regulatory powers between national and state-level agencies complicate antibiotics availability, sales, and consumption in the country. METHODS We analyzed cross-sectional data from PharmaTrac, a nationally representative private-sector drug sales dataset gathered from a panel of 9000 stockists across India. We used the AWaRe (Access, Watch, Reserve) classification and the defined daily dose (DDD) metrics to calculate the per capita private-sector consumption of systemic antibiotics across different categories: FDCs vs single formulations; approved vs unapproved; and listed vs not listed in the national list of essential medicines (NLEM). FINDINGS The total DDDs consumed in 2019 was 5071 million (10.4 DDD/1000/day). Watch contributed 54.9% (2783 million) DDDs, while Access contributed 27.0% (1370 million). Formulations listed in the NLEM contributed 49.0% (2486 million DDDs); FDCs contributed 34.0% (1722 million), and unapproved formulations contributed 47.1% (2408 million DDDs). Watch antibiotics constituted 72.7% (1750 million DDDs) of unapproved products and combinations discouraged by the WHO constituted 48.7% (836 million DDDs) of FDCs. INTERPRETATION Although the per-capita private-sector consumption rate of antibiotics in India is relatively low compared to many countries, India consumes a large volume of broad-spectrum antibiotics that should ideally be used sparingly. This, together with significant share of FDCs from formulations outside NLEM and a large volume of antibiotics not approved by the central drug regulators, call for significant policy and regulatory reform. FUNDING Not applicable.
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Affiliation(s)
| | - Senthil Ganesh
- Public Health Foundation of India, New Delhi, Delhi, India
| | | | | | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
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Restriction on antimicrobial dispensing without prescription on a national level: Impact on the overall antimicrobial utilization in the community pharmacies in Saudi Arabia. PLoS One 2022; 17:e0271188. [PMID: 35881572 PMCID: PMC9321410 DOI: 10.1371/journal.pone.0271188] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background High rates of non-prescription dispensing of antimicrobials have led to a significant increase in the antimicrobial overuse and misuse in Saudi Arabia (SA). The objective of this study was to evaluate the antimicrobial utilization following the enforcement of a new prescription-only antimicrobial dispensing policy in the community pharmacy setting in SA. Methods Data were extracted from the IQVIA database between May 2017 and May 2019. The antimicrobial utilization rates, based on sales, defined daily dose in grams (DDD), DDD/1000 inhabitants/day (DID), and antimicrobial-claims for the pre-policy (May 2017 to April 2018) and post-policy (June 2018 to May 2019) periods were assessed. Results Overall antimicrobial utilization declined slightly (~9–10%) in the post-policy versus pre-policy period (sales, 31,334 versus 34,492 thousand units; DDD, 183,134 versus 202,936), with higher claims (~16%) after policy implementation. There was a sudden drop in the utilization rate immediately after policy enforcement; however, the values increased subsequently, closely matching the pre-policy values. Utilization patterns were similar in both periods; penicillin was the most used antimicrobial (sales: 11,648–14,700–thousand units; DDD: 71,038–91,227; DID: 2.88–3.78). For both periods, the highest dip in utilization was observed in July (sales: 1,027–1,559 thousand units; DDD: 6,194–9,399), while the highest spike was in March/October (sales: 3,346–3,884 thousand units; DDD: 22,329–19,453). Conclusion Non-prescription antimicrobial utilization reduced minimally following policy implementation in the community pharmacies across SA. Effective implementation of prescription-only regulations is necessary.
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Prinja S, Kumar S, Sharma A, Kar SS, Tripathi N, Dumka N, Sharma S, Mukhopadhyay I, Rana SK, Garg S, Kotwal A, Aggarwal AK. What is the Out-of-Pocket Expenditure on Medicines in India? An Empirical Assessment using a Novel Methodology. Health Policy Plan 2022; 37:1116-1128. [PMID: 35862250 DOI: 10.1093/heapol/czac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 07/09/2022] [Accepted: 07/20/2022] [Indexed: 11/14/2022] Open
Abstract
The share of expenditure on medicines as part of the total out-of-pocket (OOP) expenditure on healthcare services has been reported to be much higher in India than in other countries. This study was conducted to ascertain the extent of this share of medicines expenditure using a novel methodology. OOP expenditure data were collected through exit-interviews with 5252 out-patient department (OPD) patients in three states of India. Follow-up interviews were conducted after day 1 and 15 of the baseline to identify any additional expenditure incurred. In addition, medicine prescription data were collected from the patients through prescription audits. Self-reported expenditure on medicines was compared with the amount imputed using local market prices based on prescription data. The results were also compared with the mean expenditure on medicines per spell of ailment among non-hospitalized cases from National Sample Survey (NSS) 75th round for the corresponding states and districts, which is based on household survey methodology. The share of medicines in OOP expenditure did not change significantly for organized private hospitals using patient-reported versus imputation-based method (30.74% to 29.61%). Large reductions were observed for single-doctor clinics, especially in case of Ayurvedic (64.51% to 36.51%) and Homeopathic (57.53% to 42.74%) practitioners. After adjustment for socio-demographic factors and types of ailments, we found that household data collection as per NSS methodology leads to an increase of 25% and 26% in reported share of medicines for public and private sector out-patient consultations respectively, as compared to facility based exit interviews with imputation of expenditure for medicines as per actual quantity and price data. The nature of health care transactions at single-doctor clinics in rural India leads to an over-reporting of expenditure on medicines by patients. While household surveys are valid to provide total expenditure, these are less likely to correctly estimate the share of medicines expenditure.
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Affiliation(s)
- Shankar Prinja
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Sumit Kumar
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Atul Sharma
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | | | - Neha Dumka
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, New Delhi, India
| | - Sandeep Sharma
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, New Delhi, India
| | - Indranil Mukhopadhyay
- School of Government and Public Policy, OP Jindal Global University, Sonipat, Haryana, India
| | - Saroj Kumar Rana
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Samir Garg
- State Health Resource Centre, Raipur, Chhattisgarh, India
| | - Atul Kotwal
- National Health Systems Resource Centre, Ministry of Health and Family Welfare, New Delhi, India
| | - Arun Kumar Aggarwal
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
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Sulis G, Pradhan R, Kotwani A, Gandra S. India's ban on antimicrobial fixed-dose combinations: winning the battle, losing the war? J Pharm Policy Pract 2022; 15:33. [PMID: 35484606 PMCID: PMC9047325 DOI: 10.1186/s40545-022-00428-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/12/2022] [Indexed: 11/20/2022] Open
Abstract
Background and objectives India, the country with the largest market availability of antimicrobial fixed-dose combinations (FDCs), banned certain antimicrobial FDCs in September 2018. Our objective was to examine the impact of Government ban on the sales of antimicrobial FDCs. Methods The sales patterns of 14 of the 26 banned antimicrobial FDCs were analyzed using monthly private sector drug sales data from IQVIA (a comprehensive and nationally representative drug sales database) between January 2018 and December 2019. We carried out descriptive analyses to evaluate the trend in sales over time for banned and non-banned antimicrobial FDCs using cumulative sales volumes. Results Overall, the cumulative sales volume of banned antimicrobial FDCs declined by 75% between January and September 2018 and the same months of 2019, although some banned FDCs continued to be available in significant volumes. The effectiveness of the ban was offset by several pathways. First, the sales of combinations containing moieties belonging to the same drug-classes as the antimicrobials in the banned FDCs increased after the ban. Second, while certain formulations of particular combinations were banned, the sales of other non-banned formulation of these combinations increased. Third, in some cases, products containing new non-antimicrobial components added to the banned combinations remained available. Interpretation and conclusions While sales of the banned antimicrobial FDCs decreased in 2019, we identified several mechanisms that counterbalanced the ban, including implementation failure, rising sales of congeners, and products with additional non-antimicrobial components. Supplementary Information The online version contains supplementary material available at 10.1186/s40545-022-00428-w.
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Affiliation(s)
- Giorgia Sulis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Richeek Pradhan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Anita Kotwani
- Department of Pharmacology, V. P. Chest Institute, University of Delhi, Delhi, India
| | - Sumanth Gandra
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in Saint Louis, Saint Louis, MO, USA.
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Malik B, Hasan Farooqui H, Bhattacharyya S. Disparity in socio-economic status explains the pattern of self-medication of antibiotics in India: understanding from game-theoretic perspective. ROYAL SOCIETY OPEN SCIENCE 2022; 9:211872. [PMID: 35154800 PMCID: PMC8826305 DOI: 10.1098/rsos.211872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/11/2022] [Indexed: 05/14/2023]
Abstract
The emergence of antimicrobial resistance has raised great concern for public health in many lower-income countries including India. Socio-economic determinants like poverty, health expenditure and awareness accelerate this emergence by influencing individuals' attitudes and healthcare practices such as self-medication. This self-medication practice is highly prevalent in many countries, where antibiotics are available without prescriptions. Thus, complex dynamics of drug- resistance driven by economy, human behaviour, and disease epidemiology poses a serious threat to the community, which has been less emphasized in prior studies. Here, we formulate a game-theoretic model of human choices in self-medication integrating economic growth and disease transmission processes. We show that this adaptive behaviour emerges spontaneously in the population through a self-reinforcing process and continual feedback from the economy, resulting in the emergence of resistance as externalities of human choice under resource constraints situations. We identify that the disparity between social-optimum and individual interest in self-medication is primarily driven by the effectiveness of treatment, health awareness and public health interventions. Frequent multiple-peaks of resistant strains are also observed when individuals imitate others more readily and self-medication is more likely. Our model exemplifies that timely public health intervention for financial risk protection, and antibiotic stewardship policies can improve the epidemiological situation and prevent economic collapse.
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Affiliation(s)
- Bhawna Malik
- Disease Modelling Lab, Mathematics, School of Natural Sciences, Shiv Nadar University, Greater Noida, India
| | - Habib Hasan Farooqui
- Indian Institute of Public Health, Public Health Foundation of India, Delhi, India
- College of Medicine, Qatar University, Doha, Qatar
| | - Samit Bhattacharyya
- Disease Modelling Lab, Mathematics, School of Natural Sciences, Shiv Nadar University, Greater Noida, India
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Phiske M, Kalathil A, Someshwar S. Photoallergic reaction to cephalosporin: Hitherto unreported. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2022. [DOI: 10.4103/ijdd.ijdd_13_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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Haque M, Godman B, Sharma P, Chowdhury K, Kumar S, Bhatt R, Hirani T, Duseja S, Lutfor A, Etando A, Škrbić R, Shahwan M, Jairoun A. A pilot study regarding the consequences of the COVID-19 pandemic on healthcare education in India and the implications. ADVANCES IN HUMAN BIOLOGY 2022. [DOI: 10.4103/aihb.aihb_34_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Paul D, Anto N, Bhardwaj M, Prendiville A, Elangovan R, Bachmann TT, Chanda DD, Bhattacharjee A. Antimicrobial resistance in patients with suspected urinary tract infections in primary care in Assam, India. JAC Antimicrob Resist 2021; 3:dlab164. [PMID: 34917941 PMCID: PMC8669238 DOI: 10.1093/jacamr/dlab164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/24/2021] [Indexed: 01/03/2023] Open
Abstract
Objectives We investigated the prevalence and diversity of antimicrobial resistance in bacteria isolated from urine samples of community-onset urinary tract infection (UTI) patients in southern Assam, India. Methods Freshly voided midstream urine samples were collected from patients attending primary healthcare centres, with the patients’ epidemiological data also recorded. Species identification was confirmed using a VITEK 2 compact automated system. Phenotypic confirmation of ESBLs was performed using the combined disc diffusion method (CLSI 2017) and carbapenemase production was phenotypically characterized using a modified Hodge test. Common ESBLs and carbapenem-resistance mechanisms were determined in Escherichia coli isolates using PCR assays. Incompatibility typing of the conjugable plasmids was determined by PCR-based replicon typing; the phylotypes and MLSTs were also analysed. Results A total of 301 (59.7%) samples showed significant bacteriuria along with symptoms of UTI and among them 103 isolates were identified as E. coli of multiple STs (ST3268, ST3430, ST4671 and others). Among them, 26.2% (27/103) were phenotypically ESBL producers whereas 12.6% (13/103) were carbapenemase producers. This study describes the occurrence of diverse ESBL genes—blaCTX-M-15, blaSHV-148, blaPER-1 and blaTEM—and two E. coli isolates carrying the blaNDM-1 carbapenemase gene. ESBL genes were located within transconjugable plasmids of IncP and IncF type whereas blaNDM-1 was carried in an IncFrepB type plasmid. Conclusions This study illustrates the high rate of MDR in E. coli causing UTI in primary care in rural Assam. UTIs caused by ESBL- or MBL-producing bacteria are very difficult to treat and can often lead to treatment failure. Thus, future research should focus on rapid diagnostics to enable targeted treatment options and reduce the treatment failure likely to occur with commonly prescribed antibiotics, which will help to combat antimicrobial resistance and the burden of UTIs.
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Affiliation(s)
- Deepjyoti Paul
- Department of Microbiology, Assam University, Silchar, India
| | - Nimmy Anto
- Department of Biochemical Engineering and Biotechnology (DBEB), Indian Institute of Technology, Delhi, India
| | - Mohit Bhardwaj
- Department of Biochemical Engineering and Biotechnology (DBEB), Indian Institute of Technology, Delhi, India
| | | | - Ravikrishnan Elangovan
- Department of Biochemical Engineering and Biotechnology (DBEB), Indian Institute of Technology, Delhi, India
| | - Till T Bachmann
- Infection Medicine, Edinburgh Medical School: Biomedical Sciences, The University of Edinburgh, Edinburgh, UK
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Pereira B, Kulkarni S. Antibiotic misuse and improper practices in India: Identifying the scope to improve through a narrative review. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2021; 33:357-364. [PMID: 34924401 DOI: 10.3233/jrs-210020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND In India, antibiotic resistance is high and by 2050, two million people will be affected. OBJECTIVE To review antibiotic practices in India and the variables that impact them. METHODS For this narrative review, research articles on antibiotic awareness, perception and practices were retrieved from PubMed and Google Scholar using search terms such as 'India AND antibiotic use AND cross sectional AND awareness'. A total of 1730 results were found on 30 June 2020, of which 35 articles were eligible for summarizing the common antibiotic practices. RESULTS We found that there are deficiencies in the implementation of existing policies in India. Several issues such as overprescribing of antibiotics, use without prescription and non-adherence to treatment regimens are contributing to irrational antibiotic practices in the country. CONCLUSION There is a need for policies at the institute level to help curb the problem of antibiotic resistance.
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Affiliation(s)
- Brinal Pereira
- Vivekanand Education Society's College of Pharmacy, Mumbai, India
| | - Shruti Kulkarni
- Vivekanand Education Society's College of Pharmacy, Mumbai, India
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de Jesus ET, Moreira AJ, Sá MC, Freschi GPG, Joya MR, Li MS, Paris EC. Potential of Nb 2O 5 nanofibers in photocatalytic degradation of organic pollutants. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:69401-69415. [PMID: 34302247 DOI: 10.1007/s11356-021-15435-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Abstract
Various photocatalytic nanomaterials for environmental remediation have been promoted due to the pollution caused by different organic pollutants. In this study, Nb2O5 nanofibers were obtained by electrospinning technique, presenting controlled crystallinity and high specific surface area to improve the photoactivity response. The structural characterization indicated Nb2O5 nanofibers with orthorhombic phase formation. The photoluminescence measurements showed different energy levels contributing to the electronic transition events. The nanofibers with a bandgap up to 3.6 eV were applied to photocatalysis of dyes (rhodamine B (RhB) or methylene blue (MB)) and fluoxetine (FLX), listed as an emergent pollutant. In the optimized condition (pH = 9), the RhB and MB photocatalysis was 59% and 93% more efficient than photolysis due to ζ = - 50 mV ± 5 for EtOH_550 sample increased interaction with MB (cationic) compared to RhB unprotonated (pKa = 3.7). Therefore, FLX (pKa = 10.7) was selected due to protonated form at pH = 9 and showed 68% ± 1 adsorption in 30 min for EtOH_550. The FLX photocatalytic degradation under UV light irradiation was up to 17% higher than the photolytic degradation. The formation of hydroxyl radicals in the photocatalytic system (EtOH_550) was proven by the Coumarine probe assay, corroborating with the greater amount of α-[2-(methylamino)ethyl]benzylalcohol (MAEB), a by-product obtained after FLX oxidation. Additionally, the material achieved specific catalytic activity for the different organic compounds (RhB, MB, or FLX). Therefore, Nb2O5 nanofibers were efficient for degrading three different pollutants under UV light, proving a viable alternative for environmental remediation.
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Affiliation(s)
- Edson Tobias de Jesus
- Nanotechnology National Laboratory for Agriculture (LNNA), Embrapa Instrumentação, XV de Novembro St., 1452, zip code, São Carlos, SP, 13560-970, Brazil
- Department of Chemistry, Federal University of São Carlos, Rod. Washington Luiz, km 235, zip code, São Carlos, SP, 13565-905, Brazil
- Federal Institute of Education, Science and Technology of Maranhão, Baronesa street, zip code, Alcântara, MA, 65250-000, Brazil
| | - Ailton José Moreira
- Department of Chemistry, Federal University of São Carlos, Rod. Washington Luiz, km 235, zip code, São Carlos, SP, 13565-905, Brazil
- LAFFEQ, Institute of Science and Technology, Federal University of Alfenas, UNIFAL-MG, Poços de Caldas, MG, 37715-400, Brazil
| | - Mayara Coelho Sá
- Nanotechnology National Laboratory for Agriculture (LNNA), Embrapa Instrumentação, XV de Novembro St., 1452, zip code, São Carlos, SP, 13560-970, Brazil
- Department of Chemistry, Federal University of São Carlos, Rod. Washington Luiz, km 235, zip code, São Carlos, SP, 13565-905, Brazil
- Federal Institute of Education, Science and Technology of Maranhão, Baronesa street, zip code, Alcântara, MA, 65250-000, Brazil
| | - Gian Paulo Giovanni Freschi
- LAFFEQ, Institute of Science and Technology, Federal University of Alfenas, UNIFAL-MG, Poços de Caldas, MG, 37715-400, Brazil
| | - Miryam Rincón Joya
- Departamento de Física, Universidad Nacional de Colombia, Calle 45 #30-03, Bogotá, C.P. 111321, Colombia
| | - Maximo Siu Li
- Institute of Physics, University of São Paulo, São Carlos, SP, 13563-120, Brazil
| | - Elaine Cristina Paris
- Nanotechnology National Laboratory for Agriculture (LNNA), Embrapa Instrumentação, XV de Novembro St., 1452, zip code, São Carlos, SP, 13560-970, Brazil.
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Tshering T, Wangda S, Buising K. Trends in antimicrobial consumption in Bhutan. IJID REGIONS 2021; 1:65-71. [PMID: 35757828 PMCID: PMC9216644 DOI: 10.1016/j.ijregi.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/09/2021] [Accepted: 09/26/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Thupten Tshering
- Department of Pharmacy, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
- Corresponding author. Address: Department of Pharmacy, JDWNR Hospital, Menkhang Lam, Thimphu, Bhutan.
| | - Sonam Wangda
- Department of Medical Services, Ministry of Health, Thimphu, Bhutan
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital, Melbourne, Australia
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Identification of Multiple Low-Level Resistance Determinants and Coselection of Motility Impairment upon Sub-MIC Ceftriaxone Exposure in Escherichia coli. mSphere 2021; 6:e0077821. [PMID: 34787446 PMCID: PMC8597738 DOI: 10.1128/msphere.00778-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Resistance to third-generation cephalosporins among Gram-negative bacteria is a rapidly growing public health threat. Among the most commonly used third-generation cephalosporins is ceftriaxone. Bacterial exposure to sublethal or sub-MIC antibiotic concentrations occurs widely, from environmental residues to intermittently at the site of infection. Quality of ceftriaxone is also a concern, especially in low- and middle-income countries, with medicines having inappropriate active pharmaceutical ingredient (API) content or concentration. While focus has been largely on extended-spectrum β-lactamases and high-level resistance, there are limited data on specific chromosomal mutations and other pathways that contribute to ceftriaxone resistance under these conditions. In this work, Escherichia coli cells were exposed to a broad range of sub-MICs of ceftriaxone and mutants were analyzed using whole-genome sequencing. Low-level ceftriaxone resistance emerged after as low as 10% MIC exposure, with the frequency of resistance development increasing with concentration. Genomic analyses of mutants revealed multiple genetic bases. Mutations were enriched in genes associated with porins (envZ, ompF, ompC, and ompR), efflux regulation (marR), and the outer membrane and metabolism (galU and pgm), but none were associated with the ampC β-lactamase. We also observed selection of mgrB mutations. Notably, pleiotropic effects on motility and cell surface were selected for in multiple independent genes, which may have important consequences. Swift low-level resistance development after exposure to low ceftriaxone concentrations may result in reservoirs of bacteria with relevant mutations for survival and increased resistance. Thus, initiatives for broader surveillance of low-level antibiotic resistance and genomic resistance determinants should be pursued when resources are available. IMPORTANCE Ceftriaxone is a widely consumed antibiotic used to treat bacterial infections. Bacteria, however, are increasingly becoming resistant to ceftriaxone. Most work has focused on known mechanisms associated with high-level ceftriaxone resistance. However, bacteria are extensively exposed to low antibiotic concentrations, and there are limited data on the evolution of ceftriaxone resistance under these conditions. In this work, we observed that bacteria quickly developed low-level resistance due to both novel and previously described mutations in multiple different genes upon exposure to low ceftriaxone concentrations. Additionally, exposure also led to changes in motility and the cell surface, which can impact other processes associated with resistance and infection. Notably, low-level-resistant bacteria would be missed in the clinic, which uses set breakpoints. While they may require increased resources, this work supports continued initiatives for broader surveillance of low-level antibiotic resistance or their resistance determinants, which can serve as predictors of higher risk for clinical resistance.
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Kumar H, Sarin E, Saboth P, Jaiswal A, Chaudhary N, Mohanty JS, Bisht N, Tomar SS, Gupta A, Panda R, Patel R, Kumar A, Gupta S, Alwadhi V. Experiences From an Implementation Model of ARI Diagnostic Device in Pneumonia Case Management Among Under-5 Children in Peripheral Healthcare Centers in India. Clin Med Insights Pediatr 2021; 15:11795565211056649. [PMID: 34803419 PMCID: PMC8600550 DOI: 10.1177/11795565211056649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/10/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To address pneumonia, a major killer of under-5 children in India, a multimodal pulse oximeter was implemented in Health and Wellness Centers. Given the evidence of pulse oximetry in effective pneumonia management and taking into account the inadequate skills of front-line healthcare workers in case management, the device was introduced to help them readily diagnose and treat a child and to examine usability of the device. DESIGN The implementation was integrated with the routine OPD of primary health centers for 15 months after healthcare workers were provided with an abridged IMNCI training. Monthly facility data was collected to examine case management with the diagnostic device. Feedback on usefulness of the device was obtained. SETTING Health and Wellness Centers (19) of 7 states were selected in consultation with state National Health Mission based on patient footfall. PARTICIPANTS Under-5 children presenting with ARI symptoms at the OPD. RESULTS Of 4846 children, 0.1% were diagnosed with severe pneumonia and 23% were diagnosed with pneumonia. As per device readings, correct referrals were made of 77.6% of cases of severe pneumonia, and 81% of pneumonia cases were correctly given antibiotics. The Pulse oximeter was highly acceptable among health workers as it helped in timely classification and treatment of pneumonia. It had no maintenance issue and battery was long-lasting. CONCLUSION Pulse oximeter implementation was doable and acceptable among health workers. Together with IMNCI training, PO in primary care settings is a feasible approach to provide equitable care to under-5 children.
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Easy Access to Antibiotics; Spread of Antimicrobial Resistance and Implementation of One Health Approach in India. J Epidemiol Glob Health 2021; 11:444-452. [PMID: 34734384 PMCID: PMC8477994 DOI: 10.1007/s44197-021-00008-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 09/14/2021] [Indexed: 11/01/2022] Open
Abstract
Antimicrobial resistance (AMR) is a global public health concern because of its fast spread. India, one of the world's top consumer of antibiotics and second most populated country has its unique constraints of social, cultural and economic strata. The continual self-medication, use of antibiotics for the growth promotion in animals, and accumulation of residual antibiotics in the environment challenge the implementation of AMR containment policy. Hence, the present review attempts to delineate the influence of antibiotics abuse on the human, animal and environmental health under the realm of one health. It was based on the literature search using public databases to highlight the rapid surge in the burden of AMR in India affecting various sectors and/or ecosystems in India. It was found that the irrational and overuse of antibiotics in different sectors have led to the emergence of extended antimicrobial resistance wherein the environment acts as a reservoir of antibiotic resistance genes (ARGs); completing the cycle of contamination and recontamination. There are efforts by government policy makers to reduce the burden of AMR in the country to reduce the health risks, through the One Health approach. Parallel efforts in educating healthcare professionals, strict legislation for pharmacies and pharmaceutical companies should be prioritize. At the same time surveillance of newly emerged AMR pathogens, prioritising research focusing on AMR, and awareness camps or programs among the local population is critical while addressing the consequences of spared of AMR in India.
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Sri Ranganathan S, Wanigatunge C, Senadheera GPSG, Beneragama BVSH. A national survey of antibacterial consumption in Sri Lanka. PLoS One 2021; 16:e0257424. [PMID: 34520501 PMCID: PMC8439449 DOI: 10.1371/journal.pone.0257424] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/31/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Optimizing the use of antibacterial medicines is an accepted strategy to combat the antibacterial resistance. Availability of reliable antibacterial consumption (ABC) data is a prerequisite to implement this strategy. OBJECTIVES To quantify and describe the national ABC in Sri Lanka and to examine any differences in the consumption between public and private sector. METHODS The methodology for this survey was adapted from World Health Organization (WHO) methodology for a global programme on surveillance of antimicrobial consumption. Aggregate data on national consumption of systemic antibacterials (J01- Anatomical Therapeutic Chemical Classification (ATC) for 2017 were retrospectively extracted from all available data sources and classified using ATC classification. Quantity of consumption was converted to Defined Daily Doses (DDDs). Data are presented as total consumption and comparison between the public and private sector. Selected key quality indicators of ABC were compared between these two sectors. FINDINGS From the available data sources, the total ABC in 2017 was 343.46 million DDDs. Private sector consumption accounted for 246.76 million DDDs compared to 97.96 million DDDs distributed to entire public sector by the Ministry of Health. Beta-lactam-penicillins antibacterial group accounted for 58.79% in public sector compared to 27.48% in private sector while macrolides, quinolones and other beta-lactam antibacterials accounted for 60.51% in the private compared to 28.41% in public sector. Consumption of Reserve group antibacterials was negligible, and limited to private sector. Watch category antibacterials accounted for 46%, 24% and 54% of the total, public and private sector consumption, respectively. CONCLUSIONS A disproportionately higher use of broad spectrum and Watch category antibacterials was observed in the private sector which needs further study. This national consumption survey highlights the need and provides the opening for establishment of ABC surveillance in Sri Lanka.
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Affiliation(s)
| | - Chandanie Wanigatunge
- Department of Pharmacology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Jayewardenepura, Sri Lanka
| | - G. P. S. G. Senadheera
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Sri Jayewardenepura, Sri Lanka
| | - B. V. S. H. Beneragama
- National focal point for combating antimicrobial resistance in Sri Lanka, Ministry of Health, Colombo, Sri Lanka
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Walia K, Gangakhedkar RR. Infectious disease blocks in district hospitals to augment India's resolve to contain antimicrobial resistance. Indian J Med Res 2021; 153:416-420. [PMID: 34380787 PMCID: PMC8354047 DOI: 10.4103/ijmr.ijmr_4031_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kamini Walia
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi 110 029, India
| | - Raman R Gangakhedkar
- Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research, New Delhi 110 029, India
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Panditrao AM, Shafiq N, Chatterjee S, Pathak A, Trivedi N, Sadasivam B, Kshirsagar N, Kaul R, Biswal M, Kakkar A, Malhotra S, Arora P, Talati S, Dhaliwal N, Hazra A, Jhaj R, Najmi A, Pandey N, Chakraverty R, Pathan S, Chauhan J, Mathur A. A multicentre point prevalence survey (PPS) of antimicrobial use amongst admitted patients in tertiary care centres in India. J Antimicrob Chemother 2021; 76:1094-1101. [PMID: 34244744 DOI: 10.1093/jac/dkaa533] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 11/23/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Data from point prevalence surveys (PPSs) in India are scarce. Conducting PPSs is especially challenging in the absence of electronic medical records, a lack of dedicated resources and a high patient load in resource-poor settings. This multicentre survey was conducted to provide background data for planning and strengthening antimicrobial stewardship programmes across the country. METHODS This inpatient PPS was conducted over 2 weeks in May 2019 simultaneously across five study centres in India. Data about patient characteristics, indications for antimicrobials use and details of each antimicrobial prescribed including supportive investigation reports were collected in predesigned forms. RESULTS A total of 3473 admitted patients in wards and ICUs were covered across five study centres. Of these, 1747 (50.3%) patients were on antimicrobials, with 46.9% patients being on two or more antimicrobials. Out of the total antimicrobials prescribed, 40.2% of the antimicrobials were prescribed for community-acquired infection requiring hospitalization followed by surgical prophylaxis (32.6%). Third-generation cephalosporins and drugs from the 'Watch' category were prescribed most commonly. Only 22.8% of the antimicrobials were based on microbiology reports. CONCLUSIONS The survey demonstrated a high use of antimicrobials in admitted patients with a considerable proportion of drugs from the 'Watch' category. The targets for interventions that emerged from the survey were: improving surgical prophylaxis, decreasing double anaerobic cover, initiating culture of sending cultures and de-escalation with targeted therapy.
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Affiliation(s)
- Aditi M Panditrao
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nusrat Shafiq
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Suparna Chatterjee
- Institute of Post Graduate Medical Education and Research (IPGMER), Kolkata, West Bengal, India
| | - Ashish Pathak
- Ruxmaniben Deepchand Gardi Medical College (RDGMC), Ujjain, Madhya Pradesh, India
| | - Niyati Trivedi
- Government Medical College and Hospital (GMC), Vadodara, Gujarat, India
| | | | | | - Rajni Kaul
- Indian Council of Medical Research, New Delhi, India
| | - Manisha Biswal
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashish Kakkar
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Samir Malhotra
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj Arora
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shweta Talati
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Navneet Dhaliwal
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Avijit Hazra
- Institute of Post Graduate Medical Education and Research (IPGMER), Kolkata, West Bengal, India
| | - Ratinder Jhaj
- All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Ahmad Najmi
- Government Medical College and Hospital (GMC), Vadodara, Gujarat, India
| | - Navin Pandey
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Raja Chakraverty
- Institute of Post Graduate Medical Education and Research (IPGMER), Kolkata, West Bengal, India
| | - Saman Pathan
- All India Institute of Medical Sciences (AIIMS), Bhopal, Madhya Pradesh, India
| | - Janki Chauhan
- Government Medical College and Hospital (GMC), Vadodara, Gujarat, India
| | - Aditya Mathur
- Ruxmaniben Deepchand Gardi Medical College (RDGMC), Ujjain, Madhya Pradesh, India
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Chandra P, Mk U, Ke V, Mukhopadhyay C, U DA, M SR, V R. Antimicrobial resistance and the post antibiotic era: better late than never effort. Expert Opin Drug Saf 2021; 20:1375-1390. [PMID: 33999733 DOI: 10.1080/14740338.2021.1928633] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction: Antimicrobial resistance (AMR) is a multi-layered problem with a calamitous impact on humans, livestock, the environment, and the biosphere. Initiatives and action plan to preclude AMR remain poorly implemented in India.Area covered: This review highlights essential factors contributing to AMR, epidemiology of the resistant bacteria, current treatment options, economic impact, and regulatory efforts initiated by the Indian government to tackle AMR.Expert opinion: Health-care professionals, hospitals, and the general public must understand and cooperatively implement the 'One Health approach,' which entails judicious use of antibiotics in humans, animals, and the environment. Neglecting the AMR problem predicts the expansion of the 'Post-antibiotic era' characterized by drying antibiotic discovery pipelines, overuse of 'Watch' and 'Reserve' groups, coupled with underuse of 'Access' antibiotics, increased daily defined doses, increased healthcare cost, rise in morbidity, mortality, and environmental degradation. The Indian case study elucidates a looming international crisis that demands global attention and commitment for envisaging and implementing locally relevant solutions.
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Affiliation(s)
- Prashant Chandra
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Unnikrishnan Mk
- Department of Pharmacy Practice, NGSM Institute of Pharmaceutical Sciences, Nitte University, Deralakatte, Mangaluru, Karnataka, India
| | - Vandana Ke
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dinesh Acharya U
- Department of Computer Science & Engineering, Manipal Institute of Technology Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Surulivel Rajan M
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajesh V
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Allwell-Brown G, Hussain-Alkhateeb L, Sewe MO, Kitutu FE, Strömdahl S, Mårtensson A, Johansson EW. Determinants of trends in reported antibiotic use among sick children under five years of age across low-income and middle-income countries in 2005-17: A systematic analysis of user characteristics based on 132 national surveys from 73 countries. Int J Infect Dis 2021; 108:473-482. [PMID: 34058373 DOI: 10.1016/j.ijid.2021.05.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/26/2021] [Accepted: 05/21/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES This study aimed to analyze any reported antibiotic use for children aged <5 years with fever, diarrhea or cough with fast or difficult breathing (outcome) from low-income and middle-income countries (LMICs) during 2005-2017 by user characteristics: rural/urban residence, maternal education, household wealth, and healthcare source visited. METHODS Based on 132 demographic and health surveys and multiple indicator cluster surveys from 73 LMICs, the outcome by user characteristics for all country-years was estimated using a hierarchical Bayesian linear regression model. RESULTS Across LMICs during 2005-2017, the greatest relative increases in the outcome occurred in rural areas, poorest quintiles and least educated populations, particularly in low-income countries and South-East Asia. In low-income countries, rural areas had a 72% relative increase from 17.8% (Uncertainty Interval (UI): 5.2%-44.9%) in 2005 to 30.6% (11.7%-62.1%) in 2017, compared to a 29% relative increase in urban areas from 27.1% (8.7%-58.2%) in 2005 to 34.9% (13.3%-67.3%) in 2017. Despite these increases, the outcome was consistently highest in urban areas, wealthiest quintiles, and populations with the highest maternal education. CONCLUSION These estimates suggest that the increasing reported antibiotic use for sick children aged <5 years in LMICs during 2005-2017 was driven by gains among groups often underserved by formal health services.
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Affiliation(s)
- Gbemisola Allwell-Brown
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85 Uppsala, Sweden.
| | - Laith Hussain-Alkhateeb
- Global Health, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden
| | - Maquins Odhiambo Sewe
- Department of Public Health and Clinical Medicine, Sustainable Health Section, Umeå University, SE-901 87, Umeå, Sweden
| | - Freddy Eric Kitutu
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85 Uppsala, Sweden; Sustainable Pharmaceutical Systems (SPS) Unit, Department of Pharmacy, School of Health Sciences, Makerere University, PO Box 7072, Kampala, Uganda
| | - Susanne Strömdahl
- Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, SE-751 85 Uppsala, Sweden
| | - Andreas Mårtensson
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85 Uppsala, Sweden
| | - Emily White Johansson
- Department of Women's and Children's Health, International Maternal and Child Health (IMCH), Uppsala University, SE-751 85 Uppsala, Sweden
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Date K, Shimpi R, Luby S, N R, Haldar P, Katkar A, Wannemuehler K, Mogasale V, Pallas S, Song D, Kunwar A, Loharikar A, Yewale V, Ahmed D, Horng L, Wilhelm E, Bahl S, Harvey P, Dutta S, Bhatnagar P. Decision Making and Implementation of the First Public Sector Introduction of Typhoid Conjugate Vaccine-Navi Mumbai, India, 2018. Clin Infect Dis 2021; 71:S172-S178. [PMID: 32725235 DOI: 10.1093/cid/ciaa597] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Typhoid fever prevention and control efforts are critical in an era of rising antimicrobial resistance among typhoid pathogens. India remains one of the highest typhoid disease burden countries, although a highly efficacious typhoid conjugate vaccine (TCV), prequalified by the World Health Organization in 2017, has been available since 2013. In 2018, the Navi Mumbai Municipal Corporation (NMMC) introduced TCV into its immunization program, targeting children aged 9 months to 14 years in 11 of 22 areas (Phase 1 campaign). We describe the decision making, implementation, and delivery costing to inform TCV use in other settings. METHODS We collected information on the decision making and campaign implementation in addition to administrative coverage from NMMC and partners. We then used a microcosting approach from the local government (NMMC) perspective, using a new Microsoft Excel-based tool to estimate the financial and economic vaccination campaign costs. RESULTS The planning and implementation of the campaign were led by NMMC with support from multiple partners. A fixed-post campaign was conducted during weekends and public holidays in July-August 2018 which achieved an administrative vaccination coverage of 71% (ranging from 46% in high-income to 92% in low-income areas). Not including vaccine and vaccination supplies, the average financial cost and economic cost per dose of TCV delivery were $0.45 and $1.42, respectively. CONCLUSION The first public sector TCV campaign was successfully implemented by NMMC, with high administrative coverage in slums and low-income areas. Delivery cost estimates provide important inputs to evaluate the cost-effectiveness and affordability of TCV vaccination through public sector preventive campaigns.
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Affiliation(s)
- Kashmira Date
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rahul Shimpi
- World Health Organization, India Country Office, New Delhi, India
| | | | - Ramaswami N
- Navi Mumbai Municipal Corporation, Navi Mumbai, India
| | - Pradeep Haldar
- Ministry of Health and Family Welfare, Government of India, India
| | - Arun Katkar
- World Health Organization, India Country Office, New Delhi, India
| | - Kathleen Wannemuehler
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Sarah Pallas
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Dayoung Song
- International Vaccine Institute, Republic of Korea
| | - Abhishek Kunwar
- World Health Organization, India Country Office, New Delhi, India
| | - Anagha Loharikar
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Vijay Yewale
- Dr. Yewale Multispecialty Hospital, Navi Mumbai, India
| | - Danish Ahmed
- World Health Organization, India Country Office, New Delhi, India
| | - Lily Horng
- Stanford University, Stanford, California, USA
| | - Elisabeth Wilhelm
- Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sunil Bahl
- World Health Organization, Regional Office for South-East Asia, New Delhi, India
| | - Pauline Harvey
- World Health Organization, India Country Office, New Delhi, India
| | - Shanta Dutta
- National Institute of Cholera and Enteric Diseases-Indian Council for Medical Research, Kolkata, India
| | - Pankaj Bhatnagar
- World Health Organization, India Country Office, New Delhi, India
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Roy S, Chatterjee S, Bhattacharjee A, Chattopadhyay P, Saha B, Dutta S, Basu S. Overexpression of Efflux Pumps, Mutations in the Pumps' Regulators, Chromosomal Mutations, and AAC(6')-Ib-cr Are Associated With Fluoroquinolone Resistance in Diverse Sequence Types of Neonatal Septicaemic Acinetobacter baumannii: A 7-Year Single Center Study. Front Microbiol 2021; 12:602724. [PMID: 33776950 PMCID: PMC7990795 DOI: 10.3389/fmicb.2021.602724] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/21/2021] [Indexed: 12/16/2022] Open
Abstract
This study investigates susceptibility toward three fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin), multiple fluoroquinolone-resistance mechanisms, and epidemiological relationship of neonatal septicaemic Acinetobacter baumannii. Previous studies on fluoroquinolone resistance in A. baumannii focused primarily on ciprofloxacin susceptibility and assessed a particular mechanism of resistance; a more holistic approach was taken here. Epidemiological relationship was evaluated by Multi Locus Sequence Typing. Minimum Inhibitory Concentrations of fluoroquinolones was determined with and without efflux pump inhibitors. Overexpression of efflux pumps, resistance-nodulation-cell-division (RND)-type, and multidrug and toxic compound extrusion (MATE)-type efflux pumps were evaluated by reverse transcriptase-qPCR. Mutations within regulatory proteins (AdeRS, AdeN, and AdeL) of RND-pumps were examined. Chromosomal mutations, presence of qnr and aac(6′)-Ib-cr were investigated. A. baumannii were highly diverse as 24 sequence-types with seven novel STs (ST-1440/ST-1441/ST-1481/ST-1482/ST-1483/ST-1484/ST-1486) were identified among 47 A. baumannii. High resistance to ciprofloxacin (96%), levofloxacin (92%), and particularly moxifloxacin (90%) was observed, with multiple mechanisms being active. Resistance to 4th generation fluoroquinolone (moxifloxacin) in neonatal isolates is worrisome. Mutations within GyrA (S83L) and ParC (S80L) were detected in more than 90% of fluoroquinolone-resistant A. baumannii (FQRAB) spread across 10 different clonal complexes (CC1/CC2/CC10/CC25/CC32/CC126/CC149/CC216/CC218/CC513). Efflux-based FQ resistance was found in 65% of FQRAB with ≥2 different active pumps in 38% of strains. Overexpression of adeB was highest (2.2−34-folds) followed by adeJ, adeG, and abeM. Amino acid changes in the regulators (AdeRS/AdeN/AdeL) either as single or multiple substitutions substantiated the overexpression of the pumps. Diverse mutations within AdeRS were detected among different CCs whereas mutations within AdeN linked to CC10 and CC32. Chromosomal mutations and active efflux pumps were detected simultaneously among 64% of FQRAB. Presence of aac(6′)-Ib-cr was also high (74% of FQRAB) but qnrS were absent. As most FQRABs had chromosomal mutations, this was considered predominant, however, isolates where pumps were also active had higher MIC values, establishing the critical role of the efflux pumps. The high variability of FQ susceptibility among FQRAB, possessing the same set of mutations in gyrA, parC, and efflux pump regulators, was also noted. This reveals the complexity of interpreting the interplay of multiple resistance mechanisms in A. baumannii.
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Affiliation(s)
- Subhasree Roy
- Division of Bacteriology, Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Somdatta Chatterjee
- Division of Bacteriology, Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Amrita Bhattacharjee
- Division of Bacteriology, Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Pinaki Chattopadhyay
- Department of Neonatology, Institute of Post-Graduate Medical Education and Research, Kolkata, India
| | - Bijan Saha
- Department of Neonatology, Institute of Post-Graduate Medical Education and Research, Kolkata, India
| | - Shanta Dutta
- Division of Bacteriology, Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Sulagna Basu
- Division of Bacteriology, Indian Council of Medical Research (ICMR)-National Institute of Cholera and Enteric Diseases, Kolkata, India
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Imchen M, Kumavath R. Shotgun metagenomics reveals a heterogeneous prokaryotic community and a wide array of antibiotic resistance genes in mangrove sediment. FEMS Microbiol Ecol 2021; 96:5897355. [PMID: 32845305 DOI: 10.1093/femsec/fiaa173] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 08/18/2020] [Indexed: 12/20/2022] Open
Abstract
Saline tolerant mangrove forests partake in vital biogeochemical cycles. However, they are endangered due to deforestation as a result of urbanization. In this study, we have carried out a metagenomic snapshot of the mangrove ecosystem from five countries to assess its taxonomic, functional and antibiotic resistome structure. Chao1 alpha diversity varied significantly (P < 0.001) between the countries (Brazil, Saudi Arabia, China, India and Malaysia). All datasets were composed of 33 phyla dominated by eight major phyla covering >90% relative abundance. Comparative analysis of mangrove with terrestrial and marine ecosystems revealed the strongest heterogeneity in the mangrove microbial community. We also observed that the mangrove community shared similarities to both the terrestrial and marine microbiome, forming a link between the two contrasting ecosystems. The antibiotic resistant genes (ARG) resistome was comprised of nineteen level 3 classifications dominated by multidrug resistance efflux pumps (46.7 ± 4.3%) and BlaR1 family regulatory sensor-transducer disambiguation (25.2 ± 4.8%). ARG relative abundance was significantly higher in Asian countries and in human intervention datasets at a global scale. Our study shows that the mangrove microbial community and its antibiotic resistance are affected by geography as well as human intervention and are unique to the mangrove ecosystem. Understanding changes in the mangrove microbiome and its ARG is significant for sustainable development and public health.
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Affiliation(s)
- Madangchanok Imchen
- Department of Genomic Science, School of Biological Sciences, Central University of Kerala, Tejaswini Hills, Periya (P.O) Kasaragod, Kerala-671320, India
| | - Ranjith Kumavath
- Department of Genomic Science, School of Biological Sciences, Central University of Kerala, Tejaswini Hills, Periya (P.O) Kasaragod, Kerala-671320, India
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Schueller E, Nandi A, Joshi J, Laxminarayan R, Klein EY. Associations between private vaccine and antimicrobial consumption across Indian states, 2009-2017. Ann N Y Acad Sci 2021; 1494:31-43. [PMID: 33547650 PMCID: PMC8248118 DOI: 10.1111/nyas.14571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 01/19/2021] [Accepted: 01/21/2021] [Indexed: 12/29/2022]
Abstract
Vaccines can reduce antibiotic use and, consequently, antimicrobial resistance by averting vaccine-preventable and secondary infections. We estimated the associations between private vaccine and antibiotic consumption across Indian states during 2009-2017 using monthly and annual consumption data from IQVIA and employed fixed-effects regression and the Arellano-Bond Generalized Method of Moments (GMM) model for panel data regression, which controlled for income and public sector vaccine use indicators obtained from other sources. In the annual data fixed-effects model, a 1% increase in private vaccine consumption per 1000 under-5 children was associated with a 0.22% increase in antibiotic consumption per 1000 people (P < 0.001). In the annual data GMM model, a 1% increase in private vaccine consumption per 1000 under-5 children was associated with a 0.2% increase in private antibiotic consumption (P < 0.001). In the monthly data GMM model, private vaccine consumption was negatively associated with antibiotic consumption when 32, 34, 35, and 44-47 months had elapsed after vaccine consumption, with a positive association with lags of fewer than 18 months. These results indicate vaccine-induced longer-term reductions in antibiotic use in India, similar to findings of studies from other low- and middle-income countries.
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Affiliation(s)
- Emily Schueller
- Center for Disease Dynamics, Economics & Policy, Silver Spring, Maryland
| | - Arindam Nandi
- Center for Disease Dynamics, Economics & Policy, Silver Spring, Maryland
| | - Jyoti Joshi
- Center for Disease Dynamics, Economics & Policy, New Delhi, India.,Amity Institute of Public Health, Amity University, Noida, Uttar Pradesh, India
| | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, New Delhi, India.,Princeton Environmental Institute, Princeton University, Princeton, New Jersey
| | - Eili Y Klein
- Center for Disease Dynamics, Economics & Policy, Silver Spring, Maryland.,Department of Emergency Medicine, Johns Hopkins School of Medicine, and Department of Epidemiology, Johns Hopkins Bloomberg School of Epidemiology, Baltimore, Maryland
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Haque M, Kumar S, Charan J, Bhatt R, Islam S, Dutta S, Abhayanand JP, Sharma Y, Sefah I, Kurdi A, Wale J, Godman B. Utilisation, Availability and Price Changes of Medicines and Protection Equipment for COVID-19 Among Selected Regions in India: Findings and Implications. Front Pharmacol 2021; 11:582154. [PMID: 33628172 PMCID: PMC7898674 DOI: 10.3389/fphar.2020.582154] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/14/2020] [Indexed: 12/12/2022] Open
Abstract
Background: COVID-19 has already claimed a considerable number of lives worldwide. However, there are concerns with treatment recommendations given the extent of conflicting results with suggested treatments and misinformation, some of which has resulted in increased prices and shortages alongside increasing use and prices of personal protective equipment (PPE). This is a concern in countries such as India where there have been high patient co-payments and an appreciable number of families going into poverty when members become ill. However, balanced against pricing controls. Community pharmacists play a significant role in disease management in India, and this will remain. Consequently, there is a need to review prices and availability of pertinent medicines during the early stages of the COVID-19 pandemic in India to provide future direction. Objective: Assess current utilisation and price changes as well as shortages of pertinent medicines and equipment during the early stages of the pandemic. Our Approach: Multiple approach involving a review of treatments and ongoing activities across India to reduce the spread of the virus alongside questioning pharmacies in selected cities from early March to end May 2020. Our Activities: 111 pharmacies took part, giving a response rate of 80%. Encouragingly, no change in utilisation of antimalarial medicines in 45% of pharmacies despite endorsements and for antibiotics in 57.7% of pharmacies, helped by increasing need for a prescription for dispensing. In addition, increased purchasing of PPE (over 98%). No price increases were seen for antimalarials and antibiotics in 83.8 and 91.9% of pharmacies respectively although shortages were seen for antimalarials in 70.3% of pharmacies, lower for antibiotics (9.9% of pharmacies). However, price increases were typically seen for PPE (over 90% of stores) as well as for analgesics (over 50% of pharmacies). Shortages were also seen for PPE (88.3%). Conclusion: The pandemic has impacted on utilisation and prices of pertinent medicines and PPE in India but moderated by increased scrutiny. Key stakeholder groups can play a role with enhancing evidenced-based approaches and reducing inappropriate purchasing in the future.
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Affiliation(s)
- Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, India
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Rohan Bhatt
- Department of Pediatric Dentistry, Karnavati University, Gandhinagar, India
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Bangladesh
| | - Siddhartha Dutta
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, India
| | | | - Yesh Sharma
- Department of Conservative Dentistry and Endodontics, Rajasthan University of Health Sciences, Jaipur, India
| | - Israel Sefah
- Pharmacy Department, Ghana Health Service, Keta Municipal Hospital, Keta-Dzelukope, Ghana
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Singh A, Sahoo A, Dhaneria S, Thangraju P, Gupta D. Evaluation of anti-microbial usage using world health organization-anatomical therapeutic chemical methodology in tertiary care teaching hospital of Central India: A cross-sectional study. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2021. [DOI: 10.4103/amhs.amhs_299_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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40
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Shyam S, Jaiswal S, Jayabalan A, Shergill SPS. A survey of out patient department prescriptions of selected departments of a tertiary care hospital on treatment practices of infections. MULLER JOURNAL OF MEDICAL SCIENCES AND RESEARCH 2021. [DOI: 10.4103/mjmsr.mjmsr_44_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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41
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Godman B, Haque M, Islam S, Iqbal S, Urmi UL, Kamal ZM, Shuvo SA, Rahman A, Kamal M, Haque M, Jahan I, Islam MZ, Hossain MM, Munzur-E-Murshid, Kumar S, Charan J, Bhatt R, Dutta S, Abhayanand JP, Sharma Y, Saleem Z, Phuong TNT, Kwon HY, Kurdi A, Wale J, Sefah I. Rapid Assessment of Price Instability and Paucity of Medicines and Protection for COVID-19 Across Asia: Findings and Public Health Implications for the Future. Front Public Health 2020; 8:585832. [PMID: 33381485 PMCID: PMC7767884 DOI: 10.3389/fpubh.2020.585832] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/15/2020] [Indexed: 12/15/2022] Open
Abstract
Background: Countries have introduced a variety of measures to prevent and treat COVID-19 with medicines and personal protective equipment (PPE), with some countries adopting preventative strategies earlier than others. However, there has been considerable controversy surrounding some treatments. This includes hydroxychloroquine where the initial hype and misinformation lead to shortages, price rises and suicides. Price rises and shortages have also been seen for PPE. Such activities can have catastrophic effects on patients where there are high co-payment levels and issues of affordability. Consequently, there is a need to investigate this further. Objective: Assess changes in the availability, utilization and prices of relevant medicines and PPE during the pandemic among a range of Asian countries. Our approach: Narrative literature review combined with interviews among community pharmacists to assess changes in consumption, prices and shortages of medicines and PPE from the beginning of March 2020 until end of May 2020. In addition, suggestions on ways to reduce misinformation. Results: 308 pharmacists took part from five Asian countries. There was an appreciable increase in the utilization of antimicrobials in Pakistan (in over 88% of pharmacies), with lower increases or no change in Bangladesh, India, Malaysia and Vietnam. Encouragingly, there was increased use of vitamins/immune boosters and PPE across the countries, as well as limited price rises for antimicrobials in India, Malaysia and Vietnam, although greater price rises seen for analgesics and vitamin C/immune boosters. Appreciable price increases were also seen for PPE across some countries. Conclusion: Encouraging to see increases in utilization of vitamins/immune boosters and PPE. However, increases in the utilization and prices of antimicrobials is a concern that needs addressing alongside misinformation and any unintended consequences from the pandemic. Community pharmacists can play a key role in providing evidence-based advice, helping to moderate prices, as well as helping address some of the unintended consequences of the pandemic.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Samiul Iqbal
- Department of Orthodontics, Faculty of Dentistry, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Umme Laila Urmi
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Zubair Mahmood Kamal
- Integrated Sleep Disorders Center, McGuire VAMC/VCU Health, Richmond, VA, United States
| | | | - Aminur Rahman
- Finance & Account Division, Grameen Euglena, Dhaka, Bangladesh
| | - Mustafa Kamal
- Al-Manar Hospital Ltd., Modern Hospital Cumilla Ltd., Dhaka, Bangladesh
| | - Monami Haque
- Human Resource Department, Square Toiletries Limited, Rupayan Center, Dhaka, Bangladesh
| | - Iffat Jahan
- Department of Physiology, Eastern Medical College, Comilla, Bangladesh
| | - Md. Zakirul Islam
- Department of Pharmacology, Eastern Medical College, Comilla, Bangladesh
| | | | - Munzur-E-Murshid
- WISH2ACTION Project, Handicap International, Kurigram, Bangladesh
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar, India
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | - Rohan Bhatt
- Department of Pediatric Dentistry, Karnavati University, Gandhinagar, India
| | - Siddhartha Dutta
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Yesh Sharma
- Department of Conservative Dentistry and Endodontics, Rajasthan University of Health Sciences, Jaipur, India
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Thuy Nguyen Thi Phuong
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Hye-Young Kwon
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- College of Pharmacy, Seoul National University, Seoul, South Korea
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Janney Wale
- Independent Consumer Advocate, Brunswick, VIC, Australia
| | - Israel Sefah
- Ghana Health Service, Keta Municipal Hospital, Pharmacy Department, Keta, Ghana
- University of Health and Allied Sciences, School of Pharmacy, Pharmacy Practice Department, Volta Region, Ghana
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42
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Gyssens IC, Wertheim HF. Editorial: Antimicrobial Stewardship in Low- and Middle-Income Countries. Front Public Health 2020; 8:617000. [PMID: 33344409 PMCID: PMC7738324 DOI: 10.3389/fpubh.2020.617000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/10/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Inge C. Gyssens
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Nijmegen, Netherlands
- Faculty of Medicine and Health Sciences, Hasselt University, Hasselt, Belgium
| | - Heiman F. Wertheim
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Nijmegen, Netherlands
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Bhattarai D, Gupta A, Vignesh P, Rao H, Angrup A, Rawat A. Infection Due to Serratia sp. in Chronic Granulomatous Disease-Is the Incidence Low in Tropical Countries? J Clin Immunol 2020; 41:486-490. [PMID: 33216270 DOI: 10.1007/s10875-020-00919-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/12/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Dharmagat Bhattarai
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, PGIMER, Chandigarh, 160012, India
| | - Aman Gupta
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, PGIMER, Chandigarh, 160012, India
| | - Pandiarajan Vignesh
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, PGIMER, Chandigarh, 160012, India.
| | - Hitender Rao
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, PGIMER, Chandigarh, 160012, India
| | - Archana Angrup
- Department of Microbiology, Post Graduate Institute of Medical Education & Research, PGIMER, Chandigarh, 160012, India
| | - Amit Rawat
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education & Research, PGIMER, Chandigarh, 160012, India
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Farooqui HH, Selvaraj S, Mehta A, Mathur MR. The impact of stringent prescription-only antimicrobial sale regulation (Schedule H1) in India: an interrupted time series analysis, 2008-18. JAC Antimicrob Resist 2020; 2:dlaa076. [PMID: 34223031 PMCID: PMC8210317 DOI: 10.1093/jacamr/dlaa076] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/02/2020] [Indexed: 12/25/2022] Open
Abstract
Objectives To assess the impact of Schedule H1 regulation notified and implemented in 2014 under the amended rules of the Drugs and Cosmetics Act (DCA), 1940 on the sale of antimicrobials in the private sector in India. Methods The dataset was obtained from the Indian pharmaceutical sales database, PharmaTrac. The outcome measure was the sales volume of antimicrobials in standard units (SUs). A quasi-experimental research design—interrupted time series analysis—was used to detect the impact of the intervention. Results We observed a substantial rise in antimicrobial consumption during 2008–18 in the private sector in India, both for antimicrobials regulated under Schedule H1 as well as outside the regulation. Key results suggested that post-intervention there was an immediate reduction (level change) in use of Schedule H1 antimicrobials by 10% (P = 0.007), followed by a sustained decline (trend change) in utilization by 9% (P > 0.000) compared with the pre-intervention trend. Segregated analysis on different antimicrobial classes suggests a sharp drop (level changes) and sustained decline (trend changes) in utilization post-intervention compared with the pre-intervention trend. Our findings remained robust on carrying out sensitivity analysis with the oral anti-diabetics market as a control. Post-intervention, the average monthly difference between antimicrobials under Schedule H1 and the control group witnessed an immediate increase of 16.3% (P = 0.10) followed by a sustained reduction of 0.5% (P = 0.13) compared with the pre-intervention scenario. Conclusions Though the regulation had a positive impact in terms of reducing sales of antimicrobials notified under the regulation, optimizing the effectiveness of such stand-alone policies will be limited unless accompanied by a broader set of interventions.
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Affiliation(s)
- Habib Hasan Farooqui
- Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram 122001, India
| | - Sakthivel Selvaraj
- Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram 122001, India
| | - Aashna Mehta
- Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram 122001, India
| | - Manu Raj Mathur
- University of Liverpool, Room B123, Waterhouse Building, Brownlow Street, Liverpool L69 3GL, UK
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Arun S, Kumar RM, Ruppa J, Mukhopadhyay M, Ilango K, Chakraborty P. Occurrence, sources and risk assessment of fluoroquinolones in dumpsite soil and sewage sludge from Chennai, India. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2020; 79:103410. [PMID: 32422279 DOI: 10.1016/j.etap.2020.103410] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/07/2020] [Accepted: 05/10/2020] [Indexed: 05/16/2023]
Abstract
Soil and sludge are major reservoirs of organic compounds such as fluoroquinolones (FQs) which are broad-spectrum antibacterial agents. Hence, we monitored three major FQs, namely, ciprofloxacin (CIP), norfloxacin (NOR), and ofloxacin (OFL), in surface soil from two major dumpsites and dry and wet sludge from sewage treatment plants in Chennai city. The mean concentration of FQs in soil and sludge samples were 20 μg/g and 26 μg/g, respectively. Nearly 50% of the total FQs in dumpsite soil was contributed by CIP followed by NOR (32%) and OFL (13%). Similarly, CIP was the major contributor in sludge samples followed by NOR and OFL. The concentration of FQs was two folds higher in wet sludge than dry sludge most likely indicating that water solubility of these compounds might play an important role for elevated level of FQs in wet sludge. Solid waste from pharmaceutical industries, households, and sludge from wastewater treatment plants were expected to be the major source of FQs in dumpsite soil. Predicted risk assessment using soil to water migration concentrations via surface run off indicated high risk to aquatic organisms. However, risk quotient (RQ) was found less to earthworm in most of the soil samples. The findings from this study might help in future policies on disposal of household antibiotics in the solid waste stream.
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Affiliation(s)
- Sija Arun
- Department of Civil Engineering, SRM Institute of Science and Technology, Kattankulathur, 603 203 Tamil Nadu, India
| | - R Mohan Kumar
- Interdisciplinary Institute of Indian System of Medicine(IIISM), SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu 603 203, India
| | - Jairaj Ruppa
- Department of Civil Engineering, SRM Institute of Science and Technology, Kattankulathur, 603 203 Tamil Nadu, India
| | - Moitraiyee Mukhopadhyay
- Department of Civil Engineering, SRM Institute of Science and Technology, Kattankulathur, 603 203 Tamil Nadu, India
| | - K Ilango
- Interdisciplinary Institute of Indian System of Medicine(IIISM), SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu 603 203, India; Department of Pharmaceutical Chemistry, SRM College of Pharmacy, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu 603 203, India
| | - Paromita Chakraborty
- Department of Civil Engineering, SRM Institute of Science and Technology, Kattankulathur, 603 203 Tamil Nadu, India; SRM Research Institute, SRM Institute of Science and Technology, Kattankulathur, Tamil Nadu, 603 203 India.
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Peiffer-Smadja N, Poda A, Ouedraogo AS, Guiard-Schmid JB, Delory T, Le Bel J, Bouvet E, Lariven S, Jeanmougin P, Ahmad R, Lescure FX. Paving the Way for the Implementation of a Decision Support System for Antibiotic Prescribing in Primary Care in West Africa: Preimplementation and Co-Design Workshop With Physicians. J Med Internet Res 2020; 22:e17940. [PMID: 32442155 PMCID: PMC7400049 DOI: 10.2196/17940] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/13/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
Background Suboptimal use of antibiotics is a driver of antimicrobial resistance (AMR). Clinical decision support systems (CDSS) can assist prescribers with rapid access to up-to-date information. In low- and middle-income countries (LMIC), the introduction of CDSS for antibiotic prescribing could have a measurable impact. However, interventions to implement them are challenging because of cultural and structural constraints, and their adoption and sustainability in routine clinical care are often limited. Preimplementation research is needed to ensure relevant adaptation and fit within the context of primary care in West Africa. Objective This study examined the requirements for a CDSS adapted to the context of primary care in West Africa, to analyze the barriers and facilitators of its implementation and adaptation, and to ensure co-designed solutions for its adaptation and sustainable use. Methods We organized a workshop in Burkina Faso in June 2019 with 47 health care professionals representing 9 West African countries and 6 medical specialties. The workshop began with a presentation of Antibioclic, a publicly funded CDSS for antibiotic prescribing in primary care that provides personalized antibiotic recommendations for 37 infectious diseases. Antibioclic is freely available on the web and as a smartphone app (iOS, Android). The presentation was followed by a roundtable discussion and completion of a questionnaire with open-ended questions by participants. Qualitative data were analyzed using thematic analysis. Results Most of the participants had access to a smartphone during their clinical consultations (35/47, 74%), but only 49% (23/47) had access to a computer and none used CDSS for antibiotic prescribing. The participants considered that CDSS could have a number of benefits including updating the knowledge of practitioners on antibiotic prescribing, improving clinical care and reducing AMR, encouraging the establishment of national guidelines, and developing surveillance capabilities in primary care. The most frequently mentioned contextual barrier to implementing a CDSS was the potential risk of increasing self-medication in West Africa, where antibiotics can be bought without a prescription. The need for the CDSS to be tailored to the local epidemiology of infectious diseases and AMR was highlighted along with the availability of diagnostic tests and antibiotics using national guidelines where available. Participants endorsed co-design involving all stakeholders, including nurses, midwives, and pharmacists, as central to any introduction of CDSS. A phased approach was suggested by initiating and evaluating CDSS at a pilot site, followed by dissemination using professional networks and social media. The lack of widespread internet access and computers could be circumvented by a mobile app with an offline mode. Conclusions Our study provides valuable information for the development and implementation of a CDSS for antibiotic prescribing among primary care prescribers in LMICs and may, in turn, contribute to improving antibiotic use, clinical outcomes and decreasing AMR.
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Affiliation(s)
- Nathan Peiffer-Smadja
- Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, University of Paris, French Institute for Medical Research (INSERM), Paris, France.,National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom.,Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.,Sorbonne Université, Paris, France
| | - Armel Poda
- Department of Infectious Diseases, University Hospital Souro Sanou, Bobo-Dioulasso, Burkina Faso.,Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Abdoul-Salam Ouedraogo
- Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso.,Service de Bactériologie Virologie, University Hospital Souro Sanou, Bobo-Dioulasso, Burkina Faso
| | | | - Tristan Delory
- Antibioclic, Paris, France.,Institut Pierre Louis d'Épidémiologie et de Santé Publique, Sorbonne Université, French Institute for Medical Research (INSERM), Paris, France.,Innovation and Clinical Research Unit, Annecy-Genevois Hospital, Épagny Metz-Tessy, France
| | - Josselin Le Bel
- Antibioclic, Paris, France.,Department of General Practice, Université Paris Diderot, Université de Paris, Paris, France
| | - Elisabeth Bouvet
- Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.,Antibioclic, Paris, France
| | - Sylvie Lariven
- Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.,Antibioclic, Paris, France
| | | | - Raheelah Ahmad
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, United Kingdom.,School of Health Sciences, City, University of London, London, United Kingdom
| | - François-Xavier Lescure
- Infection Antimicrobials Modelling Evolution (IAME), UMR 1137, University of Paris, French Institute for Medical Research (INSERM), Paris, France.,Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.,Antibioclic, Paris, France
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Rojas P, Antoñanzas F. Policies to Reduce Antibiotic Consumption: The Impact in the Basque Country. Antibiotics (Basel) 2020; 9:antibiotics9070423. [PMID: 32707701 PMCID: PMC7400169 DOI: 10.3390/antibiotics9070423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022] Open
Abstract
In 2013, a change in copayment rate was introduced in the Basque Country (one year later than in the other regions in Spain), and improvements were made to drug packaging. In 2014, a National Program Against Bacterial Resistance (Spanish abbreviation: PRAN) was approved. The aim of this study is to analyze the impact of change to the copayment rate, the adjustment of drug packaging, and the approval of PRAN on the consumption of antibiotics. Raw monthly data on the consumption of antibiotics (costs, packages, and daily defined doses per thousand people (DID)) were collected from January 2009 to December 2018 in the Basque Country. Counterfactual and intervention analysis (Autoregressive integrated moving average (ARIMA) model) was performed for the total series, disaggregated by group of antibiotics (2019 WHO Access, Watch, and Reserve (AWaRe) Classification) and active substances with the highest cost per prescription (cefditoren and moxifloxacin), the lowest cost per prescription (doxycycline and cloxacillin), and the most prescribed active ingredients (amoxicillin, azithromycin, and levofloxacin). Introduction of copayment led to a ‘stockpiling effect’ one month before its implementation, equal to 8% in the three consumption series analyzed. Only the adjustment of drug packaging significantly reduced the number of packages dispensed (−12.19%). PRAN approval reduced consumption by 0.779 DID (−4.51%), representing a significant decrease for both ’access’ and ’watch’ group antibiotics. Despite the delay in implementing changes to copayment, there was a ‘stockpiling effect’. With the adjustment of packaging, fewer packs were prescribed but with a higher drug load and price. PRAN approval reduced both the consumption of ’access group antibiotics’ (first-line treatment) and ’watch group antibiotics’ (second-line treatment).
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Unorthodox Parenteral β-Lactam and β-Lactamase Inhibitor Combinations: Flouting Antimicrobial Stewardship and Compromising Patient Care. Antimicrob Agents Chemother 2020; 64:AAC.00168-20. [PMID: 32122901 DOI: 10.1128/aac.00168-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In India and China, indigenous drug manufacturers market arbitrarily combined parenteral β-lactam and β-lactamase inhibitors (BL-BLIs). In these fixed-dose combinations, sulbactam or tazobactam is indiscriminately combined with parenteral cephalosporins, with BLI doses kept in ratios similar to those for the approved BL-BLIs. Such combinations have been introduced into clinical practice without mandatory drug development studies involving pharmacokinetic/pharmacodynamic, safety, and efficacy assessments being undertaken. Such unorthodox combinations compromise clinical outcomes and also potentially contribute to resistance development.
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Antibiotic use for Australian Aboriginal children in three remote Northern Territory communities. PLoS One 2020; 15:e0231798. [PMID: 32302359 PMCID: PMC7164616 DOI: 10.1371/journal.pone.0231798] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/31/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To describe antibiotic prescription rates for Australian Aboriginal children aged <2 years living in three remote Northern Territory communities. DESIGN A retrospective cohort study using electronic health records. SETTING Three primary health care centres located in the Katherine East region. PARTICIPANTS Consent was obtained from 149 mothers to extract data from 196 child records. There were 124 children born between January 2010 and July 2014 who resided in one of the three chosen communities and had electronic health records for their first two years of life. MAIN OUTCOME MEASURES Antibiotic prescription rates, factors associated with antibiotic prescription and factors associated with appropriate antibiotic prescription. RESULTS There were 5,675 Primary Health Care (PHC) encounters for 124 children (median 41, IQR 25.5, 64). Of the 5,675 PHC encounters, 1,542 (27%) recorded at least one infection (total 1,777) and 1,330 (23%) had at least one antibiotic prescription recorded (total 1,468). Children had a median five (IQR 2, 9) prescriptions in both their first and second year of life, with a prescription rate of 5.99/person year (95% CI 5.35, 6.63). Acute otitis media was the most common infection (683 records, 38%) and Amoxycillin was the most commonly prescribed antibiotic (797 prescriptions, 54%). Of the 1,468 recorded prescriptions, 398 (27%) had no infection recorded and 116 (8%) with an infection recorded were not aligned with local treatment guidelines. CONCLUSION Prescription rates for Australian Aboriginal children in these communities are significantly higher than that reported nationally for non-Aboriginal Australians. Prescriptions predominantly aligned with treatment guidelines in this setting where there is a high burden of infectious disease.
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Uptake and Effects of Pharmaceuticals in the Soil-Plant-Earthworm System. THE HANDBOOK OF ENVIRONMENTAL CHEMISTRY 2020. [DOI: 10.1007/698_2020_617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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