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Yamba K, Chizimu JY, Mudenda S, Lukwesa C, Chanda R, Nakazwe R, Simunyola B, Shawa M, Kalungia AC, Chanda D, Mateele T, Thapa J, Kapolowe K, Mazaba ML, Mpundu M, Masaninga F, Azam K, Nakajima C, Suzuki Y, Bakyaita NN, Wesangula E, Matu M, Chilengi R. Assessment of antimicrobial resistance laboratory-based surveillance capacity of hospitals in Zambia: findings and implications for system strengthening. J Hosp Infect 2024; 148:129-137. [PMID: 38621513 DOI: 10.1016/j.jhin.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/14/2024] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND A well-established antimicrobial resistance (AMR) laboratory-based surveillance (LBS) is of utmost importance in a country like Zambia which bears a significant proportion of the world's communicable disease burden. This study assessed the capacity of laboratories in selected hospitals to conduct AMR surveillance in Zambia. METHODS This cross-sectional exploratory study was conducted among eight purposively selected hospitals in Zambia between August 2023 and December 2023. Data were collected using the self-scoring Laboratory Assessment of Antibiotic Resistance Testing Capacity (LAARC) tool. FINDINGS Of the assessed facilities, none had full capacity to conduct AMR surveillance with varying capacities ranging from moderate (63% (5/8)) to low (38% (3/8)). Some of the barriers of AMR-LBS were the lack of an electronic laboratory information system (63% (5/8)) and the lack of locally generated antibiograms (75% (6/8)). Quality control for antimicrobial susceptibility testing (AST), pathogen identification and media preparation had the lowest overall score among all of the facilities with a score of 14%, 20% and 44%, respectively. The highest overall scores were in specimen processing (79%), data management (78%), specimen collection, transport and management (71%), and safety (70%). Most facilities had standard operating procedures in place but lacked specimen-specific standard operating procedures. CONCLUSION The absence of laboratories with full capacity to conduct AMR surveillance hinders efforts to combat AMR and further complicates the treatment outcomes of infectious diseases. Establishing and strengthening LBS systems are essential in quantifying the burden of AMR and supporting the development of local antibiograms and treatment guidelines.
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Affiliation(s)
- K Yamba
- Antimicrobial Resistance Coordinating Committee Unit, Zambia National Public Health Institute, Lusaka, Zambia
| | - J Y Chizimu
- Antimicrobial Resistance Coordinating Committee Unit, Zambia National Public Health Institute, Lusaka, Zambia.
| | - S Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - C Lukwesa
- Department of Health, Lusaka District Health Office, Lusaka, Zambia
| | - R Chanda
- Department of Pathology and Microbiology, University Teaching Hospitals, Lusaka, Zambia
| | - R Nakazwe
- Department of Pathology and Microbiology, University Teaching Hospitals, Lusaka, Zambia
| | - B Simunyola
- Department of Pharmacy, Ministry of Health, Lusaka, Zambia
| | - M Shawa
- Hokudai Center for Zoonosis Control in Zambia, Hokkaido University International Institute for Zoonosis Control, Lusaka, Zambia
| | - A C Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - D Chanda
- Department of Internal Medicine, University Teaching Hospitals, Lusaka, Zambia
| | - T Mateele
- Department of Internal Medicine, Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
| | - J Thapa
- Division of Bioresources, Hokkaido University International Institute for Zoonosis Control, Sapporo, Hokkaido, Japan
| | - K Kapolowe
- Department of Internal Medicine, University Teaching Hospitals, Lusaka, Zambia
| | - M L Mazaba
- Antimicrobial Resistance Coordinating Committee Unit, Zambia National Public Health Institute, Lusaka, Zambia
| | - M Mpundu
- Action on Antibiotic Resistance (ReAct) Africa, Lusaka, Zambia
| | - F Masaninga
- Department of Health, World Health Organization, Lusaka, Zambia
| | - K Azam
- Strengthening Pandemic Preparedness, Eastern and Southern Africa Health Community, Arusha, Tanzania
| | - C Nakajima
- Division of Bioresources, Hokkaido University International Institute for Zoonosis Control, Sapporo, Hokkaido, Japan; International Collaboration Unit, Hokkaido University International Institute for Zoonosis Control, Sapporo, Hokkaido, Japan; Division of Research Support, Hokkaido University Institute for Vaccine Research and Development, Sapporo, Hokkaido, Japan
| | - Y Suzuki
- Division of Bioresources, Hokkaido University International Institute for Zoonosis Control, Sapporo, Hokkaido, Japan; International Collaboration Unit, Hokkaido University International Institute for Zoonosis Control, Sapporo, Hokkaido, Japan; Division of Research Support, Hokkaido University Institute for Vaccine Research and Development, Sapporo, Hokkaido, Japan
| | - N N Bakyaita
- Department of Health, World Health Organization, Lusaka, Zambia
| | - E Wesangula
- Strengthening Pandemic Preparedness, Eastern and Southern Africa Health Community, Arusha, Tanzania
| | - M Matu
- Strengthening Pandemic Preparedness, Eastern and Southern Africa Health Community, Arusha, Tanzania
| | - R Chilengi
- Antimicrobial Resistance Coordinating Committee Unit, Zambia National Public Health Institute, Lusaka, Zambia
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Aladekoyi O, Siddiqui S, Hania P, Hamza R, Gilbride K. Accumulation of antibiotics in the environment: Have appropriate measures been taken to protect Canadian human and ecological health? ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 280:116513. [PMID: 38820820 DOI: 10.1016/j.ecoenv.2024.116513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/02/2024]
Abstract
In Canada, every day, contaminants of emerging concern (CEC) are discharged from waste treatment facilities into freshwaters. CECs such as pharmaceutical active compounds (PhACs), personal care products (PCPs), per- and polyfluoroalkyl substances (PFAS), and microplastics are legally discharged from sewage treatment plants (STPs), water reclamation plants (WRPs), hospital wastewater treatment plants (HWWTPs), or other forms of wastewater treatment facilities (WWTFs). In 2006, the Government of Canada established the Chemicals Management Plan (CMP) to classify chemicals based on a risk-priority assessment, which ranked many CECs such as PhACs as being of low urgency, therefore permitting these substances to continue being released into the environment at unmonitored rates. The problem with ranking PhACs as a low priority is that CMP's risk management assessment overlooks the long-term environmental and synergistic effects of PhAC accumulation, such as the long-term risk of antibiotic CEC accumulation in the spread of antibiotic resistance genes. The goal of this review is to specifically investigate antibiotic CEC accumulation and associated environmental risks to human and environmental health, as well as to determine whether appropriate legislative strategies are in place within Canada's governance framework. In this research, secondary data on antibiotic CEC levels in Canadian and international wastewaters, their potential to promote antibiotic-resistant residues, associated environmental short- and long-term risks, and synergistic effects were all considered. Unlike similar past reviews, this review employed an interdisciplinary approach to propose new strategies from the perspectives of science, engineering, and law.
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Affiliation(s)
- Oluwatosin Aladekoyi
- Department of Chemistry and Biology, Toronto Metropolitan University (formerly Ryerson University), Canada
| | - Salsabil Siddiqui
- Department of Chemistry and Biology, Toronto Metropolitan University (formerly Ryerson University), Canada
| | - Patricia Hania
- Department of Business and Law, Toronto Metropolitan University (formerly Ryerson University), Canada; TMU Urban Water, Toronto Metropolitan University (formerly Ryerson University), Canada
| | - Rania Hamza
- Department of Civil Engineering, Toronto Metropolitan University (formerly Ryerson University), Canada; TMU Urban Water, Toronto Metropolitan University (formerly Ryerson University), Canada
| | - Kimberley Gilbride
- Department of Chemistry and Biology, Toronto Metropolitan University (formerly Ryerson University), Canada; TMU Urban Water, Toronto Metropolitan University (formerly Ryerson University), Canada.
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Udas S, Chand OB, Shrestha B, Pathak S, Syantang S, Dahal A, Karkey A, Giri A, Shilpakar O, Basnyat B, Salami O, Nkeramahame J, Olliaro P, Horgan P. The facilitators of and barriers to antimicrobial use and misuse in Lalitpur, Nepal: a qualitative study. BMC Public Health 2024; 24:1219. [PMID: 38698360 PMCID: PMC11067172 DOI: 10.1186/s12889-024-18690-9] [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: 11/19/2023] [Accepted: 04/23/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a pressing global health concern driven by inappropriate antibiotic use, which is in turn influenced by various social, systemic, and individual factors. This study, nested within FIND's AMR Diagnostic Use Accelerator clinical trial in Nepal, aimed to (i) explore the perspectives of patients, caregivers, and healthcare workers (HCWs) on antibiotic prescription adherence and (ii) assess the impact of a training and communication (T&C) intervention on adherence to antibiotic prescriptions. METHODS Using qualitative, semi-structured interviews, pre-intervention and Day 7 follow-up components, and the Behaviour Change Wheel process, we investigated the facilitators of and barriers to the use and misuse of antibiotic prescriptions. RESULTS Results of the study revealed that adherence to antibiotic prescriptions is influenced by a complex interplay of factors, including knowledge and understanding, forgetfulness, effective communication, expectations, beliefs and habits, attitudes and behaviours, convenience of purchasing, trust in medical effectiveness, and issues of child preferences. The T&C package was also shown to play a role in addressing specific barriers to treatment adherence. CONCLUSIONS Overall, the results of this study provide a nuanced understanding of the challenges associated with antibiotic use and suggest that tailored interventions, informed by behaviour frameworks, can enhance prescription adherence, may be applicable in diverse settings and can contribute to the global effort to mitigate the rising threat of AMR.
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Affiliation(s)
- Summita Udas
- Oxford University Clinical Research Unit Nepal, Patan, Nepal.
| | | | - Babin Shrestha
- Oxford University Clinical Research Unit Nepal, Patan, Nepal
| | - Sushmita Pathak
- Oxford University Clinical Research Unit Nepal, Patan, Nepal
| | - Sarita Syantang
- Oxford University Clinical Research Unit Nepal, Patan, Nepal
| | - Ashata Dahal
- Oxford University Clinical Research Unit Nepal, Patan, Nepal
| | | | - Abhishek Giri
- Oxford University Clinical Research Unit Nepal, Patan, Nepal
| | - Olita Shilpakar
- Oxford University Clinical Research Unit Nepal, Patan, Nepal
| | - Buddha Basnyat
- Oxford University Clinical Research Unit Nepal, Patan, Nepal
| | | | | | - Piero Olliaro
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Philip Horgan
- FIND, Geneva, Switzerland
- Evidence & Impact Oxford, Oxford, UK
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Baral R, Tuladhar R, Manandhar S, Singh A, Sherchan S. Detection of bla KPC gene among carbapenemase producing Klebsiella pneumoniae isolated from different clinical specimens at tertiary care hospital of Nepal. BMC Microbiol 2024; 24:144. [PMID: 38664608 PMCID: PMC11044503 DOI: 10.1186/s12866-024-03301-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Klebsiella pneumoniae infections have become a major cause of hospital acquired infection worldwide with the increased rate of acquisition of resistance to antibiotics. Carbapenem resistance mainly among Gram negative is an ongoing problem which causes serious outbreaks dramatically limiting treatment options. This prospective cross-sectional study was designed to detect blaKPC gene from carbapenem resistant K. pneumoniae. MATERIALS AND METHODS A totally of 1118 different clinical specimens were screened and confirmed for KPC producing K. pneumoniae phenotypically using Meropenem (10 μg) disc. The blaKPC gene was amplified from the isolates of K. pneumoniae to detect the presence of this gene. RESULT Of the total samples processed, 18.6% (n = 36) were K. pneumoniae and among 36 K. pneumoniae, 61.1% (n = 22/36) were meropenem resistant. This study demonstrated the higher level of MDR 91.7% (n = 33) and KPC production 47.2% (n = 17) among K. pneumoniae isolates. The blaKPC gene was detected in 8.3% (n = 3) of meropenem resistant isolates. CONCLUSION Since the study demonstrates the higher level of MDR and KPC producing K. pneumoniae isolates that has challenged the use of antimicrobial agents, continuous microbiology, and molecular surveillance to assist early detection and minimize the further dissemination of blaKPC should be initiated. We anticipate that the findings of this study will be useful in understanding the prevalence of KPC-producing K. pneumoniae in Nepal.
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Affiliation(s)
- Rakshya Baral
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal.
- Department of Biology, Morgan State University, Baltimore, USA.
| | - Reshma Tuladhar
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Sarita Manandhar
- Department of Microbiology, Tri-Chandra Multiple Campus, Tribhuvan University, Kathmandu, Nepal
| | - Anjana Singh
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Samendra Sherchan
- Department of Biology, Morgan State University, Baltimore, USA
- Department of Environmental Health Sciences, Tulane University, New Orleans, USA
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Pant S, Corwin A, Adhikari P, Acharya SP, Acharya U, Silwal S, Dawadi P, Poudyal A, Paudyal V, Bhumiratana A. Evaluating Antibiotic Treatment Guideline Adherence to Ongoing Antibiotic Stewardship in a Tertiary Care Setting: A Retrospective Observational Study. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2024; 2024:6663119. [PMID: 38660495 PMCID: PMC11042908 DOI: 10.1155/2024/6663119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 03/27/2024] [Accepted: 03/30/2024] [Indexed: 04/26/2024]
Abstract
Antimicrobial resistance (AMR) is widely regarded as an increasing threat to global public health. Antibiotic treatment guidelines have been increasingly recognized as an effective tool to guide appropriate prescriptions and help curtail antibiotic resistance. The present study aimed to assess physician's adherence to hospital antibiotic treatment guideline recommendations in Nepal and determine predictive variables with a significant association. This was a retrospective, monocentric observational review to investigate the adherence to endorsed guidelines using the medical records of adults admitted to the hospital with a diagnosis of urinary tract infection (UTI), pneumonia, or skin and soft tissue infection (SSTI) from January 2018 to December 2019. Of the 2,077 medical records that were reviewed (954 UTI, 754 pneumonia, and 369 SSTI), 354 (17%) met the study inclusion criteria, which included 87 UTI, 180 pneumonia, and 87 SSTI patients. Among eligible patients with antibiotic prescriptions, the following were adherent to guideline recommendations: 33 (37.9%) UTI, 78 (43.3%) pneumonia, and 23 (26.4%) SSTI. The overall extent of adherence to hospital antibiotic treatment guidelines for the use of antibiotics among adult inpatients diagnosed with these common infections was 37.9%. Patients who received ceftriaxone (OR = 2.09, 95% CI = 1.18-3.71, p=0.012) and levofloxacin (OR = 4.63, 95% CI = 1.30-16.53, p=0.018) had significantly higher adherence to treatment guidelines. This study revealed a low adherence rate despite the availability of updated guidelines for antibiotic prescriptions. The findings confer an urgent need to confront antibiotic prescription patterns in such tertiary care centers for tailored interventions to improve adherence to antibiotic guidelines.
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Affiliation(s)
- Suman Pant
- Government of Nepal, Nepal Health Research Council, Kathmandu, Nepal
- Faculty of Public Health, Thammasat University, Rangsit Campus, Khlong Nueng, Pathum Thani 12121, Thailand
| | - Andrew Corwin
- Faculty of Public Health, Thammasat University, Rangsit Campus, Khlong Nueng, Pathum Thani 12121, Thailand
| | - Prabhat Adhikari
- Department of Infection Prevention and Control, Grande International Hospital, Kathmandu, Nepal
| | - Subhash Prasad Acharya
- Department of Infection Prevention and Control, Grande International Hospital, Kathmandu, Nepal
| | - Upasana Acharya
- Department of Infection Prevention and Control, Grande International Hospital, Kathmandu, Nepal
| | - Sashi Silwal
- Government of Nepal, Nepal Health Research Council, Kathmandu, Nepal
| | - Pratima Dawadi
- Government of Nepal, Nepal Health Research Council, Kathmandu, Nepal
| | | | - Vibhu Paudyal
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Adisak Bhumiratana
- Faculty of Public Health, Thammasat University, Rangsit Campus, Khlong Nueng, Pathum Thani 12121, Thailand
- Thammasat University Research Unit in One Health and EcoHealth, Rangsit Campus, Khlong Nueng, Pathum Thani 12121, Thailand
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Chepchumba B, Asudi GO, Katana J, Ngayo MO, Khayeli JA. Isolation of phages against Streptococcus species in the oral cavity for potential control of dental diseases and associated systemic complications. Arch Microbiol 2024; 206:175. [PMID: 38493441 DOI: 10.1007/s00203-024-03897-6] [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: 12/09/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 03/19/2024]
Abstract
Dental infections and systemic complications caused by Streptococcus species in the oral cavity are increasingly exhibiting resistance to commonly used antibiotics, posing a potential threat to global public health. Phage therapy may offer a superior alternative, given that bacteriophages can be easily isolated and rapidly replicate in large numbers. In this study, six Streptococcus species from the oral cavity were characterized. Bacteriophages isolated from wastewater using five of these species as hosts produced plaques ranging from 0.2 to 2.4 mm in size. The phages demonstrated stability within a temperature range of 4 ℃ to 37 ℃. However, at temperatures exceeding 45 ℃, a noticeable reduction in bacteriophage titer was observed. Similarly, the phages showed greater stability within a pH range of 5 to 10. The isolated phages exhibited latency periods ranging from 15 to 20 min and had burst sizes varying from 10 to 200 viral particles. This study supports the potential use of bacteriophages in controlling infections caused by Streptococcus species.
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Affiliation(s)
- Beatrice Chepchumba
- Department of Biochemistry, Microbiology and Biotechnology, Kenyatta University, Nairobi, Kenya.
| | - George O Asudi
- Department of Biochemistry, Microbiology and Biotechnology, Kenyatta University, Nairobi, Kenya
| | - Japhet Katana
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Musa O Ngayo
- Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
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Alqahtani AH, Jagpal P, Kudagammana T, Vedanthan PK, Krishnamurthy K, Hariharan S, El Shabrawy Mohamed Ali RM, Maharaj SB, Marriott JF, Krishna MT. Drug allergy management in Egypt, Sri Lanka and the Caribbean: A qualitative study. Clin Exp Allergy 2024; 54:231-233. [PMID: 38082508 DOI: 10.1111/cea.14437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/24/2023] [Accepted: 11/25/2023] [Indexed: 03/07/2024]
Affiliation(s)
- Abdulaziz H Alqahtani
- The School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
- College of Pharmacy, Taif University, Taif, Kingdom of Saudi Arabia
| | - Parbir Jagpal
- The School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Thushara Kudagammana
- Faculty of Medicine, University of Peradeniya, and Teaching hospital, Peradeniya, Sri Lanka
| | | | - Kandamaran Krishnamurthy
- The Queen Elizabeth Hospital, The University of West Indies, and ARS Medicae, Barbados, West Indies
| | - Seetharaman Hariharan
- Anaesthesia & Critical Care Medicine, The University of the West Indies, St. Augustine, Trinidad, West Indies
| | | | - Sandeep B Maharaj
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - John F Marriott
- The School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Mamidipudi Thirumala Krishna
- Institute of Immunology and Immunotherapy, University of Birmingham and Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundations Trust, Birmingham, UK
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C SK, Khanal S, Joshi TP, Khadka D, Tuladhar R, Joshi DR. Antibiotic resistance determinants among carbapenemase producing bacteria isolated from wastewaters of Kathmandu, Nepal. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 343:123155. [PMID: 38114055 DOI: 10.1016/j.envpol.2023.123155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
The emergence of carbapenem resistant bacteria (CRB) possesses a remarkable threat to the health of humans. CRB and carbapenem resistance genes (CRGs) have frequently been reported in clinical isolates from hospitals, however, their occurrence and distribution in wastewaters from various sources and river water have not been emphasized in Nepal. So, this study aimed to detect carbapenem resistant bacterial isolates and their resistance determinants in river water and different types of wastewaters. River water and both untreated and treated wastewater samples from hospitals, pharmaceutical industries, and municipal sewage were collected in summer and winter seasons. From 68 grab wastewater samples, CRB were detected only in 16 samples, which included eight hospital wastewater, and four each from untreated municipal sewage and river water. A total of 25 CRB isolates were detected with dominance of E. coli (44.0%) and K. pneumoniae (24.0%). The majority of the isolates harbored blaNDM-1 (76.0%), followed by blaOXA (36.0%) and blaKPC (20.0%) genes. Hospital wastewater majorly contributed to the presence of blaNDM-1, blaKPC, and blaOXA along with intI1 genes compared to river water and untreated municipal sewage, especially during the winter season. However, CRB were not detected in treated effluents of hospitals and municipal sewage, and both influents and effluents from pharmaceutical industries. The combined presence of each blaNDM-1 & blaOXA and blaKPC & blaOXA occurred in 16.0% of the bacterial isolates. The increased minimum inhibitory concentration (MIC) of meropenem was significantly associated with the presence of CRGs. The results of this study highlight the significance of carbapenem resistance in bacteria isolated from wastewater and river water, and underscore the necessity for efficient monitoring and control strategies to prevent the dispersion of carbapenem resistance in the environment and its potential consequences on human health.
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Affiliation(s)
- Sudeep K C
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Nepal; Environment Research Laboratory, Faculty of Science, Nepal Academy of Science and Technology (NAST), Lalitpur, Nepal
| | - Santosh Khanal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Nepal; Environment Research Laboratory, Faculty of Science, Nepal Academy of Science and Technology (NAST), Lalitpur, Nepal; Department of Microbiology, Tri-Chandra Multiple Campus, Tribhuvan University, Kathmandu, Nepal
| | - Tista Prasai Joshi
- Environment Research Laboratory, Faculty of Science, Nepal Academy of Science and Technology (NAST), Lalitpur, Nepal
| | - Deegendra Khadka
- Molecular Biotechnology, Faculty of Science, Nepal Academy of Science and Technology (NAST), Lalitpur, Nepal
| | - Reshma Tuladhar
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Nepal
| | - Dev Raj Joshi
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Nepal.
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Bhattarai RK, Basnet HB, Dhakal IP, Devkota B. Antimicrobial resistance of avian pathogenic Escherichia coli isolated from broiler, layer, and breeder chickens. Vet World 2024; 17:480-499. [PMID: 38595648 PMCID: PMC11000482 DOI: 10.14202/vetworld.2024.480-499] [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: 10/18/2023] [Accepted: 01/24/2024] [Indexed: 04/11/2024] Open
Abstract
Background and Aim Antimicrobials are extensively used in poultry production for growth promotion as well as for the treatment and control of diseases, including avian pathogenic Escherichia coli (APEC). Poor selection, overuse, and misuse of antimicrobial agents may promote the emergence and dissemination of antimicrobial resistance (AMR) in APEC. This study aimed to assess antimicrobial susceptibility patterns and detect antibiotic resistance genes (ARGs) in APEC isolated from clinical cases of colibacillosis in commercial broiler, layer, and breeder chickens. Materials and Methods A total of 487 APEC were isolated from 539 across 300 poultry farms in various regions of Nepal. Antimicrobial susceptibility patterns was determined using the Kirby-Bauer disk diffusion and broth microdilution methods. The index of AMR, such as multiple antibiotic resistance (MAR) index, resistance score (R-score), and multidrug resistance (MDR) profile, were determined. Polymerase chain reaction was employed to detect multiple ARGs and correlations between phenotypic and genotypic resistance were analyzed. Results The prevalence of APEC was 91% (487/539). All of these isolates were found resistant to at least one antimicrobial agent, and 41.7% of the isolates were resistant against 8-9 different antimicrobials. The antibiogram of APEC isolates overall showed the highest resistance against ampicillin (99.4%), whereas the highest intermediate resistance was observed in enrofloxacin (92%). The MAR index and R-score showed significant differences between broiler and layers, as well as between broiler breeder and layers. The number of isolates that were resistant to at least one agent in three or more antimicrobial categories tested was 446 (91.6%) and were classified as MDR-positive isolates. The ARGs were identified in 439 (90.1%) APEC isolates, including the most detected mobilized colistin resistance (mcr1) which was detected in the highest (52.6%) isolates. Overall, resistance gene of beta-lactam (blaTEM), mcr1, resistance gene of sulphonamide (sul1) and resistance gene of tetracycline (tetB) (in broiler), were detected in significantly higher than other tested genes (p < 0.001). When examining the pair-wise correlations, a significant phenotype-phenotype correlation (p < 0.001) was observed between levofloxacin and ciprofloxacin, chloramphenicol and tetracycline with doxycycline. Similarly, a significant phenotype-genotype correlation (p < 0.001) was observed between chloramphenicol and the tetB, and colistin with blaTEM and resistance gene of quinolone (qnrA). Conclusion In this study, the current state of APEC AMR in commercial chickens is revealed for the first time in Nepal. We deciphered the complex nature of AMR in APEC populations. This information of molecular surveillance is useful to combat AMR in APEC and to contribute to manage APEC associated diseases and develop policies and guidelines to enhance the commercial chicken production.
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Affiliation(s)
- Rebanta K Bhattarai
- Department of Veterinary Microbiology and Parasitology, Faculty of Animal Science, Veterinary Science and Fisheries, Agriculture and Forestry University, Nepal
| | - Hom B Basnet
- Department of Veterinary Microbiology and Parasitology, Faculty of Animal Science, Veterinary Science and Fisheries, Agriculture and Forestry University, Nepal
| | - Ishwari P Dhakal
- Department of Medicine and Public Health, Faculty of Animal Science, Veterinary Science and Fisheries, Agriculture and Forestry University, Nepal
| | - Bhuminand Devkota
- Department of Theriogenology, Faculty of Animal Science, Veterinary Science and Fisheries, Agriculture and Forestry University, Nepal
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Acharya R, Panthi S, Khatiwada P, Bhattarai B, Singh S, Bhattarai K, Aryal R, Neupane D, Thapa A, Karki K, Basnet LB, Khanal VK, Ghimire A. Antibiotics use among residents in Eastern Nepal: a community-based mixed method study. Ann Med Surg (Lond) 2024; 86:748-755. [PMID: 38333289 PMCID: PMC10849382 DOI: 10.1097/ms9.0000000000001611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/03/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction According to the WHO, more than two-thirds of all antibiotics are used in the community, of which about 30% are used inappropriately. The antimicrobial resistance (AMR) problem is a growing threat to Nepal because of indiscriminate and inappropriate use. However, exact data on the extent of inappropriate use of antibiotics in the community is scarce in Nepal. Objectives To know the extent of inappropriate use of antibiotics among the community and their knowledge and practice towards the usage of antibiotics. Methods A community-based cross-sectional study was conducted from 20 December 2017 to 20 March 2018 using a purposive sampling technique. A semi-structured questionnaire was used while conducting face-to-face interviews with 336 respondents to find out the knowledge and practice regarding antibiotic use. Investigators took different antibiotics (in all dosage forms) with them to show participants whether they knew and/or used the antibiotics in the last year. Results The mean age of respondents with standard deviation was 39.87±13.67 years ranging from 18 to 84 years. Around 35.42% of respondents were farmers and 34.52% were homemakers. 28.87% of respondents were illiterate, 32.44% had primary education and 33.33% had secondary education. Almost half of them (48.51%) think that antibiotics are safe and can be commonly used. So, 43.15% of them preferred taking antibiotics when they had a common cold. The majority of the participants (81.84%) did not have any idea about antibiotic resistance. 94.6% of the respondents used antibiotics inappropriately. Conclusion The results of the present study revealed that inappropriate use of antibiotics is high and associated with low earning wages in both males and females in the age group 18-39 years.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Anish Thapa
- Department of Medicine, Universal College of Medical Sciences, Bhairahawa, Lumbini Province
| | | | - Lila Bahadur Basnet
- School of Public Health and community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Province 1
| | - Vijay Kumar Khanal
- School of Public Health and community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Province 1
| | - Anup Ghimire
- School of Public Health and community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Province 1
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Marasini S, Sharma S, Joshi A, Kunwar S, Mahato RK, Shrestha A, Karmacharya B. Exploring knowledge, perceptions, and practices of antimicrobials, and their resistance among medicine dispensers and community members in Kavrepalanchok District of Nepal. PLoS One 2024; 19:e0297282. [PMID: 38241275 PMCID: PMC10798439 DOI: 10.1371/journal.pone.0297282] [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: 07/03/2022] [Accepted: 01/02/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Inappropriate use of antimicrobials is a global public health issue, particularly in developing countries, including Nepal, where over-the-counter sales and self-medication of antimicrobials are common. OBJECTIVES To explore knowledge, perceptions, and practices of antimicrobials and their resistance among medicine dispensers and community members in Nepal. METHODS The study was conducted in three rural and five urban municipalities of the Kavrepalanchok district from May 2021 to August 2021. Data were collected using two qualitative approaches: In-Depth Interviews (IDIs) and Focus Group Discussions (FGDs). Data were analyzed using thematic analysis that combined deductive and inductive approaches to identify codes under pre-specified themes. RESULTS A total of 16 In-depth interviews with medicine dispensers and 3 focus group discussions with community members were conducted. Knowledge regarding antimicrobial resistance varied among dispensers. Those with a prior educational background in pharmacy often had good knowledge about the causes and consequences of antimicrobial resistance. Meanwhile, consumers were less aware of antimicrobial resistance. Community members perceived antimicrobials as effective medicines but not long-term solution for treating diseases. They reported that dispensing without a prescription was common and that both consumers and dispensers were responsible for the inappropriate use of antimicrobials. On the contrary, several dispensers said that self-medication was common among the consumers, especially among more educated groups. The medicine dispensers and consumers expressed concerns about the weak enforcement of policies regarding pharmacy drug use and dispensing practices. CONCLUSION Promoting and strengthening the appropriate use of antimicrobials among medicine dispensers and community members is crucial. Bold policies and collective implementation of regulations could help combat antimicrobial resistance.
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Affiliation(s)
- Sabina Marasini
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Sudim Sharma
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Anjali Joshi
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Surakshya Kunwar
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Roshan Kumar Mahato
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Archana Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
- Institute for Implementation Science and Health, Kathmandu, Nepal
| | - Biraj Karmacharya
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
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12
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Halawa EM, Fadel M, Al-Rabia MW, Behairy A, Nouh NA, Abdo M, Olga R, Fericean L, Atwa AM, El-Nablaway M, Abdeen A. Antibiotic action and resistance: updated review of mechanisms, spread, influencing factors, and alternative approaches for combating resistance. Front Pharmacol 2024; 14:1305294. [PMID: 38283841 PMCID: PMC10820715 DOI: 10.3389/fphar.2023.1305294] [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: 10/01/2023] [Accepted: 12/18/2023] [Indexed: 01/30/2024] Open
Abstract
Antibiotics represent a frequently employed therapeutic modality for the management of bacterial infections across diverse domains, including human health, agriculture, livestock breeding, and fish farming. The efficacy of antibiotics relies on four distinct mechanisms of action, which are discussed in detail in this review, along with accompanying diagrammatic illustrations. Despite their effectiveness, antibiotic resistance has emerged as a significant challenge to treating bacterial infections. Bacteria have developed defense mechanisms against antibiotics, rendering them ineffective. This review delves into the specific mechanisms that bacteria have developed to resist antibiotics, with the help of diagrammatic illustrations. Antibiotic resistance can spread among bacteria through various routes, resulting in previously susceptible bacteria becoming antibiotic-resistant. Multiple factors contribute to the worsening crisis of antibiotic resistance, including human misuse of antibiotics. This review also emphasizes alternative solutions proposed to mitigate the exacerbation of antibiotic resistance.
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Affiliation(s)
- Esraa M. Halawa
- Department of Botany and Microbiology, Faculty of Science, Cairo University, Giza, Egypt
| | - Mohamed Fadel
- Department of Microbial Chemistry, Biotechnology Research Institute, National Research Centre, Dokki, Cairo, Egypt
| | - Mohammed W. Al-Rabia
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Clinical Laboratories-Diagnostic Immunology Division, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Ali Behairy
- Department of Pharmacology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Nehal A. Nouh
- Department of Microbiology, Medicine Program, Batterjee Medical College, Jeddah, Saudi Arabia
- Inpatient Pharmacy, Mansoura University Hospitals, Mansoura, Egypt
| | - Mohamed Abdo
- Department of Animal Histology and Anatomy, School of Veterinary Medicine, Badr University in Cairo (BUC), Badr City, Egypt
- Department of Anatomy and Embryology, Faculty of Veterinary Medicine, University of Sadat City, Sadat City, Egypt
| | - Rada Olga
- Department of Biology and Plant Protection, Faculty of Agriculture, University of Life Sciences “King Michael I” from Timișoara, Timișoara, Romania
| | - Liana Fericean
- Department of Biology and Plant Protection, Faculty of Agriculture, University of Life Sciences “King Michael I” from Timișoara, Timișoara, Romania
| | - Ahmed M. Atwa
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Egyptian Russian University, Cairo, Egypt
| | - Mohammad El-Nablaway
- Department of Medical Biochemistry, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Department of Basic Medical Sciences, College of Medicine, AlMaarefa University, Riyadh, Saudi Arabia
| | - Ahmed Abdeen
- Department of Forensic Medicine and Toxicology, Faculty of Veterinary Medicine, Benha University, Toukh, Egypt
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13
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Parajuli A, Garbovan L, Bhattarai B, Arjyal A, Baral S, Cooke P, Latham S, Barrington DJ, Mitchell J, King R. Exploring community insights on antimicrobial resistance in Nepal: a formative qualitative study. BMC Health Serv Res 2024; 24:57. [PMID: 38212733 PMCID: PMC10782613 DOI: 10.1186/s12913-023-10470-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is the process by which microbes evolve mechanisms to survive the medicines designed to destroy them i.e. antimicrobials (AMs). Despite being a natural process, AMR is being hastened by the abuse of AMs. In context of Nepal, there is limited information on drivers of AMR and barriers in addressing it from a community perspective. This study explores the local language and terminology used around AMs in the community, commonly used AMs and reasons for their usage, how these AMs are sourced, and the perceived barriers to addressing AMR via One Health approach. METHODS A phenomenological study design was utilized with applied qualitative research theoretically framed as pragmatism. Twelve in-depth interviews and informal discussions with a One Health focus, were purposively conducted with wide range of stakeholders and community resident of Kapilvastu municipality of Nepal during April 2022. The acquired data was analyzed manually via a thematic framework approach. The study obtained ethical approval from ethical review board of Nepal Health Research Council and University of Leeds. RESULTS Nepali and Awadhi languages does not have specific words for AMs or AMR, which is understandable by the community people. Rather, community use full explanatory sentences. People use AMs but have incomplete knowledge about them and they have their own local words for these medicines. The knowledge and usage of AMs across human and animal health is impacted by socio-structural factors, limited Government regulation, inadequate supply of AMs in local government health facilities and the presence of various unregulated health providers that co-exist within the health system. Novel ideas such as the use of visual and smart technology, for instance mobile phones and social media exposure, can enable access to information about AMs and AMR. CONCLUSION This study shows that terminology that is understandable by the community referring to AMs and AMR in Nepali and Awadhi languages does not exist, but full explanatory sentences and colloquial names are used. Despite regular utilisation, communities have incomplete knowledge regarding AMs. Since, knowledge alone cannot improve behaviour, behavioural interventions are required to address AMR via community engagement to co-produce their own solutions. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
| | - Lidis Garbovan
- Centre for World Cinema and Digital Cultures, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | | | | | | | - Paul Cooke
- Centre for World Cinema and Digital Cultures, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Sophia Latham
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Chester High Road, Neston, Liverpool, CH64 7TE, UK
| | - Dani J Barrington
- School of Population and Global Health, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western, 6009, Australia
| | - Jessica Mitchell
- Nuffield Centre for International Health and Development, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
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14
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Jana T, Sarkar D, Ganguli D, Mukherjee SK, Mandal RS, Das S. ABDpred: Prediction of active antimicrobial compounds using supervised machine learning techniques. Indian J Med Res 2024; 159:78-90. [PMID: 38345040 PMCID: PMC10954100 DOI: 10.4103/ijmr.ijmr_1832_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND OBJECTIVES Discovery of new antibiotics is the need of the hour to treat infectious diseases. An ever-increasing repertoire of multidrug-resistant pathogens poses an imminent threat to human lives across the globe. However, the low success rate of the existing approaches and technologies for antibiotic discovery remains a major bottleneck. In silico methods like machine learning (ML) deem more promising to meet the above challenges compared with the conventional experimental approaches. The goal of this study was to create ML models that may be used to successfully predict new antimicrobial compounds. METHODS In this article, we employed eight different ML algorithms namely, extreme gradient boosting, random forest, gradient boosting classifier, deep neural network, support vector machine, multilayer perceptron, decision tree, and logistic regression. These models were trained using a dataset comprising 312 antibiotic drugs and a negative set of 936 non-antibiotic drugs in a five-fold cross validation approach. RESULTS The top four ML classifiers (extreme gradient boosting, random forest, gradient boosting classifier and deep neural network) were able to achieve an accuracy of 80 per cent and above during the evaluation of testing and blind datasets. INTERPRETATION CONCLUSIONS We aggregated the top performing four models through a soft-voting technique to develop an ensemble-based ML method and incorporated it into a freely accessible online prediction server named ABDpred ( http://clinicalmedicinessd.com.in/abdpred/ ).
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Affiliation(s)
- Tanmoy Jana
- Division of Clinical Medicine, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Debasree Sarkar
- Division of Clinical Medicine, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Debayan Ganguli
- Division of Clinical Medicine, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Sandip Kumar Mukherjee
- Division of Clinical Medicine, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Rahul Shubhra Mandal
- Department of Cancer Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Santasabuj Das
- Division of Clinical Medicine, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
- ICMR-National Institute of Occupational Health, Ahmedabad, India
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Brunetti M, Singh A, Chebore S, Gyenwali D, Malou N, Ferreyra C, Gompo TR, Chapagain S, Githii S, Wesangula E, Albert H. Application of diagnostic network optimization in Kenya and Nepal to design integrated, sustainable and efficient bacteriology and antimicrobial resistance surveillance networks. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002247. [PMID: 38055687 DOI: 10.1371/journal.pgph.0002247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/06/2023] [Indexed: 12/08/2023]
Abstract
Antimicrobial resistance (AMR) is a major global public health concern, particularly in low- and middle-income countries, which experience the highest burden of AMR. Critical to combatting AMR is ensuring there are effective, accessible diagnostic networks in place to diagnose, monitor and prevent AMR, but many low- and middle-income countries lack such networks. Consequently, there is substantial need for approaches that can inform the design of efficient AMR laboratory networks and sample referral systems in lower-resource countries. Diagnostic network optimization (DNO) is a geospatial network analytics approach to plan diagnostic networks and ensure greatest access to and coverage of services, while maximizing the overall efficiency of the system. In this intervention, DNO was applied to strengthen bacteriology and AMR surveillance network design in Kenya and Nepal for human and animal health, by informing linkages between health facilities and bacteriology testing services and sample referral routes between farms, health facilities and laboratories. Data collected from the target settings in each country were entered into the open-access DNO tool OptiDx, to generate baseline scenarios, which depicted the current state of AMR laboratory networks and sample referral systems in the countries. Subsequently, baselines were adjusted to evaluate changing factors such as samples flows, transport frequency, transport costs, and service distances. Country stakeholders then compared resulting future scenarios to identify the most feasible solution for their context. The DNO analyses enabled a wealth of insights that will facilitate strengthening of AMR laboratory and surveillance networks in both countries. Overall, the project highlights the benefits of using a data-driven approach for designing efficient diagnostic networks, to ensure better health resource allocation while maximizing the impact and equity of health interventions. Given the critical need to strengthen AMR laboratory and surveillance capacity, DNO should be considered an integral part of diagnostic strategic planning in the future.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Susan Githii
- National Antimicrobial Stewardship Interagency Committee, Nairobi, Kenya
| | - Evelyn Wesangula
- National Antimicrobial Stewardship Interagency Committee, Nairobi, Kenya
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Mudenda S, Chisha P, Chabalenge B, Daka V, Mfune RL, Kasanga M, Kampamba M, Skosana P, Nsofu E, Hangoma J, Siachalinga L, Hikaambo CN, Chimombe T, Allabi AC, Boya B, Mufwambi W, Saleem Z, Matafwali SK. Antimicrobial stewardship: knowledge, attitudes and practices regarding antimicrobial use and resistance among non-healthcare students at the University of Zambia. JAC Antimicrob Resist 2023; 5:dlad116. [PMID: 37954639 PMCID: PMC10635582 DOI: 10.1093/jacamr/dlad116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
Background Antimicrobial resistance (AMR) poses a significant threat to the world and could become humanity's next major challenge. This study assessed non-healthcare students' knowledge, attitude and practices (KAP) towards antimicrobial use (AMU) and AMR at the University of Zambia. Methods This cross-sectional study was conducted among 443 non-healthcare students from August to October 2022 using a structured questionnaire. Data analysis was done using IBM SPSS version 24.0. Results Of the 433 participants, 55.2%, 63.5% and 45% had moderate KAP scores regarding AMU and AMR. The prevalence of self-medication with antibiotics was 76.7%. Male participants were less likely to have good knowledge (OR = 0.524, 95% CI: 0.347-0.792) and positive attitudes (OR = 0.585, 95% CI: 0.364-0.940) towards AMU and AMR compared with females. Students who were studying Engineering and Mining were more likely to have good knowledge of AMR (OR = 1.891, 95% CI: 1.197-2.987) compared with those in Social Sciences. Those who were in their fourth and fifth years were more likely to have positive attitudes towards AMU and AMR (OR = 1.851, 95% CI: 1.147-2.986) compared with those who were in the first, second and third years. Finally, students who practised self-medication were less likely to have good self-reported practice towards AMR (OR = 0.442, 95% CI: 0.278-0.702) compared with those who did not. Conclusions This study demonstrated that non-healthcare students had moderate KAP regarding AMU and AMR. All university students should be provided with education about AMU and AMR through free short courses, seminars, workshops, and AMR and antimicrobial stewardship awareness campaigns.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Surveillance and Research Technical Working Group, Antimicrobial Resistance, Zambia National Public Health Institute, Lusaka, Zambia
| | - Patience Chisha
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Billy Chabalenge
- Department of Medicines Control, Zambia Medicines Regulatory Authority, Lusaka, Zambia
| | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia
| | - Ruth Lindizyani Mfune
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia
| | - Maisa Kasanga
- College of Public Health, Zhengzhou University, 100 Kexue Avenue, Zhengzhou, Henan 450001, China
| | - Martin Kampamba
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Phumzile Skosana
- Department of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Eustus Nsofu
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Jimmy Hangoma
- Department of Pharmacy, School of Health Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Linda Siachalinga
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Department of Pharmacy, School of Health Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | | | - Tadious Chimombe
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Aurel Constant Allabi
- Laboratory of Pharmacology and Toxicology, University of Abomey-Calavi and Teaching Hospital of Abomey-Calavi/Sô-Ava, Abomey-Calavi, Benin
| | - Bawa Boya
- Laboratory of Biology and Molecular Typing in Microbiology, University of Abomey-Calavi, Cotonou, Benin
| | - Webrod Mufwambi
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Scott Kaba Matafwali
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Malik H, Singh R, Kaur S, Dhaka P, Bedi JS, Gill JPS, Gongal G. Review of antibiotic use and resistance in food animal production in WHO South-East Asia Region. J Infect Public Health 2023; 16 Suppl 1:172-182. [PMID: 37977981 DOI: 10.1016/j.jiph.2023.11.002] [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: 09/14/2023] [Revised: 10/30/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023] Open
Abstract
Antimicrobial resistance is an emerging global threat to public health. The resistant bacteria in food animals can be transferred to humans through the food chain. Limited information on antimicrobial usage and resistance in food animals is available in Southeast Asia due to inadequate monitoring or surveillance systems. A literature review was conducted on antimicrobial use and resistance in food animal production in Southeast Asia for the period 2011-2020, to assess the scope and extent of antibiotic use and resistance. The countries included in the study were Bangladesh, Bhutan, Democratic People's Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste. The information was categorised by country, production type and findings regarding antibiotic use and resistance. A total of 108 publications were included in the review. Results showed widespread use of critically and highly important antibiotics in livestock, poultry and aquacultured fish and their products. To curb the growing threat of antibiotic resistance, Southeast Asian countries need to strengthen surveillance and regulatory controls of antimicrobial use in food animal production through "One Health" approach.
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Affiliation(s)
- Hina Malik
- Centre for One Health, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab 141004, India
| | - Randhir Singh
- Centre for One Health, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab 141004, India
| | - Simranpreet Kaur
- Centre for One Health, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab 141004, India
| | - Pankaj Dhaka
- Centre for One Health, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab 141004, India
| | - Jasbir Singh Bedi
- Centre for One Health, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab 141004, India
| | - J P S Gill
- Directorate of Research, Guru Angad Dev Veterinary and Animal Sciences University, Ludhiana, Punjab 141004, India
| | - Gyanendra Gongal
- World Health Organization, Regional Office for South-East Asia, New Delhi 110002, India.
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Khadka C, Shyaula M, Syangtan G, Bista S, Tuladhar R, Singh A, Joshi DR, Pokhrel LR, Dawadi P. Extended-spectrum β-lactamases producing Enterobacteriaceae (ESBL-PE) prevalence in Nepal: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 901:166164. [PMID: 37572913 DOI: 10.1016/j.scitotenv.2023.166164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/09/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023]
Abstract
An alarming increase in the occurrence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) has threatened the treatment and management of bacterial infections. This systematic review and meta-analysis aimed to provide a quantitative estimate of the prevalence of ESBL among the members of the Enterobacteriaceae family by analyzing the community-based and clinical studies published between 2011 and 2021 from Nepal and determine if ESBL-PE correlates with multidrug resistance (MDR). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed for systematic review and meta-analysis and the articles' quality was assessed using the Newcastle-Ottawa scale. Of the 2529 articles screened, 65 articles were systematically reviewed, data extracted, and included in in-depth meta-analysis. The overall pooled prevalence of ESBL-producers in Enterobacteriaceae was 29 % (95 % CI: 26-32 %) with high heterogeneity (I2 = 96 %, p < 0.001). Escherichia coli was the predominant ESBL-producing member of the Enterobacteriaceae family, followed by Citrobacter spp. and Klebsiella spp. The prevalence of ESBL-PE increased from 18.7 % in 2011 to 29.5 % in 2021. A strong positive correlation (r = 0.98) was observed between ESBL production and MDR in Enterobacteriaceae. ESBL-PE isolates showed high resistance to ampicillin, cephalosporins, and amoxicillin-clavulanic acid, and blaCTX-M type was the most reported gene variant among ESBL-PE. In conclusion, this study demonstrated an increased prevalence of ESBL-PE in Nepal over the last decade, and such isolates showed a high level of MDR against the β-lactams and non-β-lactam antibiotics. Tackling the rising antibiotic resistance (AR) and MDR in ESBL-PE would require concerted efforts from all stakeholders to institute effective infection control programs in the community and clinical settings.
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Affiliation(s)
- Christina Khadka
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Manita Shyaula
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Gopiram Syangtan
- Shi-Gan International College of Science and Technology, Tribhuvan University, Kathmandu, Nepal
| | - Shrijana Bista
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Reshma Tuladhar
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Anjana Singh
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal; Faculty of Science, Nepal Academy of Science and Technology, Khumaltar, Lalitpur, Nepal
| | - Dev Raj Joshi
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Lok R Pokhrel
- Department of Public Health, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
| | - Prabin Dawadi
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
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Mudenda S, Bumbangi FN, Yamba K, Munyeme M, Malama S, Mukosha M, Hadunka MA, Daka V, Matafwali SK, Siluchali G, Mainda G, Mukuma M, Hang’ombe BM, Muma JB. Drivers of antimicrobial resistance in layer poultry farming: Evidence from high prevalence of multidrug-resistant Escherichia coli and enterococci in Zambia. Vet World 2023; 16:1803-1814. [PMID: 37859964 PMCID: PMC10583887 DOI: 10.14202/vetworld.2023.1803-1814] [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: 06/01/2023] [Accepted: 08/10/2023] [Indexed: 10/21/2023] Open
Abstract
Background and Aim Inappropriate use of antimicrobials exacerbates antimicrobial resistance (AMR) in the poultry sector. Information on factors driving AMR in the layer poultry sector is scarce in Zambia. This study examined the drivers of AMR in the layer poultry sector in the Lusaka and Copperbelt Provinces of Zambia. Materials and Methods This cross-sectional study employed a structured questionnaire in 77 layer poultry farms in the provinces of Lusaka and Copperbelt, Zambia, from September 2020 to April 2021. Data analysis was conducted using Stata version 16.1. Antimicrobial resistance was defined as the presence of multidrug resistance (MDR) isolates. Multivariable regression analysis was used to identify drivers of AMR. Results In total, 365 samples were collected, from which 339 (92.9%) Escherichia coli and 308 (84.4%) Enterococcus spp. were isolated. Multidrug resistance was identified in 39% of the E. coli and 86% of the Enterococcus spp. The overall prevalence of AMR in layer poultry farms was 51.7% (95% confidence interval [CI]: 40.3%-63.5%). Large-scale farmers (Adjusted odds ratio [AOR] = 0.20, 95% CI: 0.04%-0.99%) than small-scale and farmers who were aware of AMR than those who were unaware (AOR = 0.26, 95% CI: 0.08%-0.86%) were less likely to experience AMR problems. Conclusion This study found a high prevalence of AMR in layer poultry farming linked to the type of farm management practices and lack of AMR awareness. Evidence of high MDR in our study is of public health concern and requires urgent attention. Educational interventions must increase AMR awareness, especially among small- and medium-scale poultry farmers.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Flavien Nsoni Bumbangi
- Department of Medicine and Clinical Sciences, School of Medicine, Eden University, Lusaka, Zambia
| | - Kaunda Yamba
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
- Department of Biological Sciences, School of Natural Sciences, University of Zambia, Lusaka, Zambia
| | - Musso Munyeme
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - Sydney Malama
- Department of Pathology and Microbiology Laboratory, University Teaching Hospitals, Lusaka, Zambia
| | - Moses Mukosha
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | | | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia
| | - Scott Kaba Matafwali
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Godfrey Siluchali
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
- Department of Anatomy and Physiological Sciences, Institute of Basic and Biomedical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Geoffrey Mainda
- Food and Agriculture Organization (FAO) of the United Nations, House No. 5 Chaholi, off Addis Ababa drive, Lusaka, Zambia
| | - Mercy Mukuma
- Department of Food Science and Nutrition, School of Agricultural Sciences, University of Zambia, Lusaka, Zambia
| | - Bernard Mudenda Hang’ombe
- Department of Paraclinical Studies, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
| | - John Bwalya Muma
- Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia
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Subedi D, Jyoti S, Thapa B, Paudel S, Shrestha P, Sapkota D, Bhatt BR, Adhikari H, Poudel U, Gautam A, Nepal R, Al-Mustapha AI. Knowledge, Attitude, and Practice of Antibiotic Use and Resistance among Poultry Farmers in Nepal. Antibiotics (Basel) 2023; 12:1369. [PMID: 37760666 PMCID: PMC10525118 DOI: 10.3390/antibiotics12091369] [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: 07/14/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
The abuse and misuse of antibiotics is one of the main drivers of antimicrobial resistance (AMR). Globally, AMR in food-producing animals is a significant public health concern. This study, therefore, assessed the knowledge, attitudes, and practices related to antibiotic usage (AMU) and AMR among poultry farmers in Nepal. We conducted a cross-sectional survey of 605 poultry farmers from six districts of Nepal from May to June 2022 to assess the status of knowledge, attitude, as well as practices toward prudent antibiotic usage (AMU) and AMR. The majority of the participants in our study were from the Chitwan district (31.6%; n = 191/605), aged 30-44 (54.2%; n = 328/605), males (70.4%; n = 426/605), and farmers with a higher secondary (28.76%; n = 174/605) level of education. The tetracyclines (28%, n = 228/828), aminoglycosides (23%, n = 188/828), and fluoroquinolones (15%, n = 126/828) were the most used antibiotics classes among poultry farmers. Although 87.8% (n = 531/605) of poultry farmers used antibiotics, 49.8% (n = 301/605) of them were aware of AMR, and 55.7% (n = 337/605) knew that the misuse of antimicrobials could affect human and environmental health. There were significant differences in the knowledge, attitude, and practices toward prudent AMU and AMR among farmers who reared different birds. The mean knowledge, attitude, and practice score of the respondents were 7.81 ± 3.26, 5.8 ± 2.32, and 7.59 ± 3.38 when measured on a scale of 12, 10, and 15, respectively. Based on a cut-off of 75% of the maximum score, 49.4% (n = 299/605), 62.8% (n = 380/605), and 12.73% (n = 77/605) of the respondents had good knowledge, attitude, and practices toward prudent AMU and AMR, respectively. The multivariable logistic regression analyses revealed that the positive predictors of good knowledge and attitude were male gender, higher level of education, district, and the types of birds (layers). Similarly, those of the male gender (OR: 3.36; 95% CI: 1.38-8.20; p = 0.008) and those that rear layers (OR: 4.63; 95% CI: 1.75-12.25; p = 0.003) were more likely to practice prudent usage of antimicrobials. The findings of this study show poor practice toward prudent antibiotic usage despite good knowledge of AMR. This study provides essential baseline data on the knowledge, attitudes, and practices of poultry farmers in Nepal and offers valuable insights that could help in the design of interventions and policies aimed at addressing illicit AMU and AMR in poultry in Nepal.
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Affiliation(s)
- Deepak Subedi
- Department of Poultry Science, University of Georgia, Athens, GA 30602, USA
- Paklihawa Campus, Institute of Agriculture and Animal Science, Tribhuvan University, Bhairahawa 32900, Nepal; (S.J.); (S.P.); (P.S.); (U.P.); (A.G.); (R.N.)
| | - Sumit Jyoti
- Paklihawa Campus, Institute of Agriculture and Animal Science, Tribhuvan University, Bhairahawa 32900, Nepal; (S.J.); (S.P.); (P.S.); (U.P.); (A.G.); (R.N.)
- Department of Health Management, Atlantic Veterinary College, University of Prince Edward Island, 550 University Avenue, Charlottetown, PE C1A 4P3, Canada
| | - Bhima Thapa
- Faculty of Animal Science, Veterinary Science and Fisheries, Agriculture and Forestry University, Bharatpur 44200, Nepal; (B.T.); (D.S.); (H.A.)
| | - Sanjay Paudel
- Paklihawa Campus, Institute of Agriculture and Animal Science, Tribhuvan University, Bhairahawa 32900, Nepal; (S.J.); (S.P.); (P.S.); (U.P.); (A.G.); (R.N.)
- Faculty of Animal Science, Veterinary Science and Fisheries, Agriculture and Forestry University, Bharatpur 44200, Nepal; (B.T.); (D.S.); (H.A.)
| | - Prajjwal Shrestha
- Paklihawa Campus, Institute of Agriculture and Animal Science, Tribhuvan University, Bhairahawa 32900, Nepal; (S.J.); (S.P.); (P.S.); (U.P.); (A.G.); (R.N.)
- Department of Agriculture, University of Arkansas at Pine Bluff, Pine Bluff, AR 71601, USA
| | - Deepak Sapkota
- Faculty of Animal Science, Veterinary Science and Fisheries, Agriculture and Forestry University, Bharatpur 44200, Nepal; (B.T.); (D.S.); (H.A.)
| | - Bhuwan Raj Bhatt
- Faculty of Agriculture, Far Western University, Kailali 10900, Nepal;
| | - Hari Adhikari
- Faculty of Animal Science, Veterinary Science and Fisheries, Agriculture and Forestry University, Bharatpur 44200, Nepal; (B.T.); (D.S.); (H.A.)
| | - Uddab Poudel
- Paklihawa Campus, Institute of Agriculture and Animal Science, Tribhuvan University, Bhairahawa 32900, Nepal; (S.J.); (S.P.); (P.S.); (U.P.); (A.G.); (R.N.)
| | - Anil Gautam
- Paklihawa Campus, Institute of Agriculture and Animal Science, Tribhuvan University, Bhairahawa 32900, Nepal; (S.J.); (S.P.); (P.S.); (U.P.); (A.G.); (R.N.)
| | - Rojina Nepal
- Paklihawa Campus, Institute of Agriculture and Animal Science, Tribhuvan University, Bhairahawa 32900, Nepal; (S.J.); (S.P.); (P.S.); (U.P.); (A.G.); (R.N.)
| | - Ahmad I. Al-Mustapha
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, 00790 Helsinki, Finland
- Department of Veterinary Public Health and Preventive Medicine, Faculty of Veterinary Medicine, University of Ibadan, Ibadan 200284, Nigeria
- Department of Veterinary Services, Kwara State Ministry of Agriculture and Rural Development, Ilorin 240213, Nigeria
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21
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Nepal P, Subedee A, Shakya H, Poudel S, Joshi S, Karki K, Bajracharya D, Prentiss T, Kaljee L, Acharya Y. Protocol for a randomized controlled trial on community education and surveillance on antibiotics use among young children in Nepal. Contemp Clin Trials Commun 2023; 34:101177. [PMID: 37409187 PMCID: PMC10318443 DOI: 10.1016/j.conctc.2023.101177] [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: 03/07/2023] [Revised: 06/18/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023] Open
Abstract
Background Antimicrobial resistance (AMR) is one of the top ten threats to global health. There exists limited empirical evidence on effective approaches to address this threat. In low- and middle-income countries (LMICs), one of the primary drivers of AMR is easy access to antibiotics without prescriptions, in particular from community pharmacies. Interventions to reduce non-prescribed use of antibiotics and surveillance systems to track such usage are critically needed. This protocol describes a study that aims to test the effect of an educational intervention targeted to parents of young children on non-prescribed antibiotics consumption in Nepal and to track such consumption using a phone-based application. Methods The study is a clustered randomized controlled trial, in which we randomly assign 40 urban wards of Kathmandu Valley to either treatment group or control group, and randomly select 24 households in each ward. Households in the treatment group will receive an education intervention consisting of an "AMR pitch" (an in-person interaction that lasts up to an hour) by community nurses, videos and text messages on AMR every two weeks, and a brochure. We will conduct a survey at baseline with the parents of children ages 6 months to 10 years and track consumption of antibiotics and health care use among these children for a period of 6 months using a phone-based application. Conclusion While the study will primarily inform future policy and programmatic efforts to reduce AMR in Nepal, the study-both the education intervention and the surveillance system-can serve as a prototype for tackling AMR in other similar settings.
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Affiliation(s)
- Prajwol Nepal
- University of North Carolina-Chapel Hill, Chapel Hill, USA
| | - Anup Subedee
- Public Health Concern Trust, Nepal & Kirtipur Hospital, Nepal
| | | | | | - Supriya Joshi
- The Pennsylvania State University, University Park, USA
| | - Kshitij Karki
- Group for Technical Assistance (G.T.A.) Foundation, Kathmandu, Nepal
| | | | - Tyler Prentiss
- Global Health Initiative, Henry Ford Health, Detroit, USA
| | - Linda Kaljee
- Global Health Initiative, Henry Ford Health, Detroit, USA
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22
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Caracciolo PC, Abraham GA, Battaglia ES, Bongiovanni Abel S. Recent Progress and Trends in the Development of Electrospun and 3D Printed Polymeric-Based Materials to Overcome Antimicrobial Resistance (AMR). Pharmaceutics 2023; 15:1964. [PMID: 37514150 PMCID: PMC10385409 DOI: 10.3390/pharmaceutics15071964] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Antimicrobial resistance (AMR) developed by microorganisms is considered one of the most critical public health issues worldwide. This problem is affecting the lives of millions of people and needs to be addressed promptly. Mainly, antibiotics are the substances that contribute to AMR in various strains of bacteria and other microorganisms, leading to infectious diseases that cannot be effectively treated. To avoid the use of antibiotics and similar drugs, several approaches have gained attention in the fields of materials science and engineering as well as pharmaceutics over the past five years. Our focus lies on the design and manufacture of polymeric-based materials capable of incorporating antimicrobial agents excluding the aforementioned substances. In this sense, two of the emerging techniques for materials fabrication, namely, electrospinning and 3D printing, have gained significant attraction. In this article, we provide a summary of the most important findings that contribute to the development of antimicrobial systems using these technologies to incorporate various types of nanomaterials, organic molecules, or natural compounds with the required property. Furthermore, we discuss and consider the challenges that lie ahead in this research field for the coming years.
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Affiliation(s)
- Pablo C Caracciolo
- Biomedical Polymers Division, Research Institute for Materials Science and Technology (INTEMA), National University of Mar del Plata (UNMdP), National Scientific and Technical Research Council (CONICET), Av. Colón 10850, Mar del Plata 7600, Argentina
| | - Gustavo A Abraham
- Biomedical Polymers Division, Research Institute for Materials Science and Technology (INTEMA), National University of Mar del Plata (UNMdP), National Scientific and Technical Research Council (CONICET), Av. Colón 10850, Mar del Plata 7600, Argentina
| | - Ernesto S Battaglia
- Biomedical Polymers Division, Research Institute for Materials Science and Technology (INTEMA), National University of Mar del Plata (UNMdP), National Scientific and Technical Research Council (CONICET), Av. Colón 10850, Mar del Plata 7600, Argentina
| | - Silvestre Bongiovanni Abel
- Biomedical Polymers Division, Research Institute for Materials Science and Technology (INTEMA), National University of Mar del Plata (UNMdP), National Scientific and Technical Research Council (CONICET), Av. Colón 10850, Mar del Plata 7600, Argentina
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23
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Christopher DJ, Natania A, Daniel J, Balamugesh T, Isaac B, Krishna MT. Prevalence of drug allergy labels in a tertiary pulmonary service in South India. Clin Exp Allergy 2023. [PMID: 37365847 DOI: 10.1111/cea.14365] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023]
Affiliation(s)
| | - Arin Natania
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jefferson Daniel
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Barney Isaac
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mamidipudi Thirumala Krishna
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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24
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Rajbhandari RM, Napit R, Manandhar P, Raut R, Gurung A, Poudel A, Shrestha N, Sadaula A, Karmacharya D, Gortázar C, Alves PC, de la Fuente J, Queirós J. Phylogenomic analysis supports Mycobacterium tuberculosis transmission between humans and elephants. Front Vet Sci 2023; 10:1133823. [PMID: 37303725 PMCID: PMC10250650 DOI: 10.3389/fvets.2023.1133823] [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: 12/29/2022] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Tuberculosis is an infectious disease caused by a group of acid-fast bacilli known as Mycobacterium tuberculosis complex (MTC), which has a major impact on humans. Transmission of MTC across the human-animal interface has been demonstrated by several studies. However, the reverse zoonotic transmission from humans to animals (zooanthroponosis) has often been neglected. Methods In this study, we used Nanopore MinION and Illumina MiSeq approaches to sequence the whole genome of M. tuberculosis strains isolated from two deceased Asian elephants (Elephas maximus) and one human in Chitwan, Nepal. The evolutionary relationships and drug resistance capacity of these strains were assessed using the whole genome data generated by the stand-alone tool Tb-Profiler. Phylogenomic trees were also constructed using a non-synonymous SNP alignment of 2,596 bp, including 94 whole genome sequences representative of the previously described M. tuberculosis lineages from elephants worldwide (lineages 1 and 4) and from humans in Nepal (lineages 1, 2 and 3). Results and Discussion The new genomes achieved an average coverage of 99.6%, with an average depth of 55.67x. These M. tuberculosis strains belong to lineage 1 (elephant DG), lineage 2 (elephant PK) and lineage 4 (human), and none of them were found to have drug-resistant variants. The elephant-derived isolates were evolutionarily closely related to human-derived isolates previously described in Nepal, both in lineages 1 and 2, providing additional support for zooanthroponosis or bidirectional transmission between humans and elephants. The human-derived isolate clustered together with other published human isolates from Argentina, Russia and the United Kingdom in the lineage 4 clade. This complex multi-pathogen, multi-host system is challenging and highlights the need for a One Health approach to tuberculosis prevention and control at human-animal interface, particularly in regions where human tuberculosis is highly endemic.
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Affiliation(s)
- Rajesh Man Rajbhandari
- Departamento de Biologia, Faculdade de Ciencias da Universidade do Porto, Porto, Portugal
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado—BIOPOLIS Program in Genomics, Biodiversity and Land Planning, Campus de Vairão, Universidade do Porto, Vairão, Portugal
- SaBio, Instituto de Investigación en Recursos Cinegéticos, IREC (UCLM and CSIC), Ciudad Real, Spain
- Center for Molecular Dynamics Nepal, Kathmandu, Nepal
| | | | | | - Roji Raut
- Center for Molecular Dynamics Nepal, Kathmandu, Nepal
| | | | - Ajit Poudel
- Center for Molecular Dynamics Nepal, Kathmandu, Nepal
| | | | - Amir Sadaula
- National Trust for Nature Conservation, Biodiversity Conservation Center, Chitwan, Nepal
| | - Dibesh Karmacharya
- Center for Molecular Dynamics Nepal, Kathmandu, Nepal
- School of Biological Sciences, Faculty of Science, The University of Queensland, Brisbane, QLD, Australia
| | - Christian Gortázar
- SaBio, Instituto de Investigación en Recursos Cinegéticos, IREC (UCLM and CSIC), Ciudad Real, Spain
| | - Paulo Célio Alves
- Departamento de Biologia, Faculdade de Ciencias da Universidade do Porto, Porto, Portugal
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado—BIOPOLIS Program in Genomics, Biodiversity and Land Planning, Campus de Vairão, Universidade do Porto, Vairão, Portugal
- EBM, Estação Biológica de Mértola, Praça Luís de Camões, Mértola, Portugal
| | - José de la Fuente
- SaBio, Instituto de Investigación en Recursos Cinegéticos, IREC (UCLM and CSIC), Ciudad Real, Spain
- Department of Veterinary Pathobiology, Center for Veterinary Health Sciences, Oklahoma State University, Stillwater, OK, United States
| | - João Queirós
- Departamento de Biologia, Faculdade de Ciencias da Universidade do Porto, Porto, Portugal
- CIBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, InBIO Laboratório Associado—BIOPOLIS Program in Genomics, Biodiversity and Land Planning, Campus de Vairão, Universidade do Porto, Vairão, Portugal
- EBM, Estação Biológica de Mértola, Praça Luís de Camões, Mértola, Portugal
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Upadhyaya N, Karki S, Rana S, Elsohaby I, Tiwari R, Oli M, Paudel S. Trend of Antimicrobial Use in Food-Producing Animals from 2018 to 2020 in Nepal. Animals (Basel) 2023; 13:ani13081377. [PMID: 37106940 PMCID: PMC10135152 DOI: 10.3390/ani13081377] [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: 03/09/2023] [Revised: 04/03/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Antimicrobial resistance is a global public health problem and is primarily driven by the widespread overuse of antibiotics. However, antimicrobial use data in animals are not readily available due to the absence of a national database in many developing countries, including Nepal. This study was conducted to estimate the quantities of antimicrobials available in Nepal as an indicator of their use in food-producing animals between 2018 and 2020. Data were collected through surveys targeting major stakeholders: (i) the Department of Drug Administration (DDA), the Government of Nepal (GoN) for the authorized antimicrobials for veterinary use in Nepal, (ii) veterinary pharmaceuticals for antimicrobials produced in Nepal, (iii) the DDA and Veterinary Importers Association for antimicrobials bought by veterinary drug importers, and (iv) the Department of Customs, GoN, for antibiotics sourced through customs. Data showed that in the 3 years, a total of 96 trade names, comprising 35 genera of antibiotics representing 10 classes, were either produced or imported in Nepal. In total, 91,088 kg, 47,694 kg, and 45,671 kg of active ingredients of antimicrobials were available in 2018, 2019, and 2020, respectively. None of the antibiotics were intended for growth promotion, but were primarily for therapeutic purposes. Oxytetracycline, tilmicosin, and sulfadimidine were among the most-used antibiotics in Nepal in 2020. Oxytetracycline was primarily intended for parenteral application, whereas tilmicosin was solely for oral use. Sulfadimidine was available for oral use, except for a small proportion for injection purposes. Aminoglycosides, fluroquinolones, nitrofurans, sulfonamides, and tetracyclines were mostly produced locally, whereas cephalosporins, macrolides and "other" classes of antimicrobials were imported. Amphenicols and penicillins were exclusively imported and nitrofurans were produced locally only. In general, except for tetracyclines, the volume of antimicrobials produced locally and/or imported in 2020 was lower than that in 2018, which corresponded to a decreasing trend in total antimicrobials available. Furthermore, the subsequent years have seen a decrease in the use of critically important antibiotics, particularly class I antibiotics. Finally, this study has firstly established a benchmark for future monitoring of antimicrobial usage in food-producing animals in Nepal. These data are useful for risk analysis, planning, interpreting resistance surveillance data, and evaluating the effectiveness of prudent use, efforts, and mitigation strategies.
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Affiliation(s)
- Nabin Upadhyaya
- Veterinary Standards and Drug Regulatory Laboratory, Budhanilakantha, Kathmandu 44600, Nepal
| | - Surendra Karki
- Food and Agriculture Organization of the United Nations, Emergency Center for Transboundary Animal Diseases, Lalitpur 44700, Nepal
| | - Sujan Rana
- Department of Livestock Services, Hariharbhawan, Lalitpur 44700, Nepal
| | - Ibrahim Elsohaby
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China
- Centre for Applied One Health Research and Policy Advice (OHRP), City University of Hong Kong, Hong Kong SAR, China
| | - Ramanandan Tiwari
- Ministry of Agriculture and Livestock Development Nepal, Singhadurbar, Kathmandu 44600, Nepal
| | - Manoj Oli
- Tulsipur Municipality, Tulsipur, Dang 22412, Nepal
| | - Surya Paudel
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong SAR, China
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Anedda E, Farrell ML, Morris D, Burgess CM. Evaluating the impact of heavy metals on antimicrobial resistance in the primary food production environment: A scoping review. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 320:121035. [PMID: 36623784 DOI: 10.1016/j.envpol.2023.121035] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/03/2023] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
Heavy metals are naturally occurring environmental compounds, which can influence antimicrobial resistance (AMR) dissemination. However, there is limited information on how heavy metals may act as a selective pressure on AMR in the primary food production environment. This review aims to examine the literature on this topic in order to identify knowledge gaps. A total of 73 studies, which met pre-established criteria, were included. These investigations were undertaken between 2008 and 2021, with a significant increase in the last three years. The majority of studies included were undertaken in China. Soil, water and manure were the most common samples analysed, and the sampling locations varied from areas with a natural presence of heavy metals, areas intentionally amended with heavy metals or manure, to areas close to industrial activity or mines. Fifty-four per cent of the investigations focused on the analysis of four or more heavy metals, and copper and zinc were the metals most frequently analysed (n = 59, n = 49, respectively). The findings of this review highlight a link between heavy metals and AMR in the primary food production environment. Heavy metals impacted the abundance and dissemination of mobile genetic elements (MGEs) and antimicrobial resistance genes (ARGs), with MGEs also observed as playing a key role in the spread of ARGs and metal resistance genes (MRGs). Harmonization of methodologies used in future studies would increase the opportunity for comparison between studies. Further research is also required to broaden the availability of data at a global level.
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Affiliation(s)
- Elena Anedda
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, University of Galway, Ireland; Food Safety Department, Teagasc Food Research Centre Ashtown, Dublin, Ireland.
| | - Maeve Louise Farrell
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, University of Galway, Ireland; Centre for One Health, Ryan Institute, University of Galway, Ireland.
| | - Dearbháile Morris
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, University of Galway, Ireland; Centre for One Health, Ryan Institute, University of Galway, Ireland.
| | - Catherine M Burgess
- Food Safety Department, Teagasc Food Research Centre Ashtown, Dublin, Ireland.
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Napit R, Manandhar P, Poudel A, Rajbhandari PG, Watson S, Shakya S, Pradhan SM, Sharma AN, Chaudhary A, Johnson CK, Mazet JK, Karmacharya D. Novel strains of Campylobacter cause diarrheal outbreak in Rhesus macaques (Macaca mulatta) of Kathmandu Valley. PLoS One 2023; 18:e0270778. [PMID: 36857401 PMCID: PMC9977009 DOI: 10.1371/journal.pone.0270778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 01/06/2023] [Indexed: 03/02/2023] Open
Abstract
Campylobacter spp. is often underreported and underrated bacteria that present real health risks to both humans and animals, including non-human primates. It is a commensal microorganism of gastrointestinal tract known to cause gastroenteritis in humans. Commonly found in many wild animals including non-human primates (monkeys- Rhesus macaques) these pathogens are known to be a common cause of diarrhea in humans in many parts of developing and under developed countries. Rhesus macaques from the two holy sites in Kathmandu (Pashupati and Swoyambhu) were included in this cross-sectional study. Diarrheal samples of monkeys were analyzed to detect and characterize the pathogen using 16S rRNA-based PCR screening, followed by DNA sequencing and phylogenetic analysis. Out of a total 67 collected diarrheal samples, Campylobacter spp. were detected in the majority of the samples (n = 64; 96%). DNA sequences of the amplified PCR products were successfully obtained from 13 samples. Phylogenetic analysis identified Candidatus Campylobacter infans (n = 10, Kimura-2 parameter (K2P) pairwise distance values of 0.002287). Remaining three sequences might potentially belong to a novel Campylobacter species/sub-species- closely relating to known species of C. helviticus (K2P pairwise distance of 0.0267). Both Candidatus Campylobacter infans and C. helvitucus are known to infect humans and animals. Additionally, we also detected the bacteria in water and soil samples from the sites. Campylobacter spp. caused the 2018 diarrhea outbreak in Rhesus macaques in the Kathmandu valley. Campylobacter might be one of the important contributing pathogens in diarrheal outbreaks-both in humans and animals (monkeys) in Nepal. Due to close interactions of these animals with humans and other animals, One Health approach might be the most effective way to prevent and mitigate the threat posed by this pathogen.
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Affiliation(s)
- Rajindra Napit
- One Health Research Division, Center for Molecular Dynamics Nepal, Kathmandu, Nepal
- Research Division, BIOVAC Nepal Pvt. Ltd., Nala, Banepa, Nepal
| | - Prajwol Manandhar
- One Health Research Division, Center for Molecular Dynamics Nepal, Kathmandu, Nepal
- Research Division, BIOVAC Nepal Pvt. Ltd., Nala, Banepa, Nepal
| | - Ajit Poudel
- One Health Research Division, Center for Molecular Dynamics Nepal, Kathmandu, Nepal
- Research Division, BIOVAC Nepal Pvt. Ltd., Nala, Banepa, Nepal
| | | | - Sarah Watson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sapana Shakya
- One Health Research Division, Center for Molecular Dynamics Nepal, Kathmandu, Nepal
| | - Saman M. Pradhan
- One Health Research Division, Center for Molecular Dynamics Nepal, Kathmandu, Nepal
- Research Division, BIOVAC Nepal Pvt. Ltd., Nala, Banepa, Nepal
| | - Ajay N. Sharma
- One Health Research Division, Center for Molecular Dynamics Nepal, Kathmandu, Nepal
| | - Ashok Chaudhary
- One Health Research Division, Center for Molecular Dynamics Nepal, Kathmandu, Nepal
| | - Christine K. Johnson
- One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, United States of America
| | - Jonna K. Mazet
- One Health Institute, School of Veterinary Medicine, University of California, Davis, CA, United States of America
| | - Dibesh Karmacharya
- One Health Research Division, Center for Molecular Dynamics Nepal, Kathmandu, Nepal
- Research Division, BIOVAC Nepal Pvt. Ltd., Nala, Banepa, Nepal
- The School of Biological Sciences, University of Queensland, Queensland, Australia
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R JA, Narayan S. A Systematic Review of Different Classes of Biopolymers and Their Use as Antimicrobial Agents. RUSSIAN JOURNAL OF BIOORGANIC CHEMISTRY 2023. [DOI: 10.1134/s1068162023020103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Bhusal B, Yadav B, Dawadi P, Rijal KR, Ghimire P, Banjara MR. Multi-drug Resistance, β-Lactamases Production, and Coexistence of bla NDM-1 and mcr-1 in Escherichia coli Clinical Isolates From a Referral Hospital in Kathmandu, Nepal. Microbiol Insights 2023; 16:11786361231152220. [PMID: 36741474 PMCID: PMC9893399 DOI: 10.1177/11786361231152220] [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: 12/07/2022] [Accepted: 01/04/2023] [Indexed: 02/04/2023] Open
Abstract
The ability of pathogenic Escherichia coli to produce carbapenemase enzymes is a characteristic that allows them to resist various antibiotics, including last-resort antibiotics like colistin and carbapenem. Our objectives were to identify rapidly developing antibiotic resistance (AR), assess β-lactamases production, and detect mcr-1 and bla NDM-1 genes in the isolates. A prospective cross-sectional study was carried out in a referral hospital located in Kathmandu from November 2019 to December 2020 using standard laboratory and molecular protocols. Among 77 total E. coli isolates, 64 (83.1%) of them were categorized as MDR. Phenotypically 13 (20.3%) colistin-resistant, 30 (46.9%) ESBL and 8 (12.5%) AmpC producers, and 5 (7.8%) ESBL/AmpC co-producers were distributed among MDR-E. coli. Minimum inhibitory concentrations (MIC) against the majority of MDR isolates were exhibited at 1 g/L. Of these 77 E. coli isolates, 24 (31.2%) were carbapenem-resistant. Among these carbapenem-resistant bacteria, 11 (45.9%) isolates were reported to be colistin-resistant, while 15 (62.5%) and 2 (8.3%) were MBL and KPC producers, respectively. Out of 15 MBL producers, 6 (40%) harbored bla NDM-1, and 8 (61.5%) out of 13 colistin-resistant pathogens possessed mcr-1. The resistance by colistin- and carbapenem were statistically associated (P < .001). However, only 2 (18.2%) of the co-resistant bacteria were found to have both genes. Our study revealed the highly prevalent MDR and the carbapenem-resistant E. coli and emphasized that the pathogens possess a wide range of capabilities to synthesize β-lactamases. These findings could assist to expand the understanding of AR in terms of enzyme production.
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Affiliation(s)
- Bhimarjun Bhusal
- Central Department of Microbiology,
Tribhuvan University, Kathmandu, Bagmati, Nepal
| | - Bindeshwar Yadav
- Shahid Gangalal National Heart Center,
Kathmandu, Bagmati, Nepal
| | - Prabin Dawadi
- Central Department of Microbiology,
Tribhuvan University, Kathmandu, Bagmati, Nepal
| | - Komal Raj Rijal
- Central Department of Microbiology,
Tribhuvan University, Kathmandu, Bagmati, Nepal
| | - Prakash Ghimire
- Central Department of Microbiology,
Tribhuvan University, Kathmandu, Bagmati, Nepal
| | - Megha Raj Banjara
- Central Department of Microbiology,
Tribhuvan University, Kathmandu, Bagmati, Nepal,Megha Raj Banjara, Central Department of
Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Bagmati 44618, Nepal.
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Ghimire K, Banjara MR, Marasini BP, Gyanwali P, Poudel S, Khatri E, Dhimal M. Antibiotics Prescription, Dispensing Practices and Antibiotic Resistance Pattern in Common Pathogens in Nepal: A Narrative Review. Microbiol Insights 2023; 16:11786361231167239. [PMID: 37066121 PMCID: PMC10102948 DOI: 10.1177/11786361231167239] [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: 03/30/2022] [Accepted: 03/16/2023] [Indexed: 04/18/2023] Open
Abstract
Antimicrobial resistance (AMR) is increasing and it is a serious public health problem worldwide. Nepal is considered as one of the contributors for rising AMR due to the most prevalent irrational use of antibiotics. In this review, we have assessed the practices of antibiotic prescription and dispensing, and antibiotic resistance of commonly encountered bacteria in Nepal. There is exponential increase of therapeutic consumption of antibiotics either without clinician's prescription or irrational prescription. Almost half of the population in Nepal was found to purchase antibiotics easily from the nearby pharmacies without clinician's prescription. Irrational prescription is exceeded in remote areas which could be due to lack of access with health posts and hospitals. The third generation cephalosporins, which are considered as the last resort antibiotics were found to be relatively prescribed and dispensed higher as compared to other classes of antibiotics. Despite the existing limited functional surveillance system, antibiotic resistance among bacteria is increasing in Nepal because of irrational prescription, dispensing and consumption of antibiotics without prescription.
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Affiliation(s)
- Kalpana Ghimire
- Central Department of Microbiology,
Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Megha Raj Banjara
- Central Department of Microbiology,
Tribhuvan University, Kirtipur, Kathmandu, Nepal
- Megha Raj Banjara, Central Department of
Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44618, Nepal.
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31
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Xie J, Zhang H, Li Y, Li H, Pan Y, Zhao Y, Xie Q. Transcriptome analysis of the biofilm formation mechanism of Vibrio parahaemolyticus under the sub-inhibitory concentrations of copper and carbenicillin. Front Microbiol 2023; 14:1128166. [PMID: 36937277 PMCID: PMC10018186 DOI: 10.3389/fmicb.2023.1128166] [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: 12/20/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Biofilm formation of Vibrio parahaemolyticus enhanced its tolerance to the environment, but caused many serious problems to food safety and human health. In this paper, the effects of copper and carbenicillin (CARB) stress on the formation of the biofilms of V. parahaemolyticus organisms were studied, and RNA sequencing technology was used to compare the differences in transcriptome profiles of the biofilm-related genes of V. parahaemolyticus organisms under different sub-inhibitory stresses. The results proved that V. parahaemolyticus had a large growth difference under the two stresses, copper and CARB at 1/2 minimal inhibitory concentration (MIC), and it could form a stable biofilm under both stress conditions. The amount of biofilm formed under CARB stress was significantly higher than that of copper stress (p < 0.05). Based on the analysis of transcriptome sequencing results 323, 1,550, and 1,296 significantly differential expressed genes were identified in the three treatment groups namely 1/2 MIC CARB, Cu2+, and Cu2++CARB. Through COG annotation, KEGG metabolic pathway analysis and gene expression analysis related to biofilm formation, the functional pathways of transcriptome changes affecting V. parahaemolyticus were different in the three treatment groups, and the CARB treatment group was significantly different from the other two groups. These differences indicated that the ABC transport system, two-component system and quorum sensing were all involved in the biofilm formation of the V. parahaemolytic by regulating flagellar motility, extracellular polysaccharides and extracellular polymer synthesis. Exploring the effects of different stress conditions on the transcriptome of V. parahaemolyticus could provide a basis for future research on the complex network system that regulates the formation of bacterial biofilms.
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Affiliation(s)
- Jiaying Xie
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China
| | - Hongmin Zhang
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China
| | - Yinhui Li
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China
| | - Hao Li
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China
| | - Yingjie Pan
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China
- Laboratory of Quality and Safety Risk Assessment for Aquatic Product on Storage and Preservation, Ministry of Agriculture and Rural Affairs, Shanghai, China
- Shanghai Engineering Research Center of Aquatic Product Processing and Preservation, Shanghai, China
| | - Yong Zhao
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China
- Laboratory of Quality and Safety Risk Assessment for Aquatic Product on Storage and Preservation, Ministry of Agriculture and Rural Affairs, Shanghai, China
- Shanghai Engineering Research Center of Aquatic Product Processing and Preservation, Shanghai, China
- *Correspondence: Yong Zhao,
| | - Qingchao Xie
- College of Food Science and Technology, Shanghai Ocean University, Shanghai, China
- Laboratory of Quality and Safety Risk Assessment for Aquatic Product on Storage and Preservation, Ministry of Agriculture and Rural Affairs, Shanghai, China
- Qingchao Xie,
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32
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Screening for Escherichia coli in Chopping Board Meat Samples and Survey for Sanitary and Hygienic Practices in Retail Meat Shops of Bharatpur Metropolitan City, Nepal. MICROBIOLOGY RESEARCH 2022. [DOI: 10.3390/microbiolres13040061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In this study, chopping board meat samples collected from meat shops of Bharatpur Metropolitan City, Nepal, were screened for the presence of Escherichia coli (E. coli), with a special emphasis on the identification of extended-spectrum β-lactamase (ESBL)-producing strains. Representatives from the meat shops were also interviewed to understand the sanitary status and hygienic practices. E. coli bacteria were detected in one third (33/99) of the meat samples, while none of the samples had ESBL-producing strains. While 60.6% (60/99) of the meat shop personnel wore protective clothing, 15.15% (15/99) used gloves, and only 5.05% (5/99) had separate equipment for cleaning the viscera of animals. This study highlights the need for the regular screening of meat samples to identify pathogenic bacteria such as E. coli and for improvements in the sanitary status and hygienic practices of retail meat shops in Bharatpur Metropolitan City, Nepal.
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33
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O'Toole RF. Antibiotic resistance acquisition versus primary transmission in the presentation of extensively drug-resistant tuberculosis. Int J Mycobacteriol 2022; 11:343-348. [PMID: 36510916 DOI: 10.4103/ijmy.ijmy_187_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Mycobacterium tuberculosis is the leading cause of mortality worldwide due to a single bacterial pathogen. Of concern is the negative impact that the COVID-19 pandemic has had on the control of tuberculosis (TB) including drug-resistant forms of the disease. Antimicrobial resistance increases the likelihood of worsened outcomes in TB patients including treatment failure and death. Multidrug-resistant (MDR) strains, resistant to first-line drugs isoniazid and rifampin, and extensively drug-resistant (XDR) strains with further resistance to second-line drugs (SLD), threaten control programs designed to lower TB incidence and end the disease as a public health challenge by 2030, in accordance with UN Sustainable Development Goals. Tackling TB requires an understanding of the pathways through which drug resistance emerges. Here, the roles of acquired resistance mutation, and primary transmission, are examined with regard to XDR-TB. It is apparent that XDR-TB can emerge from MDR-TB through a small number of additional resistance mutations that occur in patients undergoing drug treatment. Rapid detection of resistance, to first-line drugs and SLD, at the initiation of and during treatment, and prompt adjustment of regimens are required to ensure treatment success in these patients. Primary transmission is predicted to make an increasing contribution to the XDR-TB caseload in the future. Much work is required to improve the implementation of the World Health Organization-recommended infection control practices and block onward transmission of XDR-TB patients to contacts including health-care workers. Finally, limiting background resistance to fluoroquinolones in pre-XDR strains of M. tuberculosis will necessitate better antimicrobial stewardship in the broader use of this drug class.
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Affiliation(s)
- Ronan Francis O'Toole
- Department of Biomedicine and Medical Diagnostics, School of Science, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
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Koju P, Shrestha R, Shrestha A, Tamrakar S, Rai A, Shrestha P, Madhup SK, Katuwal N, Shrestha A, Shrestha A, Shrestha S, K.C S, Karki P, Tamang P, Thekkur P, Shakya Shrestha S. Antimicrobial Resistance in E. coli Isolated from Chicken Cecum Samples and Factors Contributing to Antimicrobial Resistance in Nepal. Trop Med Infect Dis 2022; 7:tropicalmed7090249. [PMID: 36136660 PMCID: PMC9504632 DOI: 10.3390/tropicalmed7090249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Microorganisms with antimicrobial resistance (AMR) are prevalent among humans and animals, and also found in the environment. Though organisms with AMR can spread to humans via food from animal sources, the burden of AMR in food-producing animals remains largely unknown. Thus, we assessed the resistance pattern among Escherichia coli isolated from chicken cecum samples and explored issues contributing to AMR in animals in the Dhulikhel Municipality of Nepal. We conducted a mixed-methods study, comprising a cross-sectional quantitative component, with collection of chicken cecal samples from slaughter houses/shops. In addition, a descriptive qualitative component was undertaken, with a focus group discussion and key informant interviews among stakeholders involved in animal husbandry. Of the 190 chicken cecum samples collected, 170 (89%) were subjected to culture and drug sensitivity testing, of which E. coli was isolated from 159 (94%) samples. Of the 159 isolates, 113 (71%) had resistance to ≥3 antimicrobial class. Resistance to tetracycline (86%) and ciprofloxacin (66%) were most prevalent. Overuse of antimicrobials, easy availability of antimicrobials, and lack of awareness among farmers about AMR were major issues contributing to AMR. The high prevalence of resistance among E. coli in chicken cecal samples calls for rational use of antimicrobials, educating farmers, and multi-sectoral coordination.
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Affiliation(s)
- Pramesh Koju
- Pharmacovigilance Unit, Dhulikhel Hospital, Dhulikhel 45210, Nepal
- Department of Public Health and Community Programs, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Rajeev Shrestha
- Pharmacovigilance Unit, Dhulikhel Hospital, Dhulikhel 45210, Nepal
- Department of Pharmacology, School of Medical Sciences, Kathmandu University, Dhulikhel 45210, Nepal
- Research and Development Division, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Abha Shrestha
- Department of Public Health and Community Programs, Dhulikhel Hospital, Dhulikhel 45210, Nepal
- Department of Community Medicine, School of Medical Sciences, Kathmandu University, Dhulikhel 45210, Nepal
| | - Sudichhya Tamrakar
- Research and Development Division, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Anisha Rai
- Research and Development Division, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Priyanka Shrestha
- World Health Emergencies Programme, WHO Country Office, Kathmandu 41825, Nepal
| | | | - Nishan Katuwal
- Research and Development Division, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Archana Shrestha
- Department of Public Health and Community Programs, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Akina Shrestha
- Department of Public Health and Community Programs, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Sunaina Shrestha
- Department of Microbiology, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Sandip K.C
- Health Unit, Dhulikhel Municipality, Dhulikhel 45210, Nepal
| | - Prashamsa Karki
- Department of Microbiology, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Pooja Tamang
- Research and Development Division, Dhulikhel Hospital, Dhulikhel 45210, Nepal
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), 75000 Paris, France
| | - Sony Shakya Shrestha
- Pharmacovigilance Unit, Dhulikhel Hospital, Dhulikhel 45210, Nepal
- Department of Pharmacology, School of Medical Sciences, Kathmandu University, Dhulikhel 45210, Nepal
- Correspondence: ; Tel.: +977-9841276045
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35
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Amarasiri M, Takezawa T, Malla B, Furukawa T, Sherchand JB, Haramoto E, Sei K. Prevalence of antibiotic resistance genes in drinking and environmental water sources of the Kathmandu Valley, Nepal. Front Microbiol 2022; 13:894014. [PMID: 36071971 PMCID: PMC9441849 DOI: 10.3389/fmicb.2022.894014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Antibiotic-resistant bacteria-associated infections are responsible for more than 1.2 million annual deaths worldwide. In low- and middle-income countries (LMICs), the consumption of antibiotics for human and veterinary uses is not regulated effectively. Overused and misused antibiotics can end up in aquatic environments, which may act as a conduit for antibiotic resistance dissemination. However, data on the prevalence of antibiotic resistance determinants in aquatic environments are still limited for LMICs. In this study, we evaluated the prevalence and concentration of antibiotic resistance genes (ARGs) in different drinking and environmental water sources collected from the Kathmandu Valley, Nepal, using droplet digital polymerase chain reaction to understand the current situation of ARG contamination. River water and shallow dug well water sources were the most contaminated with ARGs. Almost all samples contained sul1 (94%), and intI1 and tet(A) were detected in 83 and 60% of the samples, respectively. Maximum ARG concentration varied between 4.2 log10 copies/100 ml for mecA and 9.3 log10 copies/100 ml for sul1. Significant positive correlations were found between ARGs (r > 0.5, p < 0.01), except for mecA, qnrS, and vanA. As sul1 and intI1 were detected in almost all samples, the presence of these genes in a given sample may need to be considered as background antibiotic resistance in LMICs. Therefore, monitoring of ARGs, such as β-lactam ARGs, quinolone resistance genes, and vancomycin resistance genes, may provide a better picture of the antibiotic resistance determinants in aquatic environments of LMICs.
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Affiliation(s)
- Mohan Amarasiri
- Laboratory of Environmental Hygiene, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan,*Correspondence: Mohan Amarasiri,
| | - Tsubasa Takezawa
- Laboratory of Environmental Hygiene, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Bikash Malla
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, Kofu, Japan
| | - Takashi Furukawa
- Laboratory of Environmental Hygiene, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
| | - Jeevan B. Sherchand
- Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Eiji Haramoto
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, Kofu, Japan
| | - Kazunari Sei
- Laboratory of Environmental Hygiene, School of Allied Health Sciences, Kitasato University, Sagamihara, Japan
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Neupane A, Bastakoti M, Tamang S, Giri B. Review of drug recalls and quality of pharmaceutical products in Nepal. BMJ Open 2022; 12:e053479. [PMID: 35788073 PMCID: PMC9255392 DOI: 10.1136/bmjopen-2021-053479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To evaluate the pattern of substandard and falsified pharmaceutical products recall in Nepal. SETTING We analysed drug recall notices issued by the Department of Drug Administration (DDA), Nepal, and systematically reviewed peer-reviewed research articles during January 2010 to December 2020. PARTICIPANTS This study did not include human participants. However, data were collected from 72 drug recall notices issued by DDA and four research papers. RESULTS A total of 346 pharmaceutical products were recalled during the reported period. The number of recalled pharmaceutical products has increased significantly over the past decade in Nepal. The most frequently recalled drugs were antimicrobials followed by gastrointestinal medicines, vitamins and supplements and pain and palliative medicines among others. Number of imported recalled drugs were slightly higher (42.2%) than domestic recalled drugs (40.7%). Sixty-two percentage of recalled drugs were substandard, 11% were falsified and remaining 27% were not registered at the DDA. Similarly, higher number of modern drugs (62%) were recalled than traditional ones (35%). Hand sanitisers used to minimise COVID-19 transmission contributed significantly to the list of recalled pharmaceutical products in 2020. Most of these sanitisers contained significant amounts of methanol (as high as 75% v/v) instead of appropriate amount of ethyl or isopropyl alcohol. The peer-reviewed research papers reported issues with labelling, unregistered drugs and drugs failed in several laboratory testing. CONCLUSION Our analysis showed that number of recalls of substandard and falsified drugs are increasing in Nepal. Since the recall data in this paper did not include number of samples tested and location of samples collected, more studies to understand the prevalence of substandard and falsified drugs in Nepal is recommended.
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Affiliation(s)
- Astha Neupane
- Center for Analytical Sciences, Kathmandu Institute of Applied Sciences, Kathmandu, Bagmati, Nepal
| | - Maheshwor Bastakoti
- Center for Analytical Sciences, Kathmandu Institute of Applied Sciences, Kathmandu, Bagmati, Nepal
| | - Sabita Tamang
- Center for Analytical Sciences, Kathmandu Institute of Applied Sciences, Kathmandu, Bagmati, Nepal
| | - Basant Giri
- Center for Analytical Sciences, Kathmandu Institute of Applied Sciences, Kathmandu, Bagmati, Nepal
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Prevalence and Risk Factors of Staphylococcal Subclinical Mastitis in Dairy Animals of Chitwan, Nepal. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.2.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Subclinical mastitis (SCM), the asymptomatic inflammation of breast tissue, is the most common form of mastitis in livestock. SCM prevalence and risk factors in dairy animals in Western Chitwan, Bagmati Province, Nepal, were the primary objectives of this study. Out of 243 dairy animals, 104 representing 42.8% were positive for SCM in the California mastitis test (CMT) in the study area. At the quarter level, out of 972 active quarters tested for SCM, 188 (19.3%) were positive to CMT test. The prevalence of Staphylococcal SCM was 39.92% (97/243) and 18.21% (177/972) at animal level and quarter level, respectively. Coagulase Negative Staphylococcus (CNS) (46.33%) was the most prevalent Staphylococcus to cause SCM at quarter level. While at animal level, SCM due to occurrence of both S. aureus and CNS (36.08%) in an individual was more common. High susceptibility towards Amikacin, Ceftriaxone and Gentamicin was seen against both isolates. Low resistance against Amikacin and Ceftriaxone was seen against both isolates. Ciprofloxacin (41.2% vs 27.4%) and Gentamicin (37.8% vs 23.2%) were more resistance towards CNS whereas Enrofloxacin (41.1% vs 25.2%) and Tetracycline (36.8% vs 15.1%) were more resistant towards S. aureus. Older aged, multiparous and late lactating animals had the highest prevalence of staphylococcal SCM i.e., 58.1%, 56% and 52.6%, respectively. The study concludes that there is a high prevalence of Staphylococcal SCM in Western Chitwan, Nepal. CNS is the most common mastitis pathogen. Increased antimicrobial resistance to S. aureus and CNS could be the result of the indiscriminate use of antibiotic drugs without an antibiotic susceptibility test (AST). This study emphasizes the importance of ongoing antibiotic surveillance, excellent farm and animal hygiene, and suitable housing and feeding management.
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Jones N, Mitchell J, Cooke P, Baral S, Arjyal A, Shrestha A, King R. Gender and Antimicrobial Resistance: What Can We Learn From Applying a Gendered Lens to Data Analysis Using a Participatory Arts Case Study? Front Glob Womens Health 2022; 3:745862. [PMID: 35720810 PMCID: PMC9199426 DOI: 10.3389/fgwh.2022.745862] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial resistance (AMR), the natural process by which bacteria become resistant to the medicines used to kill them, is becoming one of the greatest threats to health globally. AMR is accelerating at alarming rates due to behaviors across human, animal, and environmental health sectors as well as governance and policy shortfalls across each sector. Antimicrobial resistant infections occur through the same channels as other infectious diseases and are most common in countries/areas where there is limited access to improved sanitation facilities, reliable healthcare and health education. At the community level, much remains to be understood about the drivers of antimicrobial resistance and how to generate community-led, acceptable solutions. Gender can influence every part of an individual's health experiences; access to knowledge, healthcare facilities, financial resources and paid employment are all heavily gendered and influence behaviors relating to the procurement of antimicrobial and antibiotic agents. This analysis uses data gathered during a participatory video study designed to work with two communities in Nepal to understand drivers of antibiotic mis and over use from the perspective of the communities themselves. Findings reveal that gender impacts upon many aspects of AMR-driving behaviors within this community and stimulate essential discussion as to the importance of gender in future AMR research. This paper places a spotlight on gender in the wider AMR conversation, an area that is currently neglected, and improve our collective knowledge on the drivers of AMR from a gendered perspective.
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Affiliation(s)
- Nichola Jones
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Jessica Mitchell
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Paul Cooke
- Faculty of Arts, Humanities and Cultures, University of Leeds, Leeds, United Kingdom
| | | | | | | | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
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Assefa M. Multi-drug resistant gram-negative bacterial pneumonia: etiology, risk factors, and drug resistance patterns. Pneumonia (Nathan) 2022; 14:4. [PMID: 35509063 PMCID: PMC9069761 DOI: 10.1186/s41479-022-00096-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/11/2022] [Indexed: 12/27/2022] Open
Abstract
Bacterial pneumonia is one of the most serious public health issues owing to its medical and economic costs, which result in increased morbidity and mortality in people of all ages around the world. Furthermore, antimicrobial resistance has risen over time, and the advent of multi-drug resistance in GNB complicates therapy and has a detrimental impact on patient outcomes. The current review aimed to summarize bacterial pneumonia with an emphasis on gram-negative etiology, pathogenesis, risk factors, resistance mechanisms, treatment updates, and vaccine concerns to tackle the problem before it causes a serious consequence. In conclusion, the global prevalence of GNB in CAP was reported 49.7% to 83.1%, whereas in VAP patients ranged between 76.13% to 95.3%. The most commonly reported MDR-GNB causes of pneumonia were A. baumannii, K. pneumoniae, and P. aeruginosa, with A. baumannii isolated particularly in VAP patients and the elderly. In most studies, ampicillin, tetracyclines, amoxicillin-clavulanic acid, cephalosporins, and carbapenems were shown to be highly resistant. Prior MDR-GNB infection, older age, previous use of broad-spectrum antibiotics, high frequency of local antibiotic resistance, prolonged hospital stays, ICU admission, mechanical ventilation, and immunosuppression are associated with the MDR-GNB colonization. S. maltophilia was reported as a severe cause of HAP/VAP in patients with mechanically ventilated and having hematologic malignancy due to its ability of biofilm formation, site adhesion in respiratory devices, and its intrinsic and acquired drug resistance mechanisms. Effective combination therapies targeting PDR strains and drug-resistant genes, antibiofilm agents, gene-based vaccinations, and pathogen-specific lymphocytes should be developed in the future.
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Affiliation(s)
- Muluneh Assefa
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia.
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Kamara IF, Tengbe SM, Fofanah BD, Bunn JE, Njuguna CK, Kallon C, Kumar AMV. Infection Prevention and Control in Three Tertiary Healthcare Facilities in Freetown, Sierra Leone during the COVID-19 Pandemic: More Needs to Be Done! INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095275. [PMID: 35564669 PMCID: PMC9105082 DOI: 10.3390/ijerph19095275] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/04/2022] [Accepted: 04/20/2022] [Indexed: 02/06/2023]
Abstract
Infection Prevention and Control (IPC) measures are critical to the reduction in healthcare-associated infections, especially during pandemics, such as that of COVID-19. We conducted a hospital-based cross-sectional study in August 2021 at Connaught Hospital, Princess Christian Maternity Hospital and Ola During Children's Hospital located in Freetown, Sierra Leone. We used the World Health Organization's Infection Prevention and Control Assessment Framework Tool to assess the level of IPC compliance at these healthcare facilities. The overall IPC compliance score at Connaught Hospital was 323.5 of 800 points, 313.5 of 800 at Ola During Children's Hospital, 281 of 800 at Princess Christian Maternity Hospital, implying a 'Basic' IPC compliance grade. These facilities had an IPC program, IPC committees and dedicated IPC focal persons. However, there were several challenges, including access to safe and clean water and insufficient quantities of face masks, examination gloves and aprons. Furthermore, there was no dedicated budget or no healthcare-associated infection (HAI) surveillance, and monitoring/audit of IPC practices were weak. These findings are of concern during the COVID-19 era, and there is an urgent need for both financial and technical support to address the gaps and challenges identified.
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Affiliation(s)
- Ibrahim Franklyn Kamara
- World Health Organization, 21A-B Riverside, Off King Harman Road Freetown, Freetown 00232, Sierra Leone; (B.D.F.); (J.E.B.); (C.K.N.)
- Correspondence: or ; Tel.: +232-7634-5757
| | - Sia Morenike Tengbe
- Ministry of Health and Sanitation, 4th Floor, Youyi Building, Brookfields, Freetown 00232, Sierra Leone; (S.M.T.); (C.K.)
| | - Bobson Derrick Fofanah
- World Health Organization, 21A-B Riverside, Off King Harman Road Freetown, Freetown 00232, Sierra Leone; (B.D.F.); (J.E.B.); (C.K.N.)
| | - James Edward Bunn
- World Health Organization, 21A-B Riverside, Off King Harman Road Freetown, Freetown 00232, Sierra Leone; (B.D.F.); (J.E.B.); (C.K.N.)
| | - Charles Kuria Njuguna
- World Health Organization, 21A-B Riverside, Off King Harman Road Freetown, Freetown 00232, Sierra Leone; (B.D.F.); (J.E.B.); (C.K.N.)
| | - Christiana Kallon
- Ministry of Health and Sanitation, 4th Floor, Youyi Building, Brookfields, Freetown 00232, Sierra Leone; (S.M.T.); (C.K.)
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France;
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to Be University), University Road, Deralakatte 575018, India
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Liu X, Shrestha R, Koju P, Maharjan B, Shah P, Thapa P, Li H. The direct medical economic burden of healthcare-associated infections and antimicrobial resistance: A preliminary study in a teaching hospital of Nepal. J Glob Antimicrob Resist 2022; 29:299-303. [PMID: 35483612 DOI: 10.1016/j.jgar.2022.04.016] [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: 12/22/2020] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) have posed major challenges to South Asia. The purpose of this study is to explore the direct medical economic burden attributable to HAIs and AMR in Nepal. METHODS A prospective study was conducted in a teaching hospital of Nepal from 16th December 2017 to 16th April 2018. The demographic, clinical, and financial expense data were extracted from medical records, laboratory reports, and hospital information system. STATA 12.0 was used to conduct descriptive analysis, chi square test, t-test, and propensity score matching. RESULTS The prevalence of HAIs was 3.31% in the hospital. The additional total medical expenses, medicine expenses, out-of-pocket expenses, and hospitalisation days per inpatient attributable to HAIs were US$ 164.63, US$ 114.96, US$ 150.79, and 7 days, respectively. In contrast, the additional direct medical economic burden attributable to HAIs-AMR were US$ 381.15, US$ 202.37, US$ 370.56, and 9 days for each of the counterpart variables. The percentage of out-of-pocket expenses to total medical expenses was 94.24% among the HAIs inpatients, and the percentage was 96.75% among the HAIs-AMR inpatients. CONCLUSIONS The prevalence of HAIs in the hospital was low, which might be underestimated in a resource-constrained setting. Therefore, this study can only be considered as a preliminary one. Moreover, the additional direct medical economic burden was extraordinarily high among the HAIs and the HAIs-AMR inpatients, and most of the expenses were borne by themselves. A systemic solution for sustainable governance is required.
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Affiliation(s)
- Xinliang Liu
- School of Public Health/Global Health Institute, Wuhan University, Wuhan, China; School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Rajeev Shrestha
- Department of Pharmacology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal; Pharmacovigilance Unit/Research & Development Division, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Pramesh Koju
- Pharmacovigilance Unit/Research & Development Division, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Bedana Maharjan
- Infection Prevention and Control Department, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Poonam Shah
- School of Public Health/Global Health Institute, Wuhan University, Wuhan, China
| | - Pramila Thapa
- Department of Pharmacology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Hao Li
- School of Public Health/Global Health Institute, Wuhan University, Wuhan, China.
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Efendi R, Sudarnika E, Wibawan IWT, Purnawarman T. An assessment of knowledge and attitude toward antibiotic misuse by small-scale broiler farmers in Bogor, West Java, Indonesia. Vet World 2022; 15:707-713. [PMID: 35497969 PMCID: PMC9047124 DOI: 10.14202/vetworld.2022.707-713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/10/2022] [Indexed: 11/30/2022] Open
Abstract
Background and Aim: Antibiotics are often overused and misused by broiler farmers. Moreover, this practice may lead to antibiotic resistance. Antibiotics may be used for various purposes such as therapy, prophylaxis, flushing, and growth promoters. The study aimed to examine the association of knowledge and attitudes with antibiotics used by broiler farmers. Materials and Methods: The study design was cross-sectional. The data were obtained from interviewing 132 farmers’ households in Bogor District, West Java, Indonesia. The outcome variable was antibiotic use, whereas the independent variables included knowledge and attitude toward antibiotic resistance. The statistical analysis used a t-test and correlation test. Results: A total of 78% of broilers farmers use antibiotics, and most of the farmers used antibiotics for flushing and prophylaxis. Furthermore, antibiotic use was associated with broiler farmers’ knowledge and attitudes toward antibiotic resistance. However, there is no significant correlation between the duration of antibiotics use and their knowledge and attitude. Conclusion: The use of antibiotics in broilers is still high in Bogor, and most of the used antibiotics belong to the Medically Important Antimicrobial category. In general, the use of antibiotics in broilers is influenced by knowledge.
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Affiliation(s)
- Rusman Efendi
- Department of Public Health, Faculty of Public Health, Universitas Muhammadiyah Jakarta, South Tangerang City 15419 Indonesia; Department of Animal Disease and Veterinary Public Health, Faculty of Veterinary Medicine, Institut Pertanian Bogor, Bogor 16680, Indonesia
| | - Etih Sudarnika
- Department of Animal Disease and Veterinary Public Health, Faculty of Veterinary Medicine, Institut Pertanian Bogor, Bogor 16680, Indonesia
| | - I. Wayan Teguh Wibawan
- Department of Animal Disease and Veterinary Public Health, Faculty of Veterinary Medicine, Institut Pertanian Bogor, Bogor 16680, Indonesia
| | - Trioso Purnawarman
- Department of Animal Disease and Veterinary Public Health, Faculty of Veterinary Medicine, Institut Pertanian Bogor, Bogor 16680, Indonesia
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Carter MJ, Gurung M, Pokhrel B, Bijukchhe SM, Karmacharya S, Khadka B, Maharjan A, Bhattarai S, Shrestha S, Khadka B, Khulal A, Gurung S, Dhital B, Prajapati KG, Ansari I, Shah GP, Wahl B, Kandasamy R, Pradhan R, Kelly S, Voysey M, Murdoch DR, Adhikari N, Thorson S, Kelly D, Shrestha S, Pollard AJ. Childhood Invasive Bacterial Disease in Kathmandu, Nepal (2005-2013). Pediatr Infect Dis J 2022; 41:192-198. [PMID: 34955523 DOI: 10.1097/inf.0000000000003421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Invasive bacterial disease (IBD; including pneumonia, meningitis, sepsis) is a major cause of morbidity and mortality in children in low-income countries. METHODS We analyzed data from a surveillance study of suspected community-acquired IBD in children <15 years of age in Kathmandu, Nepal, from 2005 to 2013 before introduction of pneumococcal conjugate vaccines (PCV). We detailed the serotype-specific distribution of invasive pneumococcal disease (IPD) and incorporated antigen and PCR testing of cerebrospinal fluid (CSF) from children with meningitis. RESULTS Enhanced surveillance of IBD was undertaken during 2005-2006 and 2010-2013. During enhanced surveillance, a total of 7956 children were recruited of whom 7754 had blood or CSF culture results available for analysis, and 342 (4%) had a pathogen isolated. From 2007 to 2009, all 376 positive culture results were available, with 259 pathogens isolated (and 117 contaminants). Salmonella enterica serovar Typhi was the most prevalent pathogen isolated (167 cases, 28% of pathogens), followed by Streptococcus pneumoniae (98 cases, 16% pathogens). Approximately, 73% and 78% of pneumococcal serotypes were contained in 10-valent and 13-valent PCV, respectively. Most cases of invasive pneumococcal disease (IPD) were among children ≥5 years of age from 2008 onward. Antigen and PCR testing of CSF for pneumococci, Haemophilus influenzae type b and meningococci increased the number of these pathogens identified from 33 (culture) to 68 (culture/antigen/PCR testing). CONCLUSIONS S. enterica serovar Typhi and S. pneumoniae accounted for 44% of pathogens isolated. Most pneumococcal isolates were of serotypes contained in PCVs. Antigen and PCR testing of CSF improves sensitivity for IBD pathogens.
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Affiliation(s)
- Michael J Carter
- From the Department of Women and Children's Health, School of Life Course Sciences, King's College London, United Kingdom
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
- Department of Paediatrics, University of Oxford and Oxford National Institute of Health Research Biomedical Research Centre, Oxford, United Kingdom
| | - Meeru Gurung
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | - Bhishma Pokhrel
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | - Sanjeev Man Bijukchhe
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | - Sudhir Karmacharya
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | - Bijay Khadka
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | - Anju Maharjan
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | - Suraj Bhattarai
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | - Swosti Shrestha
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | - Bibek Khadka
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | - Animesh Khulal
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | - Sunaina Gurung
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | - Bijaya Dhital
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | | | - Imran Ansari
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | - Ganesh P Shah
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | - Brian Wahl
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rama Kandasamy
- Department of Paediatrics, University of Oxford and Oxford National Institute of Health Research Biomedical Research Centre, Oxford, United Kingdom
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | | | - Sarah Kelly
- Department of Paediatrics, University of Oxford and Oxford National Institute of Health Research Biomedical Research Centre, Oxford, United Kingdom
| | - Merryn Voysey
- Department of Paediatrics, University of Oxford and Oxford National Institute of Health Research Biomedical Research Centre, Oxford, United Kingdom
| | - David R Murdoch
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Neelam Adhikari
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | - Stephen Thorson
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | - Dominic Kelly
- Department of Paediatrics, University of Oxford and Oxford National Institute of Health Research Biomedical Research Centre, Oxford, United Kingdom
| | - Shrijana Shrestha
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Kathmandu, Nepal
| | - Andrew J Pollard
- Department of Paediatrics, University of Oxford and Oxford National Institute of Health Research Biomedical Research Centre, Oxford, United Kingdom
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Leong KWC, Gautam SS, Pradhan M, Singh YI, Rajendra KC, Rajbhandari SK, Ghimire GR, Adhikari K, Shrestha U, Chaudhary R, Ghimire G, Khadka S, O'Toole RF. Comparative genomic analyses of multi-drug resistant Mycobacterium tuberculosis isolates from Nepal and other geographical locations. Genomics 2022; 114:110278. [PMID: 35143885 DOI: 10.1016/j.ygeno.2022.110278] [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: 02/28/2021] [Revised: 01/20/2022] [Accepted: 01/29/2022] [Indexed: 11/04/2022]
Abstract
Nepal exhibits a tuberculosis (TB) incidence rate that is comparable to neighbouring high TB incidence countries. In addition, it records >500 cases of multi-drug resistant (MDR) TB each year. The objective of this study was to perform whole-genome bioinformatic analysis on MDR-TB isolates from Nepal (n = 19) to identify the specific mutations underlying their phenotypic resistance. In addition, we examined the dominant genotype among the Nepal MDR-TB isolates, the East-Asian Beijing sub-lineage, to determine its relatedness to a panel of 1274 genomes of international strains available from public databases. These analyses provided evidence that the XDR-TB isolates in our collection were not derived from importation of primary XDR-TB to Nepal but were more likely the result of acquisition of second-line drug resistance in Nepal. Resistance to fluoroquinolones was detected among a high proportion of the Nepal isolates. This has implications for the management of TB, including appropriate antimicrobial stewardship and susceptibility testing for fluoroquinolones and other second-line TB drugs, to minimise the development of XDR-TB among Nepal TB cases.
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Affiliation(s)
- Kelvin W C Leong
- Department of Pharmacy and Biomedical Sciences, School of Molecular Sciences, College of Science, Health and Engineering, La Trobe University, Victoria, Australia
| | - Sanjay S Gautam
- Department of Microbiology and Immunology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Manoj Pradhan
- Department of Microbiology, College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Y Ibotomba Singh
- Department of Microbiology, College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - K C Rajendra
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | | | | | - Uma Shrestha
- National Tuberculosis Control Center, Bhaktapur, Nepal
| | - Raina Chaudhary
- Department of Microbiology, College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Gyanendra Ghimire
- Department of Microbiology, College of Medicine, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
| | - Sundar Khadka
- HIV Reference Unit, National Public Health Laboratory, Kathmandu, Nepal
| | - Ronan F O'Toole
- Department of Pharmacy and Biomedical Sciences, School of Molecular Sciences, College of Science, Health and Engineering, La Trobe University, Victoria, Australia.
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Wangoye K, Mwesigye J, Tungotyo M, Twinomujuni Samba S. Chronic wound isolates and their minimum inhibitory concentrations against third generation cephalosporins at a tertiary hospital in Uganda. Sci Rep 2022; 12:1195. [PMID: 35075152 PMCID: PMC8786920 DOI: 10.1038/s41598-021-04722-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/30/2021] [Indexed: 02/04/2023] Open
Abstract
Globally, the burden of chronic wound infections is likely to increase due to the rising levels of bacterial resistance to antibiotics. In the United States of America alone, more than 6.5 million chronic wounds with evidence of bacterial infection are diagnosed every year. In addition, the polymicrobial environment in chronic wound infections has been observed from several studies as a risk factor for development of resistance to many antibiotics including the third generation cephalosporins currently used in Mbarara Regional Referral Hospital for treatment of chronic wound infections. Therefore the main objective of this study was to determine the prevalence of chronic wound isolates and their minimum inhibitory concentrations (MIC) against third generation cephalosporins. This study was a cross-sectional descriptive and analytical survey of bacterial isolates from chronic wound infection among 75 study participants admitted in the surgical ward of Mbarara Regional Referral Hospital (MRRH), a tertiary Hospital in Western Uganda. Standard laboratory bacterial culture and identification techniques as well as broth microdilution method were used to isolate, identify pathogens and test for MIC respectively. We found that 69/75 study participants had samples with bacterial growth and the most prevalent pathogens isolated were staphylococcus aureus (40.6%) and Klebsiella spp. (29%). Generally, most isolates were susceptible to cefoperazone + sulbactum 2 g (Sulcef) and ceftriaxone 1 g (Epicephin). The overall prevalence of isolates in chronic wound infection among patients admitted in the surgical ward of MRRH was 92% and the most prevalent isolates were Staphylococcus aureus, Klebsiella species and proteus species respectively. The observed MIC values were higher than the CLSI clinical breakpoint, implying a decreasing trend in susceptibility of chronic wound isolates to third generation cephalosporins.
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Affiliation(s)
- Khalim Wangoye
- Department of Pharmacy and Pharmacology, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.
| | - James Mwesigye
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Martin Tungotyo
- Department of Surgery, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
| | - Silvano Twinomujuni Samba
- Department of Pharmacy and Pharmacology, Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda
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Abdalhamed AM, Ghazy AA, Ibrahim ES, Arafa AA, Zeedan GSG. Therapeutic effect of biosynthetic gold nanoparticles on multidrug-resistant Escherichia coli and Salmonella species isolated from ruminants. Vet World 2021; 14:3200-3210. [PMID: 35153413 PMCID: PMC8829404 DOI: 10.14202/vetworld.2021.3200-3210] [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: 07/16/2021] [Accepted: 11/22/2021] [Indexed: 12/31/2022] Open
Abstract
Background and Aim: Multidrug-resistant (MDR) pathogenic microorganisms have become a global problem in ruminants as a result of the intensive use of antibiotics, causing the development of resistance among gut microbiota. The antibiotic-resistant microorganisms can be transferred from diseased animals to humans. This study aimed to determine the prevalence of MDR Escherichia coli and Salmonella spp. isolated from cattle, buffaloes, sheep, and goats suffering from respiratory signs, diarrhea, and mastitis and to screen the antibiotic sensitivity of selected isolated bacteria. It also detected antibiotic-resistance genes by polymerase chain reaction (PCR), produced green gold nanoparticles (AuNPs) using plant extracts (Artemisia herba-alba and Morus alba), and evaluated the antimicrobial activities of these biosynthesized nanoparticles on selected pathogens (E. coli and Salmonella spp.). Materials and Methods: MDR E. coli and Salmonella spp. were investigated using fecal samples (n=408), nasal swabs (n=358), and milk samples (n=227) of cattle, buffaloes, sheep, and goats with or without clinical signs, including respiratory manifestations, pneumonia, diarrhea, and mastitis, from different governorates in Egypt. E. coli and Salmonella spp. were isolated and identified on selective media, which were confirmed by biochemical reactions and PCR. Antimicrobial susceptibility testing against 10 commonly used antibiotics was performed using the Kirby-Bauer disk diffusion method. Antibiotic resistance genes blaTEM, blaSHV, blaOXA, and blaCTX−M were detected by PCR. The antibacterial effect of the biosynthesized AuNPs was evaluated by MIC and well diffusion assay. The biosynthesized AuNPs were also characterized by ultraviolet-visible spectrophotometry and transmission electron microscopy (TEM). Results: Among all fecal samples, the prevalence of E. coli was 18.4% (183/993) and that of Salmonella spp. was 16.7% (66/408), as determined by cultural and molecular tests. All isolates of E. coli and Salmonella spp. were 100% resistant to ampicillin (AM) and amoxicillin and highly resistant to cefoxitin and AM-sulbactam. The total rate of resistance genes in E. coli was 61.2% (112/183), while that in Salmonella was 63.6% (42/66) for pathogens isolated from ruminants with respiratory manifestations, pneumonia, diarrhea, and mastitis. Among the resistance genes, blaTEM had the highest prevalence rate in E. coli (25.9%, 21/81) while blaSHV had the lowest (9.8%, 8/81) in fecal swabs. AuNPs were successfully synthesized using aqueous leaf extract of A. herba-alba and M. alba as bioreducing agents. TEM analysis showed particle size of 10-42 nm for A. herba-alba and M. alba AuNPs. The biosynthesized AuNPs showed antibacterial activity against MDR E. coli and Salmonella spp. Conclusion: Rapid and accurate diagnostic methods are the cornerstone for effective treatment to reduce the risk of antimicrobial-resistant pathogenic microorganisms. This is particularly important for overcoming the increasing rate of MDR in ruminants with respiratory manifestations, pneumonia, diarrhea, and mastitis. This can be complemented by the development of AuNPs synthesized in an environmentally friendly manner AuNPs using natural plant extracts for the treatment of antibiotic-resistant microorganisms.
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Affiliation(s)
- Abeer M. Abdalhamed
- Department of Parasitology and Animal Diseases, National Research Centre, Dokki, Egypt
| | - Alaa A. Ghazy
- Department of Parasitology and Animal Diseases, National Research Centre, Dokki, Egypt
| | - Eman S. Ibrahim
- Department of Microbiology and Immunology, National Research Centre, Dokki, Egypt
| | - Amany A. Arafa
- Department of Microbiology and Immunology, National Research Centre, Dokki, Egypt
| | - Gamil S. G. Zeedan
- Department of Parasitology and Animal Diseases, National Research Centre, Dokki, Egypt
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Khanal M, Joshi PR, Paudel S, Acharya M, Rijal KR, Ghimire P, Banjara MR. Methicillin-Resistant Coagulase Negative Staphylococci and Their Antibiotic Susceptibility Pattern from Healthy Dogs and Their Owners from Kathmandu Valley. Trop Med Infect Dis 2021; 6:tropicalmed6040194. [PMID: 34842844 PMCID: PMC8628895 DOI: 10.3390/tropicalmed6040194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/02/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022] Open
Abstract
This cross-sectional study was designed to identify information on the frequency, antimicrobial resistance and species diversity of methicillin-resistant coagulase negative staphylococci (MRCoNS) among pet dogs and humans within households. Fifty five nasal swabs each from dogs and their owners were collected. MRCoNS were identified based on gram staining, culture on mannitol salt agar, biochemical tests, and mecA gene amplification. The antibiotic susceptibility of the isolates was assessed by a disc diffusion test. Uniplex and multiplex polymerase chain reaction (PCR) were employed for the species identification of MRCoNS and SCCmec typing, respectively. Species were further confirmed by MALDI-TOF-MS. The prevalence of MRCoNS was 29% in dog owners and 23.6% in dogs. Four different species of MRCoNS, Staphylococci saprophyticus (48.3%), S. haemolyticus (24.1%), S. warneri (17.2%), and S. epidermidis (10.3%), were detected. Two isolates each from dog owners and dogs showed a constitutive resistance to macrolide-lincosamide-streptogramin B (cMLSB) resistance, eight isolates each from dogs and their owners showed a macrolide-streptogramin B (MSB) resistance, and only two isolates from dog owners revealed an inducible resistance to macrolide-lincosamide-streptogramin B (iMLSB) resistance. SCCmec types were SCCmec type IV (55.2%), SCCmec type V (24.1%), SCCmec III (10.3%), SCCmec II (3.4%); two isolates were non-typable. MRCoNS are prevalent and genetically diverse in companion animals and humans. Different species of MRCoNS were found in dogs and their owners.
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Affiliation(s)
- Muna Khanal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44618, Nepal; (M.K.); (K.R.R.); (P.G.)
| | - Prabhu Raj Joshi
- Nepalese Farming Institute, Maitidevi, Kathmandu 44605, Nepal; (P.R.J.); (S.P.); (M.A.)
| | - Saroj Paudel
- Nepalese Farming Institute, Maitidevi, Kathmandu 44605, Nepal; (P.R.J.); (S.P.); (M.A.)
| | - Mahesh Acharya
- Nepalese Farming Institute, Maitidevi, Kathmandu 44605, Nepal; (P.R.J.); (S.P.); (M.A.)
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44618, Nepal; (M.K.); (K.R.R.); (P.G.)
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44618, Nepal; (M.K.); (K.R.R.); (P.G.)
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44618, Nepal; (M.K.); (K.R.R.); (P.G.)
- Correspondence:
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Shakya S, Edwards J, Gupte HA, Shrestha S, Shakya BM, Parajuli K, Kattel HP, Shrestha PS, Ghimire R, Thekkur P. High multidrug resistance in urinary tract infections in a tertiary hospital, Kathmandu, Nepal. Public Health Action 2021; 11:24-31. [PMID: 34778012 PMCID: PMC8575380 DOI: 10.5588/pha.21.0035] [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: 04/19/2021] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
SETTING: Tribhuvan University Teaching Tertiary Care Hospital, Kathmandu, Nepal, May–October 2019. OBJECTIVE: 1) To describe the bacteriological profile, 2) to identify the antimicrobial resistance (AMR) pattern, and 3) to find the demographic characteristics associated with the presence of bacterial growth and multidrug resistance (MDR) in adult urine samples undergoing culture and drug susceptibility testing. DESIGN: This was a hospital-based, cross-sectional study using routine laboratory records. RESULTS: Among 11,776 urine samples, 16% (1,865/11,776) were culture-positive, predominantly caused by Escherichia coli (1,159/1,865; 62%). We found a high prevalence of resistance to at least one antibiotic (1,573/1,865; 84%) and MDR (1,000/1,865; 54%). Resistance to commonly used antibiotics for urinary tract infections (UTIs) such as ceftazidime, levofloxacin, cefepime and ampicillin was high. Patients aged ⩾60 years (adjusted prevalence ratio [aPR] 1.6, 95% CI 1.4–1.7) were more likely to have culture positivity. Patients with age ⩾45 years (45–59 years: aPR 1.5, 95% CI 1.3–1.7; ⩾60 years: aPR 1.4, 95% CI 1.2–1.6), male sex (aPR 1.3, 95% CI 1.2–1.5) and from inpatient settings (aPR 1.4, 95% CI 1.2–1.7) had significantly higher prevalence of MDR. CONCLUSION: Urine samples from a tertiary hospital showed high prevalence of E. coli and MDR to routinely used antibiotics, especially among inpatients. Regular surveillance and application of updated antibiograms are crucial to monitor the AMR situation in Nepal.
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Affiliation(s)
- S Shakya
- Central Department of Public Health, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - J Edwards
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - H A Gupte
- Narotam Sekhsaria Foundation, Mumbai, India
| | - S Shrestha
- World Health Emergencies Programme, WHO Country Office, Kathmandu, Nepal
| | - B M Shakya
- Department of Anaesthesiology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - K Parajuli
- Department of Clinical Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - H P Kattel
- Department of Clinical Microbiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - P S Shrestha
- Department of Anaesthesiology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - R Ghimire
- Department of Clinical Pharmacology, Maharajgunj Medical Campus, Tribhuvan University, Institute of Medicine, Kathmandu, Nepal
| | - P Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,Centre for Operational Research, The Union South-East Asia Office, New Delhi, India
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Poudel RS, Shrestha S, Adhikari S. Dispensing of antibiotics without a prescription by community pharmacies in Nepal: A call for action. PUBLIC HEALTH IN PRACTICE 2021; 2:100117. [PMID: 36101578 PMCID: PMC9461566 DOI: 10.1016/j.puhip.2021.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/26/2021] [Indexed: 11/26/2022] Open
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Baral R, Shrestha LB, Ortuño-Gutiérrez N, Pyakure P, Rai B, Rimal SP, Singh S, Sharma SK, Khanal B, Selvaraj K, Kumar AMV. Low yield but high levels of multidrug resistance in urinary tract infections in a tertiary hospital, Nepal. Public Health Action 2021; 11:70-76. [PMID: 34778019 DOI: 10.5588/pha.21.0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING There are concerns about the occurrence of multidrug resistance (MDR) in patients with urine tract infections (UTI) in Nepal. OBJECTIVE To determine culture positivity, trends in MDR among Escherichia coli and Klebsiella pneumoniae infections and seasonal changes in culture-positive UTI specimens isolated from 2014 to 2018 at the B P Koirala Institute of Health Sciences, Dharan, Eastern Nepal. DESIGN This was a cross-sectional study using secondary laboratory data. RESULTS Among 116,417 urine samples tested, 19,671 (16.9%) were culture-positive, with an increasing trend in the number of samples tested and culture positivity. E. coli was the most common bacteria (54.3%), followed by K. pneumoniae (8.8%). Among E. coli and K. pneumoniae isolates, MDR was found in respectively 42.5% and 36.0%. MDR was higher in males and people aged >55 years, but showed a decreasing trend over the years. The numbers of isolates increased over the years, with a peak always observed from July to August. CONCLUSION Low culture positivity is worrying and requires further work into improving diagnostic protocols. Decreasing trends in MDR are a welcome sign. Information on seasonal changes that peak in July-August can help laboratories better prepare for this time with adequate buffer stocks to ensure culture and antibiotic susceptibility testing.
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Affiliation(s)
- R Baral
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - L B Shrestha
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | | | - P Pyakure
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal.,School of Public Health and Community Medicine, BPKIHS, Dharan, Nepal
| | - B Rai
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - S P Rimal
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - S Singh
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - S K Sharma
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - B Khanal
- BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal
| | - K Selvaraj
- All India Institute of Medical Sciences, Nagpur, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union South-East Asia Office, New Delhi, India.,Yenepoya Medical College, Yenepoya (deemed University), Mangaluru, India
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