Finding What Is Inaccessible: Antimicrobial Resistance Language Use among the One Health Domains

Rethinking the words hostspot reservoir and pristine in the environmental dimensions of antimicrobial resistance

We assess three words commonly used to represent the environmental dimensions of antimicrobial resistance (AMR) - 'hotspot', 'reservoir' and 'pristine' - through two questions: how are these terms used in published research; and how do these terms shape research being conducted? We advocate for the community to reflect on and improve its use of language, and suggest four potentially more productive and precise terms for AMR hazard: presence; transmission; evolution and connectivity.

An analysis of culture-based methods used for the detection and isolation of Salmonella spp., Escherichia coli, and Enterococcus spp. from surface water: A systematic review

Identification of methods for the standardized assessment of bacterial pathogens and antimicrobial resistance (AMR) in environmental water can improve the quality of monitoring and data collected, support global surveillance efforts, and enhance the understanding of environmental water sources. We conducted a systematic review to assemble and synthesize available literature that identified methods for assessment of prevalence and abundance of bacterial fecal indicators and pathogens in water for the purposes of monitoring bacterial pathogens and AMR. After screening for quality, 175 unique publications were identified from 15 databases, and data were extracted for analysis. This review identifies the most common and robust methods, and media used to isolate target organisms from surface water sources, summarizes methodological trends, and recognizes knowledge gaps. The information presented in this review will be useful when establishing standardized methods for monitoring bacterial pathogens and AMR in water in the United States and globally.

The language of antimicrobial and antibiotic resistance is blocking global collective action

Sustainable access to effective antibiotics is a foundational need for functioning health care that is increasingly threatened by antibiotic resistance. Although resistance has been known as long as antibiotics have been in clinical use, there are still multiple gaps in the global and local responses. One often cited cause for this complacency is the language that is used to describe the problem and its consequences. In this paper, we survey some examples of the current discussions around antibiotic resistance and seek to offer a path towards unified and understandable messaging that is relevant both to the public and policymakers by using narratives that highlight the individual and societal consequences of antibiotic resistance. Major shortcomings in the current language that hamper both the understanding of antibiotic resistance and needed behaviour change have been identified in scientific papers and special reports. These shortcomings range from terminology that is difficult to understand, through a lack of personal relevance, to a fragmented response in the policy field. We propose that scientists, including behaviour change experts, and other key stakeholders that are engaged in the issue take lead to agreement on the core scientific facts and to formulate a vision that can be a foundation for creation of consistent global narratives. These narratives must in turn be adapted to local contexts. Development of such narratives should be viewed as an essential component in national action plans on AMR to raise awareness, empower citizens and incentivise societal behaviour change, policy development and implementation of governance structures.

Formulating a Community-Centric Indicator Framework to Quantify One Health Drivers of Antibiotic Resistance: A Preliminary Step towards Fostering 'Antibiotic-Smart Communities'

Antibiotic resistance (ABR) is increasing the mortality and morbidity associated with infectious diseases, besides increasing the cost of healthcare, saturating health system capacity, and adversely affecting food security. Framing an appropriate narrative and engaging local communities through the 'One Health' approach is essential to complement top-down measures. However, the absence of objective criteria to measure the performance of ABR interventions in community settings makes it difficult to mobilize interest and investment for such interventions. An exercise was therefore carried out to develop an indicator framework for this purpose. A comprehensive list of indicators was developed from experiences gathered through community engagement work in a local panchayat (small administrative area) in Kerala, India and a consultative process with health, veterinary, environment, and development experts. A prioritization exercise was carried out by global experts on ABR, looking at appropriateness, feasibility, and validity. A 15-point indicator framework was designed based on the prioritization process. The final set of indicators covers human health, animal health, environment management, and Water Sanitation and Hygiene (WASH) domains. The indicator framework was piloted in the panchayat (located in Kerala), which attained a score of 34 (maximum 45). The score increased when interventions were implemented to mitigate the ABR drives, indicating that the framework is sensitive to change. The indicator framework was tested in four sites from three other Indian states with different socioeconomic and health profiles, yielding different scores. Those collecting the field data were able to use the framework with minimal training. It is hoped that, this indicator framework can help policymakers broadly understand the factors contributing to ABR and measure the performance of interventions they choose to implement in the community as part of National Action Plan on AMR.

Search term “One Health” remains of limited use to identify relevant scientific publications: Denmark as a case study

One Health has become a popular approach, and scientific advancements in the field should be easily findable and accessible to a wide range of relevant audiences, from researchers to policymakers, and across sectors. We conducted a systematic narrative review of available scientific publications concerning One Health in the setting of Denmark that were retrievable using “One Health” as the key search term. Three searches in two databases yielded 30 retrieved publications, 13 of which were included in the review. The included publications had been published between 2015 and 2021. Twelve of the included publications were co-authored in collaboration across institutes from different sectors. Three of the included publications had focus on antimicrobial resistance, three on disease surveillance and/or control, and five were assessments or evaluations. The overall number of publications identified by a search using “One Health” as the key search term was small, and the search identified some publications that were not relevant to One Health. Our work thus highlights a missed scientific and communication opportunity of signposting articles as relevant to One Health. Using the expression “One Health” as keyword could help making One Health research more easily findable and thereby obtaining an overview of research in the field.