Addressing the Unknowns of Antimicrobial Resistance: Quantifying and Mapping the Drivers of Burden

Knight, Gwenan M.; Costelloe, Céire; Murray, Kris A.; Robotham, Julie V.; Atun, Rifat; Holmes, Alison

doi:10.1093/cid/cix765

Cited by 19 publications

(19 citation statements)

References 23 publications

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“…Factors thought to account for this include the suboptimal use of drugs in hospitals, the community, veterinary practice and agriculture. The leakage of compounds into the environment creates pathways for antimicrobial resistance (AMR) although evidence of their relative importance and contribution has not been established [ 4–6 ].…”

Section: Introductionmentioning

confidence: 99%

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Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab, Bangladesh

Chowdhury

Williams

Wertheim

et al. 2019

Global Health Action

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Background The use of large quantities of antimicrobial drugs for human health and agriculture is advancing the predominance of drug resistant pathogens in the environment. Antimicrobial resistance is now a major public health threat posing significant challenges for achieving the Sustainable Development Goals. In Bangladesh, where over one third of the population is below the poverty line, the achievement of safe and effective antibiotic medication use for human health is challenging. Objective To explore factors and practices around access and use of antibiotics and understanding of antimicrobial resistance in rural communities in Bangladesh from a socio-cultural perspective. Methods This qualitative study comprises the second phase of the multi-country ABACUS (Antibiotic Access and Use) project in Matlab, Bangladesh. Information was collected through six focus group discussions and 16 in-depth interviews. Informants were selected from ten villages in four geographic locations using the Health and Demographic Surveillance System database. The Access to Healthcare Framework guided the interpretation and framing of the findings in terms of individuals’ abilities to: perceive, seek, reach, pay and engage with healthcare. Results Village pharmacies were the preferred and trusted source of antibiotics for self-treatment. Cultural and religious beliefs informed the use of herbal and other complementary medicines. Advice on antibiotic use was also sourced from trusted friends and family members. Access to government-run facilities required travel on poorly maintained roads. Reports of structural corruption, stock-outs and patient safety risks eroded trust in the public sector. Some expressed a willingness to learn about antibiotic resistance. Conclusion Antimicrobial resistance is both a health and development issue. Social and economic contexts shape medicine seeking, use and behaviours. Multi-sectoral action is needed to confront the underlying social, economic, cultural and political drivers that impact on the access and use of antibiotic medicines in Bangladesh.

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Section: Introductionmentioning

confidence: 99%

“…The drivers of antimicrobial use in human health are complex and multifaceted [ 4 ]. Individual behaviours that promote AMR result from limited knowledge and understanding of potential consequences [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab, Bangladesh

Chowdhury

Williams

Wertheim

et al. 2019

Global Health Action

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“…Our long-term aim is to quantify the sources of ARB [ 24 ]. With this study, we explore the relative contributions of two important environments and provide the basic structure to be expanded upon in future quantification work.…”

Section: Introductionmentioning

confidence: 99%

Quantifying where human acquisition of antibiotic resistance occurs: a mathematical modelling study

Knight

Costelloe

Deeny

et al. 2018

BMC Med

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BackgroundAntibiotic-resistant bacteria (ARB) are selected by the use of antibiotics. The rational design of interventions to reduce levels of antibiotic resistance requires a greater understanding of how and where ARB are acquired. Our aim was to determine whether acquisition of ARB occurs more often in the community or hospital setting.MethodsWe used a mathematical model of the natural history of ARB to estimate how many ARB were acquired in each of these two environments, as well as to determine key parameters for further investigation. To do this, we explored a range of realistic parameter combinations and considered a case study of parameters for an important subset of resistant strains in England.ResultsIf we consider all people with ARB in the total population (community and hospital), the majority, under most clinically derived parameter combinations, acquired their resistance in the community, despite higher levels of antibiotic use and transmission of ARB in the hospital. However, if we focus on just the hospital population, under most parameter combinations a greater proportion of this population acquired ARB in the hospital.ConclusionsIt is likely that the majority of ARB are being acquired in the community, suggesting that efforts to reduce overall ARB carriage should focus on reducing antibiotic usage and transmission in the community setting. However, our framework highlights the need for better pathogen-specific data on antibiotic exposure, ARB clearance and transmission parameters, as well as the link between carriage of ARB and health impact. This is important to determine whether interventions should target total ARB carriage or hospital-acquired ARB carriage, as the latter often dominated in hospital populations.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1121-8) contains supplementary material, which is available to authorized users.

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“…While it is undoubted that AMR constitutes one of the most dangerous threats to public health on a global scale, the scienti c community has reached no consensus yet on how to estimate and quantify the burden of AMR (175,176). This can be partly explained by the complex interactions between upstream and downstream determinants of AMR, which require a system level analysis through conceptual frameworks that need to be both context-speci c and coherent at global level (177,178).…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial resistance among GLASS pathogens in conflict and non-conflict affected settings in the Middle East: A systematic review

Truppa

Abo‐Shehada

2020

Preprint

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Background: In spite of the evident general negative effects of armed conflict on countries’ health systems and populations’ health outcomes, little is known about similar impacts of conflicts on the spread of antimicrobial resistances (AMR). This review was to address this evidence gap and describe:1. Patterns of AMR in the Middle East (ME) and resistance profiles of pathogens included in the Global AMR Surveillance System (GLASS) supported by the World Health Organization;2. Differences in proportions of AMR isolates between conflict and non-conflict countries. Methods: A systematic literature review was conducted following PRISMA guidelines and searching five electronic databases. Subject heading and free text were searched for “antimicrobial resistances” and “Middle East”, to identify observational studies on AMR published from January 2011 to June 2018. Data were extracted from included articles on a predefined set of variables. Percentages of AMR were analysed as median and interquartile ranges. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results: A total of 132 articles met the inclusion criteria. Included studies showed heterogeneity in study design, laboratory methods and standards for interpretation of results, and an overall high risk of bias. Main findings were the following:1. High proportions of carbapenem resistance in Acinetobacter spp. (median 74.2%: range), and both carbapenem resistance (median 8.1% and 15.4% for E. coli and K. pneumoniae respectively) and ESBL-production (median 32.3% and 27.9% for E. coli and K. pneumoniae respectively) amongst Enterobacteriaceae. S. aureus isolates showed a median methicillin resistance percentage of 45.1%, while vancomycin resistance was almost absent. A median of 50% of the strains of S. pneumoniae showed non-susceptibility to penicillin. 2. Similar trends were observed in conflict and non-conflict affected countries.Conclusions: There is a lack of standardization in the methodological approach to AMR research in the Middle East. The proportion of antibiotic resistances among specific GLASS pathogens is high, particularly among Acinetobacter spp.

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Addressing the Unknowns of Antimicrobial Resistance: Quantifying and Mapping the Drivers of Burden

Cited by 19 publications

References 23 publications

Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab, Bangladesh

Rural community perceptions of antibiotic access and understanding of antimicrobial resistance: qualitative evidence from the Health and Demographic Surveillance System site in Matlab, Bangladesh

Quantifying where human acquisition of antibiotic resistance occurs: a mathematical modelling study

Antimicrobial resistance among GLASS pathogens in conflict and non-conflict affected settings in the Middle East: A systematic review

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