Harmonized One Health Trans-Species and Community Surveillance for Tackling Antibacterial Resistance in India: Protocol for a Mixed Methods Study

Abstract

Background India has the largest burden of drug‑resistant organisms compared with other countries around the world, including multiresistant and extremely drug‑resistant tuberculosis and resistant Gram‑negative and Gram‑positive bacteria. Antibiotic resistant bacteria are found in all living hosts and in the environment and move between hosts and ecosystems. An intricate interplay of infections, exposure to antibiotics, and disinfectants at individual and community levels among humans, animals, birds, and fishes triggers evolution and spread of resistance. The One Health framework proposes addressing antibiotic resistance as a complex multidisciplinary problem. However, the evidence base in the Indian context is limited. Objective This multisectoral, trans-species surveillance project aims to document the infection and resistance patterns of 7 resistant-priority bacteria and the risk factors for resistance following the One Health framework and geospatial epidemiology. Methods This hospital- and community-based surveillance adopts a cross-sectional design with mixed methodology (quantitative, qualitative, and spatial) data collection. This study is being conducted at 6 microbiology laboratories and communities in Khurda district, Odisha, India. The laboratory surveillance collects data on bacteria isolates from different hosts and their resistance patterns. The hosts for infection surveillance include humans, animals (livestock, food chain, and pet animals), birds (poultry), and freshwater fishes (not crustaceans). For eligible patients, animals, birds and fishes, detailed data from their households or farms on health care seeking (for animals, birds and fishes, the illness, and care seeking of the caretakers), antibiotic use, disinfection practices, and neighborhood exposure to infection risks will be collected. Antibiotic prescription and use patterns at hospitals and clinics, and therapeutic and nontherapeutic antibiotic and disinfectant use in farms will also be collected. Interviews with key informants from animal breeding, agriculture, and food processing will explore the perceptions, attitudes, and practices related to antibiotic use. The data analysis will follow quantitative (descriptive and analytical), qualitative, and geospatial epidemiology principles. Results The study was funded in May 2019 and approved by Institute Ethics Committees in March 2019. The data collection started in September 2019 and shall continue till March 2021. As of June 2020, data for 56 humans, 30 animals and birds, and fishes from 10 ponds have been collected. Data analysis is yet to be done. Conclusions This study will inform about the bacterial infection and resistance epidemiology among different hosts, the risk factors for infection, and resistance transmission. In addition, it will identify the potential triggers and levers for further exploration and action. International Registered Report Identifier (IRRID) DERR1-10.2196/23241

One Health and research with freshwater fish: A systematic review

“…Among the remaining 20 articles that employed intrinsic relationships between One Health and fish, eight were reviews rather than primary ones. Consequently, 12 final articles met all the criteria pre-established by this systematic review (Figure-1 and Table -3) [12][13][14][15][16][17][18][19][20][21][22][23].…”

“…Alhaji et al 2021 [12] Nigeria, West Africa Food control Scopus Brunton et al 2019 [13] Vietnam, Southeast Asia Science of the total environment Scopus Sapugahawatte et al 2022 [14] Hong Kong, China Antibiotics PubMed Das et al 2020 [15] Khorda, India JMIR research protocols Scopus Cerdeira et al 2020 [16] Belém, Brazil Genomics Scopus Minja et al 2021 [17] Tanzânia, East Africa Antibiotics Scopus Sapugahawatte et al 2020 [18] Hong Kong, China mSphere PubMed Pace et al 2020 [19] Naples [23] Uganda, East Africa Cogent Food and agriculture PubMed identify emergency hotshots of antibiotic-resistant bacteria attributed to human exposure. Thus, the results revealed that the growth stage of individuals is crucial for the emergence of highly resistant bacteria due to the exacerbated use of antimicrobials and the consequent exposure to contaminated water.…”

Rothia nasimurium as a Cause of Disease: First Isolation from Farmed Geese

“…Increased drug resistance of bacteria could be effectively avoided through targeted therapy [ 28 , 29 , 30 ]. At the same time, the evolution and spread of bacterial drug resistance could be reduced [ 31 ].…”

Community-based surveillance of infectious diseases: a systematic review of drivers of success

“…13 In addition, CBS is one of the few suitable options for supporting OneHealth surveillance activities given its proximity to the interface between humans and animals. 14 15 Given its potential to enhance the early warning and containment function of national surveillance systems, CBS is increasingly framed as a promising surveillance modality in the discourse around global health security. 16 …”

“…A CBS system can: provide early case detection and reporting during disease outbreaks; monitor events of public health importance in humanitarian emergencies; and supplement non-existent or limited surveillance coverage in other complex settings 13. In addition, CBS is one of the few suitable options for supporting OneHealth surveillance activities given its proximity to the interface between humans and animals 14 15. Given its potential to enhance the early warning and containment function of national surveillance systems, CBS is increasingly framed as a promising surveillance modality in the discourse around global health security 16…”