Ten-year narrative review on antimicrobial resistance in Singapore

Chua, Alvin Qijia; Kwa, Andrea Lay-Hoon; Tan, Thean Yen; Legido‐Quigley, Helena; Hsu, Li Yang

doi:10.11622/smedj.2019088

Cited by 22 publications

(28 citation statements)

References 56 publications

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“…Our study is limited to the perspective of hospital pharmacists in Singapore, a developed country with well-established ASPs in acute hospitals [ 6 ]. Nonetheless, the findings are applicable to other developed countries with established ASPs interested to enhance the ASPs by harnessing the untapped potential of hospital pharmacists in the hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…Our previous work exploring the views of inpatient nurses on their roles in antimicrobial stewardship found that nurses played important roles as gatekeepers in the assurance of appropriate administration of prescribed antibiotics [ 52 ]. Future cross-disciplinary studies should be considered for triangulation of findings from the perspectives of physicians, nurses, and pharmacists, since one of the thrusts in Singapore’s National Strategic Action Plan on AMR is the optimisation of antimicrobial use through the further optimisation of antibiotic prescribing in hospitals [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…AMR can complicate the treatment of simple infections, prolong the length of hospital stay, and increase treatment costs and mortality rates [ 1 , 4 ]. To monitor and promote appropriate antibiotic use in hospitals, antimicrobial stewardship programmes (ASPs) were introduced in all public acute-care hospitals in Singapore since 2011 [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Hospital Pharmacists and Antimicrobial Stewardship: A Qualitative Analysis

et al. 2021

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Antimicrobial stewardship programmes (ASPs) in hospitals are predominantly led by specific ASP physicians and pharmacists. Limited studies have been conducted to appreciate non-ASP-trained hospital pharmacists’ perspectives on their roles in antimicrobial stewardship. Focus group discussions (FGDs) were conducted with 74 pharmacists, purposively sampled from the 3 largest acute-care public hospitals in Singapore, to explore facilitators and barriers faced by them in antimicrobial stewardship. Applied thematic analysis was conducted and codes were categorised using the social–ecological model (SEM). At the intrapersonal level, pharmacists identified themselves as reviewers for drug safety before dispensing, confining to a restricted advisory role due to lack of clinical knowledge, experience, and empowerment to contribute actively to physicians’ prescribing decisions. At the interpersonal level, pharmacists expressed difficulties conveying their opinions and recommendations on antibiotic therapy to physicians despite frequent communications, but they assumed critical roles as educators for patients and their caregivers on proper antibiotic use. At the organisational level, in-house antibiotic guidelines supported pharmacists’ antibiotic interventions and recommendations. At the community level, pharmacists were motivated to improve low public awareness and knowledge on antibiotic use and antimicrobial resistance. These findings provide important insights into the gaps to be addressed in order to harness the untapped potential of hospital pharmacists and fully engage them in antimicrobial stewardship.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hospital Pharmacists and Antimicrobial Stewardship: A Qualitative Analysis

et al. 2021

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“…ASPs have been emphasized as an important tool against AMR, and nationallevel guidelines are available. [11][12][13][14][15][16][17] It is, however, difficult to tell from the published literature what the actual level of penetration is, or the degree to which different components of AMS have been implemented. Where ASPs are advanced, they have reduced overall antibiotic use, cut costs, and in some instances, improved patient outcomes.…”

Section: Ams In Asiamentioning

confidence: 99%

Current state of antimicrobial stewardship in organ transplantation in Singapore

Chung

Liew

Lee

et al. 2022

Transplant Infectious Dis

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Background Antibiotic stewardship programs (ASPs) are well established in the public hospitals in Singapore, but they are not mandatory for transplant programs. Given the positive impact of ASPs in non‐organ transplant patients (improved use of broad‐spectrum antibiotics, reduced length of stay, and lower healthcare costs), stewardship principles are likely to benefit transplant recipients. Methods We reviewed the progress made in ASPs in the Asia Pacific region as well as the progress of our ASP over the last decade since it was established. We also described how stewardship strategies have evolved for the purposes of our transplant program. Results Currently, pressing stewardship issues for our transplant program include high antibiotic consumption, as well as the burden, morbidity, and mortality associated with drug‐resistant bacterial infections. Transplanting the model of stewardship onto a transplant program ignores the intricacies of transplant patients; the bespoke form of stewardship, “handshake stewardship”, is more appropriate. Conclusion To advance the cause of ASP in the transplant unit in Singapore, stakeholder buy‐in is key; empowering transplant physicians to be stewardship‐focused would be more sustainable in the long run. In addition, expanding our diagnostic armamentarium, optimizing existing therapeutics and multi‐disciplinary team involvement (including stakeholders from microbiology, and infection prevention teams) are vital.

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“…Alvin et.al reviewed the changes in Singapore in terms of antimicrobial uses, regulation and AMR epidemiology in the past ten years, mainly focusing on hospital sector [35]. The antibiotic (only antibacterial drugs are included) usage during 2000-2015 in Singapore is shown in Figure 7.…”

Section: Singapore Perspectivementioning

confidence: 99%

Whole genome sequencing analysis of antimicrobial resistant Escherichia coli : from food to human

Guo¹

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The main work of this study is to analyze antimicrobial resistant E. coli based on whole genome sequencing data. Three stages were included for isolates from different sources (ready-to-eat food, retail raw meats and human patients).At the first stage, a retrospective study for antimicrobial resistant E. coli in readyto-eat (RTE) food sold in retail food premises in Singapore was performed in collaboration with Environmental Health Institute under NEA. A total of 99 E. coli isolates from poultry-based dishes (n=77) and fish-based dishes (n=22) were obtained between 2009 and 2014 during the surveillance project. All the isolates were included for disk diffusion testing for antimicrobial susceptibility testing.Of the 99 isolates, 24 (24.2%) were resistant to at least one antimicrobial agent. These isolates were then subjected to broth microdilution testing against 33 antimicrobial agents, including β-lactams, aminoglycosides, tetracycline, fluoroquinolones and polymyxin E (colistin), to determine the minimum inhibitory concentration (MIC) of isolates. Whole genome sequence (WGS) was carried out on the strains in order to correlate resistant phenotypes to putative antimicrobial resistance-related genes. Of the 24 isolates, 15 (62.5%) were found to be resistant to three or more classes of antimicrobials and thus were defined as multi-drug resistant strains. Two isolates (8.3%) were confirmed as Extended-Spectrum β-lactamase (ESBL)-producing E. coli by double disk synergy test.Based on WGS data, online analysis tool ResFinder detected 7 classes of antimicrobial resistance genes and resistance-related chromosomal point mutations in 19 of the 24 E. coli isolates. By analyzing the WGS contigs using BLASTn and KmerFinder, ESBL genes and transferable colistin resistance gene mcr-1 (2/24) and mcr-5 (1/24) were determined to be located on plasmids, which could pose a greater risk of AMR transfer among bacteria. Mutations were detected in four isolates within genes previously shown to confer resistance to quinolones (gyrA and parE) and tetracycline (rrsB). Prediction of AMR using WGS data was evaluated for six antimicrobials including ampicillin, chloramphenicol, colistin, fluoroquinolones, tetracycline and trimethoprim. The evaluation indicates WGS-based genotype and phenotype showed high consistency, however, for some antimicrobial resistance whose mechanism is not totally clear yet (such as colistin), there is challenge for resistance gene detection.To have a better understanding of genetic environment and mobility of colistin resistance gene mcr-5.1, the isolates carrying mcr-5.1 were sequenced using long-read sequencing technology. The plasmid sequences were assembled into a closed circle using both long-read sequencing data and short-read sequencing data. The blasting result showed the closest plasmid sequence to pSGMCR103 in NCBI is plasmid pYD786-3 (accession number KU254580.1) with 77% query coverage and 99% identity, which was carried by one E. coli isolate from human urine in USA. They share antimicrobial resistanc...

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Ten-year narrative review on antimicrobial resistance in Singapore

Cited by 22 publications

References 56 publications

Hospital Pharmacists and Antimicrobial Stewardship: A Qualitative Analysis

Hospital Pharmacists and Antimicrobial Stewardship: A Qualitative Analysis

Current state of antimicrobial stewardship in organ transplantation in Singapore

Whole genome sequencing analysis of antimicrobial resistant Escherichia coli : from food to human

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