scholarly journals Updated research agenda for water, sanitation and antimicrobial resistance

2020 ◽  
Vol 18 (6) ◽  
pp. 858-866
Author(s):  
Daisuke Sano ◽  
Astrid Louise Wester ◽  
Heike Schmitt ◽  
Mohan Amarasiri ◽  
Amy Kirby ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Resistance Genes ◽  
One Health ◽  
Action Plan ◽  
Geographical Area ◽  
Health Surveillance ◽  
World Health ◽  
Resistant Bacteria ◽  
Relative Role ◽  
Human Waste

Abstract The emergence and spread of antimicrobial resistance (AMR), including clinically relevant antimicrobial-resistant bacteria, genetic resistance elements, and antibiotic residues, presents a significant threat to human health. Reducing the incidence of infection by improving water, sanitation, and hygiene (WASH) is one of five objectives in the World Health Organization's (WHO) Global Action Plan on AMR. In September 2019, WHO and the Health-Related Water Microbiology specialist group (HRWM-SG) of the International Water Association (IWA) organized its third workshop on AMR, focusing on the following three main issues: environmental pathways of AMR transmission, environmental surveillance, and removal from human waste. The workshop concluded that despite an increase in scientific evidence that the environment may play a significant role, especially in low-resource settings, the exact relative role of the environment is still unclear. Given many antibiotic-resistant bacteria (ARB) can be part of the normal gut flora, it can be assumed that for environmental transmission, the burden of fecal-oral transmission of AMR in a geographical area follows that of WASH-related infections. There are some uncertainties as to the potential for the propagation of particular resistance genes within wastewater treatment plants (WWTPs), but there is no doubt that the reduction in viable microbes (with or without resistance genes) available for transmission via the environment is one of the goals of human waste management. Although progress has been made in the past years with respect to quantifying environmental AMR transmission potential, still more data on the spread of environmental AMR within human communities is needed. Even though evidence on AMR in WWTPs has increased, the reduction in the emergence and spread of AMR by basic sanitation methods is yet unresolved. In order to contribute to the generation of harmonized One Health surveillance data, WHO has initiated an integrated One Health surveillance strategy that includes the environment. The main challenge lies in rolling it out globally including to the poorest regions.

scholarly journals Towards a research agenda for water, sanitation and antimicrobial resistance

2017 ◽  
Vol 15 (2) ◽  
pp. 175-184 ◽  
Author(s):  
Susanne Wuijts ◽  
Harold H. J. L. van den Berg ◽  
Jennifer Miller ◽  
Lydia Abebe ◽  
Mark Sobsey ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
Research Agenda ◽  
Human Exposure ◽  
Action Plan ◽  
Genetic Resistance ◽  
World Health ◽  
Low Income Countries ◽  
Resistant Bacteria ◽  
Surveillance Strategy

Clinically relevant antimicrobial resistant bacteria, genetic resistance elements, and antibiotic residues (so-called AMR) from human and animal waste are abundantly present in environmental samples. This presence could lead to human exposure to AMR. In 2015, the World Health Organization (WHO) developed a Global Action Plan for Antimicrobial Resistance with one of its strategic objectives being to strengthen knowledge through surveillance and research. With respect to a strategic research agenda on water, sanitation and hygiene and AMR, WHO organized a workshop to solicit input by scientists and other stakeholders. The workshop resulted in three main conclusions. The first conclusion was that guidance is needed on how to reduce the spread of AMR to humans via the environment and to introduce effective intervention measures. Second, human exposure to AMR via water and its health impact should be investigated and quantified, in order to compare with other human exposure routes, such as direct transmission or via food consumption. Finally, a uniform and global surveillance strategy that complements existing strategies and includes analytical methods that can be used in low-income countries too, is needed to monitor the magnitude and dissemination of AMR.

scholarly journals Genes de resistencia en bacilos Gram negativos: Impacto en la salud pública en Colombia

2016 ◽  
Vol 18 (1) ◽  
pp. 190 ◽  
Author(s):  
Diana Paola López Velandia ◽  
María Inés Torres Caycedo ◽  
Carlos Fernando Prada Quiroga
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Resistance Genes ◽  
Public Health Problem ◽  
Control Measures ◽  
World Health ◽  
Cochrane Library ◽  
Resistant Bacteria ◽  
Gram Negative ◽  
The Cochrane Library

ResumenIntroducción: La resistencia antimicrobiana es un grave problema de salud pública que se encuentra en aumento. Entre los factores más importantes relacionados con la diseminación de bacterias multirresistentes está el uso inapropiado de antibióticos y la aplicación insuficiente de las medidas de prevención y control. Adicionalmente, las bacterias tienen la capacidad de mutar o generar mecanismos de transferencia de genes de resistencia mediante plásmidos, transposones e integrones. Materiales y métodos: Se hizo una revisión crítica de la literatura sobre los principales genes de resistencia Gram negativos y su impacto en la salud pública. Fueron utilizadas las bases de datos de Medline, Embase, Lilacs, ScienceDirect, Scopus, SciELO, the Cochrane Library y Lilacs. Resultados: Se presenta una revisión de literatura que describe y analiza los principales genes de resistencia a antibióticos presentes en bacilos gram negativos, su origen, evolución y diseminación a microorganismos mediante la transferencia horizontal de genes; justificando la importancia de realizar una vigilancia epidemiológica del tránsito de clones con diferentes perfiles de resistencia y principales enzimas. Conclusiones: El seguimiento de la resistencia antimicrobiana desde el punto de vista de la epidemiología molecular forma parte transcendental de la vigilancia antibiótica como lo recomienda la Organización Mundial de la Salud; pues representa el futuro del monitoreo de la resistencia.AbstractIntroduction: Antimicrobial resistance is a serious public health problem that is increasing. Among the most important factors related to the spread of multi-resistant bacteria are the inappropriate use of antibiotics and the insufficient  implementation of prevention and control measures. Additionally, bacteria have the ability to mutate or create mechanisms for transfer of resistance genes via plasmids, transposons and integrons. Materials and methods: A critical review of the literature on major resistance genes in Gram negative bacteria and its impact on public health was conducted. Data have been collected from Medline, Embase, Lilacs, ScienceDirect, Scopus, SciELO, the Cochrane Library and Lilacs. Results: A review of literature that describes and analyzes the main antibiotic resistance genes present in gram-negative bacilli is presented, as well as their origin, evolution, and subsequent spread to hundreds of species of microorganisms by Horizontal gene transfer which justifies the importance of conducting an epidemiological surveillance on transit of clones with different resistance profiles and major enzymes. Conclusions: The control of antimicrobial resistance from the point of view of molecular epidemiology is part of the antibiotic surveillance control as recommended by the World Health Organization; as it represents the future of the surveillance of resistance.

scholarly journals Building the European Antimicrobial Resistance Surveillance network in veterinary medicine (EARS-Vet)

2021 ◽  
Vol 26 (4) ◽  
Author(s):  
Rodolphe Mader ◽  
Peter Damborg ◽  
Jean-Philippe Amat ◽  
Björn Bengtsson ◽  
Clémence Bourély ◽  
...  
Keyword(s):  
Veterinary Medicine ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
One Health ◽  
Action Plan ◽  
Animal Health ◽  
World Health ◽  
European Economic Area ◽  
Surveillance Network ◽  
Antimicrobial Resistance Surveillance

Antimicrobial resistance (AMR) should be tackled through a One Health approach, as stated in the World Health Organization Global Action Plan on AMR. We describe the landscape of AMR surveillance in the European Union/European Economic Area (EU/EEA) and underline a gap regarding veterinary medicine. Current AMR surveillance efforts are of limited help to veterinary practitioners and policymakers seeking to improve antimicrobial stewardship in animal health. We propose to establish the European Antimicrobial Resistance Surveillance network in Veterinary medicine (EARS-Vet) to report on the AMR situation, follow AMR trends and detect emerging AMR in selected bacterial pathogens of animals. This information could be useful to advise policymakers, explore efficacy of interventions, support antimicrobial stewardship initiatives, (re-)evaluate marketing authorisations of antimicrobials, generate epidemiological cut-off values, assess risk of zoonotic AMR transmission and evaluate the burden of AMR in animal health. EARS-Vet could be integrated with other AMR monitoring systems in the animal and medical sectors to ensure a One Health approach. Herein, we present a strategy to establish EARS-Vet as a network of national surveillance systems and highlight challenges of data harmonisation and bias. Strong political commitment at national and EU/EEA levels is required for the success of EARS-Vet.

scholarly journals One Health drivers of antibacterial resistance: quantifying the relative impacts of human, animal and environmental use and transmission

2020 ◽  
Author(s):  
Ross D. Booton ◽  
Aronrag Meeyai ◽  
Nour Alhusein ◽  
Henry Buller ◽  
Edward Feil ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
One Health ◽  
Transmission Rate ◽  
Action Plan ◽  
Resistant Bacteria ◽  
Antibacterial Resistance ◽  
Security Threat ◽  
Human Use ◽  
Long Term Impact

AbstractIntroductionAntimicrobial resistance (AMR), particularly antibacterial resistance (ABR) is a major global health security threat projected to cause over ten million human deaths annually by 2050. There is a disproportionate burden of ABR within lower- and middle-income countries (LMICs), but it is not well understood how ‘One Health’ drivers, where human health is co-dependent on the health of animals and environmental factors, might also impact the burden of ABR in different countries. Thailand’s “National Strategic Plan on Antimicrobial Resistance in Thailand” (NSP-AMR) aims to reduce AMR morbidity by 50% through a reduction of 20% in human antibacterial use and a 30% reduction in animal use starting in 2017. There is a need to understand the implications of such a plan within a One Health perspective that mechanistically links humans, animals and the environment.MethodsA mathematical model of antibacterial use, gut colonisation with extended-spectrum beta-lactamase (ESBL)-producing bacteria and faecal/oral transmission between populations of humans, animals and the environment was calibrated using estimates of the prevalence of ESBL-producing bacteria in Thailand, taken from published studies. This model was used to project the reduction in human ABR (% reduction in colonisation with resistant bacteria) over 20 years (2020-2040) for each potential One Health driver, including each individual transmission rate between humans, animals and the environment, exploring the sensitivity of each parameter calibrated to Thai-specific data. The model of antibacterial use and ABR transmission was used to estimate the long-term impact of the NSP-AMR intervention and quantify the relative impacts of each driver on human ABR.ResultsOur model predicts that human use of antibacterials is the most important factor in reducing the colonisation of humans with resistant bacteria (accounting for maximum 72.3 – 99.8% reduction in colonisation over 20 years). The current NSP-AMR is projected to reduce the human burden of ABR by 7.0 – 21.0%. If a more ambitious target of 30% reduction in antibacterial use in humans were set, a greater (9.9 – 27.1%) reduction in colonisation among humans is projected. We project that completely limiting antibacterial use within animals could have a lower impact (maximum 0.8 – 19.0% reductions in the colonisation of humans with resistant bacteria over 20 years), similar to completely stopping animal-to-human transmission (0.5 – 17.2%). Entirely removing environmental contamination of antibacterials was projected to reduce the percentage colonisation of humans with resistant bacteria by 0.1 – 6.2%, which was similar to stopping environment-human transmission (0.1 – 6.1%).DiscussionOur current understanding of the interconnectedness of ABR in a One Health setting is limited and precludes the ability to generate projected outcomes from existing ABR action plans (due to a lack of fit-for-purpose data). Using a theoretical approach, we explored this using the Thai AMR action plan, using the best available parameters to model the estimated impact of reducing antibacterial use and transmission of resistance between populations. Under the assumptions of our model, human use of antibacterials was identified as the main driver of human ABR, with slightly more ambitious reductions in usage (30% versus 20%) predicted to achieve higher impacts within the NSP-AMR programme. Considerable long-term impact may be also achieved through increasing the rate of loss of resistance and limiting One Health transmission events, particularly human-to-human transmission. Our model provides a simple framework to explain the mechanisms underpinning ABR, but further empirical evidence is needed to fully explain the drivers of ABR in LMIC settings. Future interventions targeting the simultaneous reduction of transmission and antibacterial usage would help to control ABR more effectively in Thailand.

scholarly journals 25.H. Workshop: Challenges in tackling antimicrobial resistance: economic and policy responses

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Antimicrobial Resistance ◽  
Environmental Health ◽  
One Health ◽  
Action Plan ◽  
National Level ◽  
World Health ◽  
Successful Implementation ◽  
Action Plans ◽  
Policy Responses ◽  
Human Animal

Abstract Antimicrobial resistance (AMR) is driven by inter-related dynamics in the human, animal, and environmental health sectors and one of the most significant and complex current public health issues of our time. Without effective antimicrobials even common infections may become life-threatening and many treatments such as surgical procedures and chemotherapy will not be possible. There is widespread consensus that the response to AMR requires multiple actions, including improving awareness and understanding of AMR, strengthening the knowledge and evidence based through surveillance and research, reducing the incidence of infection through effective sanitation, hygiene and infection prevention measures, optimising the use of antimicrobials in human and animal health and stimulating research and development (R&D) in novel antimicrobials and alternatives. International and national efforts to combat AMR have grown steadily over the last two decades. Two major landmark developments include the launch of the World Health Organisation (WHO) Global Action Plan on AMR in 2015, which asks all countries to develop national action plans by 2017, and the United Nations (UN) General Assembly agreeing a political declaration on AMR in 2016 where countries committed to work at national, regional, and global levels to develop and implement multisectoral national action plans in accordance with the 'One Health' approach. The European Commission also published a One Health action plan against antimicrobial resistance in 2017. However, despite progress at international level, there remains inconsistent progress and implementation of recommended policies to tackle AMR at national level. The UN Interagency Coordination Group on Antimicrobial Resistance (IACG) recently concluded that currently the greatest challenge in AMR is not designing a national action plan but implementing it. The contrasting cultures, behaviours and incentives of each sector and relevant stakeholders is what makes the successful implementation of AMR national action plans so challenging. The purpose of this workshop will be to discuss the evidence and thinking on the different facets of the complex problem of tackling AMR for academics and policy-makers. These discussions will be informed by a forthcoming book jointly published by the European Observatory on Health Systems and Policies and the Organisation for Economic Co-operation and Development titled 'Challenges in Tackling Antimicrobial Resistance: Economic and Policy Responses'. The workshop will focus on five key questions; How can implementation of AMR national action plans be strengthened? What is the evidence on the rise of AMR and its health and economic impact? How can AMR be most effectively addressed in community healthcare settings? How can the discovery of new antibiotics be reinvigorated to replace those rendered ineffective by resistance? Can more use be made of vaccines to tackle AMR? Key messages Antimicrobial resistance is a complex issue which requires actions across the human, animal, environmental health sectors taking a 'One Health' approach. Improving the quality of governance within antimicrobial resistance national action plans is an essential step to strengthening implementation.

scholarly journals A One Health approach to assessing occupational exposure to antimicrobial resistance in Thailand: The FarmResist project

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245250
Author(s):  
Duangdao Sudatip ◽  
Kittipong Chasiri ◽  
Anamika Kritiyakan ◽  
Wantanee Phanprasit ◽  
Chuanphot Thinphovong ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Resistance Genes ◽  
One Health ◽  
Close Contact ◽  
Antibiotic Use ◽  
Farm Animals ◽  
Resistant Bacteria ◽  
Wild Rodents ◽  
Cross Sectional ◽  
Extended Spectrum Beta Lactamase

This Southeast Asia-Europe research project will use a One Health approach to identify the major parameters responsible for the presence of animal-associated antimicrobial resistant bacteria in animal production facilities in Thailand and the risk of their transmission from animals to humans. We will focus on traditional, small, extensive pig and poultry farms where information on antibiotic use is scarce and animals live in close contact with humans. This cross-sectional study will be based on the epidemiological analysis of the antimicrobial resistance (AMR) present in fecal samples from animals and humans. Extended spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E) and Enterobacteriaceae resistant to colistin will be actively searched in the feces of farm animals (pigs and poultry), small wild rodents and farmers. Phenotypic (selective plating) and genotypic (multilocus seuquence typing and sequencing) methods will be used for the detection of AMR, the identification of antibiotic resistance genes (ARGs) and the characterization of strains carrying resistance genes. Questionnaires will be administered to investigate the effects of antibiotic use, farm characteristics and biosecurity measures on the occurrence of AMR in animals. Subsequently, the fecal carriage of AMR and ARGs in farmers will be compared to a control population with no occupational contacts with animals, thus enabling an estimation of the risk of transmission of AMR/ARGs from animals to farmers.

scholarly journals Transmission of Antibiotic Resistant Bacteria and Genes: Unveiling the Jigsaw Pieces of a One Health Problem

Pathogens ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 497
Author(s):  
Carla Novais ◽  
Ana R. Freitas
Keyword(s):  
Antibiotic Resistance ◽  
Antimicrobial Resistance ◽  
Global Health ◽  
Large Scale ◽  
One Health ◽  
Metal Tolerance ◽  
Bacterial Species ◽  
Common Species ◽  
World Health ◽  
Resistant Bacteria

Antimicrobial Resistance is one of the major Global Health challenges of the twenty-first century, and one of the World Health Organization’s (WHO) top ten global health threats. The evolution of antibiotic resistance among bacterial pathogens requires urgent concerted global efforts under a One Health approach integrating human, animal, and environmental surveillance data. This is crucial to develop efficient control strategies and counteract the spread of multidrug-resistant pathogens. The studies in this Special Issue have evidenced the hidden role of less common species, unusual clones or unexplored niches in the dissemination of antimicrobial resistance between different hosts. They reinforce the need for large-scale surveillance studies tracing and tracking both antibiotic resistance and metal tolerance in different bacterial species.

scholarly journals Country Income Is Only One of the Tiles: The Global Journey of Antimicrobial Resistance among Humans, Animals, and Environment

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 473
Author(s):  
Angela Pieri ◽  
Richard Aschbacher ◽  
Giada Fasani ◽  
Jole Mariella ◽  
Lorenzo Brusetti ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Infection Control ◽  
One Health ◽  
Action Plan ◽  
Animal Health ◽  
Animal Husbandry ◽  
Resistant Bacteria ◽  
International Agencies ◽  
Control And Prevention ◽  
Infection Control And Prevention

Antimicrobial resistance (AMR) is one of the most complex global health challenges today: decades of overuse and misuse in human medicine, animal health, agriculture, and dispersion into the environment have produced the dire consequence of infections to become progressively untreatable. Infection control and prevention (IPC) procedures, the reduction of overuse, and the misuse of antimicrobials in human and veterinary medicine are the cornerstones required to prevent the spreading of resistant bacteria. Purified drinking water and strongly improved sanitation even in remote areas would prevent the pollution from inadequate treatment of industrial, residential, and farm waste, as all these situations are expanding the resistome in the environment. The One Health concept addresses the interconnected relationships between human, animal, and environmental health as a whole: several countries and international agencies have now included a One Health Approach within their action plans to address AMR. Improved antimicrobial usage, coupled with regulation and policy, as well as integrated surveillance, infection control and prevention, along with antimicrobial stewardship, sanitation, and animal husbandry should all be integrated parts of any new action plan targeted to tackle AMR on the Earth. Since AMR is found in bacteria from humans, animals, and in the environment, we briefly summarize herein the current concepts of One Health as a global challenge to enable the continued use of antibiotics.

scholarly journals Aquatic environments in the One Health context: modulating the antimicrobial resistance phenomenon

2020 ◽  
Vol 32 ◽  
Author(s):  
Juliana Alves Resende ◽  
Vânia Lúcia da Silva ◽  
Claudio Galuppo Diniz
Keyword(s):  
Antimicrobial Resistance ◽  
One Health ◽  
Anthropogenic Activities ◽  
Treatment Strategies ◽  
Chemical Pollution ◽  
Resistant Bacteria ◽  
Aquatic Environments ◽  
Antimicrobial Substances ◽  
Antimicrobial Resistance Genes ◽  
The One

Abstract: From an anthropocentric perspective, aquatic environments are important to maintain health and survival, however, as they are sometimes managed based on misconception, they are considered a convergent pathway for anthropogenic residues and sanitation. Thus, it is observed that these ecosystems have been threatened by chemical pollution due to xenobiotics, especially from a more contemporary approach, by the selective pressure associated with antimicrobials. There are several studies that report the enrichment of antimicrobial resistant bacteria and mobilizable antimicrobial resistance genes in aquatic and adjacent ecosystems. From the perspective of the emerging and reemerging number of diseases related to the interplay of human, animal, and environmental factors, a new conception arose to address these issues holistically, which is known as the One Health approach. Scientific and political discourse on this conception should lead to effective action plans for preventing and controlling the spread of infectious diseases in open environment, including those impacted by anthropogenic activities. Therefore, nowadays, discussions on antimicrobial resistance are becoming broader and are requiring a multi-disciplinary view to address health and environmental challenges, which includes aquatic environment management. Water may represent one of the most important ecosystems for the in antimicrobial resistance phenomenon that arises when a dynamic and singular microbial community may be influenced by several characteristics. As antimicrobial substances do not all degrade at the same time under the same treatment, strategies concerning their removal from the environment should consider their individualized chemical characteristics.

scholarly journals Establishment of the South Korean national antimicrobial resistance surveillance system, Kor-GLASS, in 2016

2018 ◽  
Vol 23 (42) ◽  
Author(s):  
Hyukmin Lee ◽  
Eun-Jeong Yoon ◽  
Dokyun Kim ◽  
Seok Hoon Jeong ◽  
Jong Hee Shin ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Surveillance System ◽  
Action Plan ◽  
World Health ◽  
Surveillance Systems ◽  
The South ◽  
South Korean ◽  
Antimicrobial Resistance Surveillance ◽  
The Status ◽  
Health Organization

Surveillance plays a pivotal role in overcoming antimicrobial resistance (AMR) in bacterial pathogens, and a variety of surveillance systems have been set up and employed in many countries. In 2015, the World Health Organization launched the Global Antimicrobial Resistance Surveillance System (GLASS) as a part of the global action plan to enhance national and global surveillance and research. The aims of GLASS are to foster development of national surveillance systems and to enable collection, analysis and sharing of standardised, comparable and validated data on AMR between different countries. The South Korean AMR surveillance system, Kor-GLASS, is compatible with the GLASS platform and was established in 2016 and based on the principles of representativeness, specialisation, harmonisation and localisation. In this report, we summarise principles and processes in order to share our experiences with other countries planning to establish a national AMR surveillance system. The pilot operation of Kor-GLASS allowed us to understand the national burden of specific infectious diseases and the status of bacterial AMR. Issues pertaining to high costs and labour-intensive operation were raised during the pilot, and improvements are being made.

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