Awareness of antibiotic resistance: a tool for measurement among human and animal health care professionals in LMICs and UMICs.

BACKGROUND: Raising awareness of antimicrobial resistance is a cornerstone of action plans to tackle this global One Health challenge. Tools that can reliably assess levels of awareness of antibiotic resistance (ABR) among human or animal healthcare professionals (HCPs) are required to guide and evaluate interventions. METHODS: We designed and tested an ABR awareness scale, a self-administered questionnaire completed by human and animal HCPs trained to prescribe and dispense antibiotics in six countries-Ghana, Nigeria, Tanzania, Vietnam, Thailand and Peru. Questionnaires also elicited demographic, practice, and contextual information. Psychometric analysis for the scale followed Rasch Measurement Theory. Bivariate analysis was carried out to identify factors associated with awareness scores. RESULTS: Overall, 941 HCPs (625 human and 316 animal) from Ghana, Nigeria, Tanzania, Vietnam, Thailand and Peru were included in the study. The 23-item ABR awareness scale had high-reliability coefficients (0.88 for human and 0.90 for animal HCPs) but performed better within countries than across countries. Median ABR awareness scores were 54.6-63.5 for human HCPs and 55.2-63.8 for animal HCPs (scale of 0-100). Physicians and veterinarians scored higher than other HCPs in every country tested. HCPs in this study reported working in contexts with limited laboratory infrastructures. More than 95% of HCPs were interested in receiving information or training on ABR and antimicrobial stewardship. CONCLUSION: HCPs' awareness of ABR can be reliably assessed with this validated 23-item scale within the countries tested. Using the scale alongside context questions and objective measurement of practices is recommended to inform interventions to improve antibiotic use.

Biosecurity and water, sanitation, and hygiene (WASH) interventions in animal agricultural settings for reducing infection burden, antibiotic use, and antibiotic resistance: a One Health systematic review.

Prevention and control of infections across the One Health spectrum is essential for improving antibiotic use and addressing the emergence and spread of antibiotic resistance. Evidence for how best to manage these risks in agricultural communities-45% of households globally-has not been systematically assembled. This systematic review identifies and summarises evidence from on-farm biosecurity and water, sanitation, and hygiene (WASH) interventions with the potential to directly or indirectly reduce infections and antibiotic resistance in animal agricultural settings. We searched 17 scientific databases (including Web of Science, PubMed, and regional databases) and grey literature from database inception to Dec 31, 2019 for articles that assessed biosecurity or WASH interventions measuring our outcomes of interest; namely, infection burden, microbial loads, antibiotic use, and antibiotic resistance in animals, humans, or the environment. Risk of bias was assessed with the Systematic Review Centre for Laboratory Animal Experimentation tool, Risk of Bias in Non-Randomized Studies of Interventions, and the Appraisal tool for Cross-Sectional Studies, although no studies were excluded as a result. Due to the heterogeneity of interventions found, we conducted a narrative synthesis. The protocol was pre-registered with PROSPERO (CRD42020162345). Of the 20 672 publications screened, 104 were included in this systematic review. 64 studies were conducted in high-income countries, 24 studies in upper-middle-income countries, 13 studies in lower-middle-income countries, two in low-income countries, and one included both upper-middle-income countries and lower-middle-income countries. 48 interventions focused on livestock (mainly pigs), 43 poultry (mainly chickens), one on livestock and poultry, and 12 on aquaculture farms. 68 of 104 interventions took place on intensive farms, 22 in experimental settings, and ten in smallholder or subsistence farms. Positive outcomes were reported for ten of 23 water studies, 17 of 35 hygiene studies, 15 of 24 sanitation studies, all three air-quality studies, and 11 of 17 other biosecurity-related interventions. In total, 18 of 26 studies reported reduced infection or diseases, 37 of 71 studies reported reduced microbial loads, four of five studies reported reduced antibiotic use, and seven of 20 studies reported reduced antibiotic resistance. Overall, risk of bias was high in 28 of 57 studies with positive interventions and 17 of 30 studies with negative or neutral interventions. Farm-management interventions successfully reduced antibiotic use by up to 57%. Manure-oriented interventions reduced antibiotic resistance genes or antibiotic-resistant bacteria in animal waste by up to 99%. This systematic review highlights the challenges of preventing and controlling infections and antimicrobial resistance, even in well resourced agricultural settings. Most of the evidence emerges from studies that focus on the farm itself, rather than targeting agricultural communities or the broader social, economic, and policy environment that could affect their outcomes. WASH and biosecurity interventions could complement each other when addressing antimicrobial resistance in the human, animal, and environmental interface.

Evaluating the relationship between community water and sanitation access and the global burden of antibiotic resistance: an ecological study.

BACKGROUND: Antibiotic resistance is a leading cause of death, with the highest burden occurring in low-resource settings. There is little evidence on the potential for water, sanitation, and hygiene (WASH) access to reduce antibiotic resistance in humans. We aimed to determine the relationship between the burden of antibiotic resistance in humans and community access to drinking water and sanitation. METHODS: In this ecological study, we linked publicly available, geospatially tagged human faecal metagenomes (from the US National Center for Biotechnology Information Sequence Read Archive) with georeferenced household survey datasets that reported access to drinking water sources and sanitation facility types. We used generalised linear models with robust SEs to estimate the relationship between the abundance of antibiotic resistance genes (ARGs) in human faecal metagenomes and community-level coverage of improved drinking water and sanitation within a defined radii of faecal metagenome coordinates. FINDINGS: We identified 1589 metagenomes from 26 countries. The mean abundance of ARGs, in units of log10 ARG fragments per kilobase per million mapped reads classified as bacteria, was highest in Africa compared with Europe (p=0·014), North America (p=0·0032), and the Western Pacific (p=0·011), and second highest in South-East Asia compared with Europe (p=0·047) and North America (p=0·014). Increased access to improved water and sanitation was associated with lower ARG abundance (effect estimate -0·22, [95% CI -0·39 to -0·05]) and the association was stronger in urban (-0·32 [-0·63 to 0·00]) than in rural (-0·16 [-0·38 to 0·07]) areas. INTERPRETATION: Although additional studies to investigate causal effects are needed, increasing access to water and sanitation could be an effective strategy to curb the proliferation of antibiotic resistance in low-income and middle-income countries. FUNDING: Bill & Melinda Gates Foundation.

Aislamiento bacteriano en casos de otitis canina y su susceptibilidad antibiótica / Bacterial isolation in canine ear infections and its antimicrobial susceptibility

El objetivo de este estudio fue determinar la frecuencia de casos de otitis bacteriana en canes, las bacterias involucradas y su susceptibilidad a los antibacterianos, en base a muestras procesadas en un laboratorio de microbiología especializado en el campo veterinario en el periodo 2001-2006. Se emplearon 429 fichas de laboratorio. La bacteria de mayor frecuencia fue el Staphylococcus intermedius (27.7%), pero hubo otros agentes de importancia como Pseudomonas aeruginosa, Streptococcussp. y Staphylococcus sp. Las infecciones óticas fueron mayormente monomicrobianas (63.6%). En las pruebas de susceptibilidad por el método de Kirby-Bauer se encontró el mayor nivel de susceptibilidad de las bacterias a las quinolonas, aminoglucósidos, cefalosporinas y penicilinas combinadas con inhibidores de las betalactamasas; mientras que las penicilinas, sulfas, tetraciclinas, lincosamidas y macrólidos fueron los antimicrobianos de menor efectividad.

The objective of the study was to determine the frequency of bacterial otitis cases in dogs, the bacteria involved in the infection and the bacterial susceptibility to antibiotics in samples processed during 2001-2006 in a bacteriology laboratory specialized in the veterinary field. A total of 429 laboratory records were used. The most frequent isolated bacteria was Staphylococcus intermedius (27.7%), but other important species were also found (Pseudomonas aeruginosa, Streptococcus sp. and Staphylococcus sp). Ear infections were mostly due to a single bacteria species (63.6%). In susceptibility test using the Kirby-Bauer method the quinolones, aminoglycosides, cephalosporins, and penicillins combined with inhibitors of betalactamics showed better antimicrobial effect, while bacteria species showed high resistance to penicillin, sulpha, tetracyclines, macrolides and lincosamides.

Persistencia de la inmunidad pasiva contra Actinobacillus pleuropneumoniae en porcinos en etapa de recría / Persistence of passive immunity against actinobacillus pleuropneumoniae in piglets during the growing phase

En el presente estudio se, observó la persistencia de la inmunidad pasiva en porcinos procedentes de madres seropositivas a Actinobacillus pleuropneumoniae desde el destete hasta el final del periodo de recría en una granja tecnificada de Ica. Se colectó una muestra de sangre a 30 lechones a los 17, 42 y 73 días de edad, correspondientes al destete, y mitad y final del periodo de recría, respectivamente. El suero se analizó con una prueba de ELISA indirecta que detecta anticuerpos contra la toxina ApxIV. Todos los lechones fueron positivos a la presencia de anticuerpos maternales en el día 17 de edad, en tanto que el 56.7 y el 46.7% de los lechones resultaron positivos a los 42 y 73 días de edad, respectivamente. Existió diferencia estadística entre las medias de los niveles de anticuerpos para los días 17 y 42, y 17 y 73 (p<0.05), pero no hubo entre los días 42 y 73. El nivel de anticuerpos fue bajo al final de la etapa de recría.

The present study evaluated the persistence of passive immunity in piglets from seropositive sows to Actinobacillus pleuropneumoniae from weaning to the end of the growing phase in a commercial farm in Ica, Peru. Blood samples were collected from 30 piglets at 17, 42, and 73 days of age, which corresponded to weaning, and to mid and final period or the growing phase respectively. Serum was analyzed by an indirect ELISA testthat detects antibodies against the ApxIV toxin. All piglets were positive to the presence of maternal antibodies at day 17 of age, where as 56.7 and 46.7% were positive at 42 and 73 days of age respectively. There was statistical difference between levels of antibodies at days 17 and 42, and 17 and 73 (p<0.05), but not between days 42 and 73. The level of antibodies was low at the end of the growing phase.

Frecuencia de infección con Actinobacillus pleuropneumoniae en granjas porcinas tecnificadas de la costa peruana / Frequency of actinobacillus pleuropneumoniae infection in commercial pig farms of the peruvian coast

El objetivo del estudio fue determinar la frecuencia de anticuerpos contra la toxina ApxIV de Actinobacillus pleuropneumoniae, causante de pleuroneumonía porcina en 10 granjas porcinas tecnificadas de los departamentos de Arequipa, Lima, Ica y La Libertad. Se colectaron muestras de sangre de porcinos de las etapas de crecimiento y acabado (30 por granja) y se analizaron mediante la prueba de ELISA indirecta con un kit comercial. El 23.7% (71/300) de los animales presentaron anticuerpos contra la toxina ApxIV, correspondiendo la mayor frecuencia a la granja del departamento de Ica (60.0%). La presencia de anticuerpos contra la toxina ApxIV evidencia la presencia de la infección con A. pleuropneumoniae en la industria porcina del Perú.

The objective of the study was to determine the frequency of antibodies against the ApxIV toxin of Actinobacillus pleuropneumoniae, causal agent of porcine pleuropneumonia in 10 commercial pig farms of Arequipa, Lima, Ica and La Libertad departments. Blood samples were collected from animals in the growing and finishing stages (30 per farm) and analyzed by the indirect ELISA test using a commercial kit. The results showed that 23.7% (71/300) of the animals presented antibodies against the ApxIV toxin, and the highest frequency was found in the farm located in Ica (60%). The presence of antibodies against the ApxIV toxin indicated the presence of A. pleuropneumoniae infection in pig commercial farms in Peru.