scholarly journals Assessing Antimicrobial Resistance, Utilization, and Stewardship in Yemen: An Exploratory Mixed-Methods Study

2021 ◽  
Author(s):  
E. Sam F. Orubu ◽  
Najwa Al-Dheeb ◽  
Carly Ching ◽  
Sima Bu Jawdeh ◽  
Jessica Anderson ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
Antibiotic Use ◽  
Current Status ◽  
Rapid Diagnostics ◽  
War Wounds ◽  
Low Income Country ◽  
Antimicrobial Sensitivity ◽  
Important Solution ◽  
Amoxicillin Clavulanate

Antimicrobial resistance (AMR), largely driven by irrational use of antimicrobials, is a global, multifaceted problem calling for a complete understanding of all contributory factors for effective containment. In conflict settings, war-wounds and malnutrition can combine with existing social determinants to increase demand for antibiotics, compounding irrational use. In this study, we focus on Yemen, a low-income country with active conflict for the last 5 years, and analyze the current status of awareness and stewardship efforts regarding AMR. We performed a survey of prescribers/physicians and pharmacists to describe perceptions of AMR prevalence, antibiotic use practices, and stewardship in Yemen, supported by a nonsystematic scoping literature review and a key informant interview. Participants (96%, N = 57) reported a perceived high AMR prevalence rate. Prescribers (74%, 20/27) reported pressure to prescribe broad-spectrum antibiotics. In the majority of cases (81%, 22/27), antimicrobial sensitivity tests (AST) were not performed to inform antibiotic choice. The main barrier to AST was cost. Most pharmacists (67%, 18/27) sold antibiotics without prescriptions. Amoxicillin (including amoxicillin-clavulanate) was the most-commonly prescribed (63%, 17/27) or dispensed (82%, 22/27) antibiotic. AST was rated the least important solution to AMR in Yemen. While there was awareness of a high AMR rate, stewardship is poor in Yemen. We note that barriers to the use of AST could be addressed through the deployment of reliable, affordable, quality rapid diagnostics, and AST kits. Compulsory continuing education emphasizing the use of AST to guide prescribing and patients’ awareness programs could help avoid irrational use.

scholarly journals Assessing antimicrobial resistance, utilization and stewardship in Yemen: An exploratory mixed-methods study

2021 ◽  
Author(s):  
ESF Orubu ◽  
A Najwa ◽  
C Ching ◽  
S Bu Jawdeh ◽  
J Anderson ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
Low Cost ◽  
Antibiotic Use ◽  
Current Status ◽  
War Wounds ◽  
Low Income Country ◽  
Antimicrobial Sensitivity ◽  
Important Solution ◽  
Amoxicillin Clavulanate

AbstractAntimicrobial resistance (AMR), largely driven by irrational use of antimicrobials, is a global, multi-faceted problem calling for a complete understanding of all contributory factors for effective containment. In conflict settings, war-wounds and malnutrition can combine with existing social determinants to increase demand for antibiotics, compounding irrational use. In this study, we focus on Yemen, a low-income country with active conflict for the last five years, and analyze the current status of awareness and stewardship efforts regarding AMR. We performed a survey of prescribers/physicians and pharmacists to describe perceptions of AMR prevalence, antibiotic use practices and stewardship in Yemen, supported by a non-systematic scoping literature review and a key informant interview. Participants (96%, n=57) reported a perceived high AMR prevalence rate. Prescribers (74%, 20/27) reported pressure to prescribe broad-spectrum antibiotics. In the majority of cases (81%, 22/27), Antimicrobial Sensitivity Tests (AST) were not performed to inform antibiotic choice. The main barrier to AST was cost. Most pharmacists (67%, 18/27) sold antibiotics without prescriptions. Amoxicillin (including amoxicillin-clavulanate) was the most-commonly prescribed (63%, 17/27) or dispensed (82%, 22/27) antibiotic. AST was rated the least important solution to AMR in Yemen. While there was awareness of a high AMR rate, stewardship is poor in Yemen. We note that barriers to the use of AST could be addressed through the deployment of low-cost AST kits. Compulsory continuing education emphasizing the use of AST to guide prescribing and patients’ awareness programs could help avoid irrational use.

scholarly journals Unsafe “crossover-use” of chloramphenicol in Uganda: importance of a One Health approach in antimicrobial resistance policy and regulatory action

2021 ◽  
Author(s):  
Kayley D. McCubbin ◽  
John W. Ramatowski ◽  
Esther Buregyeya ◽  
Eleanor Hutchinson ◽  
Harparkash Kaur ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Focus Group ◽  
Low Income ◽  
One Health ◽  
Antibiotic Use ◽  
Regulatory Action ◽  
Health Concern ◽  
Drug Shop ◽  
Human Consumption ◽  
Human Use

AbstractSince the introduction of antibiotics into mainstream health care, resistance to these drugs has become a widespread issue that continues to increase worldwide. Policy decisions to mitigate the development of antimicrobial resistance are hampered by the current lack of surveillance data on antibiotic product availability and use in low-income countries. This study collected data on the antibiotics stocked in human (42) and veterinary (21) drug shops in five sub-counties in Luwero district of Uganda. Focus group discussions with drug shop vendors were also employed to explore antibiotic use practices in the community. Focus group participants reported that farmers used human-intended antibiotics for their livestock, and community members obtain animal-intended antibiotics for their own personal human use. Specifically, chloramphenicol products licensed for human use were being administered to Ugandan poultry. Human consumption of chloramphenicol residues through local animal products represents a serious public health concern. By limiting the health sector scope of antimicrobial resistance research to either human or animal antibiotic use, results can falsely inform policy and intervention strategies. Therefore, a One Health approach is required to understand the wider impact of community antibiotic use and improve overall effectiveness of intervention policy and regulatory action.

scholarly journals Detection of Salmonella spp. in exotic pigeons of North Kerala and its antibiogram

2021 ◽  
Vol 52 (3) ◽  
Author(s):  
Lijo John ◽  
Lijo John ◽  
Lijo John ◽  
Lijo John ◽  
Lijo John
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Salmonella Spp ◽  
Important Public Health ◽  
Antimicrobial Sensitivity ◽  
Antimicrobial Resistance Profile ◽  
Disk Diffusion Assay ◽  
Amoxicillin Clavulanate ◽  
Diffusion Assay ◽  
Pigeon Breeding

Pigeon breeding has transformed from being a mere hobby to becoming established as an industry. The increased trade of pigeons inadvertently invites the risk of dissemination of infections including zoonoses like salmonellosis. Pigeons once infected remain carriers for life. This coupled with the ability of the organism to acquire antimicrobial resistance makes salmonellosis, particularly from pigeons an important, public health risk for pigeon handlers. Cloacal swabs from a total of 200 exotic pigeons belonging to 24 lofts from Northern districts of Kerala were collected and attempted to isolate Salmonella and understand its antimicrobial resistance profile. Five isolates of salmonella could be obtained from four of the lofts studied. A prevalence of 2.5 per cent was identified for salmonellosis with 16.67 per cent of the lofts affected. Antimicrobial sensitivity based on disk diffusion assay revealed that all the five isolates were sensitive to amoxicillin-clavulanate and all were resistant to tetracycline and streptomycin. Sixty per cent of the isolates were sensitive to co-trimoxazole, chloramphenicol, ampicillin, cefoperazone, amikacin and gentamicin.

scholarly journals Image of Ukraine in the World: Current Status, Prospects and Challenges

2019 ◽  
pp. 698-703
Author(s):  
Olena Yalova
Keyword(s):  
Low Income ◽  
International Community ◽  
Information Space ◽  
Current Status ◽  
Global Media ◽  
Low Income Country ◽  
The World ◽  
International Image ◽  
Red Tape ◽  
The Right

The article focuses on the need to create an international image of Ukraine. The analysis of the world rankings shows that in the eyes of the international community we are a corrupt low-income country with a beseeching glance at the international community and a serious armed conflict with Russia, which results in the negative image of Ukraine. The country’s leadership does not regard the creation of a positive image of Ukraine as an extremely important task, therefore leading to the continued absence of a branding strategy. The author believes that it is necessary to determine the authority that will be responsible for the international image of the country and will help coordinate cooperation between all organizations, whether governmental or non-governmental. In Ukraine, it is necessary to overcome the bureaucratic red tape and narrow-mindedness. There is an urgent need for an elaborate strategy, in which all the mechanisms and tools to create the right image of the state should be involved. According to the author, access to the global information space looks promising. Ukraine should vigorously shape global media landscape and use the potential of its news agencies. Official state diplomacy should actively participate in the process of forming a positive international image of Ukraine. It is also necessary to thoroughly study and adopt foreign experience. Ukraine is the largest country in Europe, with rich cultural heritage, history and traditions. Currently, economic indicators are at a low level, but a prospect of their growth can attract foreign investment. The analysis of the image of Ukraine shows that the country is not consciously managing it. However, even minimal efforts can significantly improve the country’s position in the global perception. We have something to be proud of, we just need to start talking about it and bring it to the wider world audience. Keywords: international image, Ukraine, state diplomacy, information space, world ranking.

scholarly journals Etiological Agents and Antimicrobial Susceptibility in Hospitalized Children with Acute Pyelonephritis

2015 ◽  
Vol 28 (1) ◽  
pp. 15
Author(s):  
Filipa Flor-de-Lima ◽  
Tânia Martins ◽  
Ana Teixeira ◽  
Helena Pinto ◽  
Edgar Botelho-Moniz ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Susceptibility ◽  
Acute Pyelonephritis ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Resistance Rate ◽  
Antimicrobial Sensitivity ◽  
Amoxicillin Clavulanate ◽  
Etiological Agents ◽  
Sensitivity Profile

<strong>Introduction:</strong> Antibiotic resistance driven by antibiotic use remains a major public health and professional concern. Our aim was to know the local prevalence of uropathogens and their antimicrobial susceptibility profile in acute pyelonephritis.<br /><strong>Material and Methods:</strong> A prospective study of patients admitted in a level III Pediatric Department ward with acute pyelonephritis from 1994 to 2012 was performed in Northern Portugal. Etiological agents and their antimicrobial sensitivity profile were evaluated in four timed periods (G1: 1994-97; G2: 2002; G3: 2007; G4: 2012).<br /><strong>Results:</strong> We evaluated 581 patients, 66% female with median age 22 months. Escherichia coli was the leading uropathogen and its prevalence remained stable during the last 18 years. It showed an increased sensitivity to amoxicillin-clavulanate from 71% in G1 to 81.5% in G4 (p = 0.001) and a decreased resistance rate from 8.7% in G1 to 2.8% in G4 (p = 0.008). Its sensitivity to 2nd and 3rd generation cephalosporin was more than 90% (p = ns) and more than 95% to nitrofurantoin (p = ns). Resistance rate of cotrimoxazole increased from 22% to 26% (p = 0.008).<br /><strong>Discussion:</strong> Escherichia coli remains the main uropathogen responsible for acute pyelonephritis, reason why its antimicrobial sensitivity profile will determine the empirical therapeutic choice.<br /><strong>Conclusions:</strong> Amoxicillin-clavulanate remains a good first-line choice for empirical treatment of acute pyelonephritis in our inpatient health care.<br /><strong>Keywords:</strong> Anti-Bacterial Agents; Child; Drug Resistance, Bacterial; Pyelonephritis.<br /><br />

scholarly journals Overview of Delivery of Cancer Care in Nepal: Current Status and Future Priorities

2020 ◽  
pp. 1211-1217 ◽  
Author(s):  
Bishal Gyawali ◽  
Shubham Sharma ◽  
Ramila Shilpakar ◽  
Soniya Dulal ◽  
Jitendra Pariyar ◽  
...  
Keyword(s):  
Low Income ◽  
Care Delivery ◽  
Cancer Control ◽  
Public Health Problem ◽  
Health Care Delivery System ◽  
Current Status ◽  
Important Public Health Problem ◽  
Systematic Assessment ◽  
Low Income Country ◽  
Systematic Plan

Nepal is a small, low-income country between India and China with a unique health care delivery system. Cancer is becoming an important public health problem in the country, but a systematic plan to cancer control is lacking. In this article, we aim to provide a systematic assessment of the burden of disease and available resources and suggest prioritization approaches for the future to assist with any such future cancer control plans for the country.

scholarly journals Epidemiological Characteristics and Predisposing Factors for Surgical Site Infections Caused by Bacterial Pathogens Exhibiting Multidrug-Resistant Patterns

Antibiotics ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 622
Author(s):  
Abdikarim Hussein Mohamed ◽  
Hussein Ali Mohamud ◽  
Ebubekir Arslan
Keyword(s):  
Multidrug Resistance ◽  
Antimicrobial Resistance ◽  
Surgical Site Infection ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Site Infection ◽  
Antimicrobial Sensitivity ◽  
Study Results ◽  
Epidemiological Characteristics

Background: Surgical site infection is the most common kind of nosocomial infection in developed and developing countries. Objectives: Our aim was to identify the prevalence of factors predisposing to multidrug resistance and the antimicrobial susceptibility profile of pathogens. Method: This retrospective study enrolled 10,878 patients who underwent operations in 2018–2020. Pathogens were identified using eosin methylene blue agar. Mueller–Hinton agar was used to assess antimicrobial sensitivity and resistance. In total, 382 patients with confirmed surgical site infection (SSI), whose culture showed growth, were included in the study. Results: The prevalence of SSI in the current study was 3.5%. Escherichia coli was the predominant pathogen (35.8%), followed by Staphylococcus aureus (21.8%). Antibiotic use, chronic renal failure, diabetes, and emergency operations were found to increase the likelihood of multidrug resistance (OR = 6.23, CI = 1.443–26.881, p = 0.014; OR = 5.67, CI = 1.837–19.64, p = 0.02; OR = 2.54, CI = 1.46–7.35, p = 0.03; OR = 1.885, CI = 1.067–3.332, p = 0.002, respectively). The pathogens showed different levels of antimicrobial resistance against ceftriaxone (72.7%), ciprofloxacin (46.6%), and gentamicin (34%). Antimicrobial resistance of about 1–3.4% was exhibited by linezolid, tigecycline, and teicoplanin. Conclusion: The study presented significantly increased multidrug-resistant (MDR) Enterobacteriaceae pathogens isolated from surgical sites. They involve significant morbidity and mortality rates and increased health-related costs.

scholarly journals Simplified management protocol for term neonates after prolonged rupture of membranes in a setting with high rates of neonatal sepsis and mortality: a quality improvement study

2018 ◽  
Vol 104 (2) ◽  
pp. 115-120 ◽  
Author(s):  
Diana Olita’a ◽  
Roland Barnabas ◽  
Gamini Vali Boma ◽  
Wendy Pameh ◽  
John Vince ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antimicrobial Resistance ◽  
Low Income ◽  
Clinical Signs ◽  
Antibiotic Use ◽  
Low Income Countries ◽  
Antibiotic Exposure ◽  
Middle Income ◽  
Management Protocol

In low-income and middle-income countries, courses of antibiotics are routinely given to term newborns whose mothers had prolonged rupture of membranes (PROM). Rational antibiotic use is vital given rising rates of antimicrobial resistance and potential adverse effects of antibiotic exposure in newborns. However missing cases of sepsis can be life-threatening.This is a quality improvement evaluation of a protocol for minimal or no antibiotics in term babies born after PROM in Papua New Guinea. Asymptomatic, term babies born to women with PROM >12 hours prior to birth were given a stat dose of antibiotics, or no antibiotics if the mother had received intrapartum antibiotics, reviewed and discharged at 48–72 hours with follow-up. Clinical signs of sepsis within the first week and the neonatal period were assessed. Of 170 newborns whose mothers had PROM, 133 were assessed at 7 days: signs of sepsis occurred in 10 babies (7.5%; 95% CI 4.4% to 13.2%) in the first week. Five had isolated fever, four had skin pustules and one had fever with periumbilical erythema. An additional four (3%) had any sign of sepsis between 8 and 28 days. There was one case of bacteraemia and no deaths. 37 were lost to follow-up, but hospital records did not identify any subsequent admissions for infection. A rate of sepsis was documented that was comparable with other studies in low-income countries. This protocol may reduce antimicrobial resistance and consequences of antibiotic exposure in newborns, provided safeguards are in place to monitor for signs of sepsis.

scholarly journals Antimicrobial resistance in Helicobacter pylori: current situation and management strategy in Vietnam

2015 ◽  
Vol 9 (06) ◽  
pp. 609-613 ◽  
Author(s):  
Trung Nam Phan ◽  
Van Huy Tran ◽  
Thi Nhu Hoa Tran ◽  
Van An Le ◽  
Antonella Santona ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Antimicrobial Resistance ◽  
Management Strategies ◽  
Antibiotic Use ◽  
Current Situation ◽  
Treatment Regimens ◽  
Antimicrobial Sensitivity ◽  
Sensitivity Tests ◽  
History Of ◽  
H Pylori

Increasing antimicrobial resistance to key antibiotics in Helicobacter pylori has become a main cause of treatment failures in many countries, including Vietnam. For this reason it is advisable to perform antimicrobial sensitivity tests to provide more focused regimens for H. pylori eradication. However, this approach is generally unavailable for H. pylori in Vietnam and the selection of treatment regimens is mainly based on the trend of antibiotic use in the population, resistance development in the region, and history of H. pylori eradication of patients. The aim of this review is to examine the current situation of antimicrobial resistance in Vietnam and suggest management strategies for treatment selection.

scholarly journals Antimicrobial Resistance and Environmental Health: A Water Stewardship Framework for Global and National Action

Antibiotics ◽  
2022 ◽  
Vol 11 (1) ◽  
pp. 63
Author(s):  
Rachel A. Kaiser ◽  
Lina Taing ◽  
Himesh Bhatia
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
One Health ◽  
Antibiotic Use ◽  
World Health ◽  
Low Income Countries ◽  
Environmental Drivers ◽  
Environmental Waters ◽  
Health Crisis ◽  
Environmental Objectives

Antimicrobial resistance (AMR) is a global health crisis that affects all life on Earth. In 2015, the World Health Organization developed guidance to combat AMR in accordance with a One Health framework considering human, animal, and environment sectors of planetary health. This study reviewed global guidance and 25 National Action Plans to evaluate thematic priorities in One Health AMR approaches using a novel framework that additionally facilitated the identification of water-related stewardship gaps, as water resources are recognized as the primary environmental AMR reservoir and dissemination pathway. This review found that global and national stewardship primarily focuses on mitigating antibiotic use in the human and animal sectors, overlooking environmental drivers, particularly diverse environmental waters. The findings of this study highlight the need to broaden the scope of water-related AMR concerns beyond water, sanitation, and hygiene (WASH) infrastructure for water supply and wastewater treatment, and account for environmental waters in AMR development and dissemination, particularly in low-income countries where half a billion people rely on environmental waters to meet daily needs. Equitably accounting for water environments, supplies, and waste in AMR prevention, mitigation, surveillance, and innovation can significantly enhance the integration of environmental objectives in One Health AMR stewardship.

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