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The second ECDC/EFSA/EMA joint report on the integrated analysis of antimicrobial consumption (AMC) and antimicrobial resistance (AMR) in bacteria from humans and food-producing animals addressed data obtained by the Agencies’ EU-wide surveillance
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networks for 2013–2015. AMC in both sectors, expressed in mg/kg of estimated biomass, were compared at country and European level. Substantial variations between countries were observed in both sectors. Estimated data on AMC for pigs and poultry were used for the first time. Univariate and multivariate analyses were applied to study associations between AMC and AMR. In 2014, the average AMC was higher in animals (152 mg/kg) than in humans (124 mg/kg), but the opposite applied to the median AMC (67 and 118 mg/kg, respectively). In 18 of 28 countries, AMC was lower in animals than in humans. Univariate analysis showed statistically-significant (p < 0.05) associations between AMC and AMR for fluoroquinolones and Escherichia coli in both sectors, for 3rd- and 4th-generation cephalosporins and E. coli in humans, and tetracyclines and polymyxins and E. coli in animals. In humans, there was a statistically-significant association between AMC and AMR for carbapenems and polymyxins in Klebsiella pneumoniae. Consumption of macrolides in animals was significantly associated with macrolide resistance in Campylobacter coli in animals and humans. Multivariate analyses provided a unique approach to assess the contributions of AMC in humans and animals and AMR in bacteria from animals to AMR in bacteria from humans. Multivariate analyses demonstrated that 3rd- and 4th-generation cephalosporin and fluoroquinolone resistance in E. coli from humans was associated with corresponding AMC in humans, whereas resistance to fluoroquinolones in Salmonella spp. and Campylobacter spp. from humans was related to consumption of fluoroquinolones in animals. These results suggest that from a ‘One-health’ perspective, there is potential in both sectors to further develop prudent use of antimicrobials and thereby reduce AMR.
more
User GuideThe toolkit is composed of three sections: Hospital and Health System Resources - includes a readiness assessment tool, the starting point in developing or enhancing a successful Antimicrobial Stewardship Program (ASP). The tool, a checklist developed by the CDC, should be shared with se
...
nior management, a senior leader for quality, purchasing directors, clinic managers, nurse managers, key physician leaders, risk managers, pharmacy leaders, infection preventionists and hospital epidemiologists, laboratory staff and information technology staff. For ease of use, it is divided into two sections, one for those just beginning a program, the other for those who wish to enhance an existing program. Clinician Resources - includes webinars, clinical evidence supporting appropriate use of antibiotics, implementation guides and related articles.Patient Resources - includes frequently asked questions, pamphlets and handouts on how patients can best engage in their care and resources on appropriate use of antibiotics.
more
This document updates the 2014 Core Elements for Hospital Antibiotic Stewardship Programs and incorporates new evidence and lessons learned from experience with the Core Elements. The Core Elements are applicable in all hospitals, regardless of size. There are suggestions specific to small and criti
...
cal access hospitals in Implementation of Antibiotic Stewardship Core Elements at Small and Critical Access Hospitals (12).There is no single template for a program to optimize antibiotic prescribing in hospitals. Implementation of antibiotic stewardship programs requires flexibility due to the complexity of medical decision-making surrounding antibiotic use and the variability in the size and types of care among U.S. hospitals. In some sections, CDC has identified priorities for implementation, based on the experiences of successful stewardship programs and published data. The Core Elements are intended to be an adaptable framework that hospitals can use to guide efforts to improve antibiotic prescribing. The assessment tool that accompanies this document can help hospitals identify gaps to address.
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Intensive Care Med (2009) 35:9–29DOI 10.1007/s00134-008-1336-9
Although thousands of papers have been devoted tohospital-acquired pneumonia (HAP), many controversiesremain, and management of HAP is probably often sub-optimal. Several r
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eviews or guidelines have been pub-lished recently, mostly by North American initiatives(CDC, ATS). Three European Societies (ERS, ESCMID andESICM) were interested in producing a document thatcould complement in some way the last IDSA/ATS guidelines published 3 years ago. In addition, the Helics
working group supported this initiative.
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The Core Elements of Outpatient Antibiotic Stewardship provides a framework for antibiotic stewardship for outpatient clinicians and facilities that routinely provide antibiotic treatment. This report augments existing guidance for other clinical settings. In 2014 and 2015, respectively, CDC release
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d the Core Elements of Hospital Antibiotic Stewardship Programs and the Core Elements of Antibiotic Stewardship for Nursing Homes. Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing involves implementing effective strategies to modify prescribing practices to align them with evidence-based recommendations for diagnosis and management.
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Internationally, there is a growing concern over antimicro-bial resistance (AMR) which is currently estimated to ac-count for more than 700,000 deaths per year worldwide. If no appropriate measures are taken to halt its pro-gress, AMR will cost approximately 10 million lives andabout US$100 trillion
...
per year by 2050. In contrast tosome other health issues, AMR is a problem that con-cerns every country irrespective of its level of incomeand development as resistant pathogens do not respect borders.Despite the threat presented by AMR, the 2014 WorldHealth Organization (WHO) and the recent O’Neill re-port describe significant gaps in surveillance, standardmethodologies and data sharing. The 2014 WHOreport identified Africa and South East Asia as the regions without established AMR surveillance systems.
Tadesseet al. BMC Infectious Diseases (2017) 17:616 DOI 10.1186/s12879-017-2713-1
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The ECDC, the EFSA and the EMA have for the first time jointly explored associations between consumption of antimicrobials in humans and food-producing animals, and antimicrobial resistance in bacteria from humans and food-producing animals, using 2011 and 2012
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data currently available from their relevant five EU monitoring networks. Combined data on antimicrobial consumption and corresponding resistance in animals and humans for EU MSs and reporting countries were analysed using logistic regression models for selected combinations of bacteria and antimicrobials. A summary indicator of the proportion of resistant bacteria in the main food-producing animal species was calculated for the analysis, as consumption data in food-producing animals were not available at the species level
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The Global Antibiotic Resistance Partnership (GARP)-Mozambique team, in partnership with the Center for Disease Dynamics, Economics & Policy (CDDEP), has produced this report as part of a solid com-mitment to develop actionable policy proposals to tackle antibiotic resistance and improve appropriate
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antibiotic access. It is the result of a thorough review of published and unpublished data on antibiotic resistance and a long internal consultation effort that engaged academic scientists, health professionals and other stakeholders within Mozambique.
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The role of environmental contamination in transmission of COVID-19 virus is currently not clear. This protocol has been designed to determine (viable) virus presence and persistence on fomites in various locations where a patient infected with COVID-19 is currently receiving care or being isolated,
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and to understand how this may relate to COVID-19 transmission events in these settings. It is therefore important that it is done as part of a comprehensive outbreak investigation and that information obtained by environmental studies is combined with the results of epidemiological, laboratory and sequence data from COVID-19 patient investigations.
more
This document provides guidance on the implementation of the shielding approach in camps and camp-like settings for refugees and internally displaced persons. It is intended for the displaced community itself, humanitarian actors and camp coordination /
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management authorities.
more
COVID-19 disproportionately affects the poor and vulnerable. Community health workers are poised to play a pivotal role in fighting the pandemic, especially in countries with less resilient health systems. Drawing from practitioner expertise across four WHO regions, this article outlines the targete
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d actions needed at different stages of the pandemic to achieve the following goals: (1) PROTECT healthcare workers, (2) INTERRUPT the virus, (3) MAINTAIN existing healthcare services while surging their capacity, and (4) SHIELD the most vulnerable from socioeconomic shocks. While decisive action must be taken now to blunt the impact of the pandemic in countries likely to be hit the hardest, many of the investments in the supply chain, compensation, dedicated supervision, continuous training and performance management necessary for rapid community response in a pandemic are the same as those required to achieve universal healthcare and prevent the next epidemic.
BMJ Global Health2020;5:e002550. doi:10.1136/bmjgh-2020-002550
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Infection prevention and control (IPC) practices are of critical importance in protecting the function of healthcare services at all levels and mitigating the impact on vulnerable populations. Although the management of possible COVID-19 cases is us
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ually guided by national policies for specific healthcare facilities, community transmission is currently widespread in most EU/EEA countries and the UK, therefore primary healthcare providers in the community such as GPs, dentists and pharmacists are at risk of being exposed to COVID-19.
more
The speed of developing diagnostics for SARS-CoV-2, the causative agent of coronavirus disease 2019 (COVID-19), has been quite remarkable. Diagnostics have focused on nucleic acid amplification testing (NAAT) to identify infected individuals in acute-phase disease for timely implementation of mitiga
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tion strategies and case management. More and more immunodiagnostics, mostly rapid diagnostic tests, are being made available as an alternative to NAATs. This type of test can be used out-of-laboratory conditions at large scale.
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Guidelines for Diagnosing and Managing Disseminated Histoplasmosis among People Living with HIV
recommended
Histoplasmosis is a disease caused by the fungus Histoplasma capsulatum. This disease is highly endemic in some regions of North America, Central America, and South America and is also reported in certain countries of Asia and Africa. It often affects people with impaired immunity, including people
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living with HIV, among whom the most frequent clinical presentation is disseminated histoplasmosis. The symptoms of disseminated histoplasmosis are non-specific and may be indistinguishable from those of other infectious diseases, especially disseminated tuberculosis (TB), thus complicating diagnosis and treatment. Histoplasmosis is one of the most frequent opportunistic infections caused by fungal pathogens among people living with HIV in the Americas and may be responsible for 5–15% of AIDS-related deaths every year in this Region. These guidelines aim to provide recommendations for the diagnosis, treatment, and management of disseminated histoplasmosis in persons living with HIV
more
Recognizing the extent to which the COVID-19 outbreaks affects women and men differently is hugely important. Some preliminary data suggested that more men than women are dying, potentially due to sex-based immunological differences, higher rates of
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cardiovascular disease for men and lifestyle choices, such as smoking. However, the experiences and lessons learned from the Zika and Ebola outbreaks and the HIV pandemic demonstrate that robust gender analysis and informed, gender-integrated response are vital to strengthen the access and acceptability of the humanitarian services needed to meet the distinct needs of women and girls, as well as men and boy and LGBTI people.
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BUKO Pharma-Kampagne has investigated the causes and consequences of antibiotic resistance in India, South Africa, Tanzania and Germany. Together with our partners we collected data and did interviews with numerous stakeholders. The outcome is prese
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nted in a brochure that is now available in English
Resistant bacteria are spreading worldwide. In collaboration with partners in India, Tanzania, South Africa and Germany, we have investigated the causes and consequences of this spread.2 This Pharma-Brief Special presents the results. It examines the risks for humans, animals and the environment. It focuses on local problems and approaches, international interactions and the re-sponsibility of doctors, farmers and consumers.
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The semi-structured guided interviewing on ICU nurses in a medical center of southern Taiwan wasapproved by the IRB at the research department of the hospital and data collection was carried out from January toJune 2012. The investigator repeatedly
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read the transcribed text, and found statements relevant to the themes in thetranscriptions to form significant statements as the basis of data analysis. To ensure the rigor of this study, theinvestigator adopted the approach of trustworthiness of qualitative research proposed by Lincoln and Gu.
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Practical actions in cities to strengthen preparedness for the COVID-19 pandemic and beyond
recommended
This document accompanies the interim guidance on “Strengthening Preparedness for COVID-19 in cities and urban settings”. It provides local authorities, leaders and policy-makers in cities with a checklist tool to ensure that key areas have been covered. An excel version that local authorities m
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ay wish to adapt to meet their needs is also available. It allows filtering by steps of action; suggested domains and responsible teams within local governments for each action; and phase(s) of the emergency management cycle.
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Technical Note
Recently, the approach to hazardous events has undergone a considerable shift, away from reactive activities focused on managing and responding to events and towards a more proactive process of emergency and disaster risk management
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(DRM). The ultimate goal of this shift in focus is to prevent new and reduce existing disaster risks, a process known as disaster risk reduction (DRR), while strengthening individual, community, societal and global resilience.
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Birth defects surveillance: quick reference handbook of selected congenital anomalies and infections
This Quick Reference Handbook of Selected Congenital Anomalies and Infections is a companion tool to Birth defects surveillance: a manual for programme managers, and is intended for use by front-line health care professionals who are diagnosing and collecting
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data on congenital defects and infections. When used in conjunction with the manual, the tools in this handbook will help the reader to: identify an initial list of congenital anomalies to consider for monitoring;describe the tools needed to define and code identified cases; define specific congenital anomalies under surveillance.
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