REVIEW | doi:10.20944/preprints202010.0267.v2
Online: 21 June 2021 (11:25:51 CEST)
We systematically reviewed studies using wastewater for AMR surveillance in human populations, to determine: (i) the strength of the evidence for a wastewater-human AMR association, and (ii) methodological approaches which optimised identifying such an association, and which could be recommended as standard. We used Lin’s concordance correlation coefficient (CCC) to quantify agreement between AMR prevalence in wastewater and human compartments, and logistic regression to identify study features (e.g. sampling methods) associated with high-agreement (defined as wastewater-human AMR prevalences within ±10%). Of 8,867 records and 232 full-text methods reviewed, 29 studies were included. AMR prevalence data was extractable from 20 studies conducting phenotypic-only (n=11), genotypic-only (n=1) or combined (n=8) AMR detection. Overall wastewater-human AMR concordance was reasonably high for both phenotypic (CCC=0.81 [95% CI 0.74-0.87]) and genotypic comparisons (CCC=0.88 (95% CI 0.85-0.91)) despite diverse species-phenotypes/genotypes and study design. Logistic regression was limited by inconsistent reporting of study features, and limited sample size; no significant relationships between study features and high wastewater-human AMR agreement were identified. Based on descriptive synthesis, composite/flow-proportional sampling of wastewater influent, longitudinal sampling >12 months, and time/location-matched comparisons generally had higher-agreement. Further research and clear and consistent reporting of study methods is required to confirm optimal practice.
Subject: Medicine & Pharmacology, Other Keywords: Neisseria gonorrhoeae; AMR; Neisseria meningitidis; commensal Neisseria
Online: 16 January 2020 (11:12:44 CET)
In the absence of a vaccine, current antibiotic-dependent efforts to reduce the prevalence of Neisseria gonorrhoeae in high prevalence populations have been shown to result in extremely high levels of antibiotic consumption. No randomized controlled trials have been conducted to validate this strategy and an important concern of this approach is that it may induce antimicrobial resistance. To contribute to this debate, we assessed if mass treatment in the related species, Neisseria meningitidis, was associated with the emergence of antimicrobial resistance. To this end, we conducted a historical review of the effect of mass meningococcal treatment programmes on the prevalence of N. meningitidis and the emergence of antimicrobial resistance. We found evidence that mass treatment programmes were associated with the emergence of antimicrobial resistance.
ARTICLE | doi:10.20944/preprints202208.0237.v1
Subject: Life Sciences, Other Keywords: AMR; agriculture; One Health; health economics; policy; modelling
Online: 12 August 2022 (11:28:08 CEST)
Antimicrobial resistance (AMR) is an increasingly pressing threat to human, animal, and environmental health. Reducing the use of antibiotics in agriculture has been identified as a key way to curb the spread of AMR. However, the effect of such policies on AMR prevalence, and their broader impacts on agricultural, health, and economic outcomes at the population level have proven very difficult to estimate and compare. This paper draws on and formalises ideas presented at the JPIAMR New Perspectives on Bacterial Drug Resistance workshop in June of 2022. With reference to emerging literature on the topic, it proposes a quantitative framework for estimating the relevant causal relationships needed to quantify the cross-sectoral impacts of AMR policies in agriculture, and for comparing these outcomes in like terms in a way which can feed directly into policy decision-making, notably without prohibitive data requirements. The ability of researchers to apply frameworks such as this will be increasingly necessary in order to holistically capture the impacts of AMR policies and to situate them in the broader policy context; especially where the mechanisms of transmission are opaque or complex, where data availability is limited; and where policymakers must allocate scarce resources among many competing objectives.
ARTICLE | doi:10.20944/preprints202202.0309.v1
Subject: Medicine & Pharmacology, Other Keywords: Rivers; one-health; E. coli; fluoroquinolones; antimicrobial resistance; AMR
Online: 24 February 2022 (10:03:48 CET)
Extremely low concentrations of ciprofloxacin may select for antimicrobial resistance. A recent global survey found that ciprofloxacin concentrations exceded safe levels at 64 sites. We assessed if national median ciprofloxacin concentrations in rivers were associated with fluoroquinolone resistance in Escherichia coli. Methods Spearman’s regression was used to assess the country-level association between the national prevalence of fluoroquinolone resistance in E. coli and the median ciprofloxacin concentration in the countries rivers. Results The prevalence of fluoroquinolone resistance in E. coli was positively correlated with the concentration of ciprofloxacin in rivers (ρ=0.36; P=0.011; N=48). Conclusions Steps to reducing the concentrations of fluoroquinolones in rivers may help prevent the emergence of resistance in E. coli and other bacterial species.
ARTICLE | doi:10.20944/preprints202201.0234.v1
Subject: Life Sciences, Microbiology Keywords: AMR, Surveillance; One Health Approach; Alternative Antibiotics; Comparative Medicine; Phage Therapy
Online: 17 January 2022 (14:46:22 CET)
Antibiotics are in excessive use that has extensively increased antimicrobial resistance worldwide which has become the major public concern among the countries. To control this threat proper monitoring of the antimicrobial usage along with the increasing rate of antimicrobial resistance (AMR) is required. Further, surveillance of both the parameters is highly recommended for comparing the differences in distinct countries. Moreover, alternatives for antibiotics are also surveyed and are being researched for quick use in the near future. AMR is an issue that needs immense attention from various sectors. Thus, intervention of multisector is highly encouraged for better outcomes. One Health is one of the approaches that play a vital role in resolving this issue. In this research paper, six different European countries are discussed in terms of antimicrobial usage and AMR in the human and livestock sectors with the help of literature study and various reports published by different organizations. Data study has been conducted to collect the data for comparison study. Data sources of AMR and antimicrobial usage are analyzed and a thorough comparison of both antimicrobial use and AMR are conducted. Also, the application of One Health is studied for a balanced system. This article provides about various surveillance systems that are formed only to keep a track on the upcoming situation of AMR and the consumption of antimicrobials by the humans as well as animals. The article does not provide about all the details required to monitor the AMR issue but firmly allow the readers to get acknowledged with the broad information about the antimicrobial resistance across the six countries of Europe. The regular data collected by the different organizations play a vital role in monitoring the status of AMR and antimicrobial usage by humans and in live stocks. These annual reports have highly helped the government to decide for alternatives and have focused in many training activities to combat the AMR situation globally. AMR prevention is linked to the One Health concept. As antibiotic resistance genes persist on an interface between environment and animal and animal health, an approach is required in all three areas that stress the concept of 'One Approach to Health.'
ARTICLE | doi:10.20944/preprints202106.0061.v1
Subject: Medicine & Pharmacology, Allergology Keywords: antimicrobial resistance; AMR; Infections; antibiotics; inappropriate prescribing; healthcare pro-fessionals; education; training; antimicrobial stewardship programs; continuous professional development
Online: 2 June 2021 (09:58:36 CEST)
(1) Background: Factors reported in literature associated with inappropriate prescribing of antimicrobials, such as physicians with less experience, uncertain diagnosis, and patient caregiver influences on physicians' decisions. Monitoring antimicrobial resistance is critical for identifying emerging resistance patterns, developing, and assessing the effectiveness of mitigation strategies. Improvement in prescribing `antimicrobials would minimize the risk of resistance and, consequently, improve patients' clinical and health outcomes. The purpose of the study is to delineate factors associated with antimicrobial resistance, describe the factors influencing prescriber’s choice during prescribing of antimicrobial, and examine factors related to consequences of inappropriate prescribing of antimicrobial. (2) Methods: Cross-sectional study conducted among healthcare providers (190) in six tertiary hospitals in the Eastern province of Saudi Arabia. The research panel has developed validated and piloted survey specific with closed-ended questions. A value of P <0.05 was considered for statistical significance. All data analysis was performed using Statistical Package for Social Sciences (IBM SPSS version 23.0). (3) Results: 72.7% of the respondents have agreed that poor skills and knowledge are key factors that contribute to the inappropriate prescribing of antimicrobials. All the respondents acknowledged effectiveness and previous experience with the antimicrobial, and reading scientific materials (such as books, articles, and the internet) were key factors influencing physicians’ choice during antimicrobial prescribing. (4) Conclusion: The current study has identified comprehensive education and training needs for healthcare providers about antimicrobial resistance. Using antimicrobials unnecessarily, insufficient duration of antimicrobial use, and using broad spectrum antimicrobials, were reported to be common practices. Further, poor skills and knowledge were a key factor that contributed to the inappropriate use and overuse of antimicrobials and using antimicrobials without physician prescription (self-medication) were the key factors which contribute to AMR from participants’ perspectives. Furthermore, internal policy and guidelines are needed to ensure that the antimicrobials are prescribed in accordance with standard protocols and clinical guidelines.
ARTICLE | doi:10.20944/preprints202009.0008.v1
Subject: Medicine & Pharmacology, General Medical Research Keywords: Antimicrobial Resistance (AMR); Antimicrobial Stewardship (AMS); delayed/back-up prescribing; upper respiratory tract infections; developing countries; LMICs; Ghana
Online: 1 September 2020 (11:29:47 CEST)
This service improvement project was carried out at LEKMA Hospital, Ghana. Ghana has high levels of antimicrobial resistance (AMR). There is an urgent need to introduce models of care that optimize antibiotic prescribing. Methods Delayed / back-up prescribing is a strategy that could reduce antibiotic use in suspected upper respiratory tract infections. Four different models of delayed / back-up prescribing [no prescription; post-dated prescription (given to patient); post-dated prescription (forwarded to pharmacy); and follow-up appointment for reassessment after 3 days] were implemented in discussion between clinician and patient. Patients were contacted 10 days after their appointment to record compliance, check on their wellbeing, and rate their experience. Results Over a 3-month period (12/2019-02/2020), 142 patients were eligible for delayed / back-up prescribing. The most common clinical diagnoses were sore throat (102/140, 73%), common cold (22/140, 16%) and sinusitis (10/140, 7%). In total, 12 (9%) patients remained symptomatic at day 10, and only one individual in the entire cohort took antibiotics. Most patients (95%) rated their experience as good or very good. Conclusions Delayed / back-up prescribing models can lead to substantial reduction in antibiotic consumption amongst outpatient department patients with suspected upper respiratory tract infections. Delayed / back-up prescribing can be implemented safely in low and middle-income countries.
ARTICLE | doi:10.20944/preprints201811.0534.v1
Subject: Engineering, Marine Engineering Keywords: tsunami; CFD; Saint Venant (SV) model; Adaptive Mesh Refinement (AMR); large scale propagation; 3D Navier-Stokes (NS) model; coastal impact
Online: 22 November 2018 (04:43:54 CET)
Into the frame of the French TANDEM project (Tsunamis in the Atlantic and the English ChaNnel: Definition of the Effects through numerical Modelling) Principia has been working on the development and qualification of two in-house CFD software’s: the 2D EOLE-SV (Saint Venant) model for simulation of large scale tsunami propagation from the source up to coastal scale and the 3D EOLE-NS (Navier-Stokes) model dedicated to tsunami coastal impact modelling. This paper presents a large range of test cases carried out into the frame of the project and dedicated to the validation of numerical codes in various tsunami wave conditions. The main aspects of phenomena such as wave generation, propagation and coastal impact are investigated on academic situations. A real case simulation is concerned as well, the devastating 2011 Tohoku event which is compared with in-situ data.