September 04, 2023
Access to medical oxygen in Indian hospitals – Lessons from the COVID-19 pandemic
One Health Trust’s Dr. Deepshikha Batheja co-authored a study that evaluated the benefits of increased availability and use of oxygen concentrators (OCs) and cylinders during the COVID-19 pandemic in India. Over half of the 450 surveyed healthcare facilities – including government-run primary healthcare facilities (42 percent), government hospitals (35 percent), private hospitals (7 percent), and COVID care centers (5 percent) – reported that the distribution of OCs helped them meet their patients’ oxygen demand and increase their capacity to address oxygen needs in the long-term. Overall, the authors found that investing in skilled staff and timely provision of oxygenation devices can help maximize their utility and allow healthcare facilities to address COVID-related oxygen demands. [PLOS Global Public Health]
Genetic mutations can help bacteria develop cross-resistance to antivirals.
Researchers evaluated the ability of different classes of antiviral drugs to induce antibiotic cross-resistance in bacteria. Using a culture-based approach, they demonstrated that 8 of 14 tested antiviral drugs with antibacterial properties inhibited the growth of both Gram-negative Escherichia coli and Gram-positive Bacillus cereus, and three displayed antibacterial characteristics against B. cereus. Repeated exposure to antiviral drugs led to the identification of a diverse set of resistance phenotypes among the bacterial strains. Pathways related to the development of cross-resistance such as gene regulation and nucleoside metabolism could form the basis of future research to determine how bacteria become resistant to non-antibiotic antimicrobial drugs. [Nature Communications Biology]
Higher risk of TB infection in low-income households in Brazil
An analysis of data collected from the 100 Million Brazilian Cohort (100MCohort) from 2004 to 2018 suggests a higher incidence of tuberculosis (TB) in household contacts of low-income TB patients (427.8 per 100,000 person-years at risk) compared to the overall incidence (26.2 per 100,000 person-years at risk) captured in the entire cohort. TB incidence was greater among individuals who self-identified as indigenous (691.3 per 100,000 person-years at risk), were aged 15-19 years (686.0), and had an index patient with TB aged 15-19 years (715.6). The risk of active TB infection increased among contacts of Black, Pardo (mixed race with Black), or indigenous race/ethnicity who lived in poor housing conditions, highlighting a need for reinforced infection contact tracing among vulnerable populations in Brazil. [The Lancet Infectious Diseases]
Genetic mutations associated with antimalarial resistance in India
Researchers assessed the genetic profile of molecular drug resistance in malaria parasites Plasmodium falciparum and P. vivax in India between 1993 and 2019. The majority of chloroquine-resistant isolates were double mutants in the pfcrt gene, while triple mutants were predominantly only observed in the state of Maharashtra. Mutations in the genes pfdhfr and pfdhps that confer resistance to sulfadoxine/pyrimethamine, also known as SP or artesunate, were identified in 1994, one year before SP was adopted as a malaria treatment in India. High rates of pfdhfr-pfdhps quadruple mutants were observed in this study (34.7 percent), possibly due to imported malaria and SP drug pressure. [Malaria Journal]
Decolonizing global health research requires a diverse set of methodologies.
In a Viewpoint article, authors call for the decolonization of global health research by including literature that values the perspectives of local experts in low- and middle-income countries. Emphasizing the importance of diverse global health methodologies inclusive of local communities and contexts, they expose systemic power imbalances in global health scholarship. Intentional efforts must be made to publish more qualitative research articles, call for relativist research, and encourage critiques of existing ideas in the field of global health. [The Lancet Global Health]
Existing literature on animal sources of AMR in humans comes predominantly from the Global North.
A systematic review investigating the direct contribution of animals and animal products to antimicrobial resistance (AMR) in humans reveals that published studies predominantly come from Europe and North America. The presence of AMR and foodborne illness surveillance systems in the United States, such as the National Antimicrobial Resistance Monitoring System (NARMS), likely facilitated several studies tracking resistant infection outbreaks in these regions. The review did not include any studies from South America, Africa, or Oceania, indicating data scarcity or a lack of interest in the animal sources of human AMR. [Epidemiology & Infection]
Mass vaccination against typhoid did not reduce antimicrobial prescribing in Zimbabwe.
Following a one-week-long mass typhoid conjugate vaccine (TCV) campaign among individuals aged 6 months to 15 years old in Harare, Zimbabwe, researchers estimated its impact on antimicrobial prescribing rates among children between April 2021 and July 2022. Despite the perceived reduction in typhoid cases following the campaign and a decreasing trend in the prescription of antibiotics commonly used to treat typhoid, mass TCV vaccination did not affect the total rate of antimicrobials or the rate of typhoid antimicrobials prescribed. Qualitative analysis revealed that the unchanged rates of antimicrobial prescribing were likely due to the lack of additional intervention. Healthcare workers still found it challenging to rule out typhoid fever due to limited testing and diagnostic tools, leading them to prescribe antimicrobials empirically. Therefore, TCV is unlikely to reduce antimicrobial prescribing in low-resource settings without other interventions, such as increased diagnostics and improved water, sanitation, and hygiene services. [The Lancet Global Health]
Antibiotic-dependent bacteria often go undetected in standard testing protocols.
Bacterial dependence on antibiotics is a phenomenon by which antibiotics, rather than eliminating bacteria, boost their growth. In many cases, the development of dependence follows a large course of antibiotics and can be described as the “ultimate step” in the resistance development pipeline. The first case of bacterial dependence was recorded in 1947 when streptomycin-resistant Brucella isolates displayed enhanced growth by treatment with streptomycin. Since then, research aiming to characterize bacterial dependence has focused on antibiotics such as vancomycin, linezolid, and colistin – the last line of therapeutic defense. A recent review suggested a significant role for bacterial dependence in developing resistance and highlighted knowledge gaps in the relationships between dependence and other relatively unexplored bacterial responses to antibiotics. [Journal of Biomedical Science]
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