November 20, 2023
World AMR Awareness Week – 2023
For World AMR Awareness Week (WAAW), we bring together OHT research, podcasts, webinars, and more, covering the growing threat of AMR and breaking down the complexities of this global phenomenon.
The Value of Vaccines to Mitigate Antimicrobial Resistance — Evidence from Low- and Middle-Income Countries
A recent report by One Health Trust researchers highlights the importance of boosting vaccination coverage to slow the pace of antimicrobial resistance. The analysis focuses on the impact of increasing vaccination coverage on the AMR-related health and economic burden in thirteen low- and middle-income countries. It emphasizes the need for policymakers to use this evidence base to expand coverage of vaccinations in routine immunization schedules and introduce new vaccines with a demonstrable contribution to reducing AMR and antibiotic use, such as those targeting rotavirus and typhoid infections. [One Health Trust]
Mapping Antimicrobial Resistance and Use in Africa – Country Reports
OHT and MAAP partners executed an extensive, multi-year, multi-national investigation that reveals alarming details about the sparsely reported extent of the antimicrobial resistance (AMR) crisis throughout Africa. The project included analysis of 819,584 AMR records spanning from 2016-2019, obtained from 205 laboratories across Burkina Faso, Cameroon, Eswatini, Gabon, Ghana, Kenya, Malawi, Nigeria, Senegal, Sierra Leone, Tanzania, Uganda, Zambia, and Zimbabwe. The MAAP country reports are vital resources for stakeholders working to reduce the AMR burden across Africa. [African Society for Laboratory Medicine]
Mali national action plan on antimicrobial resistance: review of progress in the human health sector
This policy brief from OHT and the World Health Organization (WHO) examines the implementation of the national action plan on AMR in Mali and reports findings that can promote further advancements in the fight against AMR in human health. [WHO]
Sewage surveillance of antibiotic resistance holds both opportunities and challenges.
In a commentary, OHT’s Dr. Ramanan Laxminarayan and collaborators discuss the European Union’s proposal to amplify sewage surveillance efforts to monitor AMR in highly populated areas. The authors praise the new emphasis on sewage surveillance, a disease prevention method used for decades against polio, but caution that the data should be collected intentionally to fill knowledge gaps. Furthermore, they suggest using a combination of phenotypic and gene-based approaches, given the pros and cons of each strategy. [Nature Reviews Microbiology]
Reduction in overall antibiotic prescribing in the US in 2020
OHT researchers conducted an observational, ecological study to evaluate the impact of the COVID-19 pandemic on antibiotic prescribing in the United States between February and December 2020. The total number of antibiotic prescriptions dropped by 26 percent compared to the same period in the previous 3 years, with the most significant decline being prescriptions in children. While COVID-19 prevention measures such as facemasks and school closures were associated with lower prescribing among children, there was a positive correlation between COVID-19 cases and antibiotic prescribing in adults, implicating behavioral norms as drivers of prescribing practices. [Open Forum Infectious Diseases]
Antibiotic prescriptions for adults in the US increased with COVID-19 cases.
OHT researchers collaborated to assess the impact of the COVID-19 pandemic and related infection prevention measures on trends in antibiotic prescribing in the United States. For every 1 percent increase in county-level monthly COVID-19 cases, there was an associated 0.009 percent increase in prescriptions dispensed per 100,000 people. The primary predictor of county-level prescribing trends was prescribing rates in previous years, emphasizing the critical role of behavioral norms in inappropriate antibiotic prescribing. [Open Forum Infectious Diseases]
As COVID-19 cases increased globally, so did antibiotic sales.
OHT and collaborators analyzed sales data on 4 oral broad-spectrum antibiotics in 71 countries during the COVID-19 pandemic. While sales fell sharply in March 2020, they recovered to near pre-pandemic levels by May 2022. Across continents, a 10 percent increase in monthly COVID-19 cases was associated with 0.3 percent higher antibiotic sales per 1,000 people. Antibiotic stewardship is essential to prevent COVID-19 from becoming another influenza-like illness for which antibiotics are routinely and inappropriately prescribed. [eClinicalMedicine]
The history of colistin resistance through a One Health lens
Resistance to colistin, an antibiotic often viewed as a last-resort therapy against multi-drug-resistant Gram-negative bacteria (GNB), has emerged in Enterobacteriaceae species. OHT and collaborators analyzed the impact of regulatory policies on colistin use on the prevalence of resistant E. coli using a One Health approach. Since the discovery of mcr-1, a plasmid-mediated colistin resistance gene, regulations and policies have been created to maintain some of colistin’s efficacy. These measures have resulted in a steep decline in colistin production and the prevalence of colistin-resistant E. coli between 2016 and 2019. [International Journal of Antimicrobial Agents]
Redefining the role of the environment in antimicrobial resistance
OHT’s Dr. Ramanan Laxminarayan co-authored a correspondence piece that discusses the importance of understanding how AMR relates to environmental health. While many organizations, including the United Nations, have adopted a One Health lens when considering the harmful impact of AMR, the authors caution against conflating human and environmental health. While the environment is involved in the evolution and transmission of resistant pathogens, there is limited evidence of any deleterious effect the environment might have on it. [Nature Microbiology]
Antimicrobial consumption and socioeconomic factors drive AMR.
OHT researchers and colleagues used publicly available resistance data–including data published on ResistanceMap–to explore the relationships between socioeconomic, anthropogenic, and environmental factors and country-level AMR rates in humans and food-producing animals. They found significant positive associations between animal antimicrobial consumption and AMR in food-producing animals and between human antimicrobial consumption and AMR in WHO critical and high-priority pathogens. In concordance with previous reports, lower socioeconomic status was linked to higher rates of AMR in humans, likely due to increased transmission of resistant pathogens from poor sanitation and limited access to healthcare. [The Lancet Planetary Health]
K. Pneumoniae vaccination could reduce neonatal deaths and sepsis infection by 15 percent.
OHT’s Dr. Ramanan Laxminarayan and co-authors estimated the impact of a maternal vaccine against Klebsiella pneumoniae, the leading cause of neonatal sepsis infections and death. A K. pneumoniae maternal vaccine with 70 percent efficacy could significantly enhance child well-being, reduce neonatal deaths and sepsis infections in low- and middle-income countries by 15 percent, and lower the number of antibiotic-resistant K. pneumoniae infections. Future work, including cost-effectiveness analyses, will help further bolster the case for developing a maternal vaccine against K. pneumoniae. [PLOS Medicine]
Study finds early discontinuation of antibiotics not associated with higher mortality in patients with severe infections.
A study co-authored by OHT’s Ramanan Laxminarayan and Eili Klein shows that discontinuing antibiotics early (three to four days after initiation) was not associated with higher mortality in a large cohort of US patients hospitalized with suspected culture-negative serious infection (CNSI). Early discontinuation was also not linked to greater odds of hospital discharge to hospice care than patients receiving a full five-day course. Together with other studies on post-discharge health outcomes following early antibiotic discontinuation, these findings can help promote antibiotic stewardship and best practices among medical professionals. [Open Forum Infectious Diseases]
Middle-income countries face the greatest burden of hospital-associated resistant infections.
OHT’s Ramanan Laxminarayan, Thomas Van Boeckel, and Ruchita Balasubramanian co-authored a study that used point prevalence surveys from 99 countries to determine trends in the global prevalence of hospital-associated drug-resistant infections (HARIs). The annual incidence of HARIs between 2010 and 2020 was estimated at 136 million globally. Middle-income countries have the largest burden of HARIs, consistent with previous literature demonstrating that South and Southeast Asia countries experience the majority of the disease burden associated with bacterial AMR. A lack of antimicrobial stewardship and accountability on the part of medical personnel, resulting in the overuse and misuse of antimicrobial drugs, combined with the often unrestricted access to antibiotics in middle-income countries, could explain this trend. [PLOS Medicine]
PLOS Medicine’s Special Issue on Antimicrobial Resistance
OHT President Ramanan Laxminarayan co-authored an editorial discussing PLOS Medicine’s Special Issue on AMR, drawing studies investigating antibiotic overuse, drug-resistant infections, and interventions to reduce the spread of AMR. The authors point to the high proportion of studies focusing on infections in neonates and children, especially in low- and middle-income countries (LMICs). Another group vulnerable to AMR includes residents in high-income countries, where prolonged antibiotic overuse and misuse are prevalent and have triggered the development of “superbugs,” such as methicillin-resistant Staphylococcus aureus (MRSA). In September 2024, experts will discuss and devise a new framework to tackle the global threat AMR poses at the United Nations High-Level Meeting. Engagement across human, animal, and environmental sectors is needed to ensure that countries and organizations receive sufficient funding and resources to combat the issue. [PLOS Medicine]
Prioritizing sustainability and equity in the fight against AMR using a just transition framework.
The Just Transitions for AMR Working Group, including OHT’s Deepshikha Batheja, co-authored a commentary piece published in The Lancet that lays out the benefits of applying a just transition framework in preparation for a future with antimicrobial resistance (AMR). While AMR has been largely recognized as an immediate threat to human health, the objective of reducing AMR must not ignore inequities in burden caused by structural disparities, such as systemic racism, sexism, and poverty. These considerations warrant further involvement from both private and public sectors, as well as collaborations across sectors. In light of the second high-level meeting of the UN General Assembly in 2024, the group acknowledges that large efforts to mitigate AMR inherently necessitate trade-offs in other health and development areas. A just transitions approach can facilitate the creation of parameters for these trade-offs and ensure that equity, justice, and sustainability are kept at the forefront of the global agenda against AMR. [The Lancet]
Response to antimicrobial resistance in South-East Asia Region
OHT’s Dr. Ramanan Laxminarayan co-authored an article that outlines progress made by the 11 Member States of the World Health Organization South-East Asia (SEA) Region in mitigating the burden of antimicrobial resistance (AMR). Although all SEA Region Member States, with support from the WHO, have developed and endorsed national action plans (NAPs) on AMR, progress has been fragmented and complicated by a lack of technical capacity, limited resources, and the COVID-19 pandemic. Available data from the region show persistent levels of bloodstream infections due to resistant Escherichia coli and Staphylococcus aureus between 2017 and 2020 and an increasing level of hospital-associated bloodstream infections. Prioritization of One Health-centered policies will help countries address AMR from a holistic standpoint and accelerate the implementation of their NAPs against AMR. [The Lancet Regional Health – Southeast Asia]
Modeling study reveals that a consistently effective vaccine would reduce the most Malaria-related deaths in African countries.
In a new modeling study published in Nature Communications, OHT researchers and collaborators estimated the impact of a malaria vaccine in 42 African countries over a 10-year period in several scenarios with varying vaccine efficacy (VE) and levels of antimalarial drug resistance. The burden averted in Scenario 2, in which VE was higher right after vaccination at 80 percent and dropped by 20 percent each year, was greater than in Scenario 1, whereby the VE was constant at 40 percent for 4 years and dropped to 0 percent in year 5. However, Scenario 3, in which VE remained constant at 40 percent for the length of the study, averted the most malaria cases (384.7 [UI 311.7-496.47]) per 1,000, drug-resistant cases (1.0 [UI 0.7-1.6]) per 1,000, and deaths (1.1 [UI 0.5-1.5]) per 1,000 out of all tested scenarios. Development and distribution of an effective malaria vaccine must be fast-tracked in order to ameliorate the burden of ACT resistance on malaria-endemic regions around the world. [Communications Medicine]
Ten “golden rules” for appropriate antibiotic use in clinical practice.
OHT’s Geetanjali Kapoor was part of an international, multidisciplinary task force, established by the Global Alliance for Infections in Surgery, that published a position statement called WARNING, or the Worldwide Antimicrobial Resistance National/International Network Group, which outlines ten recommendations or “golden rules” to optimize inpatient antibiotic prescribing, increase awareness of antimicrobial stewardship, and promote best practices to reduce antimicrobial resistance (AMR) in healthcare settings. Healthcare professionals play a crucial role in mitigating the burden of AMR worldwide. By following the guidelines, they can reduce the frequency of inappropriate antibiotic prescribing, improve healthcare workers’ hygiene and handwashing practices, and promote antimicrobial stewardship. [World Journal of Emergency Surgery]
Looking for bite-sized information on AMR? Listen to our One World, One Health Podcast for expert insights on AMR Related Topics:
Stigma and Antibiotics – STIs in a Sex Workers’ Hub – Listen here.
Stranger Danger – How fear of migrants can worsen disease spread – Listen here.
Wealth, Status, Meat, and Superbugs – Listen here.
Racing Against Resistance – How will we win the fight against superbugs? – Listen here.
Will superbugs win the arms race against humanity? – Listen here.
Bread, Cheese, and Deadly Infections – Unfriendly and Untreatable Fungi – Listen here.
Taking Care of Our Most Precious Drugs – Listen here.
New Challenges from an Ancient Disease – Drug-Resistant Tuberculosis – Listen here.
Treating Antibiotics as Infrastructure – Listen here.
Gender Inequality and Superbugs – Listen here.
Watch our Conversation Series on One Health webinars discussing AMR surveillance, the connection to fungal infections, and the future of antibiotics.
Fungal Infections: A Neglected, Growing Threat – Watch here.
Antimicrobial Resistance in Africa – Findings from the Mapping AMR & AMU Partnership (MAAP) Project – Watch here.
Antimicrobials – Looking Into the Future – Watch here.
Looking for infographics that break down the complexity of AMR? Visit our collection here.