Antimicrobial Resistance: Collaborative Measures of Control

Description

Antimicrobial resistance has existed in nature long before the discovery of antibiotics. The mechanisms of resistance are prevalent among the bacterial population. Over a period of time and facilitated by indiscriminate usage of antibiotics, these mechanisms are transferred from one type of bacteria to another, including the pathogenic ones. In addition, the rate of discovery of novel antimicrobials is much slower than the rate of evolution of antimicrobial resistance. Therefore, there is a need for alternative strategies to control antimicrobial resistance to save lives. In this book, the novel strategies to combat antimicrobial resistance are described, emphasizing collaborative measures of control. We describe the concerted efforts undertaken by global communities to combat antimicrobial resistance in detail. The most efficient strategy could be a behavioral change towards indiscriminate consumption, usage, and prescription of antibiotics. Cover Title Copyright Preface Acknowledgment Disclaimer Contributors Table of Contents List of Figures List of Tables 1 Microbial Threats - The AMR Pandemic 1.1 Introduction 1.2 Microbial threats 1.3 Key drivers of emerging microbial threats 1.3.1 Genetic and environmental factors 1.3.2 Poverty and population density 1.3.3 Inadequacy in infection prevention and control strategies 1.3.4 Lack of technological advances 1.4 Consequences of delayed regulation of microbial threats 1.5 Pandemic and its association with AMR 1.5.1 AIDS and AMR (1981-present) 1.5.2 COVID-19 and AMR (2019- present) 1.6 The need to reduce AMR to prevent an upcoming pandemic 1.7 Further perspectives Bibliography 2 Diversity in the Development and Transmission of AMR 2.1 Introduction 2.2 Antimicrobial resistance 2.2.1 Origin of resistance 2.2.1.1 Natural resistance 2.2.1.2 Acquired resistance 2.2.1.3 Adaptive resistance 2.3 Drivers of AMR - Emergence and Spread 2.3.1 The driver of resistance: Antibiotic and antibiotic resistance genes 2.3.1.1 Antibiotic consumption in human 2.3.1.2 Antibiotic consumption in animals 2.3.1.3 Antibiotic pathway in environment 2.3.2 Drivers of resistance: Biocides 2.3.3 The driver of resistance: Heavy metal 2.4 Molecular mechanisms of AMR 2.4.1 Reduced drug uptake 2.4.2 Drug target modification 2.4.3 Inactivation/ degradation of drugs 2.4.4 Efflux pump activation 2.5 Diversity in mode of dissemination 2.5.1 Transformation 2.5.2 Transduction 2.5.3 Conjugation 2.6 Conclusion and Future Perspectives Bibliography 3 Alternatives to Combat AMR: Hunt for Novel Antimicrobials 3.1 Introduction 3.2 Antimicrobial Resistance 3.2.1 National Antimicrobial Resistance Policy, India 3.3 Current status of antibiotics 3.4 The need for alternative antibiotics 3.5 Bacteriophages 3.5.1 Advantages and Limitations 3.6 Quorum Sensing Inhibitors 3.6.1 Natural compounds as Quorum Quenchers 3.6.2 Synthetic compounds as Quorum Quenchers 3.6.3 Clinical trial employing QSIs as therapeutics 3.6.4 Advantages and Disadvantages 3.7 Future Perspectives Bibliography 4 Antimicrobials in Growth and Development 4.1 Introduction 4.2 Antimicrobial resistance 4.2.1 Drivers of AMR 4.2.1.1 AMR mechanisms can fall into four different groups 4.2.1.2 What is making AMR grow so extensively? 4.2.2 Transmission of AMR from animals to humans or vice versa by different routes 4.3 Application of antimicrobials 4.3.1 Disease prevention 4.3.2 Disease treatment 4.3.3 Growth promotion 4.4 Antibiotics common in human and animal health 4.5 Future perspectives Bibliography 5 Antimicrobial and Antibiotic Resistance in Developing Countries: Health Economics, Global Governance, and Sustainable Development Goals 5.1 Introduction 5.2 The economic impact of antimicrobial and antibioticresistance 5.3 Global governance, health, and Sustainable Development Goals 5.4 Antimicrobial resistance and the achievement of Sustainable Development Goals in developing countries 5.5 Conclusion Bibliography 6 Disease Economics: Economic aspects of Anti-Bacterial and Anti-Microbial Resistance: Comparative analysis of Europe and other world regions 6.1 Introduction: Health and Disease Economics 6.2 ABR and AMR economic impact principles and trends 6.2.1 Brief history on building up the economic impact 6.2.2 The core of the problems – resistance 6.2.3 Problem driver 1 – usage, consumption 6.2.4 Problem driver 2 – inappropriate and unnecessary usage and consumption 6.2.5 Resulting ABR and its economic impact interconnections 6.3 AMR and ABR economic burden and costs 6.4 Economic effects of reactive and proactive ABR tackling measures and ideas 6.5 Conclusion Bibliography 7 Leveraging Health Diplomacy in achieving AMR Policy Coherence 7.1 Introduction 7.2 AMR Policy Initiatives 7.3 Policy Coherence: Policy framing, Policy Actors and Sectors in AMR 7.4 Policy challenges in the prevention and control of AMR from the context of policy frame 7.5 Policy Solution – Leveraging Global Health Diplomacy 7.6 Conclusion Bibliography 8 AMR policies and Implementation issues: Developed vs Developing Countries 8.1 Introduction 8.2 Global initiatives for containment of AMR 8.3 Policy and Implementation issues of AMR in developing countries 8.3.1 Policy perspective 8.3.1.1 Validity period and stakeholder involvement 8.3.1.2 Objectives of GAP and NAPs 8.3.1.3 Coordination and accountability 8.3.1.4 Equity 8.3.2 Implementation perspective 8.3.2.1 Awareness, Education and Training 8.3.2.2 Surveillance 8.3.2.3 Development of research and innovation activities in AMR 8.3.2.4 Infection prevention and control 8.3.2.5 Optimising antimicrobial usage in human and animal health 8.3.2.6 International collaboration 8.3.3 Monitoring and evaluation 8.3.4 One Health perspective 8.4 Policy and implementation of AMR in developed countries 8.4.1 Policy perspective 8.4.1.1 Validity period and stakeholder involvement 8.4.1.2 Objectives of GAP and NAPs 8.4.1.3 Coordination and accountability 8.4.1.4 Equity 8.4.2 Implementation perspective 8.4.2.1 Awareness, Education and Training 8.4.2.2 Surveillance 8.4.2.3 Development of Research and innovation activities in AMR 8.4.2.4 Infection prevention and control 8.4.2.5 Optimising antimicrobial usage in human and animal health 8.4.2.6 International collaboration 8.4.3 Monitoring and evaluation 8.4.4 One Health perspective 8.5 Conclusion Bibliography 9 Implementation Challenges in Healthcare-associated Antimicrobial Resistance Prevention and Control in India 9.1 Introduction 9.1.1 Types of hospital-acquired infections 9.1.1.1 Ventilator-associated pneumonia 9.1.1.2 Central line-associated bloodstream infection (CLABSI) 9.1.1.3 Catheter-associated urinary tract infection (CAUTI) 9.1.1.4 Surgical site infection (SSI) 9.2 Burden of HAI 9.2.1 HAI in developed countries 9.2.2 Burden of HAI in developing countries 9.3 Causes/ Risk factors associated with Hospital Acquired infections 9.4 Spread of healthcare-associated infections 9.5 Detection of AMR- HAI 9.6 Infection Prevention and Control Policy 9.6.1 Prevention of HAIs 9.7 IPC core components 9.8 HAI Management- Infection control bundles 9.8.1 Benefits of care bundle approach 9.8.2 Role of hospital infection control committee 9.9 IPC in Indian context 9.9.1 IPC implementation challenges 9.10 Suggestions for effective implementation of HAI/ABR related IPC in healthcare settings Bibliography 10 Combating AMR through Behavior Change:Role of Higher Education Institutes 10.1 Introduction 10.2 Burden of AMR 10.3 Requirement of Global Action 10.4 Behavior change and its Theories 10.5 Role of Higher Education Institutes 10.6 Conclusion Bibliography 11 Behavioural Change: Role of NGOs to Combat AMR 11.1 Introduction 11.2 Human behaviour and AMR 11.3 Non- Governmental Organisations (NGO) or (CSO) 11.3.0.1 Role of NGOs in health sector 11.3.0.2 Role of NGOs in AMR prevention and control activities 11.3.0.3 International NGOs and their role in curbing AMR 11.3.0.4 NGO role in human and nonhuman use of antibiotics 11.3.0.5 NGO role in innovation 11.3.0.6 NGO role in AMR in environment 11.3.0.7 NGO role in surveillance 11.3.0.8 NGO role in diagnostics and vaccines 11.3.0.9 NGO role in monitoring and accountability 11.4 Other NGOs actively involved in AMR prevention and control activities 11.4.0.1 The Pew Charitable trusts 11.4.0.2 Centre for a Livable Future (CLF) 11.4.0.3 Alliance for Prudent Use of Antibiotics (APUA) 11.4.0.4 World Alliance Against Antimicrobial Resistance (WAAAR) 11.4.0.5 The Centre for Disease Dynamics, Economics and Policy (CDDEP) 11.5 Conclusion Bibliography 12 Measures in Preserving the effectiveness of Existing Antimicrobials 12.1 Introduction 12.2 Irrational antibiotic use in the human sector 12.2.1 Irrational Antibiotics Use Among the General Public 12.2.1.1 Poor Public Knowledge and Awareness 12.2.1.2 Access to Antibiotics Without Prescription 12.2.1.3 Self-medication 12.2.1.4 Leftover Antibiotics 12.2.2 Irrational Antibiotics Use among Healthcare Providers 12.2.2.1 Antibiotic Use and Resistance: Healthcare Providers’ Knowledge, Attitudes, and Perceptions 12.2.2.2 Inadequate professional education for Healthcare Providers 12.2.2.3 Pharmaceutical Promotion 12.2.2.4 Lack of Rapid and Sufficient Diagnostic Tests 12.2.2.5 Patient-doctor Interaction 12.2.2.6 Knowledge, Attitude and Perception of the pharmacists /personnel manning the pharmacy stores towards Antibiotic Use and Resistance 12.3 Irrational use of antibiotics in food animals and agriculture sectors 12.4 Other influencers of ABR 12.4.1 Poor infection prevention and control practices in health care facilities and animal farms 12.4.2 Unhygienic living condition and poor personal hygiene 12.4.3 Improper disposal of pharmaceuticals waste 12.4.4 Other enabling strategies to enhance the sustainability of the effectiveness of the existing antibiotics are as follows 12.5 Conclusion Bibliography 13 Technology Solutions to AMR: Focus Paediatric Population 13.1 Introduction 13.2 Risk of AMR starts from birth 13.3 AMR in the paediatric population 13.4 Gender and nutrition: relevant for understanding AMR patterns 13.4.1 Healthcare challenges due to AMR among paediatric population 13.5 Technology solutions to address these AMR issues in children 13.5.1 Database 13.5.2 Data and Storage Solutions including range of Hospital Management Information System 13.5.3 Laboratory Technology Solutions 13.5.4 Apps 13.5.5 AI based solutions 13.6 Call to action 13.6.1 AMR challenges 13.6.2 AI application in AMR 13.6.3 Gender-disaggregated data on resistance are crucial 13.6.4 Paediatric AMR Stewardship is key 13.6.5 Ensure children and their caregivers have equitable access to antimicrobials 13.7 Conclusion Bibliography 14 Human resources: Capacity building for AMR Stewardship programme 14.1 Introduction 14.2 Hospital based Antimicrobial Stewardship Team 14.2.1 Core Team 14.2.2 Monitoring Team 14.3 Hospital based Training of Staff in AMR Stewardship 14.3.1 Human Resource Training 14.3.2 On the job training 14.3.3 The training for AMS Committee covers 14.3.3.1 Proper filling of the Antibiotic Justification/ Administration Form 14.3.3.2 Familiarity with the Restricted Antibiotic List 14.3.3.3 Audit Process 14.3.4 Continuous Education 14.3.4.1 Weekly Medical Meetings 14.3.4.2 Twice monthly AMS team meetings 14.3.5 Inter-Hospital Learning 14.3.6 ICMR Projects/ Government Projects 14.4 Stewardship Program during COVID 19 14.4.1 Normal functioning of the hospital was disrupted 14.4.2 Standard Operating Protocols (SOPs) for COVID 19 patients 14.4.3 Roles and responsibilities of staff were redefined 14.4.4 Medical documentation was hampered 14.4.5 Stewardship team–functioning during COVID 302 14.5 Call to action 14.5 Call to action 14.5.1 Paediatric antibiotic stewardship program to be distinguished from adult stewardship program 14.5.2 EMR to be strengthened in view of makeshift hospitals 14.5.3 AMR Stewardship programmes to be strengthened to withstand shocks 14.5.4 Culture change among healthcare leadership to incorporate technology and ensure data flow for stewardship 14.5.5 Interlinkage of antibiotic stewardship programmes to with diagnostic stewardship 14.5.6 Curricula to incorporate stewardship 14.6 Conclusion Bibliography 15 Combating AMR- One Health Approach 15.1 Introduction 15.2 One health 15.3 One health and AMR 15.3.1 Use of antibiotics 15.3.2 Human domain 15.3.2.1 Risk factors 15.3.3 Animal domain 15.3.3.1 Risk factors 15.3.4 Plant/ environment domain 15.3.4.1 Risk factors 15.4 One health and AMR - A few examples 15.5 One health efforts to control AMR 15.6 One health approach in AMR- Challenges 15.6.1 Challenges in developing a one health program 15.6.1.1 Lack of awareness 15.6.1.2 Poor governance 15.6.2 Challenges in implementing a one health program 15.6.2.1 Lack of surveillance 15.6.2.2 Less collaborations 15.6.3 Challenges in monitoring and evaluating a one health program 15.7 Conclusion Bibliography Index