Thailand's national strategic plan on antimicrobial resistance: progress and challenges

Antimicrobial resistance is a serious threat that affects all countries. The Global Action Plan on antimicrobial resistance and the United Nations Political Declaration on antimicrobial resistance set standards for countries to resolve antimicrobial resistance challenges under the One Health approach. We assess progress and challenges in implementing Thailand’s national strategic plan on antimicrobial resistance 2017–2022, discuss interim outcomes and share lessons learnt. Major progress includes: establishing a national governance mechanism that leads high-impact policy on antimicrobial resistance and consolidates actions and multisectoral collaboration; creating a monitoring system and platform to track implementation of the strategic plan; and converting strategies of the strategic plan into actions such as controlling the distribution and use of antimicrobials in humans and animals. Interim results indicate that antimicrobial consumption in animals has nearly halved (exceeding the national goal of a 30% reduction) whereas other goals have not yet reached their targets. We have learnt that elevating antimicrobial resistance to high-level visibility and establishing a national governance mechanism is an important first step, and a monitoring and evaluation system should be developed in parallel with implementation. Securing funds is crucial. Policy coherence is needed to avoid duplication of actions. Highly ambitious goals, although yet to be achieved, can advance actions beyond expectations. Political commitment and collaboration across different sectors will continue to play important roles but might not be sustained without a well-designed governance structure to support long-term actions to address antimicrobial resistance.     

Urinary tract infections in hospital pediatrics: Many previous antibiotherapy and antibiotics resistance,including fluoroquinolones

Objective

We studied antibiotic resistance in pediatric UTIs and we evaluated the impact of antibiotic exposure in the previous 12 months, very little French data being available for this population.

Methods

We conducted a multicenter prospective study including children consulting for, or admitted in 2 hospitals. Prior antibiotic exposure was documented from their health record.

Results

One hundred and ten patients (73 girls), 11 days to 12 years of age, were included in 10 months. Ninety-six percent presented with pyelonephritis, associated to uropathy for 25%. Escherichia coli was predominant (78%), followed by Proteus spp. and Enterococcus spp. The antibiotic resistance rate of E. coli was high and close to that reported for adults with complicated UTIs: amoxicillin 60%, amoxicillin-clavulanate 35%, cefotaxim 5%, trimethoprim-sulfametoxazole 26%, nalidixic acid 9%, ciprofloxacin 7%, gentamycin 1%, nitrofurantoin and fosfomycin 0%. The antibiotic exposure in the previous 12 months involved 62 children (56%) most frequently with β-lactams (89%) for a respiratory tract infection (56%). A clear relationship between exposure and resistance was observed for amoxicillin (71% vs. 46%), first generation (65% vs. 46%) and third generation (9% vs. 3%) cephalosporins, or trimethoprim-sulfamethoxazole (36% vs. 15%). However, antibiotic exposure could not account alone for the results, as suggested by the 7% of ciprofloxacin resistance, observed without any identified previous treatment.

Conclusion

Bacterial species and antibiotic resistance level in children are similar to those reported for adults. Antibiotic exposure in the previous 12 months increases the risk of resistance but other factors are involved (previous antibiotic therapies and fecal-oral or mother-to-child transmission).     

医院感染革兰阳性球菌的耐药性及干预对策

目的 探讨医院感染革兰阳性球菌的构成比及耐药性,制定相关的医院感染干预对策.方法 细菌培养与鉴定严格按照《全国临床检验操作规程》,采用常规方法进行;药物敏感试验采用CLSI推荐的K-B法,数据统计分析采用WHONET最新版本.结果 712株革兰阳性球菌中分离率居前3位分别为金黄色葡萄球菌、凝固酶阴性葡萄球菌、粪肠球菌,各占40.6％、31.9％、10.9％;革兰阳性球菌对常用抗菌药物表现出不同程度的耐药性,但对糖肽类抗菌药物万古霉素、替考拉宁100.0％敏感;MRSA检出率为60.9％,MRCNS检出率为61.2％.结论 各级医疗机构应加大抗菌药物使用管理的力度,遏制细菌耐药率不断上升的不良趋势.     

烧伤整形外科医院感染的病原菌分布及耐药性

目的 探讨烧伤整形外科医院感染现状及病原菌耐药性,为预防与控制外科医院感染提供参考依据.方法 同顾性医院感染患者的病案资科,统计医院感染的原发疾病及手术种类、病原菌耐药率.结果 烧伤整形外科医院感染主要病原菌是:金黄色葡萄球菌、凝固酶阴性葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌,分别占28.1％、18.0％、17.2％、13.3％;以上病原菌均显示出较高的耐药性;59株葡萄球菌属中,检出耐甲氧西林葡萄球菌(MRS)28株,检出率为47.5％.结论 务必采取有效的干预措施,预防与控制烧伤整形外科医院感染.     

Antimicrobial resistance: harmonisation of national antimicrobial resistance monitoring and surveillance programmes in animals and in animal-derived food.

A guideline on the harmonisation of national antimicrobial resistance monitoring and surveillance programmes in animals and animal-derived foods has been developed by the Ad hoc Group of experts on antimicrobial resistance of the Office International des Epizooties. The objective of the guideline is to allow the generation of comparable data from various national surveillance and monitoring systems in order to compare the situations in different regions or countries and to consolidate results at the national, regional and international level. Definitions of surveillance and monitoring are provided. National systems should be able to detect the emergence of resistance, and to determine the prevalence of resistant bacteria. The resulting data should be used in the assessment of risks to public health and should contribute to the establishment of a risk management policy. Specific factors identified for harmonisation include the animal species, food commodities, sampling plans, bacterial species, antimicrobials to be tested, laboratory methods, data reporting, database structure and the structure of reports.     

某三甲综合医院医院获得性血流感染病原菌分布及耐药性分析

目的了解医院获得性血流感染(nBSI)病原菌的分布及耐药情况,以对其诊断、治疗及防控提供参考。方法回顾性分析2013年8月-2017年8月医院确诊为nBSI的1 444例患者,统计分析患者的临床资料及主要病原菌分布和耐药性特点。结果 1 444例nBSI患者中共分离病原菌1 460株,其中革兰阴性945株占64.73%、革兰阳性菌421株占28.84%、真菌94株占6.43%;大肠埃希菌和肺炎克雷伯菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、亚胺培南、美罗培南耐药率为1.51%和29.12%、4.23%和34.62%、0.91%和20.33%、0.60%和23.08%,产ESBLs菌株检出率分别为61.93%、59.34%;铜绿假单胞菌和鲍氏不动杆菌对亚胺培南、美罗培南的耐药率分别为12.36%和86.27%、8.99%和86.27%;大肠埃希菌、肺炎克雷伯菌和鲍氏不动杆菌对替加环素的耐药率分别为0、1.1%、0;耐甲氧西林金黄色葡萄球菌(MRSA)检出率为30.61%,耐甲氧西林凝固酶阴性葡萄球菌(MRCoNS)检出率为83.33%。结论 nBSI病原菌种类复杂,以革兰阴性菌为主,耐药情况严峻。临床诊治工作应重在防控,及时送检,合理使用抗菌药物。     

The Rotterdam Study: 2018 update on objectives,design and main results

The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1500 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.     

Estimating health care-associated infections and deaths in U.S. hospitals, 2002

OBJECTIVE: The purpose of this study was to provide a national estimate of the number of healthcare-associated infections (HAI) and deaths in United States hospitals. METHODS: No single source of nationally representative data on HAIs is currently available. The authors used a multi-step approach and three data sources. The main source of data was the National Nosocomial Infections Surveillance (NNIS) system, data from 1990-2002, conducted by the Centers for Disease Control and Prevention. Data from the National Hospital Discharge Survey (for 2002) and the American Hospital Association Survey (for 2000) were used to supplement NNIS data. The percentage of patients with an HAI whose death was determined to be caused or associated with the HAI from NNIS data was used to estimate the number of deaths. RESULTS: In 2002, the estimated number of HAIs in U.S. hospitals, adjusted to include federal facilities, was approximately 1.7 million: 33,269 HAIs among newborns in high-risk nurseries, 19,059 among newborns in well-baby nurseries, 417,946 among adults and children in ICUs, and 1,266,851 among adults and children outside of ICUs. The estimated deaths associated with HAIs in U.S. hospitals were 98,987: of these, 35,967 were for pneumonia, 30,665 for bloodstream infections, 13,088 for urinary tract infections, 8,205 for surgical site infections, and 11,062 for infections of other sites. CONCLUSION: HAIs in hospitals are a significant cause of morbidity and mortality in the United States. The method described for estimating the number of HAIs makes the best use of existing data at the national level.     

2001年中国食源性致病菌及其耐药性主动监测研究

目的　旨在监测中国食源性致病菌及其耐药性。方法　中国疾病预防控制中心营养与食品安全所建立的全国食品污染物监测网的食源性致病菌监测部分 ,2 0 0 1年在全国 11个省市设点采样并检测了七大类 (生肉、熟肉、生奶、冰激淋、酸奶、水产品和蔬菜 )共 4 0 34份样品。结果　沙门氏菌、大肠杆菌O15 7∶H7和单核细胞增生李斯特氏菌 ,总阳性率 5 5 0 %。其中沙门氏菌 3 32 % ,单核细胞增生李斯特氏菌 1 2 9% ,大肠杆菌O15 7∶H70 82 %。生肉的污染情况最为严重 ,阳性率 12 96 %。共分离出沙门氏菌 137株 ,德比沙门氏菌、阿贡纳沙门氏菌、肠炎沙门氏菌、里定沙门氏菌、鸭沙门氏菌、明斯特沙门氏菌及鼠伤寒沙门氏菌 7种血清型占 80 %。结论　沙门氏菌的血清型分布和耐药性各个省不同。自生、熟肉中分离到O15 7∶H7的强毒株。对分离的沙门氏菌、大肠杆菌检测了 14种抗生素的耐药性 ,结果表明沙门氏菌和大肠杆菌中都有多重耐药株。     

我国结直肠癌筛查卫生经济学证据系统更新：2009－2018

目的 系统更新中国大陆结直肠癌筛查的卫生经济学评价证据。方法 基于2015年发表的系统综述（2004-2014年），扩大检索数据库范围（PubMed、EMbase、The Cochrane Library、Web of Science、中国知网、万方数据知识服务平台、维普中文科技期刊数据库和中国生物医学文献数据库），延展时间至2018年12月，重点呈现近10年证据（2009-2018年）。系统摘录研究基本特征及主要结果。成本数据采用医疗保健类居民消费价格指数均贴现至2017年，计算增量成本效果比（ICER）与对应年份全国人均GDP的比值。结果 最终纳入12篇文献（新增8篇），其中9篇基于人群（均为横断面研究），3篇基于模型。起始年龄多为40岁（7篇），筛查频率多为终生1次（11篇）。筛查技术涉及问卷评估、免疫法粪便隐血试验和结肠镜。经济学评价指标以每检出1例结直肠癌的成本最为常见，中位数（范围，筛查方案数）为52 307元（12 967~3 769 801，n=20）；每检出1例腺瘤的成本为9 220元（1 859~40 535，n=10）。3篇文献报告了与不筛查相比，每挽救1个生命年的成本，其ICER与GDP比值为0.673（-0.013~2.459，n=11），是WHO认为的非常经济有效；不同筛查技术间及不同频率间该比值的范围重叠较大，但起始年龄50岁（0.002，-0.013~0.015，n=3）比40岁（0.781，0.321~2.459，n=8）筛查方案更经济有效。结论 人群研究提示腺瘤检出成本仅为癌症检出成本的1/6，有限的ICER证据提示在我国人群开展结直肠癌筛查经济有效；尽管最优初筛技术无法定论，但初步提示筛查起始年龄50岁优于40岁。未见随机对照试验评价等高级别证据。     

Nosocomial bacterial infections and their antimicrobial resistance patterns in university hospitals of hamedan, iran

Background: Nosocomial infections constitute a global health problem, leading to a high rate of morbidity and mortality. The aim of this study was to determine the frequency and antimicrobial resistance patterns of nosocomial infections in edu-cational hospitals of Hamadan, western Iran.Methods: During a 1-year period from April 2006 to March 2007, all patients with cul-ture-proven nosocomial infections from educational hospitals in Hamedan, west-ern Iran were included. Nosocomial infections were defined as a culture-proven infection, which occurred more than 48h after admission in the hospital. An-timicrobial susceptibility testing of isolated bacteria was performed by disc dif-fusion method. Results: A total of 170 cases of culture-proven nosocomial infections were diag-nosed. Most cases were in intensive care units (ICUs) (57.4%). The common sites of infection were lower respiratory tract (51.8%) and urinary tract (31.9%). Kleb-siella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli, were the most prevalent pathogens (32.7%, 22.9%, and 14.8% respectively). Most en-terobacteriacea isolates were resistant to third generation cephalosporins. The resis-tant rates to ceftriaxone were 75.5% for K. pneumoniae, and 76% for E. coli. Among P. aeruginosa isolates, 26.5% were resistant to ceftazidim, and 36% to cipro-floxacin. Among S. aureus isolates, 80% were methicillin-resistant. Conclusion: The patients in the ICUs are at a higher risk of nosocomial infec-tions. The high prevalence of antimicrobial resistance in the hospitals highlights the need of further infection control activities and surveillance programs.     

Health care-associated rotavirus illness in pediatric inpatients in Germany, Austria, and Switzerland.

A longitudinal study of health care-associated transmission of rotaviruses (RVs) in pediatric inpatients 0-48 months old in Austria, Germany, and Switzerland showed that almost one third of all cases occurred in patients 2 months old or younger. The effectiveness of vaccination against RV from 2 months of age onward remains to be evaluated.     

Passive surveillance of antimicrobial resistance in Queensland public hospitals: the basis for a national system?

Australia currently has no system of passive surveillance of antimicrobial resistance in spite of the importance of surveillance in identifying and defining emergent resistance being generally accepted. Queensland Health Pathology and Scientific Services have developed flexible software for passive surveillance with the capacity to handle national data. The system imports raw data strings in delimited ASCII text format into a relational database and screens to exclude duplicates before the processing of the cumulative susceptibility data. It allows considerable flexibility in inquiry parameters and has the ability to 'drill down' to individual laboratory results. Examples of analytical output are given for 49,169 unique isolate results obtained in all Queensland Health Pathology Service laboratories from 1 January to 30 June 2003. The system could form the basis of a national system for passive antimicrobial resistance surveillance.     

门诊泌尿系感染病原菌分布及耐药性分析

目的分析门诊泌尿系感染(UTI)患者分离病原菌的分布及耐药性。方法收集门诊尿常规阳性的UTI患者的清洁中段尿标本,进行细菌培养,采用纸片扩散法进行体外药敏试验,用WHONET软件分析药敏结果。结果引起门诊UTI感染主要病原菌是大肠埃希菌占74.2%,大肠埃希菌对氨苄西林的耐药率最高为69.6%,超广谱β-内酰胺酶(ESBLs)检出率为24.7%,未检测到对亚胺培南、美罗培南、阿米卡星、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦耐药的菌株。结论了解门诊泌尿系感染的病原菌分布及耐药性至关重要,可以为临床医师提供经验治疗UTI的病原学依据。     

荆州市假丝酵母菌属医院感染的菌群分布及耐药性探讨

目的 探讨荆州市医院感染假丝酵母菌属的分布及耐药特点,为临床控制真菌感染提供实验室依据.方法 真菌培养、鉴定和药敏试验严格按照《全国临床检验操作规程》进行.结果 感染真菌主要是白色假丝酵母菌占62.1％,热带假丝酵母菌占20.3％；假丝酵母菌属对两性霉素B和制霉菌素敏感率均为100.0％;对伊曲康唑及酮康唑的耐药率为8.3％～27.3％,对氟康唑耐药率有上升趋势,为13.6％～36.4％.结论 应遵照真菌病原学检查和药敏结果选择抗真菌药物,才能提高真菌感染临床治愈率.     

2016-2018年内蒙古包头地区金黄色葡萄球菌耐药监测结果分析

目的 了解内蒙古包头地区金黄色葡萄球菌（Staphylococcus aureus,SAU）分离情况以及对抗菌药物的耐药变迁情况,为临床合理使用抗菌药物提供依据。 方法 收集2016-2018年内蒙古包头地区11家全国耐药监测网成员单位上报数据,对数据采用WHONET5.6软件进行统计分析。结果 2016-2018年检出金黄色葡萄球菌2613株,其中耐甲氧西林金黄色葡萄球菌（methicillin-resistant Staphylococcus aureus,MRSA）422株,检出率为16.2%（422/2613）。包钢医院的MRSA检出率最高,为30.9%（98/317）,包头市蒙医中医医院MRSA检出率最低,为1.9%（1/53）,检出率均低于全国平均水平。不同医院的金黄色葡萄球菌分离株对多数抗菌药物的耐药率不一致,如对复方新诺明耐药率最高是包头市第八医院,为52.3%,最低是包头市蒙医中医医院,为14.3%;对红霉素耐药率最高的是内蒙古北方重工业集团有限公司医院,为90.5%,最低的是包头市中心医院,为69.5%;对环丙沙星耐药率最高是内蒙古第一机械集团有限公司医院为26.2%,最低的是包头市肿瘤医院,为0,等。金黄色葡萄球菌对万古霉素、利奈唑胺、替考拉宁、替加环素的耐药率均为0。 结论 包头地区金黄色葡萄球菌总体控制较好,但耐药率仍较高。不同医院MRSA检出率不同,且各医院分离的金黄色葡萄球菌对常用抗菌药物的耐药性也不同。     

Prevalence and pattern of antimicrobial resistance of Shigella species among patients with acute diarrhoea in Karaj,Tehran, Iran

The study was carried out to determine the prevalence and pattern of antimicrobial resistance of Shigella species among patients with acute diarrhoea in Karaj, Tehran, Iran. The study included all acute diarrhoea patients who visited the hospitals and treatment centres of Karaj during November 2001-October 2002. Of 734 stool samples collected from patients with acute diarrhoea and analyzed for Shigella spp., 123 (16.8%) yielded Shigella spp. (7.5% Shigella flexneri, 5.2% S. sonnei, 2.6% S. dysenteriae, and 1.5% S. boydii). Of the Shigella isolates, 90.8% were resistant to one or more antimicrobial agent(s), and 87.8% were multidrug resistant. The most common resistance was to tetracycline (73.5%), trimethoprim-sulphamethoxazole (70.4%), and amoxicillin-clavulanic acid (50.0%). Resistance to cefixime, ciprofloxacin, ceftriaxone, and nalidixic acid was observed in 6.1%, 3.1%, 2.0%, and 1.0% of the isolates respectively. These findings suggest that Shigella spp. may be an important aetiological agent of diarrhoea with a high rate of drug resistance in this region, which requires further study.