Antimicrobial Resistance: Collaborative Measures of Control

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