Investigación operativa para fortalecer las intervenciones basadas en la evidencia para abordar la resistencia a los antimicrobianos en la Región de las Américas
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Celis, Y., Esparza, G., Zachariah, R., & Pérez, F. (2023). Investigación operativa para fortalecer las intervenciones basadas en la evidencia para abordar la resistencia a los antimicrobianos en la Región de las Américas [Journal articles]. https://iris.paho.org/handle/10665.2/57410
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2023
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1680 5348
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[EXTRACTO] La resistencia a los antimicrobianos es una de las mayores amenazas para la salud pública en todo el mundo. Esta resistencia, asociada principalmente con el uso excesivo e indebido de antimicrobianos en seres humanos, en la medicina veterinaria y en la agricultura y ganadería, se exacerbó durante la pandemia de COVID-19 (1). Limitar la aparición y propagación de agentes patógenos resistentes a los antimicrobianos es fundamental para mantener la capacidad de tratar enfermedades en seres humanos, animales y plantas; mejorar la inocuidad de los alimentos y proteger el medioambiente. Este número especial de la Revista Panamericana de Salud Pública está dedicado a iniciativas de investigación operativa a fin de fortalecer las intervenciones basadas en la evidencia para abordar la resistencia a los antimicrobianos en la Región de las Américas. Es un esfuerzo conjunto entre la OPS y el TDR de la OMS, con varios asociados de SORT IT. En este número se presenta una selección de estudios científicos realizados en Colombia y Ecuador, y se busca generar evidencia científica sobre aspectos relevantes del enfoque de “Una salud”. La evidencia generada por estos estudios fortalecerá los planes de acción sobre la resistencia a los antimicrobianos en Colombia y Ecuador.
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Celis Y, Esparza G, Zachariah R, Pérez F. Investigación operativa para fortalecer las intervenciones basadas en la evidencia para abordar la resistencia a los antimicrobianos en la Región de las Américas. Rev Panam Salud Publica. 2023;47:e85. doi: https://doi.org/10.26633/RPSP.2023.85.
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Item From environment to clinic: the role of pesticides in antimicrobial resistance(2020)[ABSTRACT]. Antimicrobial resistance (AMR) in pathogens has been associated mainly with excessive use of antibiotics. Most studies of resistance have focused on clinical pathogens; however, microorganisms are exposed to numerous anthropogenic substances. Few studies have sought to determine the effects of chemical substances on microorganisms. Exposure to these substances may contribute to increased rates of AMR. Understanding microorganism communities in natural environments and AMR mechanisms under the effects of anthropogenic substances, such as pesticides, is important to addressing the current crisis of antimicrobial resistance. This report draws attention to molecules, rather than antibiotics, that are commonly used in agrochemicals and may be involved in developing AMR in non-clinical environments, such as soil. This report examines pesticides as mediators for the appearance of AMR, and as a route for antibiotic resistance genes and antimicrobial resistant bacteria to the anthropic environment. Available evidence suggests that the natural environment may be a key dissemination route for antibiotic-resistant genes. Understanding the interrelationship of soil, water, and pesticides is fundamental to raising awareness of the need for environmental monitoring programs and overcoming the current crisis of AMR.Item Colistin resistance in Escherichia coli and Klebsiella pneumoniae in humans and backyard animals in Ecuador(2023)[ABSTRACT]. Objective. Colistin is an antibiotic of last resort for treating serious Gram-negative bacterial infections. However, the misuse of colistin, especially as an animal growth promoter, has contributed to increasing antimicrobial resistance, mediated mainly through plasmid transfer of the mcr-1 gene. This study assessed the prevalence of phenotypic and molecular colistin resistance in Escherichia coli and Klebsiella pneumoniae in Ecuador in healthy humans and their chickens and pigs. Methods. Fecal samples were collected from humans and their chickens and pigs in two rural coastal and Amazon regions between April and August 2020. Gram-negative bacteria were isolated and identified using conventional techniques. Phenotypic resistance was determined using the broth microdilution technique, and the mcr-1 gene was detected using conventional polymerase chain reaction. Results. A total of 438 fecal samples were obtained from 137 humans, 147 pigs and 154 chickens. The preva- lence of E. coli isolates was 86.3% (378/438) and K. pneumoniae, 37.4% (164/438). Overall, the mcr-1 gene was found in 90% (340/378) of E. coli isolates, with higher prevalences found in isolates from coastal regions (96.5%, 191/198), humans (95.6%, 111/116) and chickens (91.8%, 123/134); for K. pneumoniae, the gene was found in 19.5% (32/164) of isolates, with equal distribution between regions and hosts. Only four isolates, two E. coli and two K. pneumoniae, showed phenotypic resistance: mcr-1 was present in both E. coli strains but absent in the K. pneumoniae strains. Conclusions. Despite a low prevalence of phenotypic resistance to colistin, the high prevalence of the mcr-1 gene in E. coli is of concern. Ecuador’s ban on using colistin in animal husbandry must be enforced, and con- tinual monitoring of the situation should be implemented.Item High levels of antimicrobial resistance in Escherichia coli and Salmonella from poultry in Ecuador(2023)[ABSTRACT]. Amancha G, Celis Y, Irazabal J, Falconi M, Villacis K, Thekkur P, et al. High levels of antimicrobial resistance in Escherichia coli and Salmonella from poultry in Ecuador. Rev Panam Salud Publica. 2023;47:e15. https://doi.org/10.26633/RPSP.2023.15 Objective. To describe antimicrobial resistance profiles of Escherichia coli and Salmonella spp. isolated from chicken carcasses and the antimicrobials commonly used in animals in Ecuador and provide information on antimicrobial resistance patterns for implementing evidence-based corrective measures. Methods. Meat samples were collected from chicken carcasses in 199 slaughterhouses across Ecuador as part of a national pilot study for monitoring antimicrobial resistance in agricultural sources in 2019. Samples were tested for E. coli and Salmonella spp. Sensitivity to 10 critically important and three highly important antimicrobials (from a human health perspective) was assessed. The country report submitted to the World Organization for Animal Health was accessed to extract the quantity of antimicrobials produced or imported for use in animals. Results. Of 383 samples, E. coli was isolated from 148 (39%) and Salmonella spp. from 20 (5%) samples. Ninety percent of the isolates were resistant to at least one critically important antimicrobial. Resistance was highest to erythromycin (E. coli 76%; Salmonella spp. 85%) and tetracycline (E. coli 71%; Salmonella spp. 90%). Critically or highly important antimicrobials (colistin, tetracycline, trimethoprim/sulfamethoxazole) formed the bulk (87%) of antimicrobials used in animals as per the World Organization for Animal Health report. Conclusions. High prevalence of antimicrobial resistance in poultry in Ecuador calls for the development of guidelines and regulations on the use of antimicrobials and for engagement with livestock producers. The existing surveillance system needs to be strengthened to improve the monitoring of antimicrobial use and evolving resistance patterns.Item Prevalence and antimicrobial resistance of Escherichia coli and Salmonella spp. in animal feed in Colombia(2023)[ABSTRACT]. Objective. To determine the prevalence and antimicrobial resistance of Escherichia coli and Salmonella spp. in animal feed samples collected between 2018 and 2021 in Colombia. Methods. This was a laboratory-based cross-sectional study using routine data from the program for inspec- tion, surveillance, and control of animal feed at the Colombian Agriculture Institute. Samples of animal feed for swine, poultry, canine, feline, leporine, piscine, and equine species were processed for detection of E. coli and Salmonella spp. using enrichment and selective culture methods. Isolates were tested for antimicrobial susceptibility using an automated microdilution method. Results. Of 1 748 animal feed samples analyzed, 83 (4.7%) were positive for E. coli and 66 (3.8%) for Salmonella spp. The presence of E. coli and Salmonella spp. was highest in feed for poultry (6.4% and 5.5%) and swine (6.1% and 4.3%). Antimicrobial resistance testing was performed in 27 (33%) E. coli isolates and 26 (39%) Salmonella isolates. Among E. coli, resistance was most frequently observed to ampicillin (44.5%) followed by cefazolin (33.3%), ciprofloxacin (29.6%), ampicillin/sulbactam (26%), and ceftriaxone (11.1%). The highest resistance levels in Salmonella spp. isolates were against cefazolin (7.7%) and piperacillin/tazobactam (7.7%). Conclusions. This is the first study from Colombia reporting on the prevalence and antimicrobial resistance of E. coli and Salmonella spp. in animal feed samples. Its results establish a baseline over a wide geographical distribution in Colombia. It highlights the need to integrate antimicrobial resistance surveillance in animal feed due to the emergence of resistant bacteria in this important stage of the supply chain.Item Gestão das intervenções de prevenção e controle da resistência a antimicrobianos em hospitais: revisão de evidências(2020)[RESUMO]. Objetivo. Identificar intervenções efetivas para enfrentar a resistência a antimicrobianos em hospitais e possíveis barreiras para sua implementação. Métodos. Realizou-se uma síntese de evidências para a elaboração de políticas com base na metodologia proposta nas ferramentas SUPPORT. As buscas na literatura foram realizadas em novembro e dezembro de 2018, em 14 bases de dados. Um diálogo deliberativo, para identificar barreiras na implementação das intervenções, foi realizado presencialmente com 23 participantes (gestores, pesquisadores e profissionais de saúde) e 14 ouvintes, divididos em três grupos. A moderação foi feita por pesquisadores com experiência na condução de diálogos deliberativos. Resultados. Foram identificadas 27 revisões sistemáticas sobre intervenções para gestão de antimicrobianos (programas de stewardship) combinadas e individuais. Essas intervenções abordaram estratégias de educação, sistemas eletrônicos, biomarcadores e diversas formas de manejo de antimicrobianos. As principais barreiras para a implementação das intervenções, identificadas por meio da literatura e do diálogo deliberativo, foram: falta de infraestrutura e recursos humanos, insatisfação do paciente em relação à conduta terapêutica; diferenças culturais da equipe multidisciplinar; sobrecarga de trabalho da equipe; falta de financiamento/planejamento. Conclusão. A maioria das estratégias identificadas mostrou-se efetiva para gestão da resistência aos antimicrobianos em âmbito hospitalar. Deve-se enfatizar que a confiança nos resultados pode ser melhorada com novas pesquisas de maior qualidade metodológica.