Search results

Antibiotic resistance (AR) is a global health crisis that is attracting focussed attention from healthcare, public health, governmental agencies, the public, and food producers. The purpose of this paper is to describe the work in Washington State to combat resistance and promote antimicrobial stewardship from a one health perspective.

In 2014, the Washington State Department of Health convened a One Health Steering Committee and two workgroups to focus on AR, the One Health Antimicrobial Stewardship work group and the One Health Antimicrobial Resistance Surveillance work group. The group organized educational sessions to establish a basic understanding of epidemiological factors that contribute to resistance, including antibiotic use, transmission of resistant bacteria, and environmental contamination with resistant bacteria and antibiotic residues.

The authors describe the varied uses of antibiotics; efforts to promote stewardship in human, and animal health, including examples from the USA and Europe; economic factors that promote use of antibiotics in animal agriculture; and efforts, products and next steps of the workgroups.

In Washington, human, animal and environmental health experts are working collaboratively to address resistance from a one health perspective. The authors are establishing a multi-species resistance database that will allow tracking resistance trends in the region. Gaps include measurement of antibiotic use in humans and animals; integrated resistance surveillance information; and funding for AR and animal health research.

Drawing insights from the culture-centered approach (Dutta-Bergman, 2004; Dutta, 2007), the purpose of this paper is to explore the meanings of, experiences with, and information sources for antibiotics among at-risk yet understudied populations in urban and economic margins in the Global South.

Given the exploratory purpose of this paper, it used qualitative approach specifically focus group discussions with mothers, guardians and female senior citizens from Manila, Philippines.

Antibiotics had multiple meanings – from purposes and modes of acquisition to side-effects. Experiences with antibiotics were not only tied to financial difficulties, but also in administering antibiotics to children or wards and managing side-effects. Furthermore, medical doctors were the most accessed and preferred sources of antibiotics-related information.

To date, this paper is one of the few to argue that knowing the conditions into which antibiotics are situated in the Global South is critical for strengthening global public health campaigns and policies against antimicrobial resistance a and reducing global health inequity.

The purpose of this paper is to explore the current state of antimicrobial stewardship implementation and development within Canada at both a federal and provincial level.

Narrative review.

There have been several prominent conferences and reports in Canada regarding the development and implementation of antimicrobial stewardship programs over the past two decades. However, despite the knowledge that there is a need for standardization of programs across Canada with accurate mechanisms and infrastructure in place for implementation and evaluation of these programs, there is still a lack of consistency across the country. In addition pharmacy information regarding inpatient and outpatient antimicrobial use is not uniformly reliable. Recently, the Public Health Agency of Canada using the Pan-Canadian Public Health Network as a vehicle organized a task group to help facilitate the working relationships among the provincial, territorial and federal governments in terms of implementing antimicrobial stewardship programs. This network has the potential to enhance and standardize programs across the country.

This paper looks at Canadian policy regarding antimicrobial stewardship at a federal as well as provincial level. Historic conferences, reports and discussions are highlighted emphasizing the progressive changes over the past two decades and highlight many of the challenges that Canada continues to face.

The purpose of this paper is to provide an overview of the context for strategies to overcome antimicrobial resistance in Australia, which may provide valuable learnings for other jurisdictions.

Non-systematic review of literature from websites of national, state and territory health departments and interviews with key stakeholders for Australian strategies to reduce antimicrobial resistance.

In July 2015 all states and territories in Australia adopted the National Antimicrobial Resistance Strategy 2015-2019, which is built on the World Health Organization policy package to combat antimicrobial resistance. This strategy represents “the collective, expert views of stakeholders on how best to combat antimicrobial resistance in Australia. It will also support global and regional efforts, recognising that no single country can manage the threat of antimicrobial resistance alone”. It combines quantitative and qualitative monitoring strategies with frameworks and guidelines to improve management of the use of antimicrobial resistant drugs. Prior to this, health services and states developed and implemented initiatives aimed at monitoring and improving prescribing practices. Development of the national strategy has encouraged and fostered debate within the Australian health system and a raft of new policy initiatives.

Surveillance strategies are in place to monitor impact and trends at jurisdictional and sector levels. However, actual impact on antimicrobial resistance and prescribing practices remains to be seen as existing initiatives are expanded and new initiatives implemented.

This overview of key Australian initiatives balancing quantitative and qualitative surveillance, accreditation, research, education, community awareness and price signals on antibiotic prescribing practices may be valuable to health systems in developing local strategies.

The authors provide an up to date overview of the context, strategies and aims of antimicrobial stewardship in Australia.

For this themed issue, the purpose of this paper is to select papers that examine progress on addressing concerns raised in one of the Journal’s 2015 viewpoint articles.

The authors contributing to this issue describe the evolution, current state and challenges facing development of antimicrobial stewardship initiatives in their communities. This editorial summarizes concerns raised in the 2015 viewpoint and provides a link to newer information for each of these problems.

Progress is being made to build the political will for implementing initiatives that of necessity must span a wide swath of jurisdictions and national agencies in each country; the information resources necessary to maintain current awareness of evolving drug usage and resistance patterns; the infrastructure required to educate both public and professionals; and at least monitor if not ensure compliance.

The concepts and experiences reported in this issue can inform policy and governance development in countries that are not as far along the path, as well as contribute to a global dialogue on what works best for whom under what circumstances.

Details in this themed issue expand on overviews provided in a recent World Health Organization report. This Journal intends to contribute to the advancement of timely knowledge translation by welcoming more papers on this topic, papers at a level of detail like those in this issue, so that our readers can remain abreast of the changing global context.

Antibiotic resistance presents a major public health challenge at local, national and international levels. At a local level, the challenge is to tackle the antibiotic stewardship agenda, within the clinical governance framework, across all professional groups and specialities. This paper presents the response to this challenge in a large multi‐site NHS trust. The approach focuses around a multi‐disciplinary antibiotic steering group, in which a dedicated infectious diseases pharmacist plays a key role. Proposes seven key elements for a successful antibiotic stewardship programme and discuss examples of local action. These elements are: strong leadership; dedicated individuals with responsibility for leading on antibiotic use; integration into pre‐existing trust structures; harnessing existing resources to deliver change; obtaining local data on prescribing patterns and resistance; communication; and education and training. All pillars of clinical governance are supported by the multi‐disciplinary approach described.

The purpose of this paper is to highlight the local, national and global actions from the UK to reduce the impact of antimicrobial resistance (AMR) on human health.

Synthesis of UK government policy, surveillance and research on AMR.

Activities that are taking place by the UK government, public health and professional organisations are highlighted.

This paper describes the development and areas for action of the UK AMR strategy. It highlights the many interventions that are being delivered to reduce antibiotic use and antimicrobial resistant infections.

The purpose of this paper is to report on recent developments concerning promotion of initiatives to contain the spread of resistance to antimicrobial drugs.

Narrative review.

In 2014, an American executive order made combating antimicrobial resistance a national priority. While this and other developments convey a message of growing urgency, the core elements required and challenges ahead are neither new nor unexplored. The quantity and quality of antimicrobial stewardship research over the past decade has added little to what already was known. Suppressing evolution of emerging drug resistance and containing emergence of resistant strains as on-going activities to maintain a balance might be a more realistic statement of the problem than framing it as winning a war. It remains to be seen how well those in the front lines of healthcare epidemiology and infection control shape framing of this problem before American federal and state agencies respond to their presidential directive by relaying marching orders through laws, rules, regulations, financial incentives and penalties. It remains to be seen whether the next decade will be more successful than the last given a more recent emphasis on the strategy of bundling small sets of practical key measures into effect, and the involvement of public health departments in support of antimicrobial stewardship. Unlike a generation ago, it also is clear that international trade and travel make this a global problem. America cannot be expected to resolve emerging drug resistance alone even if containment efforts within its own borders are successful, but like other developed countries it can be expected to have vested self-interests in promoting global solutions to this complex problem.

This report brings together recent American government policy decisions and insights from two noteworthy interdisciplinary conferences.

The purpose of this paper is to consider “at home ethnography” and “abroad ethnography” not as labels standing for different kinds of fieldwork “out there” but rather as the poles of a continuum identifying the ethnographer’s situated, relative and ever changing epistemic status.

Building on data from a recent fieldwork in an intensive care unit, the author identifies the different epistemic circumstances that originate from the entanglement of the multiple territories of knowledge at stake in any ethnography of complex organizations.

The analysis shows how the participants’ relative access to knowledge and rights to claim it vary according to the circumstances and the unfolding of the interaction. The discussion advances that the ethnographer oscillates between “being abroad” and “being at home” as if he was constantly moving between the two classical positions of ethnographic work: making the familiar strange as it is typical of ethnographies focusing on the “very ‘ordinariness’ of normality” (Ybema et al., 2009, p. 2), and making the strange familiar as it is typical of anthropologists studying exotic communities.

The paper contributes to the still ongoing debate on “at home” organizational ethnography, by addressing the limits of the “insider doctrine” (Merton, 1972) that still pervades contemporary ethnography and proposes cognitive oscillation as the challenging mindset of any ethnographer-in-the-field.

Healthcare-associated infections (HAIs) are a major cause of concern because of the high levels of associated morbidity, mortality, and cost. In addition, children and intensive care unit (ICU) patients are more vulnerable to these infections due to low levels of immunity. Various medical interventions and statistical process control techniques have been suggested to counter the spread of these infections and aid early detection of an infection outbreak. Methods such as hand hygiene help in the prevention of HAIs and are well-documented in the literature. This chapter demonstrates the utilization of a systems methodology to model and validate factors that contribute to the risk of HAIs in a pediatric ICU. It proposes an approach that has three unique aspects: it studies the problem of HAIs as a whole by focusing on several HAIs instead of a single type, it projects the effects of interventions onto the general patient population using the system-level model, and it studies both medical and behavioral interventions and compares their effectiveness. This methodology uses a systems modeling framework that includes simulation, risk analysis, and statistical techniques for studying interventions to reduce the transmission likelihood of HAIs.