Antibiotic Resistance

Sewerage systems of villages, townships, cities and megacities convey the urine, stool, blood, and sputum of community members, enabling through analysis of community wastewater, a near real-time assessment of population health status and of emerging public health threats. Signature compounds and biomarkers targeted analytically for surveillance may include chemical and biological threat agents, transformation products of the same, human metabolites, biomarkers of exposure and other markers of interest. Additional information can be gleaned by analyzing, in a similar fashion, municipal sewage sludge resulting from wastewater treatment, a material that during treatment becomes enriched in persistent, hydrophobic and potentially bioaccumulative pollutants, while more biodegradable compounds are converted to methane mostly. When taken together, these multi-dimensional data sources promise to yield critical information on the health status, sustainability and resilience of rural and urban human populations in a new scientific approach termed population metabolism metrology, or for city environments, urban metabolism metrology.

Objective: To highlight the new science of population and urban metabolism metrology, for characterizing human exposures to biological agents, narcotics, antimicrobials and other contaminants of emerging concern using community wastewater as a diagnostic matrix.

The emerging threat of antimicrobial resistant organisms is a pressing public health concern. Surveillance for antimicrobial resistance can prevent infections, protect patients in the healthcare setting and improve antimicrobial use. In 2018, the Utah Department of Health mandated the reporting of antimicrobial susceptibility panels performed on selected organisms. Utah utilizes the Electronic Message Staging Area (EMSA), a home-grown application to translate, process, and enter electronic laboratory results into UT-NEDSS, Utah'™s integrated disease surveillance system. Processing these results electronically is challenging due to the need to interpret results based on the antimicrobial agent combined with the organism it was performed on. The receipt of antimicrobial susceptibility panels has required enhancements to EMSA for these results to be automatically processed.

Objective: Illustrate how the Utah Department of Health automatically processes antimicrobial susceptibility results that are received electronically

Antimicrobial stewardship is crucial to the ongoing viability of existing therapies. To facilitate this stewardship, NHSN allows hospitals to submit data on their antimicrobial usage and receive feedback on how their usage compares to other facilities.1 This feedback can be used by hospital personnel to assess whether their antimicrobial policies are consistent with current best practices. Participation in this program has so far been limited. There are several barriers to participating, including the challenge of mapping local medication information to the NHSN list of antimicrobials, the burden of tabulating the necessary statistics, and the technical requirements of generating appropriate CDA documents for submission. An automated solution that obtained the necessary data from existing HL7 interfaces and generated CDA documents in the correct format could significantly lower some of the barriers to submitting antimicrobial usage information to NHSN.

Objective: To leverage existing healthcare transaction messages to automate the aggregation of antimicrobial usage statistics in a method compatible with submission to the National Healthcare Safety Network (NHSN) Antimicrobial Usage module.

India carries the highest burden of Enteric Fever in the world. This is further aggravated by the high prevalence of antimicrobial resistance (AMR) in typhoidal Salmonellae. The strategy to combat resistance has been to combine and cycle anti-microbials based on the regional AMR pattern of the organism. But this requires that resistance patterns and genetic mechanisms are mapped at a regional level and regularly recorded and disseminated by a national surveillance system.

Objective: To report on (i) the health care eco-system that produces data on AMR, and (ii) pattern of resistance in typhoidal Salmonellae isolates in the city of Ahmedabad in western India.

Antibiotic resistance is a mounting public health threat calling for action on global, national and local levels. Antibiotic use has been a major driver of increasing rates of antibiotic resistance. This has given rise to the practice of antibiotic stewardship, which seeks to reduce unnecessary antibiotic use across different care settings. Antibiotic stewardship has been increasingly applied in hospital settings, but adoption has been slow in many ambulatory care settings including primary care of humans. Uptake of antibiotic stewardship in veterinary care has been similarly limited. Audit and feedback systems of antibiotic use coupled with patterns of antibiotic use and best practice guidelines have proven useful in outpatient settings, but scale-up is limited by heterogeneous systems of care and limited resources.

Objective: To develop, evaluate, and implement a universal online platform - termed OPEN Stewardship - to promote responsible antimicrobial prescribing (antimicrobial stewardship).

It is increasingly critical to test antibiotics on local bacterial strains, due to the continuously growing resistance of microflora to extensively administered antibacterial medications. For this study, we examined the development of antimicrobial resistance of Salmonellae collected in Uzbekistan through 1998 versus those collected in 2008.

Objective

We tested local bacterial strains' resistance to antibiotics at both a broad selection and range of commercial preparations.

Methicillin Resistant Staphylococcus Aureus (MRSA) is a strain of Staphylococcus aureus resistant to methicillin/oxacillin. The high incidence of resistance to most commonly used antibiotics including carbapenems and cephalosporins among strains of MRSA present challenges to the management of cases. Vancomycin has been identified as a common antibiotic with demonstrated activity against MRSA. In most developing countries including Ghana, MRSA is not regarded as an issue of public health importance. It is not among the priority diseases under surveillance in Ghana. Active efforts at identifying cases and instituting appropriate preventive measures are largely non-existent. This is due to the unavailability of laboratories with requisite human resource and logistics to run tests for MRSA. This has further compounded the perception of non-importance with respect to MRSA in developing countries. We therefore set out to review cases of MRSA seen in a Teaching Hospital in Ghana to estimate the burden of the infection and to examine the trends in antibiotic sensitivity and clinical outcome of cases.

Objective

To review laboratory and clinical data on cases of Methicillin Resistant Staphylococcus aureus infections.

Despite decades of attempts to promote judicious AU, the US has high rates of per-person antimicrobial consumption, and extremely high rates of carbapenem use. Such profligate use is a key factor in the high rate of antimicrobial-resistant infections seen in US healthcare facilities. Antimicrobial stewardship (AS) programs have been identified as a critical component of intervention strategies. A core component of AS programs is tracking AU, which is needed to monitor trends in use, focus interventions on aberrant behaviors, promote judicious use, and evaluate the effectiveness of interventions. A system designed to extend two national data models would provide a scalable platform for rapid adoption of AU reporting.

Objective:

Plan, develop, and pilot an open source system that could be integrated into the PCORnet (PCORI) and Sentinel (FDA) national common data models (CDMs) to generate antimicrobial use (AU) reports submittable to CDC’s National Healthcare Safety Network (NHSN). The system included ancillary tables, and data quality and report generation queries. The DataMIME system will allow hospitals to generate comparable AU reports for hospital inpatients.