Ensuring Antibiotic Development, Equitable Availability, and Responsible Use of Effective Antibiotics: Recommendations for Multisectoral Action

Monnier, Annelie A; Schouten, Jeroen; Tebano, Gianpiero; Zanichelli, Veronica; Huttner, Benedikt; Pulcini, Céline; Årdal, Christine; Harbarth, Stéphan Juergen; Hulscher, Marlies; Gyssens, Inge C.

doi:10.1093/cid/ciy824

Cited by 11 publications

(4 citation statements)

References 27 publications

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“…For instance, regarding deaths caused by AMR, methicillin was the primary antibiotic class in high-income Asia Paci c. In southern sub-Saharan Africa, carbapenems was the second-ranked antibiotic class, while in other sub-Saharan Africa areas (central, eastern, and western), third-generation cephalosporins was the second-ranked antibiotic class. This discrepancy may be due to differences in the availability and affordability of different antibiotics in regions with differing economic development [33]. Additionally, factors such as awareness and knowledge of appropriate antimicrobial use, sanitation and hygiene practices, and government regulation might also in uence the use and resistance of antibiotics [34].…”

Section: Discussionmentioning

confidence: 99%

Global and regional burden of bacterial antimicrobial resistance in endocarditis in 2019: a systematic analysis

He,

Zhao,

Han

et al. 2024

Preprint

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Background The burden of endocarditis has sharply increased and antimicrobial resistance (AMR) poses an urgent threat to human health worldwide. There are currently no detailed data about the burden of bacterial AMR in endocarditis. This study aimed to comprehensively investigate the AMR burden of endocarditis to date. Methods We obtained data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). We estimated deaths, disability-adjusted life-years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) attributable to and associated with bacterial AMR in endocarditis for 7 GBD super-regions, 21 regions, 16 bacterial pathogens, 14 antibiotic classes, and 68 pathogen-antibiotic combinations in 2019. Five broad components were the backbone of our approach and the estimates were based on two counterfactual scenarios: drug-susceptible infection and no infection. Results Globally, there were 16.37 thousand deaths (95% uncertainty interval [UI]: 11.54–23.05) attributed to and 65.59 thousand deaths (95% UI: 47.15–91.12) associated with bacterial AMR in endocarditis in 2019. The all-age death rates were higher in central Europe and high-income regions, and lower in sub-Saharan Africa. Escherichia coli, Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae played the dominant roles in AMR, and high resistance to various multiple antibiotics, including fluoroquinolones, carbapenems, third-generation cephalosporins, and methicillin. There were 2 pathogen-antibiotic combinations that caused more than 1000 resistance-attributable deaths: methicillin-resistant Staphylococcus aureus and carbapenem-resistant Acinetobacter baumannii. Conclusions AMR in endocarditis is a non-ignorable health problem, and it is an urgent priority to identify tailored strategies that can effectively reduce the burden of bacterial AMR in endocarditis based on region-specific pathogen-antibiotic condition and resources.

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Section: Discussionmentioning

confidence: 99%

Global and regional burden of bacterial antimicrobial resistance in endocarditis in 2019: a systematic analysis

He,

Zhao,

Han

et al. 2024

Preprint

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“…For instance, in terms of deaths attributable to AMR, the second-ranked antibiotic class in Australasia was β-lactam or β-lactamase inhibitors, and the third-ranked antibiotic class was trimethoprim/sulfamethoxazole in four sub-Saharan Africa areas (central, eastern, southern, and western). This discrepancy may be caused by variations in the availability and affordability of different antibiotics in regions with different levels of economic development [ 23 ]. Moreover, other factors such as the awareness and knowledge of appropriate use of antimicrobials, government regulation, and sanitation and hygiene might also influence the use and resistance of antibiotics in one region [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Global and Regional Burden of Bacterial Antimicrobial Resistance in Urinary Tract Infections in 2019

Fan

et al. 2022

JCM

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Background: There are still no detailed data about the burden of bacterial antimicrobial resistance (AMR) in urinary tract infections (UTI). Concrete knowledge of global and regional bacterial AMR data is crucial for developing informed programs and policies to control bacterial AMR and for prudent use of antibiotics to optimize antibiotic therapy in patients with UTI. This study aimed to provide comprehensive global and regional estimates for the AMR burden of UTI in 2019. Methods: Data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), including death, disability-adjusted life-years (DALYs), year lived with disability (YLD), and years of life lost (YLL) for bacterial AMR in UTI for 7 GBD super-regions, 21 regions, 14 pathogens, 13 antibiotic classes, and 66 pathogen-antibiotic combinations in 2019. The estimates were based on two counterfactual scenarios: drug-susceptible infection and no infection. Results: Globally, there were 64.89 thousand deaths (95% uncertainty interval [UI]: 45.86–93.35) attributed to and 0.26 million deaths (95% UI: 0.18–0.36) associated with bacterial AMR in UTI in 2019. Among regions, the all-age death rates were higher in southern Latin America, tropical Latin America, and Europe and lower in sub-Saharan Africa. Escherichia coli and Klebsiella pneumoniae accounted for more than 50% of deaths attributable to and associated with AMR, and resistance was high among multiple types of antibiotic class, including fluoroquinolones, carbapenems, and third-generation cephalosporins. There were 2 pathogen-drug combinations that caused more than 6000 resistance-attributable deaths: third-generation cephalosporin-resistant Escherichia coli and fluoroquinolone-resistant Escherichia coli. Conclusions: AMR in UTI is an unignorable health problem, both for the management of urology disease and for global antibiotic resistance. Special tailored strategies, including enhanced surveillance and rational use of antibiotics, should be developed for different regions according to the region-specific pathogen-antibiotic situations and resources.

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“…In all countries, it may be the case that certain communities do not receive appropriate and equitable access to antimicrobials. 34,35 The concepts of responsible use and equitable access are inextricably linked, and the focus should be on facilitating equitable access to the right antimicrobial, at the right time, based on clinical need. Shortages of antimicrobials can drive AMR, as prescribers have to resort to less-effective treatments, 36 or to a broader spectrum of antimicrobial than is necessary.…”

Section: -Equitymentioning

confidence: 99%

A governance framework for development and assessment of national action plans on antimicrobial resistance

Anderson

Schulze

Cassini

et al. 2019

The Lancet Infectious Diseases

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Strengthening governance is an essential strategy to tackling antimicrobial resistance (AMR) at all levels; global, national, regional and local. To date, no systematic approach to governance of AMR national action plans (NAPs) exists. To address this, we aimed to develop the first governance framework to offer guidance for both the development and assessment of AMR national action plans (NAPs). We reviewed health system governance framework reviews to inform the basic structure of our framework, international guidance documents from the WHO, FAO, OIE and the EU, and sought the input of over 25 experts from international organizations, government ministries, policy institutes and academic institutions to develop and refine our framework. The framework consists of 18 domains with 52 indicators that are contained within three governance areas: "policy design", "implementation tools", and "monitoring and evaluation". To consider the dynamic nature of AMR, the framework is conceptualized as a cyclical process, which is responsive to the context and allows for continuous improvement and adaptation of AMR NAPs. Key messages • Antimicrobial Resistance (AMR) is one of the most pressing and complex issues today, with multi drug-resistant, extensively drug-resistant, and even pan drug-resistant organisms emerging. • AMR is driven by interrelated dynamics in the human, animal, and environmental health sectors, which makes governance challenging. • Strengthening governance of AMR policies at all levels; global, national, regional and local, is essential to tackling AMR. To date, no comprehensive framework for the governance of AMR National Action Plans (NAPs) has been developed. • To our knowledge, this is the first study that has developed a governance framework for AMR NAPs, based on a systematic review of the literature, international guidance, and over 20 experts from various international organizations, government ministries, policy institutes and academic institutions • The framework is conceptualized as a cyclical process between the three governance areas; policy design, implementation tools, and monitoring and evaluation.

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Ensuring Antibiotic Development, Equitable Availability, and Responsible Use of Effective Antibiotics: Recommendations for Multisectoral Action

Abstract: This viewpoint presents recommendations for lifting the barriers to antibiotic development, equitable availability of effective (existing and new) antibiotics and their responsible use. These recommendations should guide future multisectoral policy action.

Cited by 11 publications

References 27 publications

Global and regional burden of bacterial antimicrobial resistance in endocarditis in 2019: a systematic analysis

Global and regional burden of bacterial antimicrobial resistance in endocarditis in 2019: a systematic analysis

Global and Regional Burden of Bacterial Antimicrobial Resistance in Urinary Tract Infections in 2019

A governance framework for development and assessment of national action plans on antimicrobial resistance

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