Resetting the agenda for antibiotic resistance through a health systems perspective

Cars, Otto; Chandy, Sujith J; Mpundu, Mirfin; Peralta, Arturo Quizhpe; Zorzet, Anna; So, Anthony D.

doi:10.1016/s2214-109x(21)00163-7

Cited by 52 publications

(46 citation statements)

References 26 publications

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“…can be used as components of the reaction mixture and extractants [32][33][34][35][36]. In recent years, the issue of the accumulation of antibiotics in the environment has been of concern to the World Health Organization (WHO) and the expert scientific community, as it is one of the reasons for the emergence of antibiotic-resistant bacteria resistant and resistant genes, which are increasingly threatening to human health and life [37,38]. Antibiotics enter the environment with wastewater from pharmaceutical and food industries, fish farming and animal husbandry, and household and medical wastewater.…”

Section: Introductionmentioning

confidence: 99%

Recovery of Model Pharmaceutical Compounds from Water and Organic Solutions with Alginate-Based Composite Membranes

2022

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In this work, we combined the non-solvent induced phase separation (NIPS) and further cross-linking by cations towards the preparation of nanofiltration membranes based on sodium alginate, a biodegradable, natural polymer. Acetone, ethanol, toluene, and hexane were used as non-solvents, and cations of calcium, silver, and aluminum—for polymer cross-linking, respectively. Results showed the precipitation strength of non-solvent played a noticeable role in the membrane’s performance; for instance, the toluene permeability changed by four orders of magnitude with the decrease of precipitation strength of the non-solvent: acetone (Ptoluene = 0.1 kg∙m−2∙h−1∙bar−1) < ethanol (3 kg∙m−2∙h−1∙bar−1) < hexane (41 kg∙m−2∙h−1∙bar−1) < toluene (415 kg∙m−2∙h−1∙bar−1). It was shown that simultaneous precipitation and crosslinking in aqueous solutions AlCl3 or AgNO3 must be used in the preparation of alginate membranes for the highly selective recovery of pharmaceutical compounds from organic media. These membranes show rejection R = 90–93% of substances with MW = 626 g/mol and ethanol permeability PEtOH = 1.5–2.5 kg∙m−2∙h−1∙bar−1. For the highly selective recovery of pharmaceutical compounds from water, the method of obtaining membranes must be changed. Precipitation in toluene and then crosslinking in aqueous solutions of AlCl3 or AgNO3 must be used sequentially instead of simultaneous precipitation and crosslinking in aqueous solutions of the same inorganic salts. The permeability of such membranes varied from 0.44 to 7.8 kg∙m−2∙h−1∙bar−1 depending on the crosslinking cation in the alginate. The rejection of model substances with MW 350 and 626 g/mol were on the level of 99%. Alginate membranes can be used to solve separation problems in the pharmaceutical field, for example, to isolate antibiotics from their extractants and remove the same antibiotics from aqueous pharmaceutical waste to prevent their accumulation in the environment and the emergence of resistant genes and bacteria.

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Section: Introductionmentioning

confidence: 99%

Recovery of Model Pharmaceutical Compounds from Water and Organic Solutions with Alginate-Based Composite Membranes

2022

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“…In addition, overall expenditure on antibiotics decreased. From our point of view, the interprofessional collaboration led to an enhanced understanding of the "silent pandemic" [34] of antibiotic resistance and how it can be addressed from a health systems perspective beyond disciplines and professions. The value of the hospital pharmacist in antibiotic stewardship has been highlighted before [19,[35][36][37].…”

Section: Discussionmentioning

confidence: 99%

Interprofessional Collaboration between ICU Physicians, Staff Nurses, and Hospital Pharmacists Optimizes Antimicrobial Treatment and Improves Quality of Care and Economic Outcome

et al. 2022

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(1) Background: Antibiotic resistance is a worldwide health threat. The WHO published a global strategic plan in 2001 to contain antimicrobial resistance. In the following year, a workshop identified crucial barriers to the implementation of the strategy, e.g., underdeveloped health infrastructures and the scarcity of valid data as well as a lack of implementation of antibiotic stewardship (ABS) programs in medical curricula. Here, we show that interprofessional learning and education can contribute to the optimization of antibiotic use and preserving antibiotic effectiveness. We have initiated interprofessional rounds on a medical intensive care unit (MICU) with a focus on gastroenterology, hepatology, infectious diseases, endocrinology, and liver transplantation. We integrated ICU physicians, hospital pharmacists, nursing staff, and medical students as well as students of pharmacy to broaden the rather technical concept of ABS with an interprofessional approach to conceptualize awareness and behavioral change in antibiotic prescription and use. Methods: Clinical performance data and consumption figures for antibiotics were analyzed over a 10-year period from 2012 to 2021. The control period covered the years 2012–2014. The intervention period comprised the years 2015–2021, following the implementation of an interprofessional approach to ABS at a MICU of a German university hospital. Data from the hospital pharmacy, hospital administration, and hospital information system were included in the analyses. A specific electronic platform was developed for the optimization of documentation, interprofessional learning, education, and sustainability. The years 2020 and 2021 were analyzed independently due to the SARS-CoV-2 pandemic and the care of numerous COVID-19 patients at the MICU. Results: Implementation of an interprofessional ABS program resulted in the optimization of antibiotic management at the MICU. The suggestions of the hospital pharmacist for optimization can be divided into the following categories (i) indication for and selection of therapy (43.6%), (ii) optimization of dosing (27.6%), (iii) drug interactions (9.4%), (iv) side effects (4.1%), and (v) other pharmacokinetic, pharmacodynamic, and pharmacoeconomic topics (15.3%). These suggestions were discussed among the interprofessional team at the MICU; 86.1% were consequently implemented and the prescription of antibiotics was changed. In addition, further analysis of the intensive care German Diagnosis Related Groups (G-DRGs) showed that the case mix points increased significantly by 31.6% during the period under review. Accordingly, the severity of illness of the patients treated at the ICU as measured by the Simplified Acute Physiology Score (SAPS) II increased by 21.4% and the proportion of mechanically ventilated patients exceeded 50%. Antibiotic spending per case mix point was calculated. While spending was EUR 60.22 per case mix point in 2015, this was reduced by 42.9% to EUR 34.37 per case mix point by 2019, following the implementation of the interprofessional ABS program on the MICU. Through close interprofessional collaboration between physicians, hospital pharmacists, and staff nurses, the consumption of broad-spectrum antibiotics, e.g., carbapenems, was significantly reduced, thus improving patient care. In parallel, the case mix and case mix index increased. Thus, the responsible use of resources and high-performance medicine are not contradictory. In our view, close interprofessional and interdisciplinary collaboration between physicians, pharmacists, and nursing staff will be of outstanding importance in the future to prepare health care professionals for global health care to ensure that the effectiveness of our antibiotics is preserved.

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“…This toll on the healthcare system, along with the resultant social and economic turbulences, highlights the importance of pandemic preparedness. Although public health experts believe that respiratory-borne RNA viruses, such as the corona and influenza viruses, are most likely to cause naturally occurring global infectious catastrophes [2], the rapid emergence of bacterial and fungal infections associated with antimicrobial resistance (AMR) also sound the alarm for widespread deadly infections caused by these microorganisms and remain an ongoing priority for risk preparedness [3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Non-Canonical Host Intracellular Niche Links to New Antimicrobial Resistance Mechanism

et al. 2022

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Globally, infectious diseases are one of the leading causes of death among people of all ages. The development of antimicrobials to treat infectious diseases has been one of the most significant advances in medical history. Alarmingly, antimicrobial resistance is a widespread phenomenon that will, without intervention, make currently treatable infections once again deadly. In an era of widespread antimicrobial resistance, there is a constant and pressing need to develop new antibacterial drugs. Unraveling the underlying resistance mechanisms is critical to fight this crisis. In this review, we summarize some emerging evidence of the non-canonical intracellular life cycle of two priority antimicrobial-resistant bacterial pathogens: Pseudomonas aeruginosa and Staphylococcus aureus. The bacterial factors that modulate this unique intracellular niche and its implications in contributing to resistance are discussed. We then briefly discuss some recent research that focused on the promises of boosting host immunity as a combination therapy with antimicrobials to eradicate these two particular pathogens. Finally, we summarize the importance of various strategies, including surveillance and vaccines, in mitigating the impacts of antimicrobial resistance in general.

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Resetting the agenda for antibiotic resistance through a health systems perspective

Cited by 52 publications

References 26 publications

Recovery of Model Pharmaceutical Compounds from Water and Organic Solutions with Alginate-Based Composite Membranes

Recovery of Model Pharmaceutical Compounds from Water and Organic Solutions with Alginate-Based Composite Membranes

Interprofessional Collaboration between ICU Physicians, Staff Nurses, and Hospital Pharmacists Optimizes Antimicrobial Treatment and Improves Quality of Care and Economic Outcome

Non-Canonical Host Intracellular Niche Links to New Antimicrobial Resistance Mechanism

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