Preface

BackgroundAntimicrobial resistance (AMR) has become an emerging issue in the developing countries as well as in Bangladesh. AMR is aggravated by irrational use of antimicrobials in a largely unregulated pluralistic health system. This review presents a ‘snap shot’ of the current situation including existing policies and practices to address AMR, and the challenges and barriers associated with their implementation.MethodsA systematic approach was adopted for identifying, screening, and selecting relevant literature on AMR situation in Bangladesh. We used Google Scholar, Pubmed, and Biomed Central databases for searching peer-reviewed literature in human, animal and environment sectors during January 2010-August 2019, and Google for grey materials from the institutional and journal websites. Two members of the study team independently reviewed these documents for inclusion in the analysis. We used a ‘mixed studies review’ method for synthesizing evidences from different studies.ResultOf the final 47 articles, 35 were primary research, nine laboratory-based research, two review papers and one situation analysis report. Nineteen articles on human health dealt with prescribing and/or use of antimicrobials, five on self-medication, two on non-compliance of dosage, and 10 on the sensitivity and resistance patterns of antibiotics. Four papers focused on the use of antimicrobials in food animals and seven on environmental contamination. Findings reveal widespread availability of antimicrobials without prescription in the country including rise in its irrational use across sectors and consequent contamination of environment and spread of resistance. The development and transmission of AMR is deep-rooted in various supply and demand side factors. Implementation of existing policies and strategies remains a challenge due to poor awareness, inadequate resources and absence of national surveillance.ConclusionAMR is a multi-dimensional problem involving different sectors, disciplines and stakeholders requiring a One Health comprehensive approach for containment.

The irrational use of medicines is strongly influenced by issues such as self-medication, advertising and biased advertising. According to the World Health Organization (WHO), antimicrobials have often been used inappropriately, without observing some criteria, such as: time of use, suggested effective dosage, correct indications, among others, can accelerate the defense mechanisms of bacteria, causing the drug to lose its efficiency. Bacterial resistance is a global health problem, rapidly growing and with varying prevalence between countries, and increasingly becoming a serious problem. The irrational use of antimicrobials can lead to bacteria adapting and multiplying, increasing and promoting antibiotic resistance. Under the practice of storing medicines, it was observed that, according to the data obtained from the forms, in Teixeirópolis, approximately 78%, that is, 39 people interviewed, out of a total of 50, have the habit of storing medicines at home, while in Mirante da Serra 42 (84%) interviewees stated that they do this practice and in the municipality of Ji-Paraná 81 (81%) of the 100 interviewees. Therefore, it is important that there are always permanent actions aimed at health education, which are of a practical and effective nature, capable of involving the entire community so that situations such as the one described in our study are minimized.

The irrational use of antibiotics in aquaculture represents a growing threat to public health, due to the risk of the emergence of resistant bacteria. In this context, the present study aims to assess the knowledge, attitudes, and practices of fish farmers in the peri-urban area of Bobo-Dioulasso in Burkina-Faso regarding the use of antibiotics in fish farms. A descriptive cross-sectional study was conducted among 46 fish farmers selected through convenient purposive sampling. The sampling was exhaustive and took place from January to June 2025. Data was collected using a structured questionnaire based on the World Health Organization (WHO)/World Organisation for Animal Health guidelines. The results indicate that fish farmers’ knowledge of antibiotics and their effects shows a significant gap. The majority (84.8%) are unaware of the risks associated with the irrational use of antimicrobials, particularly antimicrobial resistance. Observed attitudes reveal a low perception of the danger: although some fish farmers recognize the importance of veterinary advice, most do not consider systematic involvement of veterinarians in treatments necessary. Regarding practices, 45.7% of fish farmers use antibiotics, of whom 76.2% self-medicate. Furthermore, 81% source antibiotics from the informal market. These results highlight sanitary management that remains empirical and poorly regulated, fostering risky practices. The study recommends strengthening producer awareness, promoting good practices, strictly regulating antibiotic distribution, and better integrating veterinary services into the aquaculture production chain. Key words: Antimicrobial resistance, antibiotic use, fish farming, public health, Bobo-Dioulasso, Burkina Faso.

In December 2019, a novel coronavirus was identified in Wuhan City, Hubei Province, China and later the disease was named coronavirus disease 2019 (COVID-19). On March 11, 2020, the World Health Organization (WHO) officially announced that COVID-19 had reached global pandemic status. This article summarized the understanding of the etiology, pathogenesis, epidemiology, clinical characteristics, diagnosis, treatment, rehabilitation, and prevention and control measures of COVID-19 based on the available data and anti-epidemic experience in China.

Position statement of the Spanish Society of Paediatric Infectious Diseases on the introduction, implementation and assessment of antimicrobial stewardship programmes in paediatric hospitals

Background: Irrational use of antimicrobials poses a significant risk for public health by aggravating antimicrobial resistance. The aim of this repeated point prevalence survey (PPS) was to evaluate the impact of a carbapenem-focused antimicrobial stewardship program (ASP) on overall antimicrobial use and quality of antimicrobial prescribing during the COVID-19 pandemic. Methods: All adult inpatients in the University Hospital of Heraklion in Greece were audited twice, before and after the implementation of the ASP, in October 2019 and October 2020, respectively. Patient characteristics, indications and diagnoses for antimicrobial administration, antimicrobials prescribed, and compliance with treatment guidelines were recorded. Results: Of 743 adult inpatients on the days of the two surveys, 398 (53.6%) were on antimicrobials for 437 diagnoses. Following implementation of the ASP, there was substantial decrease in the utilization of carbapenems (4.9% of all antibacterials prescribed in the second PPS compared to 10.3% in the first PPS). A significant improvement was observed for all indicators of the quality of antimicrobial prescribing. Conclusions: Our study demonstrated a positive impact of an ASP implementation during the first stages of the COVID-19 pandemic on reducing the use of last-line antimicrobials and improving overall quality of antimicrobial prescribing.

ABSTRACTObjectives.To determine the proportion of Salmonella enterica in fecal samples of live pigs with suspected salmonellosis analyzed at the diagnostic unit of the University of Antioquia, Colombia between 2019 and 2021, and examine the serotypes and antimicrobial resistance patterns.Methods.This was a laboratory-based cross-sectional study of routine data on fecal samples received from pig farms in all nine subregions of Antioquia state, Colombia. Salmonella spp. detection at the university is done using enrichment, selective culture, and polymerase chain reaction. Serotypes were identified using the Kauffmann–White scheme and isolates were tested for antimicrobial susceptibility using broth microdilution.Results.Of 653 samples tested, 149 (23%) were positive for S. enterica. Nine serotypes were identified. The most common were Salmonella Typhimurium (56%) and its monophasic variant (35%). Resistance to ampicillin (70%) was most frequently observed, followed by ciprofloxacin (55%), and sulfamethoxazole–trimethoprim (52%). No isolates were resistant to amikacin and gentamicin. Multidrug resistance (resistance to ≥ 3 classes of antibiotics) was observed in 61 (44%) isolates. Multidrug resistance was highest in S. Typhimurium (57%) compared with the other serotypes. Serotype was associated with multidrug resistance (p = 0.01), but age of the pig and sub-region were not.Conclusions.The proportion of Salmonella spp. and the associated high levels of multidrug resistance are of concern and may indicate irrational use of antimicrobials and poor management practices in pig production systems in the region. Strengthened surveillance is needed to monitor and improve farm management practices and the use of antimicrobials in farms in Colombia.

The pressure of the COVID-19 pandemic on healthcare systems led to limited roles of infectious diseases services, increased rates of irrational use of antimicrobials, and incidence of infections by multidrug-resistant microorganisms. The aim of the present study is to evaluate the incidence of antimicrobial resistance and the management of bloodstream infections before and during the COVID-19 pandemic at the University General Hospital of Alexandroupolis (Greece). This is a retrospective study conducted from January 2018 to December 2022. Data were collected from the University Microbiology Laboratory per semester regarding the isolated strains of Gram-positive and -negative bacteria in blood cultures and respiratory samples in hospitalized patients in medical and surgical wards and in the intensive care unit (ICU). Additionally, bloodstream infections with requested infectious disease consultations were reported (n = 400), determining whether these were carried out via telephone contact or at the patient's bedside. Demographic data, comorbidities, focus of infection, antimicrobial regimen, duration of treatment, length of hospitalization, and clinical outcome were analyzed. A total of 4569 strains of Gram-positive and -negative bacteria were isolated. An increasing trend was reported compared to the pre-pandemic period in the incidence of resistant Gram-negative bacteria, particularly in ICUs. Prior antimicrobial use and the rate of hospital-acquired infections were increased significantly during the pandemic. In the pre-pandemic period 2018-2019, a total of 246 infectious disease consultations were carried out, while during the period 2020-2022, the number was 154, with the percentage of telephone consultations 15% and 76%, respectively. Detection of the source of infection and timely administration of appropriate antimicrobial agents were more frequently recorded before the pandemic, and 28-day mortality was significantly reduced in cases with bedside consultations. The empowering of infectious disease surveillance programs and committees, rational use of antimicrobials agents, and bedside infectious disease consultations are vital in order to reduce the impact of infections caused by multidrug-resistant strains.

Self-medication is a global phenomenon and potential contributor to human pathogen resistance to antibiotics. The adverse consequences of such practices should always be emphasized to the community and steps to curb it. Rampant irrational use of antimicrobials without medical guidance may result in greater probability of inappropriate, incorrect, or undue therapy, missed diagnosis, delays in appropriate treatment, pathogen resistance and increased morbidity. This review focused on the self-medication of allopathic drugs, their use, its safety and reason for using it. It would be safe, if the people who are using it, have sufficient knowledge about its dose, time of intake, side effect on over dose, but due to lack of information it can cause serious effects such as antibiotic resistance, skin problem, hypersensitivity and allergy. There is need to augment awareness and implement legislations to promote judicious and safe practices. Improved knowledge and understanding about self-medication may result in rationale use and thus limit emerging microbial resistance issues. Articles which were published in peer reviewed journals, World Self-Medication Industry and World Health Organization websites relating to self-medication reviewed.

Background and aim: Nigeria, being the most populous country in Africa, faces a significant burden of antimicrobial resistance (AMR). This article aims to highlight the need for all sectors in One Health, including human and animal health, to work together in reducing the misuse of antimicrobials in Nigeria. Methodology: Past and present articles were systematically searched on electronic databases such as Google Scholar, ResearchGate, and PubMed within 10 years (2013–2023). Rayyan software was used for screening the articles. After the first screening, 100 (n = 100) articles met our inclusion criteria, while 63 articles were excluded. A total of 37 articles that met the objectives of this study were finally used. Results: There is irrational use of antimicrobials in Nigeria. A high prevalence of AMR was found in Nigeria. Results of a national survey of public awareness of AMR in Nigeria showed that about one-third of the general public uses antibiotics without a prescription. Poor knowledge, attitude, and practice of One Health towards AMR were found in most parts of Nigeria. Conclusion: To avert the escalation of AMR to critical levels within Nigeria, the Nigerian government and the general public need to work together in the spirit of self-reliance and honesty to take prompt, decisive, and substantive actions towards AMR control in Nigeria. One Health impact statement Combating antimicrobial resistance (AMR) has always involved the need for a One Health approach. This article aims to highlight the need for all sectors in One Health, including human and animal health, to work together in reducing the misuse of antimicrobials in Nigeria. The Nigeria Centre for Disease Control (NCDC), in 2017, launched a plan that utilizes a One Health approach in solving AMR. The plan included surveillance of antimicrobial use in One Health sector, scaling up vaccination in both humans and animals and improving the capacity of regulatory agencies across One Health sector (Nigeria Centre for Disease Control (NCDC), 2017 ). Though enforcement of these plans in Nigeria is still underway, Nigeria is still plagued with AMR as it received a score of 2.4 out of 5 in a recent evaluation (Abujah, 2023 ). This review aims to reiterate the importance of a One Health approach and highlights the progress of AMR eradication in Nigeria.

The discovery of the first antimicrobial was the beginning of the development of numerous antimicrobials. However, proportionately the amplitude of this therapeutic arsenal, its consumption has become excessive and inadequate, leading to the current situation, in which the resistance of bacteria to these drugs has been making difficult the pharmacotherapy of infectious diseases. Thus, the study of the consumption of these drugs must be carried out so that strategies are developed in the fight against the irrational use of antimicrobials. Therefore, the objective of this study is to evaluate the consumption of antimicrobials for therapeutic and prophylactic purposes in a hospital of high complexity for a period equivalent to one year, as well as of their respective sectors of hospitalization. Therefore, it was decided to carry out a study observational, retrospective, descriptive and cross-sectional study at Hospital das Clnicas of the Medical School of Ribeiro Preto -USP with hospitalized adult patients who received antimicrobial prescription during the year 2014. The data collection will be performed through the hospital's electronic information systems. Thus, the data collected consisted of patient registration, sociodemographic information, patient hospitalization information, culture and antibiogram examination results, and information on antimicrobial prescription. Descriptive analysis of sociodemographic data, hospitalization, test results, and antimicrobial prescription was done by means of summary measures (mean and standard deviation) and absolute and relative frequency distribution. The comparison of the means of consumption between the prophylaxis vs treatment groups and empirical x direct treatment was done by the Student t test for dependent samples. The Principal Component Analysis and Hierarchical grouping analysis were tools used for the exploratory analysis of prophylatic antimicrobial consumption. We found 7287 with 90475 antimicrobial prescriptions (between prophylactic prescriptions, empirical and targeted therapy). The consumption of prophylactic antimicrobials covers 11.69% of all consumption of these drugs, and more than half of this consumption comes from orthopedics, a postoperative intensive care unit and a postoperative chest and cardiovascular unit. In addition, cefazolin was the Most commonly used medication for prophylaxis (52%). Among the consumption for the treatment, 84% happened in an empirical way with the use of broad-spectrum antimicrobial agents. When looking at the antimicrobials used in a targeted manner, we highlight the appearance of oxacillin, polymyxin B and aminoglycosides. In view of the results, there is a high prophylaxis of antimicrobial use in some hospitalization sectors, in addition to a greater proportion of consumption in empirical treatment, so further investigations should be made to understand the behavior of this excess in the use of these drugs.

BackgroundAntimicrobials and anthelmintics are the most commonly used veterinary drugs to control animal diseases. However, widespread use of these drugs could contribute to the emergence of drug resistance. Information on the practice of antimicrobial usage among food animal raising communities in Central Ethiopia is scarce. We used a standardised questionnaire survey to assess knowledge, awareness, and practices related to drug use and resistance in food animals among the farmers in and around Bishoftu town.ResultsOf the total of 220 livestock owners interviewed, around 80% of the respondents were not able to define what antimicrobials are and for what purposes they are used. Only 14.1% (n = 31) of the respondents had awareness about antimicrobial resistance (AMR) and its consequences; and 35.5% (n = 11/31) and 9.7% (n = 3/31) of them agreed that the irrational use of antimicrobials in animals could lead to AMR in animals and humans. Oxytetracycline was the most commonly available antibiotic in veterinary drug shops/pharmacies and the most widely used drug in the area. However, 43.3% of the respondents did not see clinical improvements after using antibiotics. Similarly, the respondents explained that no response was observed in 73.3, 70.8 and 52.5% of the cases after medication with anthelmintics, antiprotozoal and acaricides, respectively. About 56.7% of the respondents considered traditional medicines equally important to modern medicines. It was also noted that there were illegal drug vendors, dispensing medicines under unfavourable conditions which include a direct exposure to sunlight, which practice violates the drug handling and storage recommendations given by WHO.ConclusionThe study revealed that there is a general lack of awareness among food animal owners about the correct use of antibiotics and anthelmintics. The widespread misuse and improper drug dispensing and handling practices observed in this study can affect the drug quality and can also contribute to the development of drug resistance in central Ethiopia.

The comsumption of antibiotics is high, mainly in intensive care units. Unfortunately, most are inappropriately used leading to increased multi-resistant bacteria. It is well known that initial empirical therapy with broad-spectrum antibiotics reduce mortality rates. However the prolonged and irrational use of antimicrobials may also increase the risk of toxicity, drug interactions and diarrhea due to Clostridium difficile. Some strategies to rational use of antimicrobial agents include avoiding colonization treatment, de-escalation, monitoring serum levels of the agents, appropriate duration of therapy and use of biological markers. This review discusses the effectiveness of these strategies, the importance of microbiology knowledge, considering there are agents resistant to Staphylococcus aureus and Klebsiella pneumoniae, and reducing antibiotic use and bacterial resistance, with no impact on mortality.

BackgroundAntimicrobial misuse and overuse propagate antimicrobial resistance, yet data on factors influencing antibiotic prescription decisions in low-resource settings are limited. We describe factors influencing antimicrobial prescription at a large tertiary care private not-for-profit hospital in Uganda.MethodsWe conducted a descriptive phenomenology qualitative study involving face-to-face in-depth interviews of 12 purposively selected prescribers (four intern doctors, six medical officers and two Internal Medicine physicians) in a private not-for-profit hospital in Kampala, Uganda. Audio recordings and filed notes were transcribed verbatim and analysed manually by content analysis. Emerging themes and sub-themes were recorded and reported.ResultsThree broad themes emerged: experience with antimicrobial use in Uganda, barriers and facilitators to rational antimicrobial prescription and measures to address irrational antimicrobial use. Participants recognized that antibiotics are often used irrationally, prescribed even when there is uncertainty regarding clinical evidence for infection, and influenced by drug promoters, and noted high levels of antibiotic resistance. Patients’ symptoms and clinical signs, previous experience using antibiotics, fear of bad outcomes, patient demand and expectations, influence from senior colleagues, the turnaround time of clinical investigations and drug marketers were the barriers and facilitators to antimicrobial prescription. Prescribers also acknowledged the need to update clinical guidelines, set up hospital antibiograms, and provide continuous medical education on rational antimicrobial use.ConclusionsA complex interplay of intrinsic and extrinsic factors influences antibiotic prescribing decisions in this hospital. Targeted interventions through continuous education and training for prescribers, providing local prescription guidelines and antibiograms and implementing regulations on over-the-counter antibiotic sales are needed to implement robust antimicrobial stewardship programmes to curb antimicrobial resistance successfully.

Presumptive treatment of infections often results in irrational antimicrobial use resulting in detrimental spread of drug resistance and untoward side effects. A rapid diagnostic test (RDT) is a test that delivers a result earlier than conventional testing methods employed in the past to identify the offending microorganism. RDTs help in early definitive therapy, reduction in hospital stay and cost, and in degree of morbidity and mortality associated with the infection. To select a proper RDT, one should consider how specific and sensitive the test is. Most RDTs gives a qualitative result not quantitative; hence disease severity, monitoring of the disease, prognostication and therapeutic efficacy cannot be assessed. A RDT should be easy to perform, should not require sophisticated machines, and kits should be stable in extremes of temperature. RDTs may be of immense help in remote places where conventional diagnostic facilities are unavailable or lack quality. RDTs hold promise of reasonable diagnostic accuracy if done in a optimal clinical background. They should never be ordered as a shotgun approach to exclude all possible infections but should be used judiciously with appropriate interpretation.