Strengthening antimicrobial resistance diagnostics in National Reference Laboratories across One Health in South and Southeast Asia: impact of external quality assessment and targeted follow-up.

Objectives: The intent of this study was to evaluate and improve microbiology laboratory diagnostic capacity in selected National AMR Reference laboratories from South and Southeast Asia for AMR testing utilizing EQA and targeted follow-up support.

Methods: A baseline assessment was conducted to evaluate quality management system (QMS) practices for laboratories participating in the Strengthening External Quality Assessment in Asia (EQASIA-EQA) programme for the first time. Following each EQA iteration, laboratory assessments were conducted, and underperforming laboratories received online consultations to identify root causes of deviations and implement corrective and preventive actions (CAPA).

Prevalence of Extended-Spectrum β-Lactamase-Producing , and in Wastewater Effluent in Blantyre, Malawi.

: Wastewater treatment plants (WWTPs) serve as a sink for both antimicrobial residues and bacteria carrying resistant genes, which are later disseminated into the environment, facilitating the spread of antimicrobial resistance. This study investigated the presence of extended-spectrum beta-lactamase (ESBL) producing , , and in effluent from WWTP in Blantyre, Malawi, to generate evidence and provide baseline information for interventions. : Selective chromogenic agar was used to identify ESBL-producing bacteria.

Economic costing methodologies for drug-resistant bacterial infections in humans in low-and middle-income countries: a systematic review.

Background: This review examined methodologies used to cost the impact of antimicrobial resistance (AMR) infections in humans from household and health system perspectives. Although extensive research has been conducted on the clinical AMR burden in low- and middle-income countries (LMICs) in terms of prevalence and other drivers of antimicrobial resistance, there is increased misuse and overuse of antibiotics which increases the risk of AMR infections compared to high-income countries. Lack of comprehensive estimates on economic costs of AMR in LMICs due to lack of standard methodologies that incorporate time biases and inference for instance, may negatively affect accuracy and robustness of results needed for reliable and actionable policies.

Establishing core competencies for antimicrobial stewardship teams: a consensus development using the modified Delphi technique-an European Society of Clinical Microbiology and Infectious Diseases Study Group for Antimicrobial Stewardship position paper.

Objectives: This study aimed to identify and develop a standard set of competencies needed for members of an antimicrobial stewardship (AMS) team.

Methods: A panel of experts in AMS utilized a survey based on a modified Delphi technique to establish consensus on AMS competencies.

Results: The authors identified 88 competencies covering 15 domains with strong agreement by 58 international experts.

External quality assurance (EQA) network in South and South-East Asia: experience and results from an international EQA programme in One Health sector reference laboratories.

Objectives: External quality assurance (EQA) is an objective tool to assess laboratories' diagnostic performance and their adherence to recognized international standards. External Quality Assessment in Asia (EQASIA) is an EQA network in South and South-East Asia established in 2020 with the aim of improving the quality of bacteriology diagnostics across all One Health sectors in the region. The aim of this paper is to provide a comprehensive overview of the EQA results collected from the EQASIA network and to assess improvements among the participating laboratories.

International and regional spread of carbapenem-resistant Klebsiella pneumoniae in Europe.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) are of particular concern due to the spread of antibiotic resistance genes associated with mobile genetic elements. In this study, we collected 687 carbapenem-resistant strains recovered among clinical samples from 41 hospitals in nine Southern European countries (2016-2018). We identified 11 major clonal lineages, with most isolates belonging to the high-risk clones ST258/512, ST101, ST11, and ST307.

Assessment of three antibiotic combination regimens against Gram-negative bacteria causing neonatal sepsis in low- and middle-income countries.

Gram-negative bacteria (GNB) are a major cause of neonatal sepsis in low- and middle-income countries (LMICs). Although the World Health Organization (WHO) reports that over 80% of these sepsis deaths could be prevented through improved treatment, the efficacy of the currently recommended first- and second-line treatment regimens for this condition is increasingly affected by high rates of drug resistance. Here we assess three well known antibiotics, fosfomycin, flomoxef and amikacin, in combination as potential antibiotic treatment regimens by investigating the drug resistance and genetic profiles of commonly isolated GNB causing neonatal sepsis in LMICs.

Attributable mortality of infections caused by carbapenem-resistant Enterobacterales: results from a prospective, multinational case-control-control matched cohorts study (EURECA).

Objectives: To assess the mortality attributable to infections caused by carbapenem-resistant Enterobacterales (CRE) and to investigate the effect of clinical management on differences in observed outcomes in a multinational matched cohort study.

Methods: A prospective matched-cohorts study (NCT02709408) was performed in 50 European hospitals from March 2016 to November 2018. The main outcome was 30-day mortality with an active post-discharge follow-up when applied.

Patterns of antibiotic use, pathogens, and prediction of mortality in hospitalized neonates and young infants with sepsis: A global neonatal sepsis observational cohort study (NeoOBS).

Background: There is limited data on antibiotic treatment in hospitalized neonates in low- and middle-income countries (LMICs). We aimed to describe patterns of antibiotic use, pathogens, and clinical outcomes, and to develop a severity score predicting mortality in neonatal sepsis to inform future clinical trial design.

Methods And Findings: Hospitalized infants <60 days with clinical sepsis were enrolled during 2018 to 2020 by 19 sites in 11 countries (mainly Asia and Africa).

Challenges in the Implementation of the NeoOBS Study, a Global Pragmatic Observational Cohort Study, to Investigate the Aetiology and Management of Neonatal Sepsis in the Hospital Setting.

Neonatal sepsis is a significant cause of mortality and morbidity in low- and middle-income countries. To deliver high-quality data studies and inform future trials, it is crucial to understand the challenges encountered when managing global multi-centre research studies and to identify solutions that can feasibly be implemented in these settings. This paper provides an overview of the complexities faced by diverse research teams in different countries and regions, together with actions implemented to achieve pragmatic study management of a large multi-centre observational study of neonatal sepsis.

An analysis of existing national action plans for antimicrobial resistance-gaps and opportunities in strategies optimising antibiotic use in human populations.

At the 2015 World Health Assembly, UN member states adopted a resolution that committed to the development of national action plans (NAPs) for antimicrobial resistance (AMR). The political determination to commit to NAPs and the availability of robust governance structures to assure sustainable translation of the identified NAP objectives from policy to practice remain major barriers to progress. Inter-country variability in economic and political resilience and resource constraints could be fundamental barriers to progressing AMR NAPs.

Importance of antimicrobial stewardship in solid organ transplant recipients: An ESCMID perspective.

Background: In the last decades, solid organ transplantation (SOT) has emerged as an important method in the management of chronic kidney, liver, heart, and lung failure. Antimicrobial use has led to a significant reduction of morbidity and mortality due to infectious complications among patients with SOT; however, it can lead to adverse events and drive the development of antimicrobial resistance; thus, antimicrobial stewardship is of extreme importance. Even though there are ongoing efforts of transplant societies to implement principles of antimicrobial stewardship in everyday practice in SOT, there is still a lack of guidelines in this patient population.

Are antibiotic prescription practices in Eastern Uganda concordant with the national standard treatment guidelines? A cross-sectional retrospective study.

Objectives: This study aimed to evaluate the antibiotic prescription patterns of health workers in Eastern Uganda and more specifically whether they are in accordance with the Ugandan standard treatment guidelines and other indicators of appropriate antimicrobial prescription.

Methods: Patient data were obtained from the health management information system of the outpatient department registers of Soroti and Mbale Regional Referral Hospitals from 2016-2018.

Results: The prevalence of non-adherence to treatment guidelines when prescribing antibiotics was 82.

Indications for medical antibiotic prophylaxis and potential targets for antimicrobial stewardship intervention: a narrative review.

Background: Most of the antimicrobial stewardship (AMS) literature has focused on antimicrobial consumption for the treatment of infections, for the prophylaxis of surgical site infection and for the prevention of endocarditis. The role of AMS for medical antibiotic prophylaxis (AP) has not been adequately addressed.

Aims: To identify targets for AMS interventions for medical AP in adult patients.

COMBACTE LAB-Net: building a European laboratory network for clinical trials on anti-infectives.

LAB-Net, the laboratory network of COMBACTE, has established itself as an indispensable network for clinical trials in infectious diseases that plays a crucial part across 30 clinical studies not only within, but also outside the COMBACTE consortium. Since its official launch in January 2013, LAB-Net has expanded more than threefold and in Q4 2020 it encompasses 841 labs across 41 countries in Europe. In addition, LAB-Net has crossed the European borders and collaborates with more than 300 laboratories spread across the globe.

Experiences and views of healthcare professionals on the prescription of antibiotics in Eastern Uganda: A qualitative study.

Objectives: This study aimed to explore the experiences and views of healthcare professionals on antibiotic prescription in Eastern Uganda.

Methods: This was an exploratory qualitative study using semi-structured interviews. Participants included 16 healthcare professionals from Mbale and Soroti Regional Referral Hospitals.

Prevalence of antibiotic-resistant bacteria among patients in two tertiary hospitals in Eastern Uganda.

Objective: The aim of this study was to determine the prevalence and antibiotic resistance patterns of bacterial isolates from inpatients and outpatients in Mbale and Soroti regional referral hospitals in Eastern Uganda.

Methods: A retrospective analysis of culture and antibiotic sensitivity test results from the microbiology laboratories of the two tertiary hospitals was conducted for a 3-year period (January 2016-December 2018).

Results: Microbiology records of 3092 patients were reviewed and analysed, with 1305 (42.

Evaluation of a Loop-Mediated Isothermal Amplification Assay to Detect Carbapenemases Directly From Bronchoalveolar Lavage Fluid Spiked With spp.

Carbapenem-resistant spp. mainly are frequently causing nosocomial infections with high mortality. In this study, the efficacy of the Eazyplex SuperBug Complete A system, based on loop-mediated isothermal amplification (LAMP), to detect the presence of carbapenemases in spp.

White Paper: Bridging the gap between human and animal surveillance data, antibiotic policy and stewardship in the hospital sector-practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks.

Background: Antimicrobial surveillance and antimicrobial stewardship (AMS) are essential pillars in the fight against antimicrobial resistance (AMR), but practical guidance on how surveillance data should be linked to AMS activities is lacking. This issue is particularly complex in the hospital setting due to structural heterogeneity of hospital facilities and services. The JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks have joined efforts to formulate a set of target actions for linking surveillance data with AMS activities.

A one health framework to estimate the cost of antimicrobial resistance.

Objectives/purpose: The costs attributable to antimicrobial resistance (AMR) remain theoretical and largely unspecified. Current figures fail to capture the full health and economic burden caused by AMR across human, animal, and environmental health; historically many studies have considered only direct costs associated with human infection from a hospital perspective, primarily from high-income countries. The Global Antimicrobial Resistance Platform for ONE-Burden Estimates (GAP-ON€) network has developed a framework to help guide AMR costing exercises in any part of the world as a first step towards more comprehensive analyses for comparing AMR interventions at the local level as well as more harmonized analyses for quantifying the full economic burden attributable to AMR at the global level.

Management of bloodstream infections by infection specialists: an international ESCMID cross-sectional survey.

Bloodstream infections (BSIs) are common, however international guidelines are available only for methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia and candidaemia. This international ESCMID cross-sectional survey, open from December 2016 to February 2017, explored the management of BSIs by infection specialists. All infection specialists (senior or trainees) giving at least weekly advice on positive blood cultures could participate.