Spatial and temporal variation in the community prevalence of antibiotic resistance in Bangladesh: an integrated surveillance study protocol

Introduction: Increasing antibiotic resistance (ABR) in low and middle-income countries such as Bangladesh presents a major health threat. However, assessing the scale of the health risk is problematic in the absence of reliable data on the community prevalence of antibiotic-resistant bacteria. We describe the protocol for a small-scale integrated surveillance programme that aims to quantify the prevalence of colonisation with antibiotic resistant bacteria and concentrations of antibiotic resistant genes from a ‘One Health’ perspective. The holistic assessment of antibiotic resistance in humans, animals and within the environment in urban and rural Bangladesh will generate comprehensive data to inform human health risk. Methods and analysis: The study design focuses on three exposure-relevant sites where there is enhanced potential for transmission of ABR between humans, animals and the environment: i) rural poultry-owning households, ii) commercial poultry farms and iii) urban live-bird markets. The comparison of ABR prevalence in human groups with high and low exposure to farming and poultry will enable us to test the hypothesis that ABR bacteria and genes from the environment and foodproducing animals are potential sources of transmission to humans. Escherichia coli is used as an ABR indicator organism due to its widespread environmental presence and colonisation in both the human and animal gastrointestinal tract. Ethics and dissemination: The study has been approved by the Institutional Review Board of the International Centre for Diarrhoeal Disease Research, Bangladesh, (icddr,b) and Loughborough University Ethics Committee. Data for the project will be stored on the open access repository of the Centre for Ecology and Hydrology, Natural Environment Research Council. The results of this study will be published in peer-reviewed journals and presented at national and international conferences. STRENGTHS AND LIMITATIONS OF THIS STUDY • We present a study protocol focused on integrated surveillance of ABR in urban and rural Bangladesh using a One Health approach • Assessment of the human, poultry and environmental prevalence of antibiotic resistant E. coli will identify potential hotspots for transmission in Bangladesh • Seasonal and spatial variation on the occurrence of antibiotic resistant bacteria in humans, poultry and the wider environment will be assessed • The two regions included in the study may not be typical of all regions within Banglades

Tackling antimicrobial resistance in Bangladesh: A scoping review of policy and practice in human, animal and environment sectors

Background Antimicrobial 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. Methods A 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. Result Of 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. Conclusion AMR is a multi-dimensional problem involving different sectors, disciplines and stakeholders requiring a One Health comprehensive approach for containment

Pathways of antibiotic use in Bangladesh: a qualitative protocol for the PAUSE study

Introduction: Global actions to reduce antimicrobial resistance include optimising the use of antimicrobial medicines in human and animal health. In countries with weak healthcare regulation, this requires a greater understanding of the drivers of antibiotic use from the perspective of providers and consumers. In Bangladesh, there is limited research on household decision-making and healthcare seeking in relation to antibiotic use and consumption for humans and livestock. Knowledge is similarly lacking on factors influencing the supply and demand for antibiotics among qualified and unqualified healthcare providers. The aim of this study is to conduct integrated research on household decision-making for healthcare and antibiotic use, as well as the awareness, behaviours and priorities of healthcare providers and sellers of antibiotics to translate into policy development and implementation. Methods and analysis: In-depth interviews will be conducted with i) household members responsible for decision-making about illness and antibiotic use for family and livestock; ii) qualified and unqualified private and government healthcare providers in human and animal medicine and iii) stakeholders and policy makers as key informants on the development and implementation of policy around antimicrobial resistance (AMR). Participant observation within retail drug shops will also be carried out. Qualitative methods will include a thematic framework analysis. A holistic approach to understanding who makes decisions on the sale and use of antibiotics, and what drives healthcare seeking in Bangladesh will enable identification of routes to behaviour change and the development of effective interventions to reduce the health risks of antimicrobial resistance. Ethics and Dissemination Approval for the study has been obtained from the Institutional Review Board at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) following review by the Research and Ethic committees (PR-16100) and from Loughborough University (R17-P081). Dissemination will take place through stakeholder workshops, international conferences and publication

Occurrence and genetic characteristics of mcr-1-positive colistin-resistant E. coli from poultry environments in Bangladesh

ObjectivesColistin is one of the last-resort antibiotics for treatment of multi-drug resistant (MDR) Gram negative bacterial infections. We determined occurrence and characteristics of mcr-1-producing E. coli obtained from live bird markets (LBM), rural poultry farms (RPF) and rural household backyard poultry (HBP) in Bangladesh.MethodsWe tested 104 extended-spectrum β-lactamase (ESBL)-producing E. coli isolated during 2017-2018 from poultry sources for colistin resistance. We analyzed the resistant isolates for mcr gene and characterized mcr positive isolates for antibiotic susceptibility, antibiotic resistance genes, transmissible plasmids and clonal diversity.ResultsOf 104 isolates, 98 (94%) had MICcolistin ≥4 μg/mL and 14 (13.5%) were positive for mcr-1 of which 10 were from LBM (n = 10), 3 from RFP and 1 from HBP. All 14 mcr-1 E. coli were resistant to third generation cephalosporin and tetracycline, while 12 were resistant to fluoroquinolone and sulphamethoxazole, 10 were to aminoglycosides and 3 were to nitrofurantoin. Four isolates carried conjugative mcr-1 plasmid of 23 to 55 MDa in size. The 55 MDa plasmid found in 2 isolates carried additional resistant genes including blaCTX-M-group-1 and blaTEM-1 (ESBL), qnrB (fluoroquinolone) and rmtB (aminoglycoside). These plasmids belong to IncF family with additional replicons: HI1 and N. ERIC-PCR revealed a heterogeneous banding pattern of mcr-1 positive isolates.ConclusionWe report a 13.5% prevalence of mcr-1 positive MDR E. coli in poultry fecal samples predominantly from LBMs in Bangladesh accentuating the need for safe disposal of poultry feces and hygiene practices among people exposed to poultry.</div

Human, animal and environmental contributors to antibiotic resistance in low resource settings: integrating behavioural, epidemiological and One Health approaches

Antibiotic resistance (ABR) is recognised as a One Health challenge because of the rapid emergence and dissemination of resistant bacteria and genes among humans, animals and the environment on a global scale. However, there is a paucity of research assessing ABR contemporaneously in humans, animals and the environment in low resource settings. This critical review seeks to identify the extent of One Health research on antibiotic resistance in low and middle income countries (LMICs). Existing research has highlighted hotspots for environmental contamination; food-animal production systems that are likely to harbour reservoirs or promote transmission of ABR as well as high and increasing human rates of colonisation with ABR commensal bacteria such as Escherichia coli. However, very few studies have integrated all three components of the One Health spectrum to understand the dynamics of transmission of AMR and the prevalence of community-acquired resistance in humans and animals. Microbiological, epidemiological and social science research is needed at community and population levels across the One Health spectrum in order to fill the large gaps in knowledge of ABR in low resource settings

Design and concept of renewable energy driven auto-detectable railway level crossing systems in Bangladesh

Bangladesh’s railway system mostly uses typical manual railway crossing techniques or boom gates through its 2955.53 km rail route all over the country. Accidents frequently happen at railway crossings due to the lack of quickly operating gate systems, and to fewer safety measures at the railway crossing as well. Currently, there are very few automatic railway crossing systems available (without obstacle detectors). Additionally, all of them are dependent on the national power grid, without a backup plan for any emergency cases. Bangladesh is still running a bit behind in generating enough power for its consumption; hence, it is not possible to have a continuous power supply at all times all over the countryside. We aim to design and develop a smart railway crossing system with an obstacle detector to prevent common types of accidents at railway crossing points. We use two infrared (IR) sensors to operate the railway crossing systems, which are controlled by an Arduino Uno. This newly designed level crossing system is run with the help of sustainable renewable energy, which is cost-effective and eco-friendly, and applied under the national green energy policy towards achieving sustainable development in Bangladesh as a part of the global sustainable goal to face climate change challenges. We have summarized the simulated the results of several renewable energy sources, including a hybrid system, and optimized the Levelized Cost of Energy (LCOE) and the payback periods

Pathways of antibiotic use in humans and animals in Bangladesh: Interview Guides

These guides are those used by interviewers who conducted interviews around antibiotic use in humans and animals in Bangladesh. Interviews examined antibiotic use and behaviours contributing to antibiotic resistance from the perspective of household members and healthcare providers in one urban and one rural site in Bangladesh. Household interviews were carried out with the household decision-maker or main care-giver (total 48 interviews). Healthcare provider interviews were carried out with a range of qualified and unqualified providers from human and veterinary medicine (total 46 interviews). The interviews gathered information on where people sought treatment for illnesses due to infection, what determined their choice of healthcare provider; factors contributing to antibiotic use in humans and animals; knowledge and understanding of antibiotic resistance. Similar questions about antibiotic prescribing and selling practices were asked of healthcare providers.The associated transcripts are available upon request to the PI at https://doi.org/10.17028/rd.lboro.8953118.v1Further information on the study as well as details on methods and analysis are available under a CC-BY licence at https://doi.org/10.1136/bmjopen-2018-028215 or https://dspace.lboro.ac.uk/2134/36467</div

Rooftop PV or Hybrid Systems and Retrofitted Low-E Coated Windows for Energywise and Self-Sustainable School Buildings in Bangladesh

The electricity crisis is a common issue in Bangladesh; however, recently the electricity scenario has been getting worse due to various reasons including power generation and distribution all over the country. Meanwhile, the large number of people requires a huge amount of energy which is not possible to be met by the national grid due to the limited power generation from different plants. Among all renewable energy sources, the solar photovoltaics (PV) system is the best choice as a generation source, either off-grid or with a grid-tied connection, to reduce the pressure on the national grid. In Bangladesh, there are more than 175,000 schools, and it is possible to generate a huge amount of renewable (solar) power to supply all the schools by using rooftop PV systems. We propose a new approach that combines solar energy harvesting and savings to make the schools self-sufficient and energywise. We performed a Hybrid Optimization Model for Multiple Energy Resources (HOMER) pro simulation and find that it was possible to generate approximately 200 megawatts (MW) of power. We conducted a feasibility study on generating power from rooftop PV systems on school buildings and reduced the power consumption using retrofitted thin-film-coated glass by around 16–20% per day depending on the school size, which can help the national power grid system by either making all the schools off-grid or grid-connected to supply power to the national grid. In addition, we perform a HelioScope simulation to investigate the maximum upscaling of PV sizing for the rooftops of school buildings in Bangladesh to realize how to make each school a mini solar power station in the future. The HelioScope simulation performance showed that it was possible to generate approximately 96,993 kWh per year from one school building

Impact of contrasting poultry exposures on human, poultry, and wastewater antibiotic resistomes in Bangladesh

Interactions between humans, animals, and the environment are considered critical foci for addressing antimicrobial resistance (AMR). However, One Health data on AMR in low- and middle-income countries are presently scarce. Using metagenomics, we investigated whether and how the fecal antibiotic resistomes of humans are influenced by exposure to intensive and non-intensively reared poultry within contrasting settings of urban wet markets ( n = 13) and rural households ( n = 7) in Bangladesh. We also considered poultry ( n = 10) and wastewater ( n = 10) resistomes in these settings. We found that occupational poultry exposures did not significantly alter the human fecal resistome. In contrast, macrolide-lincosamide-streptogramin and streptothricin antibiotic resistance genes (ARGs) were enriched in poultry from urban wet markets relative to rural household chickens. Wastewater had the highest ARG richness, though this was only partially explained by poultry cecal and human fecal sources. Wastewater also contained clinically significant carbapenem ARGs. This study therefore provides critical insight into the distribution of ARGs in Bangladesh. IMPORTANCE Through the use of DNA sequencing, our study shows that there is no significant difference in the antibiotic resistance genes found in stool samples taken from individuals with high exposure to poultry routinely fed antibiotics and those without such exposure. This finding is significant as it suggests limited transmission of antibiotic resistance genes between poultry and humans in these circumstances. However, our research also demonstrates that commercially reared poultry are more likely to possess resistance genes to antibiotics commonly administered on medium-sized farms. Additionally, our study highlights the under-explored potential of wastewater as a source of various antibiotic resistance genes, some of which are clinically relevant.</p

Prevalence of 3GCr and carbapenem-resistant pathogens among patients with community-acquired UTI.

Prevalence of 3GCr and carbapenem-resistant pathogens among patients with community-acquired UTI.</p