ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance

Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest

ACORN (A Clinically-Oriented Antimicrobial Resistance Surveillance Network) II: protocol for case based antimicrobial resistance surveillance

Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest

Methodological quality of studies evaluating the burden of drug-resistant infections in humans due to the WHO Global Antimicrobial Resistance Surveillance system target bacteria

The health impact of antimicrobial resistance (AMR) has not been included in the Global Burden Disease (GBD) report, as reliable data has been lacking. AMR burden estimates have been derived from models combining incidence and/or prevalence data from national and/or international surveillance systems and mortality estimates from clinical studies. Depending on utilized empirical data, statistical methodology and applied endpoints, the validity and reliability of results can substantially differ

FAO Regional Office for Asia and the Pacific Animal Production and Health Commission for Asia and the Pacific REPORT on Antimicrobial Usage and Alternatives for Prophylaxis and Performance Enhancement in Pig Populations in East and

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Knowledge, attitudes and practices of Cambodian swine producers in relation to porcine reproductive and respiratory syndrome (PRRS)

AbstractPorcine reproductive and respiratory syndrome (PRRS) was first detected in Cambodia in 2010. The disease was responsible for high morbidity and high mortality in adult pigs and the outbreak had a costly impact on those farmers affected. The aim of this study was to generate a better understanding of Cambodian swine producers’ behaviour, in relation to PRRS and its control, in areas that have previously been affected by the disease. A survey of the knowledge, attitude and practices (KAPs) of pig owners with regard to PRRS was conducted in semi-commercial and backyard farms in Takeo province in southeast Cambodia. The survey was designed to assess knowledge of PRRS disease and its transmission, farmers’ attitudes and practices related to preventive and control measures, knowledge on vaccination and perception towards local veterinary authority activities. Descriptive statistics were used to summarise qualitative data, while multivariate regression analyses were used to assess the association between selected outcomes and a number of hypothetical predictors. When presented with clinical signs typical of PRRS, most farmers identified an infectious disease as the most likely explanation for the listed clinical conditions. Farmers were also confident in recognising direct contact between pigs as one of the main ways of disease transmission; however, other viral transmission patterns typical of PRRS were mostly unknown or ignored. In general, male farmers and farmers with a higher level of education were more likely to have a better knowledge of transmission routes between pigs. In terms of attitude towards control measures, vaccination and disinfection were perceived as the most effective control practices. Farmers with a better knowledge of vaccine protocols were more likely to find vaccination effective. Village animal health workers (VAHWs) were generally in contact more with backyard farmers, while semi-commercial farmers were more prone to treat pigs themselves, raising the issue of easy and uncontrolled access to medication and vaccination. In general, farmers had a positive attitude towards local veterinarians, and lack of contact between farmers and the veterinary authority was associated more with logistic constraints than with farmers’ mistrust towards the authority