Association between antimicrobial stewardship programs and antibiotic use globally: a systematic review and meta-analysis

IMPORTANCE: Antimicrobial resistance continues to spread rapidly at a global scale. Little evidence exists on the association of antimicrobial stewardship programs (ASPs) with the consumption of antibiotics across health care and income settings. OBJECTIVE: To synthesize current evidence regarding the association between antimicrobial stewardship programs and the consumption of antibiotics globally. DATA SOURCES: PubMed, Web of Science, and Scopus databases were searched from August 1, 2010, to Aug 1, 2020. Additional studies from the bibliography sections of previous systematic reviews were included. STUDY SELECTION: Original studies of the association of ASPs with antimicrobial consumption across health care and income settings. Animal and environmental studies were excluded. DATA EXTRACTION AND SYNTHESIS: Following the Preferred Reporting Items in Systematic Reviews and Meta-Analyses guideline, the pooled association of targeted ASPs with antimicrobial consumption was measured using multilevel random-effects models. The Effective Public Health Practice Project quality assessment tool was used to assess study quality. MAIN OUTCOMES AND MEASURES: The main outcome measures were proportion of patients receiving an antibiotic prescription and defined daily doses per 100 patient-days. RESULTS: Overall, 52 studies (with 1 794 889 participants) measured the association between ASPs and antimicrobial consumption and were included, with 40 studies conducted in high-income countries and 12 in low- and middle-income countries (LMICs). ASPs were associated with a 10% (95% CI, 4%-15%) reduction in antibiotic prescriptions and a 28% reduction in antibiotic consumption (rate ratio, 0.72; 95% CI, 0.56-0.92). ASPs were also associated with a 21% (95% CI, 5%-36%) reduction in antibiotic consumption in pediatric hospitals and a 28% reduction in World Health Organization watch groups antibiotics (rate ratio, 0.72; 95% CI, 0.56-0.92). CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, ASPs appeared to be effective in reducing antibiotic consumption in both hospital and nonhospital settings. Impact assessment of ASPs in resource-limited settings remains scarce; further research is needed on how to best achieve reductions in antibiotic use in LMICs

Association Between Antimicrobial Stewardship Programs and Antibiotic Use Globally: A Systematic Review and Meta-Analysis.

IMPORTANCE: Antimicrobial resistance continues to spread rapidly at a global scale. Little evidence exists on the association of antimicrobial stewardship programs (ASPs) with the consumption of antibiotics across health care and income settings. OBJECTIVE: To synthesize current evidence regarding the association between antimicrobial stewardship programs and the consumption of antibiotics globally. DATA SOURCES: PubMed, Web of Science, and Scopus databases were searched from August 1, 2010, to Aug 1, 2020. Additional studies from the bibliography sections of previous systematic reviews were included. STUDY SELECTION: Original studies of the association of ASPs with antimicrobial consumption across health care and income settings. Animal and environmental studies were excluded. DATA EXTRACTION AND SYNTHESIS: Following the Preferred Reporting Items in Systematic Reviews and Meta-Analyses guideline, the pooled association of targeted ASPs with antimicrobial consumption was measured using multilevel random-effects models. The Effective Public Health Practice Project quality assessment tool was used to assess study quality. MAIN OUTCOMES AND MEASURES: The main outcome measures were proportion of patients receiving an antibiotic prescription and defined daily doses per 100 patient-days. RESULTS: Overall, 52 studies (with 1 794 889 participants) measured the association between ASPs and antimicrobial consumption and were included, with 40 studies conducted in high-income countries and 12 in low- and middle-income countries (LMICs). ASPs were associated with a 10% (95% CI, 4%-15%) reduction in antibiotic prescriptions and a 28% reduction in antibiotic consumption (rate ratio, 0.72; 95% CI, 0.56-0.92). ASPs were also associated with a 21% (95% CI, 5%-36%) reduction in antibiotic consumption in pediatric hospitals and a 28% reduction in World Health Organization watch groups antibiotics (rate ratio, 0.72; 95% CI, 0.56-0.92). CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis, ASPs appeared to be effective in reducing antibiotic consumption in both hospital and nonhospital settings. Impact assessment of ASPs in resource-limited settings remains scarce; further research is needed on how to best achieve reductions in antibiotic use in LMICs

Threatened ecosystems of Myanmar. An IUCN Red List of ecosystems assessment. Version 1.0.

[Excerpt:] Myanmar's Red List of Ecosystems is a tool to understand our threats and plan for conservation and sustainable management. Forests constitute the dominant ecosystems in Myanmar, and we are blessed with high forest cover (42.92%) and diversity, with 36 of our 64 ecosystems identified as forest and mangrove. These forests and biodiversity underpin a range of ecosystem services which are central to Myanmar’s sustainable development, supporting human and resource needs, and contributing to a more stable climate. The loss of forests and our biodiversity leads to degradation and deterioration of ecosystem services and threatens Myanmar’s irreplaceable ecological heritage. We often discuss ecosystem services but this study documents Myanmar’s terrestrial ecosystem typology and spatial distribution for the first time. This is one of the first ecosystem red lists developed within ASEAN and this will inform our implementation for decades to come to inform legislation, land-use planning, protected area expansion, monitoring and reporting, and ecosystem management. To sustain our forests and our biodiversity we need to sustainably manage all of these incredible ecosystems

SARS-CoV-2-specific immune responses and clinical outcomes after COVID-19 vaccination in patients with immune-suppressive disease

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immune responses and infection outcomes were evaluated in 2,686 patients with varying immune-suppressive disease states after administration of two Coronavirus Disease 2019 (COVID-19) vaccines. Overall, 255 of 2,204 (12%) patients failed to develop anti-spike antibodies, with an additional 600 of 2,204 (27%) patients generating low levels (<380 AU ml−1). Vaccine failure rates were highest in ANCA-associated vasculitis on rituximab (21/29, 72%), hemodialysis on immunosuppressive therapy (6/30, 20%) and solid organ transplant recipients (20/81, 25% and 141/458, 31%). SARS-CoV-2-specific T cell responses were detected in 513 of 580 (88%) patients, with lower T cell magnitude or proportion in hemodialysis, allogeneic hematopoietic stem cell transplantation and liver transplant recipients (versus healthy controls). Humoral responses against Omicron (BA.1) were reduced, although cross-reactive T cell responses were sustained in all participants for whom these data were available. BNT162b2 was associated with higher antibody but lower cellular responses compared to ChAdOx1 nCoV-19 vaccination. We report 474 SARS-CoV-2 infection episodes, including 48 individuals with hospitalization or death from COVID-19. Decreased magnitude of both the serological and the T cell response was associated with severe COVID-19. Overall, we identified clinical phenotypes that may benefit from targeted COVID-19 therapeutic strategies

Growth of Zinc Oxide Nanowire with Natural Dye Extract for Dye Sensitized Solar Cell Application

This research focused on the synthesis of 200 nanowires for its application in OSSC devices using the natural bark dye sensitizer. Zinc oxide nanowires grown from hexamethylenetetramine (C6H12N4) and zinc nitrate (Zn (NO3)2.6H20) were used as photoelectrodes for dye-sensitized solar cells. Firstly, 200 seed layer film was coated by using spin coating technique. 200 nanowires were grown by using chemical bath deposition (CBD). The concentration of the hexamethylenetetramine in chemical bath deposition (CBD) significantly affected the growth rate of the nanowires. Structural, diameter in size and morphology of ZnO nanowire films were investigated in detail by X-ray diffraction (XRD) and Field Emission Scanning Electron Microscopy (FESEM). The optical properties of ZnO nanowire films were studied by UV-Vis spectroscopy. The nanowires structure was sensitized with natural bark dye and assembled into a DSSC. High performance carbon electrode was prepared onto ITO substrate and used as counter electrode. I-V characteristic was measured and conversion efficiency (ƞcon) and fill factor (FF) were determined. It was found that OH- ion concentration played a key role during the process of regulating the growth rate and forming the ZnO nanowires by chemical bath deposition (CBD). The conversion efficiency of DSSC at growing time 14 h (4.257%) was investigated to be larger than that of the cell at 7 h (2.795%). According to the experimental results, ZnO nanowires might be promising, credible and applicable for photoelectrode of dye-sensitized solar cell (DSSC) architecture

Transfusion-Associated Graft-Versus-Host Disease in Two Patients at Yangon General Hospital

Transfusion-associated graft-versus-host disease (TA-GVHD) is a rare complication&nbsp;of blood transfusion. Two male patients admitted to the Department of Clinical Haematology,&nbsp;Yangon General Hospital (YGH) diagnosed to have TA-GVHD in 2011 and in 2016 are presented. Both of the patients received blood donation from close relatives where&nbsp;neither leukoreduction nor irradiation was done. Both patients had fever, skin rashes,gastrointestinal symptoms, raised liver enzymes and pancytopenia. Skin biopsies of both patients showed characteristic histological changes. Unlike graft-versus-host disease that&nbsp;occurred after haemopoeitic stem cell transplantation, TA-GVHD involves the recipient&rsquo;s&nbsp;bone marrow leading to bone marrow aplasia</p

Myanmar's terrestrial ecosystems: Status, threats and conservation opportunities

Myanmar is highly biodiverse, with more than 16,000 plant, 314 mammal, 1131 bird, 293 reptile, and 139 amphibian species. Supporting this biodiversity is a variety of natural ecosystems—mostly undescribed—including tropical and subtropical forests, savannas, seasonally inundated wetlands, extensive shoreline and tidal systems, and alpine ecosystems. Although Myanmar contains some of the largest intact natural ecosystems in Southeast Asia, remaining ecosystems are under threat from accelerating land use intensification and over-exploitation. In this period of rapid change, a systematic risk assessment is urgently needed to estimate the extent and magnitude of human impacts and identify ecosystems most at risk to help guide strategic conservation action. Here we provide the first comprehensive conservation assessment of Myanmar's natural terrestrial ecosystems using the IUCN Red List of Ecosystems categories and criteria. We identified 64 ecosystem types for the assessment, and used models of ecosystem distributions and syntheses of existing data to estimate declines in distribution, range size, and functioning of each ecosystem. We found that more than a third (36.9%) of Myanmar's area has been converted to anthropogenic ecosystems over the last 2–3 centuries, leaving nearly half of Myanmar's ecosystems threatened (29 of 64 ecosystems). A quarter of Myanmar's ecosystems were identified as Data Deficient, reflecting a paucity of studies and an urgency for future research. Our results show that, with nearly two-thirds of Myanmar still covered in natural ecosystems, there is a crucial opportunity to develop a comprehensive protected area network that sufficiently represents Myanmar's terrestrial ecosystem diversity

Epidemiological characteristics and real‐world treatment outcomes of hepatitis C among HIV/HCV co‐infected patients in Myanmar: A prospective cohort study

Abstract Background and Aims In Myanmar, public sector treatment programs for hepatitis C virus (HCV) infection were nonexistent until June 2017. WHO highlights the importance of simplification of HCV service delivery through task‐shifting among health workers and decentralization to the primary health care level. Between November 2016 and November 2017, a study was conducted to describe the epidemiological data and real‐world outcomes of treating HIV/HCV coinfected patients with generic direct acting antiviral (DAA) based regimens in the three HIV clinics run by nonspecialist medical doctors in Myanmar. Methods HCV co‐infection among people living with HIV (PLHIV) from two clinics in Yangon city and one clinic in Dawei city was screened by rapid diagnostic tests and confirmed by testing for viral RNA. Nonspecialist medical doctors prescribed sofosbuvir and daclatasvir based regimens (with or without ribavirin) for 12 or 24 weeks based on the HCV genotype and liver fibrosis status. Sustained virologic response at 12 weeks after treatment (SVR12) was assessed to determine cure. Results About 6.5% (1417/21,777) of PLHIV were co‐infected with HCV. Of 864 patients enrolled in the study, 50.8% reported history of substance use, 27% history of invasive medical procedures and 25.6% history of incarceration. Data on treatment outcomes were collected from 267 patients of which 257 (96.3%) achieved SVR12, 7 (2.6%) failed treatment, 2 (0.7%) died and 1 (0.4%) became loss to follow‐up. Conclusion The study results support the integration of hepatitis C diagnosis and treatment with DAA‐based regimens into existing HIV clinics run by nonspecialist medical doctors in a resource‐limited setting. Epidemiological data on HIV/HCV co‐infection call for comprehensive HCV care services among key populations like drug users and prisoners in Yangon and Dawei