Stewardship/Resistance Analysis March 03, 2022

WHO handbook aims to help countries implement antimicrobial resistance action plans

The World Health Organization (WHO) released new technical guidelines this week to help countries implement National Action Plans (NAPs) against antimicrobial resistance in the human health sector.

Written for national health authorities, policymakers, technical experts and other stakeholders, the WHO Implementation Handbook aims to help fill important gaps in countries’ implementation of NAPs. A recent survey by WHO, the World Organization for Animal Health and the Food and Agriculture Organization of the United Nations showed that of the 117 countries with NAPs, only 20% had fully financed these plans.

“For most countries, the biggest challenge is not to develop a NAP; rather, it is to achieve an implementation of a NAP that is evidence-based and demonstrates sustained action” , indicates the document.

The manual presents six steps for the sustainable implementation of NAPs in the health system. Steps include strengthening governance, prioritizing activities based on an assessment of the current situation, estimating costs and developing a budget for priority activities, mobilizing resources to fund the plan, the implementation of priority activities and the monitoring and evaluation of progress in the implementation of the plan.

Each chapter of the manual provides specific instructions on the six steps, links to existing WHO guidance and tools to support implementation, and checklists. An online version of the manual will contain case studies.

Future manuals will provide technical guidance for the implementation of NAPs in the animal health, food safety and environment sector.
February 28 WHO implementation manual

Study finds high levels of multidrug resistance E-coli in Chinese pig farms

Surveillance study of Chinese pig farms found high level of multidrug resistance Escherichia coli samples of pigs and their rearing environments, Chinese researchers reported yesterday in Communication Nature.

For the study, researchers from Huazhong Agricultural University collected and performed antimicrobial susceptibility testing (AST) on 1,871 E-coli isolates from pig farms in 31 Chinese provinces from October 2018 to September 2019. China is the largest pig-breeding country in the world, and E-coli is a commonly used biomarker of antimicrobial resistance (AMR) in pig farms. The most representative provinces by isolate were Hubei (250 isolates) and Henan (191), the two largest pig-breeding provinces in the country.

AST results showed that 90.5% of the 1,871 isolates were multidrug resistant (MDR) strains. A large proportion of isolates were resistant to tetracycline (96.2%), chloramphenicol (82%), moxifloxacin (81.6%) and trimethoprim/sulfamethoxazole (80.3%). Resistance was also detected to antibiotics of last resort such as tigecycline (37.3%), colistin (3.8%) and carbapenems (imipenem [2.6%]meropenem [2.3%]and ertapenem [2.5]). Most isolates resistant to colistin and carbapenems came from Henan province.

The study also identified a heterogeneous group of O serogroups and sequence types among MDR isolates. These isolates harbored several resistance genes, genes encoding virulence factors and putative plasmids. In addition, phylogenetic analysis showed that 515 of the MDRs E-coli isolates from pig farms were closely related to 287 publicly available draft human commensal genomes E-coli strains from all over China. These results suggest a strong genetic propensity to spread from pig farms to humans, posing health risks.

“Our AST results suggest a worrying AMR situation in pig farms, as evidenced by the common recovery of MDR E.coli isolates from both pigs and their rearing environments on farms in different provinces, including Tibet, Xinjiang and Qinghai,” the study authors wrote. “This worrying situation is widely recognized as being the result of overuse and misuse of antibiotics in the Chinese pork industry. “

The authors say the data could help inform government efforts to reduce antibiotic use and antimicrobial resistance in China’s pork industry.
March 2 Nat Common

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