Stewardship / Resistance Scan for Mar 03, 2022

News brief

WHO handbook aims to help countries implement AMR action plans

The World Health Organization (WHO) this week published new technical guidance to help countries implement national action plans (NAPs) for 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 significant gaps in countries' implementation of NAPs. A recent survey by the WHO, the World Organisation for Animal Health, and the United Nations Food and Agriculture Organization showed that, of the 117 countries with NAPs, only 20% had fully financed those plans.

"For most countries, the greatest challenge is not developing a NAP; rather, it is achieving NAP implementation that is evidence-based and demonstrates sustained action," the document states.

The handbook lays out six steps for sustainable implementation of NAPs in the healthcare system. The steps include strengthening governance, prioritizing activities based on an assessment of the current situation, estimating costs and developing a budget for prioritized activities, mobilizing resources to fund the plan, implementing the prioritized activities, and monitoring and evaluating progress in implementing the plan.

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

Future handbooks will provide technical guidance for NAP implementation in the animal health, food safety, and environment sector.
Feb 28 WHO implementation handbook

Study finds high levels of multidrug-resistant E coli on Chinese pig farms

A surveillance study of Chinese pig farms found a high level of multidrug resistance in Escherichia coli samples from pigs and their breeding environments, Chinese researchers reported yesterday in Nature Communications.

For the study, researchers from Huazhong Agricultural University collected and conducted antimicrobial susceptibility testing (AST) on 1,871 E coli isolates from pig farms in 31 Chinese provinces from October 2018 through September 2019. China is the largest pig-rearing country in the world, and E coli is a commonly used biomarker of antimicrobial resistance (AMR) on pig farms. The most representative provinces by isolate were Hubei (250 isolates) and Henan (191), the two largest pig-farming 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 last-resort antibiotics such as tigecycline (37.3%), colistin (3.8%), and carbapenems (imipenem [2.6%], meropenem [2.3%], and ertapenem [2.5]). Most colistin-resistant and carbapenem-resistant isolates came from Henan province.

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

"Our AST results suggest a worrisome AMR situation on pig farms, as evidenced by the common recovery of MDR E. coli isolates from both pigs and their breeding environments on farms in different provinces, including Tibet, Xinjiang, and Qinghai," the study authors wrote. "This worrisome situation is widely accepted to be the result of antibiotic overuse and misuse in the Chinese pig industry."

The authors say the data may help inform governmental efforts to reduce antibiotic use and AMR in the Chinese pig industry.
Mar 2 Nat Commun study

News Scan for Mar 03, 2022

News brief

Women have borne an outsized social, economic burden during pandemic

From March 2020 to September 2021, women were more likely than men to lose their jobs, forego work to care for others, and report increasing violence, and women and girls were more likely than men and boys to drop out of school for reasons other than school closures, according to a study yesterday in The Lancet.

University of Washington at Seattle researchers reviewing public datasets found that relative to men, women were more likely to report job loss (26.0% vs 20.4%) and staying home from work to care for others (1:8 ratio of men to women in March, 2.4 by September). They were also 1.23 times more likely to say that gender-based violence had increased during the pandemic.

Women and girls were 1.21 times more likely than men to say they dropped out of school for reasons other than school closures. Women and men didn't significantly differ in terms of vaccine hesitancy or uptake.

The study authors said that the disparities highlighted in the study show that the pandemic exacerbated already-widespread inequalities between men and women.

"Political and social leaders should prioritise policies that enable and encourage women to participate in the labour force and continue their education, thereby equipping and enabling them with greater ability to overcome the barriers they face," they wrote.

In a Lancet news release, senior author Emmanuela Gakidou, PhD, called for an investment in empowering women to ensure that progress toward gender equity doesn't unravel further. "We cannot let the social and economic fallouts from the pandemic continue into the post-COVID era," she said. "Action must be taken now to not only reverse the current disparities, but to further close the gaps present before the pandemic began."

In a related commentary, Rosemary Morgan, PhD, of Johns Hopkins University, Denise Nacif Pimenta, PhD, of Rene Rachou Institute in Brazil, and Sabina Rashid, PhD, of BRAC University in Bangladesh, said that the manifestations of gender inequities depend on the context.

"It is therefore important that global analyses do not take the place of regional or national level analyses: if policy is going to effectively address gender inequities, we must understand the ways in which inequities manifest at every level, paying attention to and actively recognising the diverse variations and contexts," they wrote.
Mar 2 Lancet study, commentary, and news release

Study: Spending time outdoors lessened pandemic anxiety, depression

Denver residents who spent significant time in green space during the pandemic had lower levels of anxiety and depression, according to a new study in PLOS One.

The study was conducted by researchers at the University of Colorado Boulder and tracked mood changes and green space use during the first year of the pandemic among 1,200 Denver residents. Respondents' answers were paired with satellite images of green space near residential addresses.

In the survey, one third (33%) of participants said they spent more time in green spaces during the pandemic than in pre-COVID times. A total of 31% of respondents reported that they lost job-related income due to the pandemic, and 35% said they were impacted financially by the pandemic. Thirteen percent reported spending a lot of time online or watching TV trying to find information about COVID-19, the authors said.

The respondents with the most stress, anxiety, or depression, reported having a difficult time locating goods during the pandemic, including food and toilet paper. Contracting COVID-19 was not associated with significant stress.

"This research shows how critical it is to keep parks and green spaces open in times of crisis," said senior author Colleen Reid, PhD, an assistant professor of geography in the Institute for Behavioral Science in a press release. "It also shows that, as a public health measure, more effort should be made to put in green spaces and make them accessible."

The research also supports the "biophilia hypothesis," an idea that humans have better health outcomes when they spend time outdoors.
Mar 2 PLOS One study
Mar 2 University of Colorado press release