World AMR Awareness Week
18 – 24 November 2023
Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial agents. As a result of drug resistance, antibiotics and other antimicrobial agents become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness and death. WHO
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Articles
Clinical practice
How clinicians decide? Exploring complexity of antibiotic prescribing in emergency departments using Video-Reflexive Ethnography
Antibiotic overprescribing is a global issue that significantly contributes to increased antimicrobial resistance. Strengthening antimicrobial prescribing practices should be considered a priority. The emergency department (ED) represents a setting where antibiotics are frequently prescribed, but the determinants that influence prescribing choices are complex and multifaceted. Qualitative health research 23 October 2023
The interventions and challenges of antimicrobial stewardship in the emergency department
Over the last decades, we have witnessed a constant increase in infections caused by multi-drug-resistant strains in emergency departments. Despite the demonstrated effectiveness of antimicrobial stewardship programs in antibiotic consumption and minimizing multi-drug-resistant bacterium development, the characteristics of emergency departments pose a challenge to their implementation. The inclusion of rapid diagnostic tests, tracking microbiological results upon discharge, conducting audits with feedback, and implementing multimodal educational interventions have proven to be effective tools for optimizing antibiotic use in these units. Nevertheless, future multicenter studies are essential to determine the best way to proceed and measure outcomes in this scenario. Antibiotics 9 October 2023
Reducing antibiotic prescribing in general practice in Australia: a cluster randomised controlled trial of a multimodal intervention
A multimodal package of interventions to enhance rational prescribing of antibiotics is effective, feasible and acceptable in general practice. Investment in antimicrobial stewardship strategies in primary care may ultimately provide the important returns for public health into the future. Australian journal of primary health 17 October 2023
Real-world data about commonly used antibiotics in long-term care homes in Australia from 2016 to 2019
In this study, the authors use real-world data to explore trends in antibiotic use in a dynamic cohort of long-term care (LTC) residents. A cross-sectional retrospective analysis of pharmacy medication supply records of 3459 LTC residents was conducted from 31 May 2016 to 31 May 2019. The primary outcome was the monthly prevalence of residents with an antibiotic episode. Secondary outcomes were the type of antibiotic used and duration of use. Over the three-year study period, residents were supplied 10460 antibiotics. On average, 18.9% of residents received an antibiotic monthly. Antibiotic use decreased slightly over time with a mean of 168/1000 (95% CI 146–177) residents using at least one antibiotic per month in June 2016 to 148/1000 (95% CI 127–156) in May 2019. The total number of antibiotic days per 100 resident days remained relatively constant over the study period: 8.8 days in 2016–2017, 8.4 in 2017–2018 and 6.4 in 2018–2019. Prolonged durations exceeding 100 days were seen for a small percentage of residents. They found extensive antibiotic use, which is a recognized contributor to antimicrobial resistance development, underscoring the necessity for quality treatment guidelines in this vulnerable population. Antibiotics 31 August 2023
The role of adult vaccines as part of antimicrobial stewardship: A scoping review
The evidence supports the role of vaccines as part of AMS practices and the value of their inclusion in creating improved and comprehensive AMS strategies to further combat the development of AMR. Antibiotics 10 September 2023
Availability and efficacy of assessment strategies for delabelling of antibiotic allergies, and the role of the pharmacist
The three-tiered skin prick test/intradermal testing/oral challenge method is still considered to be the gold standard for antibiotic allergy de-labelling. However, in Australia this is still unavailable to a high percentage of healthcare professionals. Contributions from the antimicrobial stewardship team, including pharmacists, were shown in multiple studies to effectively facilitate allergy assessment and de-labelling. Allergy assessment has been proven to decrease the utilisation of restricted antimicrobials, to enhance prescribing of beta-lactam antibiotics, and reduce healthcare expenditures. Thus, clinicians should increase its utilisation in addition to risk stratification tools where relevant in clinical practice. The Australian pharmacy students' journal 27 August 2023
A systematic review of antimicrobial therapy in children with tracheostomies
This systematic review summarises the current evidence base for antimicrobial selection, duration, and administration route in paediatric tracheostomy associated infections. It also highlights significant variation in practice between centres and the urgent need for further prospective evidence to guide the management of these vulnerable patients. Pediatric pulmonology 11 November 2023
An analysis of Australia’s national action plan on antimicrobial resistance using a governance framework
Overall, Australia’s governance on AMR has demonstrated siloed implementation with an absence of strategic objectives to measure progress. Governance structure, surveillance and mechanisms for stakeholder participation have been identified as potential actionable points for AMR strategy refinement that can improve overall accountability towards progress. Journal of public health 24 July 2023
Exploring the preferences of the Australian Public for antibiotic treatments: A discrete choice experiment
Despite concerted public awareness raising campaigns, our results suggest that several factors may influence the preferences of Australians when considering antibiotic use. However, for those more likely to be aware of the need to preserve antibiotics, out-of-pocket costs and limiting the contribution to antibiotic resistance are the dominant influence. Delays in starting treatment were not important for any latent class, suggesting public tolerance for this measure. These results could help inform strategies to promote prudent antibiotic stewardship. The Patient - Patient-centered outcomes research 18 July 2023
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Research
Antimicrobial resistance and its possible implications in the future: a mini review
The emergence of antimicrobial resistance (AMR) among different species of microbes, or infectious agents, has become a major public health concern worldwide. This alarming trend is due to the rapid development of new resistance mechanisms and the decreasing effectiveness of treating common infectious diseases. As a result, standard treatments often fail to elicit a proper microbial response, leading to prolonged illness, increased healthcare costs, and a higher risk of mortality. Many infectious agents, including bacteria, fungi, viruses, and parasites, have developed high levels of multidrug resistance, resulting in increased morbidity and mortality rates, and being called as "superbugs." While the development of MDR is a natural process, it is exacerbated by the inappropriate use of antimicrobial drugs, inadequate sanitary conditions, improper food handling, and subpar infection prevention and control practices. Given the importance of AMR, this paper enlists the AMR issue along with its significance, mechanism and its possible impact in the future. The creation of innovative treatments to fight these persistent infections should be made easier by a better strategy of educating the population about the drivers of AMR. International journal of community medicine and public health 10 November 2023
Quantifying the economic and clinical value of reducing antimicrobial resistance in gram-negative pathogens causing hospital-acquired infections in Australia
The results of this study demonstrate the clinical and economic value of reducing AMR impact in Australia. Of note, since this analysis only considered a limited number of pathogens in the hospital setting only and for a limited number of infection types, the benefits of counteracting AMR are likely to extend well beyond the ones demonstrated here. Infectious disease and therapy 21 June 2023
Analysis of Australian business and research specialisation in antimicrobial resistance technology
Rising rates of antimicrobial resistance (AMR) is one of the major threats to the delivery of effective healthcare worldwide. Technology to manage AMR, and its associated risks, is rapidly evolving in Australia and internationally. In this paper the authors determine how Australia is positioned in the AMR-domain, compared with its international peers, when accounted for scientific, business and patent activity in the domain. MPRA 11 October 2023
Cleaning up our disinfectants: Usage of antimicrobial biocides in direct-to-consumer products in Australia
In supermarkets and chemists worldwide, consumers are faced with an array of antimicrobial domestic cleaning and personal hygiene products purporting to kill germs and keep people safe. Many of these proven active ingredients (biocides) encourage the development of antimicrobial resistance (AMR) in microbes and microbial populations, in turn increasing the likelihood of AMR infections. In order to understand and address the selective pressure towards AMR posed by the unrestricted use of biocides, it is necessary to understand which biocides are most frequently found in consumer products and the current regulatory framework that governs their use. In this research the authors survey the biocidal active ingredients in the major categories of cleaning and personal care products available from supermarkets and pharmacies in Australia, and comment on the regulations that dictate how these products are tested and marketed. Microbiology society 4 October 2023
Refractory Helicobacter pylori infection in Australia: updated multicentre antimicrobial resistance
This first multicentre, multistate study of H. pylori resistance in Australian patients exposed to prior therapy demonstrated high rates of antimicrobial resistance, including levofloxacin (>20%). This raises concern about recommending levofloxacin in empirical second-line therapies. Increased monitoring and awareness of current H. pylori resistance rates in Australia are needed to guide local eradication practices. Internal medicine journal 13 September 2023
A review of resistance to Polymyxins and evolving Mobile Colistin Resistance Gene (mcr) among Pathogens of clinical significance
The global rise in antibiotic resistance in bacteria poses a major challenge in treating infectious diseases. Polymyxins (e.g., polymyxin B and colistin) are last-resort antibiotics against resistant Gram-negative bacteria, but the effectiveness of polymyxins is decreasing due to widespread resistance among clinical isolates. The aim of this literature review was to decipher the evolving mechanisms of resistance to polymyxins among pathogens of clinical significance. Antibiotics 6 November 2023
Evaluation of Antibiotic Resistance Mechanisms in Gram-Negative Bacteria
Multidrug-resistant Gram-negative bacterial infections are exponentially increasing, posing one of the most urgent global healthcare and economic threats. Due to the lack of new therapies, the World Health Organization classified these bacterial species as priority pathogens in 2017, known as ESKAPE pathogens. This classification emphasizes the need for urgent research and development of novel targeted therapies. The majority of these priority pathogens are Gram-negative species, which possess a structurally dynamic cell envelope enabling them to resist multiple antibiotics, thereby leading to increased mortality rates. Antibiotics 3 November 2023
Nocardia species distribution and antimicrobial susceptibility within Australia
Nocardia is a ubiquitous saprophyte capable of causing human disease. The authors demonstrate geographical variation in the distribution of Nocardia incidence. Four species predominate in the Australian setting, and nationwide data confirm a high in vitro susceptibility to trimethoprim-sulphamethoxazole and linezolid, justifying their ongoing role as part of first-line empiric therapy. Internal medicine journal 6 November 2023
Antibiotics online: digital pharmacy marketplaces and pastiche medicine
The internet enables access to information and the purchasing of medical products of various quality and legality. Research and regulatory attention have focused on the trafficking of illicit substances, potential physical harms of pharmaceuticals, and possibilities like financial fraud. However, there is far less attention paid to antibiotics and other antimicrobials used to treat infections. The authors find that digital pharmacy marketplaces constitute ‘pastiche medicine’. They curate access to pharmaceutical and information products that emulate biomedical authority combined with emphasis on the ‘self-assembly’ of healthcare. Pastiche medicine empowers the consumer but borrows biomedical expertise about antibiotics, untethering these goods from critical medicine information, and from AMR prevention strategies. They reflect on the implications of pastiche medicine for AMR policy, what the antibiotics case contributes to wider critical scholarship on digital pharmacy, and how medical humanities research might consider researching online consumption in future. Medical humanities 31 July 2023
What influences parental decisions about antibiotic use with their children: A qualitative study in rural Australia
Mothers living in remote areas experiencing reduced access to health services may make decisions about antibiotic use out of fear and based on the advice of their personal network when they perceive their child is vulnerable to a health threat. Findings from this study provide guidance for future research in the prediction of antibiotic use behaviours and for context-specific interventions. Plos One 19 July 2023
Sex, drugs and superbugs: The rise of drug resistant STIs
Antimicrobial resistance (AMR) presents a swiftly advancing challenge to a wide range of healthcare and health promotion practices. While rising rates of AMR share some dimensions across contexts, the specificities of field, practice, place and population shape – and at times hinder attempts to stem – the rising tide of this health threat. Sexually transmitted infections (STIs) are one area of healthcare where the threat of AMR has traditionally been met with lethargy. In this paper, the authors draw on a range of stakeholder perspectives across practice, innovation and regulatory systems in Australia, the US and the UK to understand and examine the evolving nexus of STIs and AMR, including the roles of cultural reception, professional practice and political traction. SSM - Qualitative research in health 18 July 2023
Vancomycin resistant enterococcus risk factors for hospital colonization in hematological patients: a matched case-control study
Antimicrobial stewardship strategies to reduce inappropriate Gram-positive coverage in hematological patients is urgently required, as independent risk factors for Vancomycin-resistant enterococcus (VRE) nosocomial colonization identified in this study include any use of vancomycin and altered bowel habits. VRE colonization and infection did not influence 30- and 90-day mortality. There was a strong correlation between Clostridioides difficile infection (CDI) and VRE, which deserves further investigation to target new therapeutic approaches. Antimicrobial resistance & infection control 13 November 2023
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Reports
Optimising antimicrobial stewardship in Australian primary care
Australia is one of the highest antimicrobials (antibiotic) prescribing countries in the developed world. Overprescription and inappropriate prescribing is contributing to the development of antimicrobial resistant infections, as well as increasing adverse side effects and treatment costs. Without action, the expected global costs of antimicrobial resistance will exceed $1 trillion by 2050. Preventing antimicrobial resistance requires the establishment of antimicrobial stewardship (AMS) practices in prescribing. In Australia, AMS programs are well established in secondary and tertiary care. However, 80% of antibiotics in Australia are prescribed within primary care. Despite this, AMS programs are yet to be widely established within primary care. To prevent antimicrobial resistance, barriers to AMS programs in primary care must be addressed, and interprofessional collaboration between general practice and community pharmacy fostered. Deeble Institute 25 July 2023
AURA 2023: Fifth Australian report on antimicrobial use and resistance in human health
AURA 2023 includes data and analyses from 2020–2022 (primarily 2020–2021) and reports on patterns and trends in antimicrobial use and appropriateness and antimicrobial resistance in Australian acute and community healthcare settings. Australian Commission on Safety and Quality in Healthcare 16 November 2023
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