Antimicrobial Resistance and Infection Control (ARIC) has launched with BioMed Central today.
Led by Andreas Voss, ARIC is a global forum for the scientific community working on the prevention, diagnosis and treatment of healthcare-associated infections.
Healthcare-associated infections are on the rise because of changes in healthcare systems and the spread of antimicrobial-resistant strains of both new and well-known pathogens. With increasing numbers of people travelling nationally and internationally, borders to transmission of infections no longer exist and fighting healthcare-associated infections has truly become a global challenge.
Therefore, it is important to share knowledge in this field on a global scale. This was highlighted at the 1st International Conference on Prevention and Infection Control and consequently ARIC was born.
With the support of an internationally recognized Editorial Board, ARIC aims to become the leading resource for the dissemination of scientific knowledge on all aspects of healthcare-associated infections. Please visit the journal website to learn more about the ARIC and to submit your research.
Srimathy Sriskantharajah
Srimathy is the Executive Publisher for Parasites & Vectors, Malaria Journal and other microbiology/ infectious diseases journals at BioMed Central.
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Antimicrobial Resistance (AMR) Programs in Canada 1995-2010: A Critical Evaluation
An interesting “in a nut-shell” review. Not exactly a success story.
My take… Not rocket science, but some of the probable causes for limited impact of interventions against inappropriate use of antimicrobials are that:
– It is often approached from a general perspective, i.e. decrease it “across the table”, as opposed to aim for specific uses, e.g. “decrease inappropriate use of antimicrobials in children under five with respiratory infections”. The latter was the purpose we selected based on an eco-systemic analysis of antimicrobial resistance disclosing elements such: most out-patient care events are or children under five, due to respiratory infections for which antimicrobials are prescribed in 71% of cases mostly unnecessarily; prescribers, dispensers and parents were prone to do the right thing (taking the ill child to a health service, prescribing correctly, selling/buying the prescribed dosage, adhering to treatment).
The eco-systemic analysis of determinants of AMR led to an intervention including developing and introducing clinical guidelines, providing information to community face to face and through media, improving quality assurance and control of antimicrobials, strengthening local laboratory capacity to monitor antimicrobial resistance, etc.).
For a description of the SAIDI approach see https://usaidsaidi.org/extras/SAIDI_APPROACH_lo_f_012411.pdf
and for technical reports, articles, materials produced under SAIDI see https://www.usaidsaidi.org/resources.shtml
– Top down, whole of organization interventions often do not include necessary restrictive and enabling changes in working environment, are not sustained long enough, and fail to elicit ownership. Interventions based on small teams that have incentives for change and are empowered to do so, and accompanied by systemic changes seem more successful.
It’s probably the situation in which a “guerrilla” approach sustained long enough will be better than approaches based on achieving changes at the individual level (as most KAP-based interventions).
An example: The evidence-based intervention used to reduce the incidence of catheter-related bloodstream infections reported by Provonost years ago – See https://www.nejm.org/doi/full/10.1056/NEJMoa061115 -, and the initiatives based on it (e.g infection zero).
Among probable causes for limited impact of interventions against inappropriate use of antimicrobials are:
General perspective approaches as opposed to specific ones, e.g. decrease it in respiratory infections in children under five. For the latter we did an eco-systemic analysis that led to a multi-prong intervention (introducing clinical guidelines, informing the community face to face and through media; improving quality assurance/control of antimicrobials, and local capacity to monitor antimicrobial resistance, etc.). See http://www.usaidsaidi.org
Top down, whole of organization interventions lacking necessary restrictive and enabling changes in work environment, and not sustained long enough. Probably, “motivated, enabled guerrilla” approaches sustained long enough will be better than approaches based on individual changes (as most KAP interventions are). E.g, reduction of catheter-related bloodstream infections reported by Provonost and infection zero initiative.