Acharya Jyoti, Jha Runa, Gompo Tulsi Ram, Chapagain Sharmila, Shrestha Lilee, Rijal Nisha, Shrestha Anjana, Koirala Pragya, Subedi Suraj, Tamang Binita, Kattel Hari Prasad, Khaniya Bishal, Shrestha Basudha, Karki Aruna, Adhikari Ram Prasad, Kayastha Sanita, Pradhan Prasil, Shrestha Sarada Duwal, Raghubanshi Bijendra Raj, Tuladhar Heera, Kansakar Palpasa, Shrestha Saugat, Shrestha Priyanka, Shrestha Binay, Soares Magalhaes Ricardo J, Kakkar Manish, Govindakarnavar Arunkumar, Gocotano Allison, Samuel Reuben
National Public Health Laboratory, Tripura Marg, Kathmandu, Nepal.
Central Veterinary Laboratory, Tripureshwor, Kathmandu, Nepal.
Int J Microbiol. 2024 Oct 16;2024:1094816. doi: 10.1155/2024/1094816. eCollection 2024.
The need to address antimicrobial resistance (AMR) through a One Health (OH) approach is now well recognized. There is, however, limited guidance on how AMR surveillance should be implemented across sectors to generate meaningful AMR and AMU data for decision-making. Using a sympatric approach to cross-sector sample collection, Nepal adopted the WHO extended-spectrum beta-lactamase (ESBL)-producing () Tricycle Project as a step toward OH surveillance for assessing the prevalence of ESBL-producing across human, veterinary, and environment sectors. This involved a three-stage approach: identification of human hotspots (Stage 1) and sample collection sites for poultry (Stage 2) and wastewater (Stage 3). A total of 53 blood cultures from patients with bloodstream infections (BSIs), 100 stool samples from healthy pregnant women, 220 poultry ceca from slaughterhouses and live markets, and 48 wastewater samples were processed for bacterial culture and analyzed for the presence of ESBL-producing . The prevalence of ESBL-producing among isolated was the highest in wastewater samples (91%) followed by human BSIs (49%), poultry (38.6%), and fecal carriage isolates from healthy pregnant females (15%). A statistically significant association was seen in the prevalence of multidrug resistance among ESBL producers (52%) and nonproducers (26%). ESBL-producing was detected in all wastewater samples tested except for the upstream river. The findings of the study showed a high prevalence of ESBL-producing in samples from all three sectors and provided baseline data based upon which strategies for the safe disposal of communal and hospital waste, integrated AMR surveillance, and control strategies could be planned and implemented.
通过“同一健康”（OH）方法应对抗菌药物耐药性（AMR）的必要性现已得到广泛认可。然而，关于如何跨部门实施AMR监测以生成有意义的AMR和抗菌药物使用（AMU）数据用于决策的指导却很有限。尼泊尔采用同域方法进行跨部门样本采集，将世卫组织产超广谱β-内酰胺酶（ESBL）的[具体细菌名称未给出]三轮车项目作为迈向OH监测的一步，以评估人类、兽医和环境部门中产ESBL的[具体细菌名称未给出]的流行情况。这涉及三个阶段的方法：确定人类热点地区（第1阶段）以及家禽（第2阶段）和废水（第3阶段）的样本采集地点。共对53份血流感染（BSI）患者的血培养样本、100份健康孕妇的粪便样本、220份来自屠宰场和活禽市场的家禽盲肠样本以及48份废水样本进行细菌培养，并分析其中产ESBL的[具体细菌名称未给出]的存在情况。在分离出的[具体细菌名称未给出]中，产ESBL的[具体细菌名称未给出]在废水样本中的流行率最高（91%），其次是人类BSI（49%）、家禽（38.6%）和健康孕妇粪便携带分离株（15%）。在产ESBL菌株（52%）和非产ESBL菌株（26%）中，多重耐药性的流行率存在统计学上的显著关联。除上游河流外，在所有测试的废水样本中均检测到产ESBL的[具体细菌名称未给出]。该研究结果表明，来自所有三个部门的样本中产ESBL的[具体细菌名称未给出]流行率很高，并提供了基线数据，据此可规划和实施社区及医院废物安全处置、综合AMR监测和控制策略。
