Advancing Public Health Research in Central America - An Integrated Surveillance Platform for Infectious Diseases and Their Burden on Antibiotic Resistance

项目摘要 抗生素耐药性的日益普遍对全球人类健康构成威胁。超过 世界上80%的人口生活在低收入和中等收入国家， 受到抗生素耐药性的挑战。出现这种情况是因为疾病负担更大， 更大的抗生素需求，更大的无监督抗生素供应，以及更多的机会 传播病原体和抗药性细菌，从而增加疾病 发病率和抗生素需求。我们假设，这种传输组件 这一过程甚至比抗生素的使用更重要，因此， 在资源有限的情况下，传播将是最有效的。拟议项目将 直接评估疾病负担（定义为综合征性疾病） 包括急性发热性疾病、腹泻和呼吸道感染）以及随后对 抗生素对抗生素耐药菌（细菌和致病菌）的流行率的影响。我们 将建立一个监测平台，在农村和城市社区位于 危地马拉克萨尔特南戈省。一个横截面，随机选择的样本， 在研究的初始阶段，将招募家庭（n=600），并且粪便和 将收集咽喉样本，以检测是否存在（定殖）超广谱 头孢菌素耐药肠杆菌科（ESCrE），碳青霉烯耐药肠杆菌科 (CRE)和A组链球菌。基线数据将与后续数据进行比较。 纵向样本，而综合征性疾病的病例将在入组时进行研究。 户在当地医院进行病原体分离和患者追踪， 卫生保健对社区抗生素耐药性流行的贡献。如果资金 监测平台将继续收集以下方面的基线流行率数据： 抗生素耐药性和调查综合征疾病三年。额外的工作将 包括细菌分离物分子表征和包含单独的交叉- 一项横断面研究，旨在检查社区中耐药性细菌的患病率， 急性发热性疾病的发病率较高。第1-3年的数据将用于确定和 在第4-5年进行试验干预。

PROJECT SUMMARY The growing prevalence of antibiotic resistance is a threat to human health globally. More than 80% of the world’s population lives in low- and middle-income countries that are particularly challenged by antibiotic resistance. This situation arises because of greater disease burdens, greater antibiotic demand, greater unsupervised antibiotic availability, and more opportunities for transmission of pathogens and antibiotic-resistant bacteria that, in turn, increases disease incidence and demand for antibiotics. We hypothesize that the transmission component of this process is even more important than antibiotic use, and consequently interventions that limit transmission would be most efficacious in resource-limited settings. The proposed project will directly assess the connection between burden of disease (defined as syndromic illness including acute febrile illness, diarrhea, and respiratory infections) and subsequent demand for antibiotics on the prevalence of antibiotic-resistant bacteria (commensal and pathogenic). We will establish a surveillance platform in a rural and an urban community located in the Quetzaltenango Department of Guatemala. A cross-sectional, randomly-selected sample of households (n=600) will be enrolled during the initial phase of the study, and both stool and throat samples will be collected to detect the presence (colonization) of extended-spectrum cephalosporin-resistant Enterobacteriaceae (ESCrE), carbapenem-resistant Enterobacteriaceae (CRE) and Group A Streptococcus. The baseline data will be compared with subsequent longitudinal samples while cases of syndromic illness will be investigated at the enrolled households. Pathogen isolation and tracking of patients at local hospital will be used to examine the healthcare contribution to the prevalence of antibiotic resistance in the community. If funding is available, the surveillance platform will continue to collect baseline prevalence data on antibiotic resistance and investigate syndromic illness for three years. Additional work will include molecular characterization of bacterial isolates and inclusion of a separate cross- sectional study to examine the prevalence of antibiotic-resistant bacteria in a community that has a higher incidence of acute febrile illness. Data from years 1-3 will be used to identify and test interventions during years 4-5.