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

项目总结 抗生素耐药性的日益流行在全球范围内对人类健康构成威胁。多过 世界上80%的人口生活在中低收入国家，这些国家特别 受到抗生素耐药性的挑战。这种情况的出现是因为疾病负担更大， 更大的抗生素需求，更多的非监督抗生素供应，以及更多的机会 传播病原体和抗药性细菌，这反过来又会增加疾病 抗生素的发生率和需求。我们假设这个信号的传输部分 过程甚至比抗生素的使用更重要，因此干预措施限制了 在资源有限的情况下，传播将是最有效的。拟议的项目将 直接评估疾病负担(定义为症状性疾病)之间的联系 包括急性发热病、腹泻和呼吸道感染)以及随后对 抗生素对抗生素耐药细菌(共生和致病)的流行。我们 将在农村和城市社区建立一个监测平台，位于 危地马拉Quetzaltenango部门。一个横截面的，随机选择的样本 家庭(n=600)将在研究的初始阶段登记，凳子和 将采集咽喉样本以检测超广谱的存在(定植) 头孢菌素耐药肠杆菌科(ESCrE)、碳青霉烯类耐药肠杆菌科 (Cre)和A组链球菌。基准数据将与后续数据进行比较 在被录取的医院将对综合征病例进行调查时进行纵向抽样 家庭。将在当地医院对患者进行病原体分离和跟踪检查 医疗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基线流行率数据 抗生素耐药性和三年的综合征疾病调查。其他工作将 包括细菌分离株的分子特征和包含一个单独的交叉- 调查耐抗生素细菌在一个社区中的流行率的分区研究 有较高的急性发热病发病率。第1-3年中的数据将用于确定和 在第4-5年间测试干预措施。

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.