One Health Drivers of Antibacterial Resistance in Thailand

泰国抗菌素耐药性的健康驱动因素之一

• 批准号: MR/S004769/1
• 负责人: Matthew Avison
• 金额: $ 371.96万
• 依托单位: University of Bristol
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FS004769%2F1
• 关键词: Health; Drivers; Antibacterial; Resistance; Thailand

Antibacterial Resistance (ABR) is a significant source of excess mortality in Overseas Development Assistance (ODA) countries and constitutes a major, increasing threat to wellbeing and economic development. Antimicrobial Resistance (AMR), predominantly ABR, is estimated to have caused 38,000 deaths and an economic loss of 1.2 billion US$ in Thailand in 2010. Because of good record keeping and surveillance, Thailand has been used as an exemplar for characteristics of ABR in ODA countries. ABR is common in human, environmental and animal bacterial isolates. However, ABR has mostly been studied separately in discrete sectors (e.g. hospital patients or poultry). The key drivers of ABR relevant to human health cannot be pinpointed in this way because the selection and transmission of ABR results from interactions between humans, animals, and the environment. A "One Health" approach to the problem is required.During this consortium project, we will study the Enterobacteriaceae family bacteria Klebsiella pneumoniae (Kp) and Escherichia coli (Ec), which reside in the human and animal gut, are common in environments contaminated with faeces, are are considered a significant threat to human health in Thailand. They are commonly carbapenem- and/or 3rd-generation cephalosporin-resistant (3GCR), which are drugs commonly used for serious infections. Carbapenem-resistant Enterobacteriaceae (CRE) are also recognised by WHO as one of the highest priority pathogens globally for which new ABs are urgently needed. Ec and Kp cause a range of infections in hospitalized patients (e.g. surgical site, intra-abdominal, pneumonia, sepsis) and serious community-acquired infections (e.g. complicated urinary tract infection, pyogenic liver abscess, meningitis). The prevalence of 3GCR Kp and Ec in human infections in Thailand has been increasing from less than 10% in 1999 to 50% in 2016, and of carbapenem-resistant Kp from none prior to 2010 to 10%-20% in 2016.Our consortium's vision is to build a holistic picture of the drivers of ABR in Thailand and to use this information to benefit the Thai people, and as an exemplar for other ODA countries. The term "driver" may refer to: 1) a material condition or substance, such as a chemical (e.g. an Antibiotic), which, at a particular concentration, selects for the increased prevalence of ABR bacteria; 2) an action, such as exposing bacteria to that chemical by taking an antibiotic; or 3) a socioeconomic condition or circumstance which accounts for that action (e.g. the economic necessity to keep working in the face of illness). A full understanding of ABR drivers at every level is important for the design of effective and appropriate interventions to limit ABR. Hence, this interdisciplinary consortium will investigate them all.Our study area will be the Mae Klong-Ta Chin Basin, which covers an area of 80x80 km in the central and western part of Thailand. This is the area where the Mae Klong and Ta Chin rivers run from their mountain sources along the Thai-Myanmar border (Mae Klong river) and upper central Thailand (Ta Chin river) down to the Gulf of Thailand. The study area includes districts spread over five provinces (Karnchanaburi, Ratchaburi, Samut Songkram, Samut Sakorn and Nakornprathom). Both rivers enter the study site and run through areas where there are numerous factories, animal farms, rice fields, fruit orchards and communities, allowing multiple possible drivers to be considered in our work.Our work will run alongside Thailand's National Strategic Plan on AMR, giving us a perfect opportunity to embed our findings in annual reviews of the Strategic Plan, influencing policy and having a relatively short term and direct impact on human health in Thailand. Our engagement and stakeholder activities will also facilitate dissemination of our findings into other countries within the same global region, and comparisons with other projects across the globe will yield added value.

抗生素耐药性（ABR）是海外发展援助（ODA）国家死亡率过高的一个重要原因，对福祉和经济发展构成了日益严重的威胁。据估计，2010年泰国的抗菌素耐药性（AMR），主要是ABR，已经造成38，000人死亡和12亿美元的经济损失。由于良好的记录保存和监测，泰国被用作官方发展援助国家ABR特征的典范。ABR在人类、环境和动物细菌分离株中很常见。然而，ABR主要是在离散部门（例如医院患者或家禽）单独研究的。与人类健康相关的ABR的关键驱动因素不能以这种方式确定，因为ABR的选择和传播是人类，动物和环境之间相互作用的结果。在这个联合项目中，我们将研究肠杆菌科细菌肺炎克雷伯氏菌（Klebsiella pneumoniae，Kp）和大肠杆菌（Escherichia coli，Ec），它们存在于人类和动物的肠道中，在被粪便污染的环境中很常见，被认为是对泰国人类健康的重大威胁。它们通常是碳青霉烯和/或第三代头孢菌素耐药（3GCR），这是常用于严重感染的药物。耐碳青霉烯类肠杆菌科（CRE）也被世卫组织认定为全球最优先的病原体之一，迫切需要新的AB。Ec和Kp引起住院患者的一系列感染（例如手术部位、腹腔内、肺炎、败血症）和严重的社区获得性感染（例如复杂性尿路感染、化脓性肝脓肿、脑膜炎）。在泰国，3GCR Kp和Ec在人类感染中的流行率从1999年的不到10%增加到2016年的50%，碳青霉烯类耐药Kp从2010年之前的零增加到2016年的10%-20%。我们联盟的愿景是建立泰国ABR驱动因素的整体图景，并利用这些信息造福泰国人民。也是其他ODA国家的榜样。术语“驱动器”可以指：1）物质条件或物质，例如化学物质，（例如抗生素），其在特定浓度下选择ABR细菌的增加的流行率; 2）动作，例如通过服用抗生素使细菌暴露于该化学品;或3）导致这种行为的社会经济条件或环境（例如，在疾病面前继续工作的经济必要性）。在每个层次上对ABR驱动因素的充分理解对于设计有效和适当的干预措施以限制ABR是重要的。因此，这个跨学科联盟将对所有这些进行调查。我们的研究区域将是Mae Klong-Ta Chin盆地，该盆地位于泰国中西部，占地80 x80公里。这是Mae Klong和Ta Chin河从他们的山源运行的区域沿着泰国-缅甸边界（Mae Klong河）和上中部泰国（Ta Chin河）向下到泰国海湾。研究区域包括五个省（Karnchanaburi，拉查武里，Samut Songkram，Samut Sakorn和Nakornprathom）的地区。这两条河流进入研究地点，流经众多工厂、农场、稻田、果园和社区的区域，因此我们的工作可以考虑多种可能的驱动因素。我们的工作将与泰国的AMR国家战略计划一起进行，这为我们提供了一个绝佳的机会，将我们的研究结果嵌入战略计划的年度审查中，影响政策，并对泰国的人类健康产生相对短期和直接的影响。我们的参与和利益攸关方活动还将有助于将我们的调查结果传播到同一全球区域的其他国家，与地球仪的其他项目进行比较将产生附加值。

项目成果

One Health drivers of antibacterial resistance: Quantifying the relative impacts of human, animal and environmental use and transmission.

• DOI: 10.1016/j.onehlt.2021.100220
• 发表时间: 2021-06
• 期刊: One health (Amsterdam, Netherlands)
• 作者: Booton RD;Meeyai A;Alhusein N;Buller H;Feil E;Lambert H;Mongkolsuk S;Pitchforth E;Reyher KK;Sakcamduang W;Satayavivad J;Singer AC;Sringernyuang L;Thamlikitkul V;Vass L;OH-DART Study Group;Avison MB;Turner KME
• 通讯作者: Turner KME

ONE-HEALTH APPROACH TO INVESTIGATE AMU AND AMR DRIVERS IN THAILAND

采用单一健康方法调查泰国 AMU 和 AMR 驱动因素

• DOI: 10.1016/j.ijid.2023.05.037
• 发表时间: 2023
• 期刊: International Journal of Infectious Diseases
• 影响因子: 8.4
• 作者: Alhusein N

The unseen use of antimicrobials: Drivers of human antibiotic use in a community in Thailand and implications for surveillance

• DOI: 10.1080/17441692.2023.2298940
• 发表时间: 2024-12-31
• 期刊: GLOBAL PUBLIC HEALTH
• 影响因子: 3.3
• 作者: Alhusein，Nour;Charoenboon，Nutcha;Lambert，Helen
• 通讯作者: Lambert，Helen

Mutations in Ribosomal Protein RplA or Treatment with Ribosomal Acting Antibiotics Activates Production of Aminoglycoside Efflux Pump SmeYZ in Stenotrophomonas maltophilia.

核糖体蛋白 RplA 突变或核糖体作用抗生素治疗可激活嗜麦芽寡养单胞菌中氨基糖苷外排泵 SmeYZ 的产生。

• DOI: 10.1128/aac.01524-19
• 发表时间: 2020
• 期刊: Antimicrobial agents and chemotherapy
• 影响因子: 4.9
• 作者: Calvopiña K

Estimating the COVID-19 epidemic trajectory and hospital capacity requirements in South West England: a mathematical modelling framework.

• DOI: 10.1136/bmjopen-2020-041536
• 发表时间: 2021-01-07
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Booton RD;MacGregor L;Vass L;Looker KJ;Hyams C;Bright PD;Harding I;Lazarus R;Hamilton F;Lawson D;Danon L;Pratt A;Wood R;Brooks-Pollock E;Turner KME
• 通讯作者: Turner KME