动物部门的抗微生物耐药性干预措施:范围界定综述

A. B. Jacobsen, J. Ogden, A. Ekiri
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摘要

动物被认为是产生和传播抗菌素耐药性(AMR)的关键因素。然而,人们对动物部门现有的抗菌素耐药性干预措施知之甚少。本范围审查审查了针对牲畜、动物卫生专业人员(ahp)和农民的抗菌素耐药性干预措施的现有证据,同时审查了其影响、局限性、差距和供未来使用的经验教训。范围审查是按照PRISMA-ScR检查表的指导方针进行的。检索了Web of Science、Scopus、PubMed和国际组织的网站(WHO、FAO、WOAH)等数据库,查找报告针对牲畜、农民和ahp的干预措施的文章。干预措施根据七个预先定义的主要措施进行分类,包括:改变抗微生物药物使用(AMU)做法;抗菌药物管理(AMS)吸收的变化;抗菌素耐药性发展的变化;适当的AMU实践、AMR和AMS知识的变化;对AMU、AMR和AMS的态度和认知的改变;以及监控策略。共纳入93个来源:66项研究、20份报告和7个网页。回顾的干预措施主要集中在AMU实践(22/90)、AMS摄取(8/90)和减少细菌或耐药菌株(30/90)。知识(14/90)和态度(1/90)的变化较少被评估,而且往往是隐性的。大多数干预措施是在选定的国家内进行的(83/90),7/90是在全球一级进行的。只有19%(16/83)的干预措施是在低收入和中等收入国家实施的,而且大多数处于群体水平,存在许多自我报告变化。大多数注重监测战略的干预措施(30/83)是在高收入国家实施的(62/83)。只有一项研究调查了干预的经济影响。研究结果概述了现有的抗菌素耐药性干预措施,并深入了解了可以解决的差距,以指导未来的干预措施和研究。将重点放在制定、实施和评估中低收入国家的干预措施上,并结合使用客观的结果衡量指标(例如,可衡量的结果与自我报告),将提高我们对这些环境中干预措施影响的理解。最后,有必要评估干预措施的经济效益,以便为可行性提供信息,并鼓励采取旨在减少动物卫生部门抗菌素耐药性的干预措施。
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Antimicrobial resistance interventions in the animal sector: scoping review
Animals are considered key contributors to the development and spread of antimicrobial resistance (AMR). However, little is known about the existing AMR interventions in the animal sector. This scoping review examines the existing evidence on AMR interventions aimed at livestock, animal health professionals (AHPs), and farmers, while reviewing their impact, limitations, gaps, and lessons for future use. The scoping review was conducted following guidelines from the PRISMA-ScR checklist. The databases, Web of Science, Scopus, PubMed, and international organisations’ websites (WHO, FAO, WOAH) were searched for articles reporting interventions targeting livestock, farmers, and AHPs. Interventions were categorised based on seven pre-defined primary measures including: change in antimicrobial use (AMU) practices; change in the uptake of antimicrobial stewardship (AMS); change in development of AMR; change in knowledge of appropriate AMU practices, AMR, and AMS; change in attitudes and perceptions concerning AMU, AMR, and AMS; and surveillance strategies. In total, ninety three sources were included: 66 studies, 20 reports, and 7 webpages. The reviewed interventions focused mostly on AMU practices (22/90), AMS uptake (8/90), and reduction of bacterial or resistant strains (30/90). Changes in knowledge (14/90) and attitude (1/90) were less frequently assessed and were often implicit. Most interventions were conducted within a select country (83/90) and 7/90 were at a global level. Only 19% (16/83) of interventions were implemented in low- and middle-income countries (LMICs) and most were at herd level with many self-reporting changes. Most of the interventions that focused on surveillance strategies (30/83) were implemented in high-income countries (62/83). Only one study investigated the financial implications of the intervention. The study findings provide an overview of existing AMR interventions and insights into the gaps which can be addressed to guide future interventions and research. A focus on developing, implementing and evaluating interventions in LMICs coupled with the use of objective outcome measures (e.g., measurable outcomes vs. self-reporting) will improve our understanding of the impact of interventions in these settings. Finally, assessing the financial benefits of interventions is necessary to inform feasibility and to encourage uptake of interventions aimed at reducing AMR in the animal health sector.
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