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  • Slaughterhouses may be hotspots for the transmission of antimicrobial resistant pathogens. To obtain information on the antimicrobial resistance landscape in Kenyan slaughterhouses, a team of scientists from the International Livestock Research Institute and others collected swabs of the environment, animal carcasses, and workers. They identified bacterial isolates in 52.3 % of 193 samples, and most isolates showed resistance to streptomycin (68.7 %), ampicillin (48.7 %), and tetracycline (42.5 %). About 44% of the 80 isolates showed multi-drug resistance, while 6.3% of isolates expressed Extended Spectrum Beta Lactamase. These findings illustrate the presence of resistant bacteria throughout the slaughterhouse environment, posing a risk to workers and meat consumers. This highlights the need for an integrated surveillance system along the food chain. Citation Hamilton, K.A., Njoroge, S.M., Momanyi, K., Murungi, M.K., Odinga, C.O., Bor, N., Ogendo, A., Odaba, J., Ogola, J.G., Fèvre, E.M. and Falzon, L.C. 2024. The antimicrobial resistance landscape of slaughterhouses in western Kenya: A microbiological case study. One Health 19: 100899. Photo: A typical mixed crop-livestock farming household, western Kenya (ILRI/Charlie Pye-Smith)
    Friday, September 20, 2024 - 11:35
  • Background: Children with under-five year age disproportionally affected with foodborne illness. Campylobacteriosis is the most common foodborne disease next to Norovirus infection. Macrolides are commonly prescribed as the first line of treatment for Campylobacter gastroenteritis, with fluoroquinolone and tetracycline as secondary options. However, resistance to these alternatives has been reported in various regions worldwide. Objective:To determine the prevalence, associated risk-factors and antimicrobial resistance of Campylobacter jejuni and C. coli among under-five children with diarrhea. Methods: Institution-based cross-sectional study was conducted from November, 2022 to April 2023. The study sites were selected using a random sampling technique, while the study subjects were included using a convenient sampling technique. The data were collected using a structured questionnaire. Stool samples were inoculated onto modified charcoal cefoperazone deoxycholate agar and incubated for 48 hours. The suspected colonies were analyzed using matrix-assisted laser desorption ionization-time of flight mass spectrometry to confirm the species. Antimicrobial susceptibility testing was performed using a disc diffusion technique. All potential covariates (independent variables) were analyzed one by one using bivariate logistic regression model to identify candidate variables with P value < 0.25. Multivariable logistic analysis was used to identify potential associated factors using the candidate variables. A p value ≤ 0.05 at a 95% confidence interval was statistically significant. Result: Among the 428 samples, 7.0% (CI: 4.5–9.3) were confirmed Campylobacter species. The prevalence of C. jejuni and C. coli among under-five children was 5.1% (CI: 3.0–7.0) and 1.9% (CI: 0.7–3.3), respectively. C. jejuni (73.3%) was dominant over C. coli (26.7%). The resident, contact with domestic animals, and parents/guardians education level were significantly associated with campylobacteriosis among under-five children. One-third of the Campylobacter isolates (33.3%, 10/30) were resistant to ciprofloxacin and tetracycline whereas 10.0% (3/30) were resistant to erythromycin. Furthermore, 3.3% (1/30) of the Campylobacter were found to be multidrug-resistant. Conclusion: The prevalence of Campylobacter species was 7.0%. The resistance rate of Campylobacter species of ciprofloxacin and tetracycline-resistance strains was 33.3%. Peri-urban residence, contact with domestic animals, and low parental educational statuses were significantly associated factors with increased risk of Campylobacter infection. Continuous surveillance on antimicrobial resistance and health education of personal and environmental hygiene should be implemented in the community. Citation Worku, M., Tessema, B., Ferede, G., Ochieng, L., Leliso, S.A., Mutua, F., Moodley, A., Grace, D. and Gelaw, B. 2024. Campylobacter jejuni and Campylobacter coli infection, determinants and antimicrobial resistance patterns among under-five children with diarrhea in Amhara National Regional State, Northwest Ethiopia. PLOS ONE 19(7): e0304409.
    Friday, July 5, 2024 - 08:40
  • Rising levels of antimicrobial resistance in both humans and animals have reached alarming levels and are being recognized as a serious incremental threat to global food security, animal health and public health. The One Health approach recognizes the interconnectedness of human, animal and environmental health, and that antimicrobial resistance can be spread between different species and environments. The Fleming Fund, a United Kingdom (UK) Overseas Development Aid program managed by the UK Department of Health and Social Care, aims to improve antimicrobial resistance and antimicrobial use surveillance data in Africa and Asia by generating, sharing, and using data to improve antimicrobial use and encourage investment in antimicrobial resistance research and development. The fund awarded grants to several countries, including Kenya, to support national efforts in strengthening their capacity to collect, manage and use data on antimicrobial use and resistance. Six institutions formed the Fleming Fund consortium in Kenya. These are the Aga Khan University, the International Livestock Research Institute, the Kenya Medical Research Institute, PATH, the  University of Nairobi  and Washington State University. Across animal and human health sectors, this consortium supported activities that address the gaps in the surveillance of antimicrobial resistance and its causes including antimicrobial stewardship training, development and dissemination of standard operating procedures for both active and passive antimicrobial resistance surveillance, capacity building of field and laboratory personnel and infrastructure work among other activities. The wide range of data acquired through this program will impact evidence-based policies and programs, enabling consumers and stakeholders to make informed decisions that preserve the effectiveness of antibiotics. Citation Kasudi, M.R., Muloi, D.M., Murungi, M.K., Azegele, A., Ndanyi, R., Gunturu, R., Ombajo, L., Tanui, E., Onsare, R.S., Omuse, G., Kariuki, S. and Fèvre, E. 2024. Scaling antimicrobial resistance surveillance nationally: The case of the Fleming Fund in Kenya. One Health Cases 2024(2024).
    Thursday, June 13, 2024 - 08:28
  • Livestock associated antimicrobial resistance can reduce productivity and cause economic losses, threatening the livelihoods of poor farming communities in low-income settings. We investigated the practices and risk factors for increased antibiotic use, and antimicrobial resistance in Escherichia coli including resistance to human critically important antibiotics like cefotaxime and colistin in semi-intensive and free-range poultry farms in Uganda. Samples and farm management data were collected from 402 poultry farms in two districts between October 2021 to March 2022. Samples were processed to isolate E. coli and to quantify cefotaxime (CTX) and colistin (COL) resistant coliforms. The identification of presumptive E. coli isolated on MacConkey agar without antibiotics, was confirmed by matrix-assisted laser desorption/ionization-time of flight mass spectrometry and subjected to antimicrobial susceptibility testing by disk diffusion using EUCAST guidelines. Our models indicated that antibiotic use was associated with production intensity, and type of feed used. Moreover, semi-intensive farmers had better knowledge on antibiotic use compared to farmers in the free-range system. In semi-intensive farms, 52% harbored COLR and 57% CTXR coliforms. In free-range farms, 54% had COLR and 67% CTXR coliforms. Resistance to tetracycline, ampicillin and enrofloxacin were more frequent in semi-intensive farms compared to the free-range farms. Multi-drug resistant E. coli were identified in both poultry production systems despite different management and antibiotic use practices. There was no significant relationship between antibiotic use and resistance for the six antibiotics tested. Citation Mbatidde, I., Ndoboli, D., Ayebare, D., Muloi, D., Roesel, K., Ochieng, L., Dione, M., Tenhagen, B.-A., Biryomumaisho, S., Wampande, E., Wieland, B., Olsen, J.E. and Moodley, A. 2024. Antimicrobial use and antimicrobial resistance in Escherichia coli in semi-intensive and free-range poultry farms in Uganda. One Health 18: 100762.
    Monday, June 3, 2024 - 08:12
  • The COVID-19 pandemic has significantly impacted healthcare systems, including antibiotic use practices. We present data on patterns of antibiotic dispensing and use in community and hospital settings respectively in Nairobi, Kenya during the pandemic. We conducted interviews with 243 pharmacies in Nairobi using a standardised questionnaire from November to December 2021. The data collected included demographic characteristics, antibiotic customers, types of antibiotics sold, and antibiotic prescribing practices. Additionally, we retrospectively reviewed health records for 992 and 738 patients admitted in COVID-19 and general wards at two large inpatient hospitals between April 2020 and May 2021, and January 2019 to October 2021, respectively. Demographic, utilisation of laboratory services, treatment, clinical, and outcome data were collected using a modified Global WHO Point Prevalence Surveys (Global-PPS) tool. Almost all pharmacies (91.4%) served customers suspected of having COVID-19 with a mean weekly number of 15.6 customers. All pharmacies dispensed antibiotics, mainly azithromycin and beta lactams to suspected COVID-19 infected customers. 83.4% of hospitalised COVID-19 patients received at least one antibiotic at some point during their hospitalisation, which was significantly higher than the 53.8% in general ward patients (p<0.001). Similarly, the average number of antibiotics administered to COVID-19 patients was higher than that of patients in the general ward (1.74 vs 0.9). Azithromycin and ceftriaxone were the most commonly used antibiotics in COVID-19 patients compared to ceftriaxone and metronidazole in the general wards. Only 2% of antibiotic prescriptions for COVID-19 patients were supported by microbiological investigations, which was consistent with the proportion of 6.8% among the general ward population. Antibiotics were commonly prescribed to customers and patients suspected of having COVID-19 either in community pharmacies or in hospital, without a prescription or laboratory diagnosis. These findings emphasize the crucial role of antibiotic stewardship, particularly in community pharmacies, in the context of COVID-19. Citation Gacheri, J., Hamilton, K.A., Munywoki, P., Wakahiu, S., Kiambi, K., Fèvre, E.M., Oluka, M.N., Guantai, E.M., Moodley, A. and Muloi, D.M. 2024. Antibiotic prescribing practices in community and clinical settings during the COVID-19 pandemic in Nairobi, Kenya. PLOS Global Public Health 4(4): e0003046.
    Thursday, May 2, 2024 - 09:46
  • To effectively regulate and reduce antibiotic use, in the livestock sector, a thorough understanding of the flow of veterinary antibiotics will help to identify key nodes in the chain for targeted interventions. The aim of this study was to understand the flow of antibiotics from import to end-user, and identify relevant governance mechanisms. A mixed methods approach was used to collect data in three Kenyan counties (Nairobi, Kiambu and Kajiado). Twenty-three focus group discussions, 148 individual interviews and 10 key informant interviews were conducted. The key actors identified include primary wholesalers, secondary wholesalers, retailers, animal health service providers, and farmers. Kenya imports all of its veterinary antibiotics. Primary wholesalers legally import antibiotics as finished pharmaceutical products (90%) or active pharmaceutical ingredients (10%) after approval by the Directorate of Veterinary Medicine. Secondary wholesalers play a major role in the distribution of antibiotics (60% of antibiotics) from importers to farmers, animal health service providers and retailers. Some of the illegal sources of antibiotics include unlicenced/unauthorized middlemen and online platforms that sell directly to retailers, animal health service providers and farmers. Despite the presence of various laws and regulations governing the antibiotic value chain, implementation has been a challenge due to financial and human resource constraints. This contributes to over-the-counter sale of antibiotics without prescription, unlicensed businesses selling antibiotics, illegal importation, and presence of poor-quality drugs. There is a need to review the applicability of existing policies and address policy gaps (for example, product containing antibiotic combinations, and use of human critically important antibiotics) to ensure the prudent sale and use of antibiotics, pharmacovigilance, antimicrobial use surveillance, and developing a business model that aligns with antibiotic stewardship. Additional interventions include awareness raising and capacity building of the different stakeholders along the antibiotic distribution chain to reduce antibiotic mis- and overuse. Citation Morang’a, A.K., Muloi, D.M., Kamau, S.M., Onono, J.O., Gathura, P.B. and Moodley, A. 2024. Mapping the flow of veterinary antibiotics in Kenya. Frontiers in Veterinary Science 11: 1304318.
    Monday, April 8, 2024 - 09:25
  • Antibiotics are frequently utilized in livestock, particularly poultry, for therapy and growth promotion, resulting in antimicrobial resistance. Multidrug-resistant bacteria are frequent in poultry samples from India. The purpose of this study was to better understand main antibiotic consumption patterns in poultry value chains, as well as antibiotic knowledge and practices among the stakeholders. A cross-sectional survey was conducted in Assam and Karnataka, India. The poultry farmers were interviewed on antibiotic usage, antibiotic knowledge, feeding practices, and preventive measures on the farm. Poultry farmers reported their veterinarians, and we also interviewed them on knowledge and practices related to antimicrobial use in poultry and antimicrobial resistance. Item response theory (IRT) was used to assess the association between the answers and demographic factors. This survey interviewed 62 poultry farmers and 11 veterinarians. Small poultry farms with fewer than 4000 birds were owned by 51.6% of farmers. Most poultry farmers had heard about antibiotics, and 62.9% thought they cured all diseases. If one chicken is sick, 72.6% said others should be given antibiotics to prevent the disease. All veterinarians utilized tetracyclines, aminoglycosides, and cephalexin on the poultry farms. Over half (54.5%) stated antibiotics prevent diseases, and 72.7% said they treat and prevent diseases. Some (45.5%) said antibiotics boost growth. IRT analysis showed that 8 questions assessed a knowledge scale well. Univariable analysis showed that Assam farmers and women were likely to have have more knowledge. The poultry farmers were mostly unaware of the relation between antibiotic use and antimicrobial resistance. Despite being aware, the veterinarians agreed with use antibiotics as a prophylactic measure. It is vital that these stakeholders understand the repercussions of such widespread antibiotic use. In order to increase knowledge, frequent trainings and antimicrobial stewardship programmes with effective communication and incentives for behaviour change should be conducted. Citation Sharma, G., Dey, T., Hazarika, R.A., Shome, B.R., Shome, R., Singh, V.P., Deka, R.P., Grace, D. and Lindahl, J.F. 2024. Knowledge and practices related to antibiotics among poultry producers and veterinarians in two Indian states. One Health 18: 100700. Photo: Chickens at the Ganeshguru livestock market, Guhawati, India (ILRI/Stevie Mann)
    Monday, March 25, 2024 - 09:37
  • Antibiotic use on Kenya’s dairy farms is putting consumers and animals at risk Dishon Muloi, International Livestock Research Institute and Arshnee Moodley, CGIAR System Organization Farmers often use antibiotics to keep their livestock healthy. They’re sometimes used as “quick fixes”, to avoid more costly management measures like regular disinfection, waste management, routine vaccination or provision of clean drinking water. Animal husbandry now accounts for about two thirds of the global consumption of antibiotics. As livestock and fish production grows, by 2030 the consumption of antibiotics is projected to increase by 67%. Worryingly, this overuse in food animal production can create problems for both animals and people. It can contribute to the development of antibiotic-resistant bacteria which, through food or environmental exposure such as drinking contaminated water, can be transmitted to people. This means that some antibiotics may become ineffective in treating human infections. Antibiotic resistant infections are associated with 4.95 million deaths globally every year. Sub-Saharan Africa accounts for 22% of these. Similarly, animals can also become infected with antibiotic-resistant bacteria. This leads to infections that are difficult or impossible to treat. Our latest study, which focused on the central Kenyan highlands, looked at antibiotic use on smallholder dairy farms as well as antibiotic quality (substandard or counterfeit antibiotics). Kenya is one of the largest milk producers in Africa and one of the countries with the largest per capita consumption of milk. About 80% of the milk produced in Kenya comes from smallholder farmers. We found that smallholder farmers weren’t using antibiotics properly and were buying poor quality products. Also, traces of some antibiotics were found in milk. This puts the health of both people and animals at risk. Antibiotic access and use For our study, we collected data from 248 dairy farms and 72 veterinary drug stores between February 2020 and October 2021. This included milk samples and the antibiotics themselves. Most dairy farms surveyed reported using antibiotics at least once in the past year. This is not unusual – cows get sick. Dairy cows are especially prone to getting udder infections. Antibiotics were used to treat and to prevent infections. Most were obtained through animal health service providers. A small number (6%) were bought directly from veterinary drug stores or other farmers. Antibiotics were often sold without a prescription, and based on farmers’ own diagnosis. These are imprudent practices – the wrong antibiotic could be used to treat an infection or antibiotics could be overused. The improper or excessive use of antibiotics in dairy farming can lead to the development of antibiotic-resistant bacteria. This then leads to economic losses for farmers, because animals will be less productive and the cost of treatment will grow. It’s estimated that, as a result of antimicrobial resistance, livestock output could fall by 11% by 2050, with the highest decline in low income countries. There’s also the risk of these antibiotic-resistant bacteria being transmitted to humans, either directly through contact with animals or indirectly through the consumption of milk and dairy products. This can lead to infections that are difficult to treat, posing a public health risk. Antibiotics found in milk Also worrying, in this study we detected nine antibiotics in milk. Three samples exceeded global standards. Antibiotics can get into milk supplies when withdrawal times are not strictly followed. The presence of antibiotic residues in milk – even at low levels – can pose health risks to consumers, particularly those who are allergic to specific antibiotics. Even for those who aren’t allergic, prolonged exposure to low levels of antibiotics may contribute to the development of antibiotic-resistant bacteria. Quality of antibiotics The study also examined the quality of antibiotics available in veterinary drug stores in central Kenya. Poor quality, substandard, or counterfeit antibiotics can lead to ineffective treatment and prolonged illness. Low-quality antibiotics are even more likely to contribute to the development of antibiotic-resistant bacteria. This is because they won’t fully eradicate the pathogen (disease-causing bacteria), allowing them to adapt and become resistant. Almost 44% of the antibiotics we tested were of poor quality. This has considerable implications for the efficacy and safety of these drugs. It can also contribute to antibiotic resistance. Implications The findings of the study underscore the need for better management practices on Kenya’s dairy farms. This includes: stricter regulation of antibiotic sales improved veterinary oversight education of farmers about the risks of antibiotic misuse. For a country like Kenya, where agriculture plays a significant role in the economy, ensuring livestock is healthy and productive is crucial for both farmers and the country. We recommend a few steps for policymakers to take: strengthen regulations around antibiotic use in livestock enhance surveillance and monitoring systems for antibiotic residues in milk improve the quality control of antibiotics sold in veterinary drug stores educate farmers about the responsible use of antibiotics promote better animal husbandry practices that reduce the reliance on antibiotics. Dishon Muloi, Research scientist, International Livestock Research Institute and Arshnee Moodley, AMR Team Leader, CGIAR System Organization This article is republished from The Conversation under a Creative Commons license. Read the original article.
    Friday, February 23, 2024 - 09:23
  • Understanding antibiotic use in dairy systems is critical to guide antimicrobial stewardship programs.  A new research study reports the findings of an investigation into antibiotic use practices in smallholder dairy farms, antibiotic quality and antimicrobial resistance (AMR) awareness among veterinary drug retailers in a mixed farming community in the central Kenyan highlands.  The study is published in Scientific Reports (Dec 2023). Data were collected from 248 dairy farms and 72 veterinary drug stores between February 2020 and October 2021.  A scale was developed to measure knowledge about AMR and antibiotic use using item response theory, and regression models were used to evaluate factors associated with antibiotic use and AMR knowledge.  The active pharmaceutical ingredient content of 27 antibiotic samples was determined using high-performance liquid chromatography.  The presence and levels of 11 antibiotic residues in 108 milk samples collected from the study farms were also investigated using liquid chromatography tandem mass spectrometry.  Almost all farms (98.8%) reported using antibiotics at least once in the last year, mostly for therapeutic reasons (35.5%).  The most used antibiotics were tetracycline (30.6%), penicillin (16.7%) and sulfonamide (9.4%), either individually or in combination, and predominantly in the injectable form.  Larger farm size and history of vaccination use were significantly associated with a higher frequency of antibiotic use.  Drug retailers who advised on animal treatments had a significantly higher mean knowledge scores than those who only sold drugs.  The study found that 44.4% of the tested antibiotics did not meet the United States Pharmacopeial test specifications (percentage of label claim).  Nine antibiotics were detected in milk, including oxytetracycline, sulfamethoxazole, and trimethoprim.  However, only three samples exceeded the maximum residue limits set by the Codex Alimentarius Commission.  The study findings indicate that antibiotics of poor quality are accessible and used in smallholder dairy systems, which can be found in milk.  These findings will aid future investigations on how to promote sustainable antibiotic use practices in dairy systems. Citation Muloi, D.M., Kurui, P., Sharma, G., Ochieng, L., Nganga, F., Gudda, F., Muthini, J.M., Grace, D., Dione, M., Moodley, A. and Muneri, C. 2023. Antibiotic quality and use practices amongst dairy farmers and drug retailers in central Kenyan highlands. Scientific Reports 13: 23101. Photo credit: Milk at the Kiambaa Dairy Rural Sacco Society (ILRI/Eyeris pictures media)
    Friday, December 29, 2023 - 14:53
  • The intersection of human, animal, and ecosystem health at One Health interfaces is recognised as being of key importance in the evolution and spread of antimicrobial resistance (AMR) and represents an important, and yet rarely realised opportunity to undertake vital AMR surveillance.  A working group of international experts in pathogen genomics, AMR, and One Health convened to take part in a workshop series and online consultation focused on the opportunities and challenges facing genomic AMR surveillance in a range of settings.  In a new article published in Lancet Microbe (Dec 2023), they outline the working group's discussion of the potential utility, advantages of, and barriers to, the implementation of genomic AMR surveillance at One Health interfaces and propose a series of recommendations for addressing these challenges.  Embedding AMR surveillance at One Health interfaces will require the development of clear beneficial use cases, especially in low-income and middle-income countries.  Evidence of directionality, risks to human and animal health, and potential trade implications were also identified by the working group as key issues.  Addressing these challenges will be vital to enable genomic surveillance technology to reach its full potential for assessing the risk of transmission of AMR between the environment, animals, and humans at One Health interfaces. This article is the fourth in a series of five papers about harnessing genomics for antimicrobial resistance surveillance. All papers in the series are available at www.thelancet.com/microbe. Citation Muloi, D.M., Jauneikaite, E., Anjum, M.F., Essack, S.Y., Singleton, D.A., Kasudi, M.R., Wade, M.J., Egyir, B., Nunn, J.G., Midega, J.T., Peacock, S.J., Feasey, N.A., Baker, K.S. and Zadoks, R.N. for the SEDRIC Genomics Surveillance Working Group. 2023. Exploiting genomics for antimicrobial resistance surveillance at One Health interfaces. Lancet Microbe e1056–e1062. Photo credit: Antimicrobial resistance research facilities at ILRI Nairobi (ILRI/Paul Karaimu)
    Friday, December 29, 2023 - 14:37