Antimicrobial resistance – why this topic?
AMR (Antimicrobial resistance)
AMR refers to the reduction or even loss of susceptibility of microbes (bacteria, viruses, fungi, and some parasites) to antimicrobial agents that were previously effective in their treatment. Infections can thus no longer be effectively treated with drugs such as antibiotics, fungicides, antiparasitics, and others. Not only the health of humans and animals is directly affected, but AMR also threatens food and environmental safety. In addition, AMR poses a huge global economic burden. Therefore, AMR is connected to several SDGs.
Resistance in microbes can develop naturally and can be transferred between organisms and ecosystems. However, there are several factors that accelerate the development of AMR like the improper use of antimicrobials in humans, animals and agriculture or antimicrobial residues in the environment.
Especially low- resource areas with a higher burden of infectious diseases, weak health- care systems and limited regulation, surveillance and prevention of AMR, are disproportionately affected. However, AMR is not limited to specific regions. The dissemination of AMR is accelerated by the increased mobility of people, animals, and goods.
Therefore, the One Health approach and international cooperation are essential to systematically address the challenges of AMR to secure the achievements of modern medicine for our future.
Within this approach systematic and continuous monitoring of antimicrobial agent consumption and resistance in animals, food, the environment and humans forms the basis of AMR control.
AMR in bacteria – how it spreads
Local antimicrobial stewardship – why this topic?
AMS (Antimicrobial stewardship)
One of the main causes of the rapid spread of antibiotic resistance is the improper and excessive use of antimicrobial drugs in human and veterinary medicine and in food production. AMS is a coordinated effort to optimise the use of antimicrobial agents, to minimise adverse events, excessive costs and the selective pressure of resistance and to improve treatment outcomes. However, studies have shown that the prudent use of antimicrobials alone is not sufficient to contain the spread of AMR. The impact of AMS therefore depends on bundled and coordinated interventions.
Baseline conditions for AMS are different in LMICs than in HICs. Ethical issues of limited access to antibiotics, for example, need to be considered. Context-specific and community-based intervention approaches are preferable to maximize effectiveness of AMS in LMICs.
Theory of change for antimicrobial stewardship (AMS) on a local level
Project profiles
Liberia
About the project
Project Health Systems Strengthening and Epidemic Prevention
Goal Protect the population of Liberia against disease outbreaks with epidemic potential
Implementation period 9/2020 – 4/2024
How does it work?
- pilot AMR sentinel surveillance systems and AMS programs at three clinical sites
- application of bundle of measures such as empirical therapy according to local guidelines, bed- side consultations and training of prescribers
- multidisciplinary AMS teams (pharmacist, nurse, physician, infection prevention and control practitioners, laboratory scientists, technicians and administrators) conduct regular ward rounds
- support development of national policy, technical guidelines, national reporting systems
- procurement of lab equipment and human capacity development (e.g., training of lab staff)
- support of remote health care facilities and labs with sample collection and transport
What was achieved?
- with support from the project, the Government of Liberia was able to submit data to the WHO’s global AMR surveillance system (GLASS) for the first time in 2021)
- quality assessment was performed to identify barriers and point of entry for improved approach to reduction of AMR
- adherence to treatment guidelines improved: the majority of the recommendations of the AMS team were followed (85%), and correct antimicrobial choice increased from 35% → 61% (n=310)
- 80% of patients had microbiological samples collected and analysed through a functional referral laboratory structure
- Lessons learned:
- AMS behaviour change is a marathon, not a sprint – long-term, multifaceted interventions (training, coaching, mentoring) are essential
- AMS Steering Committees with clear roles and responsibilities strengthen antimicrobial prescribing practices
- functional microbiology capacity and sentinel sites are crucial for targeted therapy and system efficiency
- regular ward rounds and consistent use of laboratory results significantly improve antimicrobial use
- success stories help build motivation, ownership and sustained buy-in for AMS interventions
Starting points towards One Health Approach
- laboratory capacity development
- integrated disease surveillance and response
- community Event-Based Surveillance
- university curriculum
Cameroon
About the project
Project Part of Green Innovation Centres for the Agriculture and Food Sector
Goal Increase smallholder income, boost employment, and improve regional food supply in selected rural target regions
Implementation period 2014 – 2026
How does it work?
- the project strengthens poultry producers by providing training materials and training opportunities on good poultry management and the responsible use and handling of antimicrobial substances. Small broiler farms, the use of incubators, feed mixing facilities, and the establishment of veterinary service centers are promoted as business models. Vaccination campaigns against Newcastle disease are supported. Additional training with the aim of improving diagnostics for poultry diseases is offered.
What was achieved?
- 30 veterinary offices set up, and 29 veterinarians/veterinarians assistants received practical training.
- 25,000 producers trained in good animal husbandry practices through a cascade approach (476 model farmers and 89 Heads of Zootechnical and Veterinary Centres (CVZC))
- 840 vaccinators trained and 923,646 chickens vaccinated
- 9,700 farmers learned farm management via the Farmer Business School approach
- 40 carpenters trained in the production of an improved chicken coop model
Starting points towards One Health Approach
- lack of knowledge, innovation and training in good poultry management
Zambia
About the project
Project Combating antimicrobial resistance and antimicrobial residues in the Zambian poultry sector (ICARS)
Project no external project
Goal Improve practices in the poultry value chain and provide measurable data to make a case for policy makers and community actors
Implementation period 5/2022 – 4/2025
How does it work?
- various institutions work closely together to implement the project “Combating AMR antimicrobial resistance and antimicrobial residues in the Zambian poultry sector (ICARS)” effectively. National partners are the Ministry of Livestock and Fisheries, Central Veterinary Research Institute, Ministry of Fisheries and Livestock, University of Zambia, Veterinary Association of Zambia, and Zambia Medicines Regulatory Authority.
- The key interventions are to develop and disseminate novel treatment guidelines and, with training for the veterinarians, help improve poultry disease treatment regimes; and training, incentives, and sensitisation that will target farmers, veterinary paraprofessionals, and agro-vet shop sellers to improve antimicrobial use, advice and selling practices.
What was achieved?
- the Project started Mid-2022; reporting is yet not available
Starting points towards One Health Approach
- lack of guidelines for prescribing and treatment in poultry husbandry
Selected indicators for structural and process measures
| Area | Indicator |
|---|---|
| Human health | • AMS guidelines in use (also for treatment of vulnerable groups, e.g., children) • antimicrobial consumption in humans based on sales data |
| Animal health | • antimicrobial consumption in animals based on sales data |
| Human and animal health | • number of professionals trained in complying to guidelines • proportion of prescriptions for restricted antimicrobials that comply with the locally endorsed approval policy and guidelines • availability of cross sectoral analysis of antimicrobial resistance data • cross-sectoral/cross-disciplinary coordination mechanism in place |