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Containing antimicrobial resistance is a smart investment in global public health and wealth

Dr Eni̇s Bariş, Practice Manager, Health, Nutrition and Population Global Practice, World Bank; Alexander Irwin, Consultant, Health, Nutrition and Population Global Practice, World Bank; Alessia Thiebaud, Research Analyst, Health, Nutrition and Population Global Practice, World Bank and Dr Timothy Grant Evans, Senior Director, Health, Nutrition and Population Global Practice, World Bank In this article, we summarize the investment case for antimicrobial resistance (AMR) action; discuss policy options for low- and middle-income countries; and describe what the World Bank Group is doing to fight AMR. Annual global gross domestic product may drop by up to 3.8% by 2050, if AMR remains unchecked. To avoid this outcome, the world must invest US$ 9 billion annually. Cumulative benefits from this investment through 2050 may range between US$ 9.8 trillion and US$ 26.8 trillion, in net present value terms. Returns on AMR investments are likely to be exceptional: up to 88% annually, if 75% of AMR costs can be avoided. Promising AMR strategies for countries include harnessing universal health coverage (UHC) reforms to accelerate AMR gains and reducing antibiotic use in livestock. The World Bank Group will support country and global action on AMR, for, example, by developing a global investment framework to optimize AMR finance.     Antimicrobial resistance (AMR): From tragedy to transformational investment he dwindling efficacy of antibiotics and other antimicrobials worldwide can be seen as a “tragedy of the...

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Embedding quality improvement through a learning collaborative to reduce and sustain hospital-acquired infections in the west bank

Abed Alra’oof Saleem, Director, Quality Planning Department, Ministry of Health, Palestine; Dr Musa Hindiyeh, Director of Caritas Baby Hospital Clinical Laboratory, Bethlehem; Dr Ali Ahmed Sabateen, Head, ID Unit, Augusta Victoria Hospital, East Jerusalem; Dina Nasser, Nurse; Dr Rabee S A Adwan, Al Makassed Hospital, East Jerusalem; Lisa Dolan-Branton, Senior Improvement Advisor, USAID; Jennifer Ross, Lecturer, Robert Gordon University, Aberdeen UK, Ghazaleh Samandari and Sarah Kauder, Improvement Specialist, USAID ASSIST While life expectancy and mortality indicators in the Palestinian Territories have improved since 2010, hospitals across the West Bank and Gaza are experiencing an alarming surge in antibiotic resistance due to a lack of standardized infection prevention and control processes and systems. Combined with a dearth in uniform microbiology protocols and processes within the Palestinian Health System, hospital-acquired infections (HAIs) pose a serious public health risk. This short article describes a newly launched learning collaborative led by the Ministry of Health, with support from the United States Agency for International Development, to embed stronger infection prevention and control practices in 13 public and nine private hospitals in the West Bank and institutionalize a system to reduce hospital-acquired infections. At first glance, health indicators in the Palestinian Territories imply long-term positive gains in healthcare. Overall life expectancy is 75 years for females and 72 years for males. The infant mortality rate declined from 25.5 per 1,000 live births in 2000 to...

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Using quality improvement to address hospital-acquired infections and antimicrobial resistance

Leighann E Kimble, Healthcare Improvement Fellow, quality & performance institute, University Research Co., LLC, USAID applying science to strengthen and improve systems (ASSIST) Project; Dr M Rashad Massoud, Chief Medical and Quality Officer/Senior Vice President, quality & performance institute, university research co., LLC, Director USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project and Dr James Heiby, Medical Officer, US Agency for International Development, Bureau for Global Health, Office of Health Systems This article discusses the importance of quality improvement to address hospital-acquired infections and antimicrobial resistance (AMR). By focusing on improving the quality of care through increased adherence to guidelines and evidence-based best practices, quality improvement plays a role increasing the prevention and surveillance of infection outbreaks, while increasing ability of healthcare systems to respond to and build resilience to outbreaks through changes in their care delivery processes.  In weak health systems, the risk for hospital-acquired infections (HAI) and consequently developing antimicrobial resistance (AMR) is especially high. Addressing hospital-acquired infections and AMR requires healthcare processes that include not only infection prevention, surveillance and response, but ensure quality in care delivery. By ensuring compliance with evidence-based best practices in care delivery processes, quality improvement acts as a prevention mechanism against HAI outbreaks and AMR stemming from poor-quality care. AMR must therefore be addressed not only as a public health concern, but as an issue of quality of care...

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Potential impact of telemonitoring by connected devices on the evaluation of antibiotic therapy’s duration in the ambulatory treatment of pulmonary infections

Dr Aurélien Dinh, Infectious Disease Specialist and Dr Clara Duran, Clinical Research Associate, infectious disease unit, raymond poincaré teaching hospital, versailles Saint-Quentin University, Garches, France; and Dr François Teboul, Emergency MD and Medical Director for Visiomed, Paris, France This article considers recent developments in antibiotic therapy and how simple changes to a course of antibiotics given in specific environments can reduce antimicrobial resistance. Short courses of antibiotics can be effective, but need close and careful monitoring, which in the past has proved difficult outside the hospital environment. New telemonitoring technology can help remotely observe the condition of the patient taking the short course and report any abnormalities back to medical professionals. A rapid emrgence of multidrug-resistant (MDR) bacteria strains is occurring worldwide, compromising the efficacy of antibiotics, which have been saving millions of lives (1). Indeed, decades after the first use of antibiotic treatments on patients, bacterial infections have again become a threat (2), due to antimicrobial overuse and misuse, as well as a stalling in new drug development in the pharmaceutical industry. Antibiotic-resistant infections are already widespread across the globe (3). In 2011, the IDSA (Infectious Disease Society of America) Emerging Infections Network found in a national survey that more than 60% of participants had seen a drug-resistant untreatable bacterial infection within the prior year (2). Most public health organizations have been warning the medical community about the rapid emergence...

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Infections in surgery – a key battleground to combat antimicrobial resistance

Dr Massimo Sartelli, Consultant surgeon, department of general and emergency surgery, Macerata Hospital , Italy, and founder and acting director of the global alliance for infections in surgery In recent years, there has been a worldwide increase in infections caused by multidrug-resistant organisms (MRDOs). The threat of antimicrobial resistance (AMR) is one of the major challenges associated with the management of surgical infections. Ohe increasing prevalence of AMR is responsible for a significant increase in morbidity and mortality rates associated with surgical infections, as well as a subsequent increase in overall healthcare costs (1, 2).  Although AMR is a natural phenomena that occurs as bacteria evolve, there is a well-established relationship between antimicrobial prescribing practices and the emergence of antimicrobial- resistant pathogens (3). The problem of AMR is widespread worldwide. Clinicians should be aware of their role and responsibility for maintaining the effectiveness of current and future antimicrobials. Clinicians may fight this battle by: enhancing infection prevention and control; prescribing and dispensing antimicrobials only when they are truly needed; prescribing and dispensing the right antimicrobial(s) to treat the illness (3). By optimizing the use of antibiotics, clinicians improve patient outcomes and provide better initial antibiotic administration, minimizing the chances of AMR (3). In surgery, antibiotics are used as prophylaxis or as therapy. The use of antibiotic prophylaxis contributes considerably to the total amount of antibiotics used in hospitals and...

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