The Pew Charitable Trusts Project
APUA has been part of an ongoing partnership with The Pew Health Group's Campaign on Human Health and Industrial Farming. In 2010, APUA and Pew hosted the roundtable meeting "The EU Ban on Use of Antibiotics for Growth Promotion in Agriculture: Review of Scientific Evidence and Implications for Public Health" in Paris. The meeting discussed the EU and individual country bans on the use of antibiotics for livestock growth promotion and reviewed EU and individual country policies and processes involved in implementing the ban. In 2012, APUA has partnered with Pew on nationwide campaigns to rally support for FDA actions such as the ban on extralabel uses of cephalosporins and the recommendations (Guidance for Industry #209, #213, and the Veterinary Feed Directive) for phasing out antibiotic use in growth promotion.
Gates Foundation Project: Antibiotic Resistance Situation Analysis and Needs Assessment in Uganda and Zambia
In October 2008, APUA received a $1.37 million grant from the Bill & Melinda Gates Foundation, to explore ways of reducing millions of preventable deaths from severe respiratory and diarrheal infections in Africa. The project, "Antibiotic Situation Analysis and Needs Assessment," was designed to evaluate antibiotic use and resistance in the African countries of Uganda and Zambia by conducting a comprehensive analysis and needs assessment. The goal was to guide evidence-based interventions to reduce mortality due to pneumonia and diarrheal diseases. The acquired knowledge is expected to contribute to appropriate healthcare practice and policy in Africa.
International Surveillance of Reservoirs of Antibiotic Resistance (ISRAR)
The International Surveillance of Reservoirs of Antibiotic Resistance (ISRAR) project is a joint research collaboration of the laboratory at Tufts University School of Medicine’s Center for Adaptation Genetics and Drug Resistance, APUA Country Chapters, and the U.S. National Biodefense Analysis and Countermeasures Center Biological Threat Characterization Program (NBACC-BTC) to collect global environmental and veterinary commensal isolates. The primary goals of ISRAR are: (1) to investigate the potential for a global surveillance system to track antibiotic resistance in commensal bacteria and (2) assist in national biodefense efforts by determining which genotypes and phenotypes of resistant bacteria found in the global biome have the possibility of being utilized as enhancers of agents of biological terrorism.
Facts about Antibiotics in Animals and their Impact on Resistance (FAAIR)
The FAAIR (Facts about Antibiotics in Animals and Their Impact on Resistance) project, supported by the Joyce Foundation, was designed to bring scientific evidence to the policy debate on antimicrobial use in agriculture and the risk it poses to human, animal, and ecological health. The APUA "FAAIR Report" published as a comprehensive report in the journal Clinical Infectious Diseases in Spring 2002 (UChicago Journals, Journal of Clinical Infectious Diseases, Vol. 34, Supplement 3, 1 June 2002, p. S71-S144) is based on a review of approximately 500 published studies on the topic of antimicrobial use in agriculture and is the first of its kind to evaluate the risk to human health from: (1) direct and indirect transfer of resistance through the food chain and ecosystems, as well as (2) the cumulative effects of the dissemination of antimicrobial resistance in the environment. As part of the report, APUA also convened a Scientific Advisory Panel of experts from a variety of fields in research and medicine. Panel members analyzed relevant data from the scientific literature and developed consensus conclusions and policy recommendations. In 2005 the FAAIR Report was entered into evidence in the US Food and Drug Administration deliberations to ban the use of enrofoxacin in poultry and used as scientific evidence in FDA hearings to remove fluoroquinolones from use in animal growth promotion. The report was also cited by the Institute of Medicine and served as the scientific basis for the McDonald’s Corporation ban on certain antibiotics to promote animal growth.
Facts about Antibiotics in Animals and their Impact on Resistance II (FAAIR II)
This project focused on obtaining improved antibiotic usage estimates in US food animal production to guide regulatory decision-making. FAAIR II involved collaboration with an expert panel composed of representatives from academia, food producer organizations, public interest groups, veterinary professional associations, public health agencies, and the pharmaceutical industry. FAAIR II was supported by The Joyce Foundation.
The Reservoirs of Antibiotic Resistance (ROAR) Project
Coordinated by the Alliance for the Prudent Use of Antibiotics, the ROAR project was initiated with a 5-year grant from the National Institute of Allergy and Infectious Diseases, as an unprecedented effort to improve scientific understanding of the role of commensal bacteria in the spread of antimicrobial resistance. This is approached by 1) compiling existing commensal isolate data and literature into a Web-based bioinformatics tool; 2) using statistical, risk analysis, and mathematical modeling techniques to analyze the data in order to determine if the frequency of antibiotic resistance genes in commensals can predict the subsequent emergence of antibiotic resistance in pathogenic bacterial populations and 3) encouraging, directing, and funding research efforts to evaluate antibiotic resistance in commensals. ROAR has awarded ten research sub-grants since 1997.
Measuring the Economic Burden of Drug Resistance in the US
In 2009 the Alliance for the Prudent Use of Antibiotics (APUA) and Cook County Hospital (currently John H. Stroger, Jr. Hospital of Cook County) released an eye-opening study on the economic impact of antibiotic overuse and antibiotic-resistant infections (ARIs) sponsored by an unrestricted educational grant from bioMérieux and the Centers for Disease Control and Prevention (CDC).
Antibiotics and the Consumer: Perceptions and Use
This project, funded by Pfizer, centered around the development, fielding, and analysis of a national consumer survey aimed at gaining information on the beliefs and circumstances which motivate people to use antibiotics inappropriately. The project advisory board, which met for the first time on June 5, 2006, included experts from the fields of clinical medicine, health communications, infectious disease research, and managed care.
Hygiene for a Healthy Household
Patient Behaviors and Beliefs Regarding Antibiotic Use: Implications for Clinical Practice
In 2006, APUA launched a research and education campaign aimed at helping consumers decide how and where to target their cleaning efforts to maintain a healthy home. The topic was considered in the context of broader issues, including consideration of the hygiene hypothesis and the possible role of antibacterial cleansers in contributing to antimicrobial resistance and convened a scientific advisory board of experts from fields including epidemiology, clinical medicine, risk analysis, disinfection, and public health. At the meeting, the group chose to focus on identification of a small number of targeted hygiene practices that were likely to have the greatest capacity to reduce levels of disease transmission. A risk reduction framework was used to identify areas of focus, and all messages to come out of the project were low cost and easy to implement.
Continuing Medical Education Curriculum- Bacteria Battle Back: Addressing Antibiotic Resistance
Until 2003 APUA ran a continuing education program made possible by an unrestricted educational grant from Proctor and Gamble Pharmaceuticals and cosponsored by the Massachusetts College of Pharmacy and Health Sciences. The program was accredited by the Massachusetts College of Pharmacy and Health Sciences and the American Academy of Nurse Practitioners for 2 contact hours. The curriculum was designed for pharmacists, nurse practitioners, physicians, physician assistants and other healthcare provider and addressed current antibiotic resistance trends, clinical treatment guidelines and pharmacological and clinical approaches to combating increasing antibiotic resistance in the community.
Global Research to Improve Antimicrobial Policy and Practice (GRIP) Program
APUA’s GRIP Program provided technical assistance and small research grants to research teams in developing countries for short-term research and research-based educational activities designed to curb antibiotic resistance and promote the prudent use of antibiotics. Through the provision of targeted technical assistance with an emphasis on capacity building, GRIP-funded scientists had a supportive environment in which to explore new areas of research vital to the development of area-appropriate interventions to contain AMR. APUA Chapters in Belarus, Brazil, Bulgaria, Columbia, Cuba, Guatemala, India, Moldova, Nepal, Peru, Poland, Russia, Ukraine, Uruguay and Vietnam were awarded grants for research projects.
Integrating Escherichia coli Antimicrobial Susceptibility Data from Multiple Surveillance Programs
In June 2005, a team of researchers, including various APUA scientists, coordinated efforts of various surveillance groups and cross-validated findings from APUA's Global Advisory for Antibiotic Resistance Data (GAARD) datasets (MYSTIC and SENTRY). The analysis explored temporal, geogrpahic, and demographic trends in Escherichia coli resistance from 1997 to 2001.
Pilot Survey of Massachusetts Physicians
In July of 1998 APUA, in cooperation with the Massachusetts Infectious Disease Society (MIDS) and the Massachusetts Department of Public Health, conducted an opinion survey to document factors which may affect physicians' decision making and prescribing practices. All primary care physicians in Massachusetts (approximately 6,000) were asked to complete a one-page questionnaire indicating the importance of fifteen factors influencing their antibiotic prescribing. Four hundred and ninety-nine usable questionnaires were returned (a response rate of 8%). Primary care physicians who responded indicated that purulent discharge and diagnostic uncertainty were the most important factors leading to increased antibiotic prescribing. Patient request also represented a noteworthy influence on the tendency to increase prescribing of antibiotics, but was not as influential. External regulatory factors such as drug formularies and peer review were said to exert little influence on prescribing behaviors. Findings suggested that improved diagnostic methods and targeted educational campaigns aimed at improving diagnostic skills and increasing awareness of the antibiotic resistance problem would foster more appropriate antibiotic use.
Physician Antibiotic Prescribing Practices and Knowledge in Seven Countries in Latin America and the Caribbean
In 2002 APUA and the Pan American Health Organization (PAHO) collaborated on a regional survey regarding antibiotic use in Latin America to determine physicians' knowledge and prescribing practices.
Swine Health Demonstration Project
APUA provided support to researchers at Tufts University School of Veterinary Medicine on a CDC-funded swine health demonstration project. The project examined microbiological characteristics and health in swine herds raised without antibiotics. APUA also developed educational and outreach materials to inform stakeholders and the public of the project’s results and significance.
South American Infectious Disease Initiative (SAIDI)
APUA was a project partner in the USAID South American Infectious Disease Initiative (SAIDI). The central objective of the initiative was the containment of the emergence and spread of AMRB by improving the availability and the use of good quality antimicrobials in three countries in the region (Bolivia, Peru, and Paraguay).
USDA-ARS Regional Comparison of Antimicrobial Resistance in the Environment
Ecology Program Staff collaborated with USDA-ARS to provide water samples and fecal samples from veterinary clinics in the Boston metropolitan area for analysis of bacterial resistance profiles.
Environmental Impact of Antibiotics
In 1998, APUA received a two-year grant from the Nathan Cummings Foundation to support a national public awareness campaign intended to increase public awareness of the need for responsible use of antibiotics, and to improve the ecological balance of resistant and susceptible strains of bacteria, both in the human health care setting and in the overall environment. The objectives of the project were to describe, quantify, and document the cumulative selective force of various antibiotic uses in the environment (plants, animals and humans) on the emergence of antibiotic resistance; to disseminate this information to the public, the press, and policy makers in order to lessen the misuse of antibiotics; and to document links between antibiotic use in a species and/or geographical areas and the emergence of resistant bacteria in adjacent or related species or areas.
Antimicrobial Resistance Summit: Truth and Consequences in Community Medical Practice
Grantmakers in Health issue dialogue (October 2000)
WHO consultation in Oslo, Norway (September 2001)
In September 1999, APUA hosted the Summit on Antimicrobial Resistance in San Francisco, made possible through an unrestricted educational grant from Procter & Gamble Pharmaceuticals. The Summit, entitled "Truth and Consequences in Community Medical Practice," addressed solutions to the increasing prevalence of resistant pathogens, antibiotic misuse by both physicians and patients, and factors driving doctors to overprescribe antibiotics. The conclusions reached at these day-long proceedings are strategies recommended by the Summit's participants for effectively managing the crisis of antibiotic resistance in community practice. For more information please see the 2006 APUA Antibiotic Stewardship Newsletter.