Tackling AMR from a multidisciplinary perspective: a primer from education and psychology

Alicia Calvo‐Villamañán1, Álvaro San Millán1, Laura Carrilero2
1Department of Microbial Biotechnology, Centro Nacional de Biotecnología–CSIC, 28049, Madrid, Spain
2School of Biosciences, The University of Sheffield, Western Bank, Sheffield, S10 2TN, UK

Tóm tắt

Abstract Antimicrobial resistance (AMR) is currently one of the most concerning threats in public health. The efforts to tackle the problem require a global One Health approach, using multidisciplinary approaches and a thorough understanding of the topic both by the general public and the experts. Currently, the lack of a shared mental model of the problem, the absence of a sense of responsibility amongst the different actors and a deficient education on the topic burden the efforts to slow down the emergency and spread of antimicrobial resistant infections. We here propose a multidisciplinary approach to tackle the AMR problem, taking into consideration not only the input from the biological and medical sciences but also the input from the social sciences. Specifically, we suggest strategies from education and psychology to increase awareness about antimicrobial resistance and to implement more effective interventions. Finally, we advocate for a comprehensive and a solidaristic model as the only solution for a problem which knows no borders. As such, political will and international cooperation will be key to achieve the desired change in antibiotic resistance trend.

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Tài liệu tham khảo

Altiner A et al (2007) Reducing antibiotic prescriptions for acute cough by motivating GPs to change their attitudes to communication and empowering patients: a cluster-randomized intervention study. J Antimicrob Chemother 60:638–644

Anderson M, Clift C, Schulze K, Sagan A, Nahrgang S, Ait Ouakrim D, Mossialos E (2019) Averting the AMR crisis: what are the avenues for policy action for countries in Europe? European observatory policy briefs. European Observatory on Health Systems and Policies, Copenhagen

Antibiotic Use | CDC (2021) https://www.cdc.gov/antibiotic-use/index.html. Accessed 18 Jan 2022

Baquero F, Campos J (2003) The tragedy of the commons in antimicrobial chemotherapy. Rev Espanola Quimioter Publicacion Soc Espanola Quimioter 16:11–13

Binagwaho A, Mathewos K (2022) Infectious disease outbreaks highlight gender inequity. Nat Microbiol 7:361–362

Brooks L, Shaw A, Sharp D, Hay AD (2008) Towards a better understanding of patients’ perspectives of antibiotic resistance and MRSA: a qualitative study. Fam Pract 25:341–348

Broom A, Kenny K, Prainsack B, Broom J (2021) Antimicrobial resistance as a problem of values? Views from three continents. Crit Public Health 31:451–463

Bueso-Bordils JI, Suay-García B, Galiana-Roselló C, Marco-Crespo E, Pérez-Gracia M-T (2020) Evaluation of the impact of the tiny earth project on the knowledge about antibiotics of pre-university students in the province of Valencia on three different school years (2017–2020). Front Microbiol 11:576315

Cantarero-Arévalo L, Hallas MP, Kaae S (2017) Parental knowledge of antibiotic use in children with respiratory infections: a systematic review. Int J Pharm Pract 25:31–49

Caprile M, Caprile M, Palmén R, Sanz P, Dente G (2015) Encouraging STEM Studies for the labour market. European parlament directorate-general for internal policies 44

Caudell MA et al (2020) Towards a bottom-up understanding of antimicrobial use and resistance on the farm: a knowledge, attitudes, and practices survey across livestock systems in five African countries. PLoS ONE 15:e0220274

Chaw PS, Höpner J, Mikolajczyk R (2018) The knowledge, attitude and practice of health practitioners towards antibiotic prescribing and resistance in developing countries—a systematic review. J Clin Pharm Ther 43:606–613

Cooper VS, Warren TM, Matela AM, Handwork M, Scarponi S (2019) EvolvingSTEM: a microbial evolution-in-action curriculum that enhances learning of evolutionary biology and biotechnology. Evol Educ Outreach 12:12

Crayton E et al (2020) Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review. BMC Geriatr 20:237

Cully M (2014) Public health: The politics of antibiotics. Nature 509:S16–S17

Di Paolo EA, Barandiaran XE, Beaton, M, Buhrmann T (2014) Learning to perceive in the sensorimotor approach: Piaget’s theory of equilibration interpreted dynamically Front Hum Neurosci 8

Done HY, Venkatesan AK, Halden RU (2015) Does the recent growth of aquaculture create antibiotic resistance threats different from those associated with land animal production in agriculture? AAPS J 17:513–524

Dyar OJ, Hills H, Seitz L-T, Perry A, Ashiru-Oredope D (2018) Assessing the knowledge, attitudes and behaviors of human and animal health students towards antibiotic use and resistance: a pilot cross-sectional study in the UK. Antibiot Basel Switz 7:E10

English LD (2016) STEM education K-12: perspectives on integration. Int J STEM Educ 3:3

Flowers P (2018) Antimicrobial resistance: a biopsychosocial problem requiring innovative interdisciplinary and imaginative interventions. J Infect Prev 19:195–199

Gladstone JR, Cimpian A (2021) Which role models are effective for which students? A systematic review and four recommendations for maximizing the effectiveness of role models in STEM. Int J STEM Educ 8:59

Gonzalez-Gonzalez C et al (2015) Effect of physicians’ attitudes and knowledge on the quality of antibiotic prescription: a cohort study. PLoS ONE 10:e0141820

Harring N, Krockow EM (2021) The social dilemmas of climate change and antibiotic resistance: an analytic comparison and discussion of policy implications. Humanit Soc Sci Commun 8:1–9

Harrington RD, Hooton TM (2000) Urinary tract infection risk factors and gender. J Gend Specif Med 3:27–34

Helou RI et al (2020) Use of stewardship smartphone applications by physicians and prescribing of antimicrobials in hospitals: a systematic review. PLoS ONE 15:e0239751

Hendriksen RS et al (2019) Global monitoring of antimicrobial resistance based on metagenomics analyses of urban sewage. Nat Commun 10:1124

Hernando-Amado S, Coque TM, Baquero F, Martínez JL (2019) Defining and combating antibiotic resistance from One Health and Global Health perspectives. Nat Microbiol 4:1432–1442

Hernando-Amado S, Coque TM, Baquero F, Martínez JL (2020) Antibiotic resistance: moving from individual health norms to social norms in one health and global health. Front Microbiol 11

Huttner B, Goossens H, Verheij T, Harbarth S (2010) Characteristics and outcomes of public campaigns aimed at improving the use of antibiotics in outpatients in high-income countries. Lancet Infect Dis 10:17–31

Institute of Medicine & National Research Council (2015) Transforming the workforce for children birth through age 8: a unifying foundation. (The National Academies Press).https://doi.org/10.17226/19401

Karkman A, Pärnänen K, Larsson DGJ (2019) Fecal pollution can explain antibiotic resistance gene abundances in anthropogenically impacted environments. Nat Commun 10:80

Keep antibiotics working [overview] (n.d.) https://campaignresources.phe.gov.uk/resources/campaigns/58-keep-antibiotics-working/Overview. Accessed 18 Jan 2022

Kelley TR, Knowles JG (2016) A conceptual framework for integrated STEM education. Int J STEM Educ 3:11

Klein EY et al (2018) Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci U S A 115:E3463–E3470

Krockow EM (2020) Nomen est omen: why we need to rename ‘antimicrobial resistance.’ JAC-Antimicrob Resist 2:dlaa067

Kvint K, Palm M, Farewell A (2020) Teaching about antibiotic resistance to a broad audience: a multidisciplinary approach. FEMS Microbiol Lett 367:fnaa111

Laxminarayan R, Weitzman ML (2002) On the implications of endogenous resistance to medications. J Health Econ 21:709–718

Lee C-R, Lee JH, Kang L-W, Jeong BC, Lee SH (2015) Educational effectiveness, target, and content for prudent antibiotic use. BioMed Res Int 2015:214021

Machowska A, Lundborg CS (2018) Drivers of irrational use of antibiotics in Europe. Int J Environ Res Public Health 16:E27

MacLean AB (2001) Urinary tract infection in pregnancy. Int J Antimicrob Agents 17:273–277

Magliano E et al (2012) Gender and age-dependent etiology of community-acquired urinary tract infections. Sci World J 2012:e349597

Maicas S et al (2020) Implementation of antibiotic discovery by student crowdsourcing in the Valencian community through a service learning strategy. Front Microbiol 11:564030

Mayer RE (2008) Learning and instruction. (Pearson Merrill Prentice Hall)

Mazińska B, Strużycka I, Hryniewicz W (2017) Surveys of public knowledge and attitudes with regard to antibiotics in Poland: did the European Antibiotic Awareness Day campaigns change attitudes? PLoS ONE 12:e0172146

McCullough AR, Parekh S, Rathbone J, Del Mar CB, Hoffmann TC (2016) A systematic review of the public’s knowledge and beliefs about antibiotic resistance. J Antimicrob Chemother 71:27–33

McNulty CAM, Boyle P, Nichols T, Clappison P, Davey P (2007) The public’s attitudes to and compliance with antibiotics. J Antimicrob Chemother 60:i63–i68

McNulty CAM, Cookson BD, Lewis MAO (2012) Education of healthcare professionals and the public. J Antimicrob Chemother 67:i11–i18

Melhuish E (2014) The impact of early childhood education and care on improved wellbeing. “If you could do one thing...” Nine local actions to reduce health inequalities (pp 33–43). United Kingdom: British Academy, London

Michie S, van Stralen MM, West R (2011) The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci 6:42

Moura A, Henriques I, Smalla K, Correia A (2010) Wastewater bacterial communities bring together broad-host range plasmids, integrons and a wide diversity of uncharacterized gene cassettes. Res Microbiol 161:58–66

Murray CJ, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, Han C, Bisignano C, Rao P, Wool E, Johnson SC, Browne AJ, Chipeta MG, Fell F, Hackett S, Haines-Woodhouse G, Kashef Hamadani BH, Kumaran EAP, McManigal B, Agarwal R, Akech S, Albertson S, Amuasi J, Andrews J, Aravkin A, Ashley E, Bailey F, Baker S, Basnyat B, Bekker A, Bender R, Bethou A, Bielicki J, Boonkasidecha S, Bukosia J, Carvalheiro C, Castañeda-Orjuela C, Chansamouth V, Chaurasia S, Chiurchiù S, Chowdhury F, Cook AJ, Cooper B, Cressey TR, Criollo-Mora E, Cunningham M, Darboe S, Day NPJ, De Luca M, Dokova K, Dramowski A, Dunachie SJ, Eckmanns T, Eibach D, Emami A, Feasey N, Fisher-Pearson N, Forrest K, Garrett D, Gastmeier P, Giref AZ, Greer RC, Gupta V, Haller S, Haselbeck A, Hay SI, Holm M., Hopkins S, Iregbu KC, Jacobs J, Jarovsky D, Javanmardi F, Khorana M, Kissoon N, Kobeissi E, Kostyanev T, Krapp F, Krumkamp R, Kumar A, Kyu HH, Lim C, Limmathurotsakul D, Loftus MJ, Lunn M, Ma J, Mturi N, Munera-Huertas T, Musicha P, Mussi-Pinhata MM, Nakamura T, Nanavati R, Nangia S, Newton P, Ngoun C, Novotney A, Nwakanma D, Obiero CW, Olivas-Martinez A, Olliaro P, Ooko E, Ortiz-Brizuela E, Peleg AY, Perrone C, Plakkal N, Ponce-de-Leon A, Raad M, Ramdin T, Riddell A, Roberts T, Robotham JV, Roca A, Rudd KE, Russell N, Schnall J, Scott JAG, Shivamallappa M, Sifuentes-Osornio J, Steenkeste N, Stewardson AJ, Stoeva T, Tasak N, Thaiprakong A, Thwaites G, Turner C, Turner P, van Doorn HR, Velaphi S, Vongpradith A, Vu H, Walsh T, Waner S, Wangrangsimakul T, Wozniak T, Zheng P, Sartorius B, Lopez AD, Stergachis A, Moore C, Dolecek C, Naghavi M (2022) Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet S0140673621027240. https://doi.org/10.1016/S0140-6736(21)02724-0

Office for National Statistics, UK (2012) Annual population survey (APS) QMI 11

Oniciuc EAA et al (2019) A European questionnaire-based study on population awareness and risk perception of antimicrobial resistance. FEMS Microbiol Lett 366:fnz221

Papoutsi C et al (2017) Social and professional influences on antimicrobial prescribing for doctors-in-training: a realist review. J Antimicrob Chemother 72:2418–2430

Pham-Duc P et al (2019) Knowledge, attitudes and practices of livestock and aquaculture producers regarding antimicrobial use and resistance in Vietnam. PLoS ONE 14:e0223115

Plachouras D et al (2018) Antimicrobial use in European acute care hospitals: results from the second point prevalence survey (PPS) of healthcare-associated infections and antimicrobial use, 2016 to 2017. Eurosurveillance 23:1800393

Pulcini C, Gyssens IC (2013) How to educate prescribers in antimicrobial stewardship practices. Virulence 4:192–202

Redding LE et al (2020) Addressing individual values to impact prudent antimicrobial prescribing in animal agriculture. Front Vet Sci 7

Reverter M et al (2020) Aquaculture at the crossroads of global warming and antimicrobial resistance. Nat Commun 11:1870

Santos-Lopez A, Marshall CW, Scribner MR, Snyder DJ, Cooper VS (2019) Evolutionary pathways to antibiotic resistance are dependent upon environmental structure and bacterial lifestyle. eLife 8:e47612

Schneider S et al (2018) Perceptions and attitudes regarding antibiotic resistance in Germany: a cross-sectoral survey amongst physicians, veterinarians, farmers and the general public. J Antimicrob Chemother 73:1984–1988

Schröder W et al (2016) Gender differences in antibiotic prescribing in the community: a systematic review and meta-analysis. J Antimicrob Chemother 71:1800–1806

Suetens C et al (2018) Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute care hospitals and long-term care facilities: results from two European point prevalence surveys, 2016 to 2017. Eurosurveillance 23:1800516

Tsuzuki S et al (2020) Factors associated with sufficient knowledge of antibiotics and antimicrobial resistance in the Japanese general population. Sci Rep 10:3502

United Nations Development Group (UNDG) – Western and Central Africa (2015) Socio-Economic impact of ebola virus disease in west African countries.

Valderrama MJ et al (2018) Educating in antimicrobial resistance awareness: adaptation of the Small World Initiative program to service-learning. FEMS Microbiol Lett 365

Vooren M, Haelermans C, Groot W, van den Brink HM (2022) Comparing success of female students to their male counterparts in the STEM fields: an empirical analysis from enrollment until graduation using longitudinal register data. Int J STEM Educ 9:1

Wagner CE et al (2020) Economic and behavioral influencers of vaccination and antimicrobial use. Front Public Health 8

World Bank (2017) Drug-resistant infections: a threat to our economic future. Washington, DC: World Bank. License: Creative Commons Attribution CC BY 3.0 IGO

World Health Organisation (n.d.) 10 global health issues to track in 2021. https://www.who.int/news-room/spotlight/10-global-health-issues-to-track-in-2021. Accessed 18 Jan 2022

World Health Organisation (n.d.) Ten health issues WHO will tackle this year. https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019. Accessed 18 Jan 2022

World Health Organisation (n.d.) World antimicrobial awareness week. https://www.who.int/campaigns/world-antimicrobial-awareness-week. Accessed 18 Jan 2022

World Health Organization (2007) Addressing sex and gender in epidemic-prone infectious diseases 40

Xie Y, Fang M, Shauman K (2015) STEM education. Annu Rev Sociol 41:331–357