PDF(Pubmed)
Abstract：
UNASSIGNED: Local and global surveillance of antibiotic resistance (ABR) has proven a challenge to implement effectively in low- and middleincome (LMI) settings. Environmental surveillance solutions are increasingly highlighted as a strategy to help overcome such problems, and thus to promote global health as well as the local management of ABR in LMI countries. While technical and scientific aspects of such solutions are being probed continuously, no study has investigated their practical feasibility.
UNASSIGNED: Explore practical barriers for environmental surveillance of ABR in LMI countries, and pathways for surveillance experts to manage these.
UNASSIGNED: To start charting this unknown territory, we conducted an explorative, qualitative interview study with key informants, applying a constructivist grounded theory approach to analyze the results.
UNASSIGNED: Barriers were identified across infrastructural, institutional and social dimensions, and pathways to manage them were mostly counterproductive from an ABR management perspective, including avoiding entire regions, applying substandard methods and failing to include local collaborators.
UNASSIGNED: The research community as well as international agencies, organizations and states have key roles and responsibilities for improving the prospects of feasible environmental ABR surveillance in LMI-settings.
Main result: Physical infrastructural, institutional and socio-cultural barriers to environmental antibiotic resistance surveillance in low- and middle-income countries contribute to global health injustices as well as ineffective global antibiotic resistance management, while surveillance experts report pathways to manage these barriers which tend to worsen these negative effects. Added value: This seminal study is the first to probe this area, and thus provides unique new insights for further research and improved practices, as well as practical suggestions for research and policy to this effect. Practical implications: As environmental strategies are main candidates to avoid known problems to achieve effective antibiotic resistance surveillance in low- and middle income-settings, causing major gaps in global health surveillance as well as problems to clinically manage resistant infections in local health systems, it is important that the implementation of environmental surveillance strategies are optimal and avoid counterproductive measures to overcome obstacles.
UNASSIGNED: Explore practical barriers for environmental surveillance of ABR in LMI countries, and pathways for surveillance experts to manage these.
UNASSIGNED: To start charting this unknown territory, we conducted an explorative, qualitative interview study with key informants, applying a constructivist grounded theory approach to analyze the results.
UNASSIGNED: Barriers were identified across infrastructural, institutional and social dimensions, and pathways to manage them were mostly counterproductive from an ABR management perspective, including avoiding entire regions, applying substandard methods and failing to include local collaborators.
UNASSIGNED: The research community as well as international agencies, organizations and states have key roles and responsibilities for improving the prospects of feasible environmental ABR surveillance in LMI-settings.
Main result: Physical infrastructural, institutional and socio-cultural barriers to environmental antibiotic resistance surveillance in low- and middle-income countries contribute to global health injustices as well as ineffective global antibiotic resistance management, while surveillance experts report pathways to manage these barriers which tend to worsen these negative effects. Added value: This seminal study is the first to probe this area, and thus provides unique new insights for further research and improved practices, as well as practical suggestions for research and policy to this effect. Practical implications: As environmental strategies are main candidates to avoid known problems to achieve effective antibiotic resistance surveillance in low- and middle income-settings, causing major gaps in global health surveillance as well as problems to clinically manage resistant infections in local health systems, it is important that the implementation of environmental surveillance strategies are optimal and avoid counterproductive measures to overcome obstacles.
摘要：
■对抗生素耐药性（ABR）的本地和全球监测已被证明是在低收入和中等收入（LMI）环境中有效实施的挑战。环境监测解决方案越来越被强调为帮助克服这些问题的策略，从而促进全球卫生以及LMI国家ABR的本地管理。在不断探索此类解决方案的技术和科学方面的同时，没有研究调查它们的实际可行性。
■探索LMI国家ABR环境监测的实际障碍，以及监控专家管理这些的途径。
■要开始绘制这个未知的领域，我们进行了探索性的，与关键线人进行定性访谈研究，运用建构主义扎根理论方法对结果进行分析。
■在整个基础设施中发现了障碍，体制和社会层面，从ABR管理的角度来看，管理它们的途径大多适得其反，包括避开整个地区，应用不合格的方法，未能包括当地合作者。
■研究界以及国际机构，组织和州在改善LMI设置中可行的环境ABR监测的前景方面具有关键作用和责任。
主要结果：物理基础设施，低收入和中等收入国家环境抗生素耐药性监测的体制和社会文化障碍导致全球健康不公正以及无效的全球抗生素耐药性管理,而监测专家报告了管理这些障碍的途径，这些障碍往往会加剧这些负面影响。附加值：这项开创性的研究是第一个探索这一领域的研究，从而为进一步的研究和改进的实践提供了独特的新见解，以及这方面的研究和政策的实际建议。实际影响：由于环境策略是避免已知问题的主要候选者，以在低收入和中等收入环境中实现有效的抗生素耐药性监测，在全球卫生监测中造成重大差距，以及在当地卫生系统中临床管理耐药感染的问题，重要的是，环境监测策略的实施是最佳的，并避免采取适得其反的措施来克服障碍。
■探索LMI国家ABR环境监测的实际障碍，以及监控专家管理这些的途径。
■要开始绘制这个未知的领域，我们进行了探索性的，与关键线人进行定性访谈研究，运用建构主义扎根理论方法对结果进行分析。
■在整个基础设施中发现了障碍，体制和社会层面，从ABR管理的角度来看，管理它们的途径大多适得其反，包括避开整个地区，应用不合格的方法，未能包括当地合作者。
■研究界以及国际机构，组织和州在改善LMI设置中可行的环境ABR监测的前景方面具有关键作用和责任。
主要结果：物理基础设施，低收入和中等收入国家环境抗生素耐药性监测的体制和社会文化障碍导致全球健康不公正以及无效的全球抗生素耐药性管理,而监测专家报告了管理这些障碍的途径，这些障碍往往会加剧这些负面影响。附加值：这项开创性的研究是第一个探索这一领域的研究，从而为进一步的研究和改进的实践提供了独特的新见解，以及这方面的研究和政策的实际建议。实际影响：由于环境策略是避免已知问题的主要候选者，以在低收入和中等收入环境中实现有效的抗生素耐药性监测，在全球卫生监测中造成重大差距，以及在当地卫生系统中临床管理耐药感染的问题，重要的是，环境监测策略的实施是最佳的，并避免采取适得其反的措施来克服障碍。
