Minimizing the effect of antimicrobial resistance (AMR) requires an adequate policy response that relies on good governance and coordination. This study aims to have a better comprehension of how AMR is understood and perceived by policy-makers and stakeholders in a multinational context. A digital survey was designed to capture the knowledge, attitudes, and perceptions (KAP) towards AMR, and it was distributed to politicians, policy advisors, and stakeholders. A total of 351 individuals from 15 different countries participated, 80% from high-income countries (HICs) and 20% from low- and middle-income countries (LMICs). The Netherlands, Spain, and Myanmar were the top 3 represented countries. Participants had sufficient knowledge regarding AMR and reported the importance of political willingness to tackle AMR. Overall, LMIC participants demonstrated better knowledge of AMR but showed poor perception and attitude towards antimicrobial use compared to HIC participants. In addition, level of education and field of expertise were significantly associated with knowledge, perception, and practices regardless of demographic characteristics. Inter-regional differences in KAP regarding AMR exist among politicians, policy advisors, and relevant stakeholders. This study captures multinational policy-maker and stakeholder mapping that can be used to propose further policy implementation on various governance levels.

Antimicrobial resistance (AMR) is a silent pandemic causing 1.27 million deaths in 2019, disproportionately affecting low- and middle-income countries, but resistance among commensal microbiota and the determinants of carriage have not been widely reported. This cross-sectional household study aimed to determine the prevalence of carbapenem-resistant (CRE) and third-generation cephalosporin-resistant Enterobacterales (C3GRE) in a rural community in Ha Nam northern Vietnam, as well as the socio-demographic, behavioural, and environmental determinants of carriage. 1502 individuals across 324 households were surveyed between July 2018 and April 2019. Faecal samples were cultured on meropenem and ceftazidime supplemented media to identify CRE and C3GRE, respectively. Logistic regression models were used to explore risk factors for CRE and C3GRE carriage compared to susceptible strains. Colonisation with C3GRE and CRE was 94.0% (95% Confidence Interval (CI) 93.5%–94.4%) and 1.9% (1.6%–2.2%), respectively. The CRE prevalence was too low to explore determinants. Antibiotic use in the last month (adjusted OR 1.22 [95% CI 0.45–3.31]) and recent illness (aOR 1.48 [0.34–6.51]) were not associated with C3GRE carriage. Variables associated with C3GRE carriage were high-income (OR 0.29 [0.12–0.74]), worse sanitary conditions (aOR 4.35 [1.07–17.43]), and frequent beef consumption (aOR 6.56 [2.16–19.98]). A protective association between C3GRE carriage and animal husbandry was observed in children under 5-years (aOR 0.27 [0.09–0.84]). For participants 5-years and older, chicken consumption was associated with increased likelihood of C3GRE carriage (aOR 3.45 [1.45–8.22]), while a protective association was observed for regular tofu (aOR 0.32 [0.14–0.74]) and fermented food consumption (aOR 0.55 [0.31–0.96]). In this high-prevalence setting, colonisation with C3GRE was not associated with individual antibiotic use, while environmental exposures, including food and sanitary conditions, were associated with C3GRE colonisation. Further research is required to understand the mechanisms behind these associations. This work was supported by 10.13039/501100000769 Oxford University Clinical Research Unit internal grants in Vietnam from the 10.13039/100010269 Wellcome Trust Africa Asia Programme core grants (2015-2022—106680/Z/14/Z, and 2022-2029—225167/Z/22/Z).

Objective: The aim of this observational study was to describe the real-world use of botulinum toxin-A in patients with a stroke in the Netherlands. Methods: This study used longitudinal insurance claims data between 2012 and 2016 with 30% nationwide coverage and included patients with both stroke-related and botulinum toxin-A claims. All analyses were descriptive and displayed as summary statistics. Results: 60,222 patients with a stroke were identified, of whom 18,141 (30.1%) were treated in a rehabilitation centre or hospital and 1.7% (1,036 patients) were treated with botulinum toxin-A. A total of 2,855 botulinum toxin-A claims from 890 patients were included in the analysis (1.5% of all patients in the database). Mean age was 63.4 (SD ± 14.0) years at index injection cycle, with a median follow-up of 3.7 years (interquartile range [IQR] 2.2–4.5 years). Patients received up to 16 injection cycles with a median of 2 injection cycles (IQR 1–5 cycles). The median Time-To-Next-Injection-Cycle was 17 weeks (IQR 13–25 weeks). The total number of injection cycles was 604 for abobotulinumtoxinA (22.1%) and 2,251 (78.8%) for onabotulinumtoxinA. Doses per cycle ranged from 200–660 for abobotulinumtoxinA and 101–400 units for onabotulinumtoxinA. Discussion: Claims data from a national healthcare insurance fund in the Netherlands showed that only 1.7% of patients with post-stroke spasticity received botulinum toxin-A. Botulinum toxin-A treatment doses and intervals varied widely across patients and most patients received only 1 or 2 botulinum toxin-A injection cycles. Our results suggest undertreatment of spasticity with botulinum toxin-A and suboptimal treatment adherence in Dutch clinical practice.

Introduction: Antimicrobial resistance (AMR) is a pressing public health threat, and the prevalence of AMR is particularly high in Vietnam. A comprehensive review of AMR in humans, animals and/or the environment in Vietnam has however not been conducted to date. This systematic review aims to address this evidence gap and will collect and aggregate findings from literature on AMR in Vietnam among bacterial pathogens of public health interest from a One Health perspective. The results from this countrywide literature review may serve as a guiding tool for policymakers, medical practitioners, veterinarians and other relevant stakeholders in Vietnam and outside the country. This review will also identify specific areas where critical information is lacking, which will be of value for future surveillance programmes and epidemiological research. Methods and analysis: Studies reporting primary data on antimicrobial susceptibility testing from human (both community and hospital settings), animal and environmental samples in Vietnam will be included. The search will be conducted in PubMed, Web of Science, Embase and Scopus. In addition, Google Scholar will be used to retrieve literature published in Vietnamese and Open Access Theses and Dissertations will be used to seek relevant PhD dissertations. More than 18 different pathogens will be included in this review, mainly based on the 2017 and 2024 WHO bacterial priority pathogens list and the WHO Global Antimicrobial Resistance and Use Surveillance System. Risk of bias (quality) assessment of included studies will be conducted using (1) The thirteen mandatory elements of the Microbiology Investigation Criteria for Reporting Objectively checklist and (2) The bias appraisal framework of Hoy et al . The outcome of this literature review will be the prevalence of resistance among selected bacteria, stratified by setting (human (hospital or community), animal and the environment). Pooled prevalence estimates will be calculated for each of the selected antimicrobial-bacterial pathogen combinations. This literature review will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Ethics and dissemination: Ethical approval is not required as no primary data are to be collected. The results from this review will be submitted for publication in a peer-reviewed journal. PROSPERO registration number: PROSPERO CRD420251047399.