ABSTRACT

This article examines tensions that professionals in healthcare settings in low-to-middle income countries (LMICs) face in the evolving field around surveillance of antimicrobial resistance (AMR). Few public health problems are of greater global importance today than AMR, that poses a threat to our ability to treat infections. In this context, the microbiology laboratory occupies a prominent place and the knowledge field of microbiology is expanding. In this study, we interviewed twenty-three (n = 23) professionals with expertise on AMR and public health systems to synthesise knowledge on strengthening AMR surveillance in LMICs. By drawing on a practice approach [Schatzki, T. R. 2001. “Practice Ttheory.” In The Practice Turn in Contemporary Theory (1–14), edited by T. R. Schatzki, K. Knorr-Cetima, and E. von Savigny. New York: Routledge.] combined with socio-cultural and cultural-historical theories (CHAT) [Engeström, Y. 1987. Learning by Expanding: An Activity-Theoretical Approach to Developmental Research. Helsinki: Orienta-Konsultit] the analysis reveals seven tensions between elements of the systems and discusses how such tensions serve to frame implications for implementing a capacity strengthening programme. The analysis shows that the novelty of the AMR as well as being a multi-disease and multisectoral by nature challenges existing forms of professional practice in healthcare settings. It also suggests that AMR requires to be dealt with through inter-professional and inter-sectoral approaches, while maintaining a focus across the local, national, and global systems, which is essential for initiatives that are set to address challenges to global health.

摘要

本文探讨了中低收入国家 (LMIC) 医疗保健机构的专业人员在围绕抗菌素耐药性 (AMR) 监测不断发展的领域中所面临的紧张局势。如今，很少有公共卫生问题比 AMR 更具全球重要性，它对我们治疗感染的能力构成威胁。在此背景下，微生物实验室占据突出地位，微生物学的知识领域不断扩大。在这项研究中，我们采访了二十三名 ( n  = 23) 具有 AMR 和公共卫生系统专业知识的专业人士，以综合有关加强 LMIC 中 AMR 监测的知识。通过借鉴实践方法 [Schatzki, TR 2001。“实践理论”。在实践中转向当代理论(1–14)，由 TR Schatzki、K. Knorr-Cetima 和 E. von Savigny 编辑。纽约：Routledge。] 结合社会文化和文化历史理论 (CHAT) [Engeström, Y. 1987. Learning by Expanding: An Activity-Theoretical Approach to Developmental Research. 赫尔辛基：Orienta-Konsultit] 分析揭示了系统要素之间的七种紧张关系，并讨论了这种紧张关系如何对实施能力加强计划产生影响。分析表明，AMR 的新颖性以及它本质上是一种多疾病和多部门的挑战，挑战了医疗保健环境中现有的专业实践形式。它还表明，需要通过跨专业和跨部门的方法来应对 AMR，同时保持对地方、国家和全球系统的关注，这对于旨在应对全球健康挑战的举措至关重要。