从他Gandra博士获得了医学学位a Medical College, Hyderabad, India in 2004. In 2007, he received his MPH degree in community health from Eastern Kentucky University. He completed his internal medicine residency at the University of Illinois College of Medicine, Peoria in 2010 and his infectious diseases fellowship at the University of Massachusetts Medical School in 2013. After his infectious diseases fellowship, he worked at the Center for Disease Dynamics, Economics & Policy (CDDEP) institute in Washington, DC until 2017. At CDDEP, he was involved in the surveillance of antibiotic resistance, antibiotic consumption and establishing a repository of global antibiotic resistance data. His work at CDDEP also focused on understanding the drivers of antibiotic resistance and consumption in India and other low-income countries. He serves as a member of the WHO Expert Committee on the Selection and Use of Essential Medicines since 2017. In 2018, he completed a medical microbiology fellowship at the University of Chicago/NorthShore University HealthSystem and then joined the Department of Medicine in the Division of Infectious Diseases at Washington University School of Medicine as an Assistant Professor in January 2019.

His research interests include understanding the molecular epidemiology, burden, and transmission dynamics of antimicrobial resistance in healthcare settings and in the community in India. He is also interested in studying the transmission dynamics of antibiotic resistance among humans during religious mass-bathing events and studying the use of antibiotics in the poultry industry in India. His ultimate goal is to design interventions to reduce the burden of antibiotic resistance and improve antimicrobial use in India and other resource-limited countries.

是什么促使您对从事传染病职业的兴趣，自从您刚开始以来，您是否看到整个领域和自己的研究的重点变化？

The reasons for high environmental contamination are poor sanitation, pharmaceutical and hospital effluents with high antibiotic residues and resistant bacteria released into sewage treatment plants, antibiotic laden effluents from food animal productions, and religious events such as mass bathing in rivers.

印度的高传染病负担以及公共卫生计划在控制感染中的重要性吸引了我从事传染病的职业。我工作的公共卫生方面是我最喜欢的。我最初专注于病毒感染，主要是登革热，每年继续影响数百万印第安人。但是，在我的传染病奖学金培训中，我将重点转移到了抗生素耐药性上，这是当时的一个新兴问题，在印度和其他资源有限的国家中没有太多意识。

Why did you then choose to focus your research on antibiotic resistance surveillance and understanding the drivers of antibiotic resistance and consumption in India, while at CDDEP (Center for Disease Dynamics, Economics & Policy)?

当我开始在CDDEP工作时，在细菌中没有太多关于引起低收入和中等收入国家（LMIC）常规感染的抗生素耐药性的数据。该信息对于将LMICS政策制定者的注意力引起抗生素耐药性问题至关重要。我的工作重点是使用公共数据库和LMICS合作者整理抗生素耐药性数据。在这项工作中，我观察到印度的抗生素耐药性患病率最高。这使我探索了印度可能抗生素耐药性高的原因。

Why does India have one of the highest burdens of AMR globally, and what affect do you think this burden will have long-term on other regions?

There are several reasons. In my opinion, the most important reason is the high degree of environmental contamination with resistant bacteria in the community. This can be inferred from studies that focused on intestinal colonization of resistant bacteria among return travellers from high-income countries. The reasons for high environmental contamination are poor sanitation (about 50% of population don’t have access to safe disposal of human waste), pharmaceutical and hospital effluents with high antibiotic residues and resistant bacteria released into sewage treatment plants, antibiotic laden effluents from food animal productions, and religious events such as mass bathing in rivers. Poor personal hygiene and lack of access to clean water for drinking and for domestic use facilitates high burden of AMR in the community. Although India has highest antibiotic consumption at national level, per-capita consumption is much lower than several other high-income countries. However, once a resistant bacterium or gene emerges, the spread is easy in India due to poor sanitation, personal hygiene, and lack of access to clean water. Poor infection control practices in hospitals is one the major reasons for high burden of AMR in hospital settings. Bacteria do not have boundaries and with ease of global travel, importation of resistant bacteria is a constant threat for other regions.

您认为2017年制定的印度AMR国家行动计划有助于解决AMR？

制定了印度的AMR国家行动计划，非常关注与印度有关的关键问题，包括解决环境污染的重要性。但是，由于负责地面实施的州政府的财务限制和对实施的财务限制和吸收而导致的缓慢执行令人失望。不幸的是，库维德大流行进一步影响了AMR计划的工作。自2017年以来，采取了一些重大行动，包括在2018年9月禁止使用几种固定剂量药物组合，包括2019年7月的食用动物的生长促进生长，并于2020年1月在药物中设置最低抗生素残留水平。但是，2020年1月。，挑战将是执行这些措施，因此需要评估这些措施。

There has been tremendous progress on antimicrobial resistance surveillance however the progress on antimicrobial stewardship and antibiotic use surveillance is lagging behind.

您想在修订后的NAP（2021年到期）中看到哪些更改，以帮助解决抗生素管理计划中的当前差距？

There has been tremendous progress on antimicrobial resistance surveillance however the progress on antimicrobial stewardship and antibiotic use surveillance is lagging behind. The Indian Council of Medical Research (ICMR) has developed guidance document on Antimicrobial Stewardship Programs (AMSP) and conducted workshops for about 30 hospitals. The expectation is that these hospitals will become nodal centres which subsequently conduct training to other regional and district/secondary hospitals. However, there has been less focus on antimicrobial stewardship activities in the community settings where the major portion of antibiotic prescribing happens. Initiatives aimed at improving antibiotic prescribing in the private sector which accounts for approximately 70% of healthcare are also lacking. The NAP should incorporate WHO’s AWaRe (Access, Watch and Reserve) categorization of antibiotics for optimising antibiotic use and setting targets for reducing overall antibiotic use and the use of Watch and Reserve antibiotics. Antibiotic use surveillance at national level should be a priority and should utilize data resources from private and public sector for conducting surveillance.

您认为改变印度社区对卫生行为的态度有多远将有助于遏制感染和抗性细菌的传播并减少抗生素处方？

In my opinion there will be a significant impact on curbing the spread of AMR and reducing antibiotic over use. There is good evidence indicating that “spread” of resistant bacteria is the major factor contributing to antimicrobial resistance in LMICs. There is also emerging evidence indicating that the relationship between antibiotic use and resistance selection is altered by hygiene behaviour. Poor hygiene results in proliferation of AMR in LMICs and thus improving investment in infrastructure to improve hygiene could significantly impact AMR levels. One study in Guatemala demonstrated that improvement in the household hygiene index was associated with a 30% reduction in the likelihood of detecting antimicrobial-resistant bacteria within people. There are also studies indicating that improving personal hygiene especially “targeted hygiene” in homes could lower the incidence of acute respiratory tract and diarrheal infections in community settings. These two infection syndromes are the most common reasons for overuse of antibiotics in India.

With the World Antibiotic Awareness Week in November (18-22 November 2020) focusing on preventing the COVID-19 pandemic from worsening the ongoing antibiotic resistance crisis, what is the most important focus to help reduce AMR in India?

毫无疑问，Covid-19-毫无疑问，人们对个人卫生在LMIC（包括印度）中的重要性有很高的认识，这可能会间接影响AMR。然而，尽管印度国家的指南建议在这些情况下不开处方抗生素，但在印度仍有广泛的针对温和和中等共同案例的抗生素处方。这个世界抗生素意识周的重点应该在于对处方者和公众对Covid-19的不必要的抗生素进行认识。

如果您可以快速前进10年，那么您希望在印度以及在全球范围内看到什么变化？您认为最有可能的是哪些？

改善基础设施(水、sanitatio清洗n and hygiene), minimal antibiotic residues in pharmaceutical effluents, banning antibiotic use for growth promotion in food animals, prescription only dispensing of antibiotics at least in urban areas, improved infection and control practices in healthcare facilities, low cost point of care diagnostics for respiratory tract and diarrheal infections, increased awareness of antimicrobial resistance in the general public, increased government expenditure on health with decreased reliance on private sector, decreasing trends in antibiotic use in humans, renewed antibiotic pipeline pertinent to bacterial pathogens (e.g- NDM producing Enterobacteriaceae) encountered in India. Most of these changes will happen to some extent. However, in 10 years it is most likely that antibiotics will be banned for growth promotion in food animals and pharmaceutical effluents will be free of antibiotic residues.