MAKEAWARE! Raising the awareness of antimicrobial resistance

DATA PILLS

Question 1

What is antimicrobial resistance?

Answer

Antimicrobial resistance (AMR) is one of the major threats to global health, food security and development as it threatens the effective prevention and treatment of infections caused by bacteria, parasites, viruses and fungi. In 2020, the World Health Organization (WHO) declared AMR to be one of the top 10 global public health threats facing humanity.
AMR occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines designed to kill them. This results in harder to treat infections and increased risk of disease spread, severe illness and death. Antibiotic resistance is a specific form of antimicrobial resistance occurring when bacteria overcome the use of antibiotics, and this is mainly due to their overuse and misuse.

Visualization

Visual explanation of antibiotic resistance.

Source: Federal Office of Public Health [FOPH]

[1]

The resistance of microbes to antibiotics is a natural phenomenon, developed by microbes to survive external attacks. There are ecosystems in which antimicrobial-resistant and non-resistant species coexist in a stable balance, like in the human microbiota.

[2]

The resistance process can be intensified by other factors, such as the inappropriate use of antibiotics in humans and veterinary medicine, and poor hygiene conditions in practices, healthcare settings and in the food chain.

[3]

Overuse and misuse of antibiotics are the main causes of bacteria resistance. Antibiotics stop and limit the growth of bacteria but, in case of resistance, their action is useless. Resistant bacteria survive the cure as the antibiotic is no more effective on them.

[4]

Instead of disappearing, resistant bacteria keep growing and reproducing themselves. The effect is that available antibiotics are becoming less effective, while the number of diseases that we rely on antibiotics to neutralise keep increasing.

[5]

In the end, microbes are not killed and different treatments are needed, which are not always available. Resistance is a characteristic of microorganisms and not humans, but the transmission of resistant bacteria can occur among humans, animals and the environment too.

Extra sources: World Health Organization [WHO] - European Food Safety Authority - American Chemical Society
Question 2

How many resistant bacteria have been detected Worldwide?

Answer

The visualization shows how many resistant bacteria had been detected in 2020, out of the samples gathered. India is the country that identified the highest number of resistant bacteria. The colour of the bubble shows that India is also the second country in terms of samples analysed. The comparison between the number of resistant bacteria and the amount of samples taken gives the percentage of the samples in which had been found resistant bacteria (the more you test the more you have chances to detect what you are looking for).
It is important to specify that figures refer to microbes and not people. A one-person test can reveal more than one resistant microbe. Other criteria, such as the availability of antibiotics and the number of inhabitants, should also be contemplated in case of a deeper analysis.

Visualization

Number of resistant bacteria observed by country in 2020.

In 2020, Switzerland has registered 158 antimicrobial resistant bacteria out of 1’958 samples taken.

Data source: Arensis

Extra sources: European Centre for Disease Prevention and Control - Centers for Disease Control and Prevention, US
Question 3

Which geographic region has the highest number of resistant bacteria in Switzerland?

Answer

In 2019, worldwide, 4.95 million deaths were estimated to be associated with resistant bacteria, of which 1.27 million were directly attributable to bacterial antimicrobial resistance.
Compared to other countries and considering the number of inhabitants and samples taken, Switzerland has an intermediate position regarding the number of antibiotic resistant microbes. In 2019, 158 resistant bacteria had been found out of 1'958 tests gathered, with a positivity rate of 8%. In Europe, among the available data, only the Nordic countries show a lower rate. Border nations, such as Germany, France and Italy register higher numbers.
Switzerland combines different socio-cultural regions, the influence of which influences antibiotic prescription practices, especially in outpatient settings. For example, French- and Italian-speaking cantons' consumption of antibiotics is higher than in German-speaking areas.

Visualization

Number of bacterial samples analyzed and number of samples where resistance was detected by geographic region and year.

Data source: Anresis

Extra sources: STAR: Strategy on Antimicrobial Resistance
Question 4

What is the impact of antimicrobial resistance in the future?

Answer

Resistance to antibiotics has serious consequences, causing prolonged illness and hospital stays, increasing the cost of treatments for both, patients and the health care system. Treatments involve habit changes, affecting people's and their families lives. And, in the worst scenario, this disease can lead to disability or death.
It has been estimated that in 2050, 10 million people will die due to antimicrobial resistance, which risks becoming the first cause of death, overtaking cancer. There are no exhaustive estimates as a broad range of factors contribute in the definition of these figures. But, it makes clear that the spread of antimicrobial resistance, including antibiotic resistance, is an urgent problem requiring an immediate global response.

Visualization

Projected number of deaths in 2050 by cause.

Data source: Review on Antimicrobial Resistance

Extra sources: World Economic Forum - Antibiotics: Use wisely, take precisely - PEW Trusts
Question 5

When did the lack of antibiotics start?

Answer

Nearly all of the antibiotics currently available are based on discoveries made over 30 years ago. Since 2017 only 12 antibiotics have been approved, 10 of which belong to existing classes with established mechanisms of antimicrobial resistance (AMR). Bacterial resistance to one antibiotic often leads to resistance to similar types of antibiotics, so novel classes of antibiotics, which are drugs significantly different from existing antibiotics in core molecular structure or mode of attack, are needed to stay ahead of resistance.
The challenge is that novel classes of antibiotics are difficult for scientists to find due to key scientific barriers. On top of that, research interests are focused on areas with higher commercial returns and not requiring long-term development time. Increasingly studies are highlighting the use of non-antibiotic alternatives, especially for the prevention of urinary tract infections (UTIs), but research has not yet confirmed the efficacy of these substances or treatments, so they can not be officially prescribed.

Visualization

Classes of antibiotics organised based on discovering and clinical introduction date.

Data source: Hutchings, 2019 - Laxminarayan, 2022 - ReAct Group.

Extra sources: The New York Times - WHO - PEW Trusts

WORKSHOPS

15 September, 2024

HEK, Basel

Perturband Fluids

w/Zoe Romano

Perturbant Fluids workshop aims to enhance and disseminate bodily autonomy and rethink possible relationships with the "perturbing" entities that embody us. During this workshop participants will be involved in the discovery of scientific protocols and tools to redefine the way we can contribute and redesign the narrative around science.

9 August, 2024

Fab24 Mexico

DipLab - Digital Petri Laboratory

w/ Matteo Subet

This workshop offers participants an exciting opportunity to deepen their understanding of antibiotics and antibiotic resistance through the digitization of the antibiogram test, made possible outside of microbiology laboratories. Attendees will be able to broaden their knowledge of antibiotics and antibiotic resistance, and explore the role of these life-saving drugs in modern medicine.

TBD

Visualizing the Resistance

w/ Cristina Corti

This workshop proposes an hands-on experience to learn and discover the science around antimicrobial resistance. Starting from scientific contents, the activities will engage the participants in the creation of a collaborative repository of images, resources and stories that will help contributing to the fight against antibiotics misuses and its consequences.

Past

Basel

OneHealth Datathon

at Novartis Pavillon

Antimicrobial resistance is a global threat that directly or indirectly affects each and every one of us. On the 21st of June, people who experienced antimicrobial resistance, together with healthcare professionals, will be working supported by designers to envision possible technology solutions to the challenge of resistance development.

Past

Biofilie Lab

w/ Isabel Farina & Giulia Tomasello

TBD

Shape your Symptoms

w/ Ginevra Terenghi

Are you a women and suffer from urinary tract infections (UTIs)? Have you ever experienced urinary tract infections, such as cystitis, or are you chronically affected by this sort of diseases? Did you have any troubles with the treatment? Was the antibiotic not effective or did it cause side effects? Take part in this workshop to support the research.

Past activities

28.11.24

DiPLab

Matteo Subet

Musée de la main UNIL-CHUV

Lausanne, CH

25.10.24

Shape your Symptoms

Ginevra Terenghi

Bern Academy of the Arts - BFH

Bern, CH

15.10.24

Shape your Symptoms

Ginevra Terenghi

Universidad de Monterrey - UDEM

Monterrey, Mexico

09.08.24

DiPLab - Digital Petri Laboratory

Matteo Subet

Universidad Iberoamericana Puebla

Puebla, Mexico

21.06.24

OpenHealth Datathon

MAKEAWARE! team

Novertis Pavillon

Basel, CH

10.06.24

DiPLab - Digital Petri Laboratory

Matteo Subet

SUPSI

Mendrisio, CH

24.05.24

Shape Your Symptomps

Ginevra Terenghi

SUPSI

Mendrisio, CH

18.05.24

Perturbant Fluids

Zoe Romano

OBOT Project

La Rada

Locarno, CH

02.05.24

Shape Your Symptomps

Ginevra Terenghi

Brunel University London

London, UK

30.04.24

DiPLab - Digital Petri Laboratory

Ginevra Terenghi

SSMT

Locarno, CH

27.03.24

DiPLab - Digital Petri Laboratory

Matteo Subet

Liceo Cantonale

Locarno, CH

01.12.23

DiPLab - Digital Petri Laboratory

Matteo Subet & Antonella Autuori

Kantonsschule Zürcher Unterland

Bülach, UK

24.11.23

Biofilie Lab: Growing vaginal microbiome at home
+ more info

Isabel Farina & Giulia Tomasello

SUPSI, FabLab

Mendrisio, CH

23.11.23

Perturbant Fluids

Zoe Romano

OBOT Project

ImpactHub Ticino

Lugano, CH

27.09.23

Visualizing the Resistance

Cristina Fragoso

Applied Microbiology Lab

SUPSI, FabLab

Mendrisio, CH

26.09.23

Visualizing the Resistance

Cristina Fragoso

Applied Microbiology Lab

SUPSI, FabLab

Mendrisio, CH

12.05.23

Visualizing the Resistance

Cristina Fragoso

Applied Microbiology Lab

SUPSI, FabLab

Mendrisio, CH

18.03.23

Perturbant Fluids

Zoe Romano

OBOT Project

Onl'fait

Genève

05.12.22

Visualizing the Resistance

+ read the article

Pamela Principi, Cristina Corti Fragoso

Applied Microbiology Lab

SUPSI, FabLab

Mendrisio, CH

11.11.22

Perturbant Fluids

+ read the article

Zoe Romano

OBOT

SUPSI, FabLab

Mendrisio, CH

PROTOCOLS

Protocol 1

VISUALIZING THE RESISTANCE

Description

This format focuses on the use of antibiotic pills and Petri dishes to visualize participants’ personal relationship with antibiotics. The workshop is built on the actions performed by scientists in the laboratory to test the efficacy of antibiotics on specific bacteria. In order to do so, antibiotic pills are positioned into a transparent lidded dish (called Petri) covered by bacteria. After some cultivation hours, it is possible to observe the efficacy of antibiotics that prevent bacteria from growing. The higher the antibiotic efficacy, the less the bacteria spread, leaving an empty space around the pill. On the other hand, the smaller that area, the higher the resistance development of microbes which are not affected by the antibiotic.

Research areas

Goal

The workshop aims to introduce participants to the phenomena of antimicrobial resistance through the explanation of antibiotic working action. Understanding what antibiotics are and how they work aims to stimulate better consumption of drugs. The activity also encourages the ability to understand data through the help of visualization techniques encouraged by hands-on actions and participatory processes.

Protocol
/intro

1. An initial presentation introduces the project, explaining what antimicrobial resistance is and the importance of consuming antibiotics responsibly. Participants move to the Microbiology Lab, where they are introduced to the safety measures and receive the security equipment. The expert explains what antibiotics are and how they work. The difference between gram-positive and gram-negative bacteria is demonstrated with the support of slices containing different bacteria to observe with microscopes.

/activity

2. Tools and materials to perform the activity are presented, such as Petri dishes and antibiotic pills. Everything needed is available from the material list. A drawing guide is given to participants to drive their actions during the activity. On one side, the guide explains how to perform the activity step by step, on the other, there is a circle representing the Petri dish. The circle is divided into four quadrants, each of them dedicated to a question. The diagram indicates where participants have to position the antibiotic pill to answer the question.

3. First of all, the Petri dishes need to be brushed with the bacteria. A gram-positive (e.g. Enterococcus Faecalis) and a gram-negative bacteria (e.g. Escherichia Coli) are chosen to demonstrate the different reactions and possible resistance of antibiotics. The activity will be performed starting from one of the bacteria selected. We preferred to start with Escherichia Coli. The activity will be performed starting from one of the bacteria selected. We preferred to start with Escherichia Coli.

4. Participants are provided with a Petri dish and a phial, containing Escherichia Coli bacteria. The bacteria are brushed on the Petri’s surface, which is called terrain, with the help of a swab. Participants dive the swab into the phial and cover the terrain 3 times in different directions. This is to spread the bacteria properly. This action requires sensitivity, as the terrain breaks easily.

5. At this point, participants are asked 4 questions related to their personal experience on antibiotic consumption: How do you feel about taking antibiotics?; How often do you suffer from urinary tract infections?; How often do you consume antibiotics? And how active do you consider yourself in the relationship with your doctor? For each question, there are possible 7 answers from which participants have to choose. Each answer is associated with an antibiotic name. Participants have to tick the answer on the guide and ask for the antibiotic pills corresponding to their answer.

6. Participants approach the table, read the name of the antibiotics needed and the facilitator provides them into a little container, together with a tweezer. Participants move back to their desks and, using the tweezer, position the pills into the Petri’s quadrant assigned to the answer the antibiotic pill corresponds to. Pills are pressed into the Petri’s terrain, so they do not move. Petri dishes are then sealed and collected.
Once the first part of the activity is performed, participants repeat the same actions on a different Petri dish, which will be, in this case, covered by the gram-positive bacteria (Enterococcus Faecalis).

7. In the end, all the Petri dishes (Escherichia Coli and Enterococcus Faecalis) are collected and stored in a cell with a temperature of 36°C, which is about the human body temperature where bacteria usually grow. Bacteria require 24/48 hours to grow and for this reason, participants can not see the results immediately. A picture of the Petri dishes will be taken after the cultivation hours by the facilitator and sent to the participants a couple of days after the activity.

8. Results are meant to show the antibiotics’ inhibition zones tested on that particular bacteria. The inhibition zone is the circular area around the antibiotic pill in which bacteria do not grow because of the efficacy of the antibiotic. The bigger that area, the higher the antibiotic efficacy. On the opposite, the smaller the inhibition zone, the lower the antibiotic effect on bacteria which developed resistance. Answers are correlated to the effect of antibiotics: the bigger the circles produced out of the answers, the more the participant behaviour contributes to preserving antibiotic efficacy.

/post-activity

9. After a break, participants get reunited. They are given a card reporting two series of questions, one per side: One one side: Have you ever experienced antimicrobial resistance or do you know anyone suffering from antimicrobial resistance? How did it happen? How have you become aware? And how does it affect your life? On the other: What information do you get or provide to your doctor during the consultation? How would you improve the prescription process? What would you do to better communicate with your doctor?

10. Participants write their answers down. 15 minutes are dedicated to this activity.
Cards are then collected, mixed up and redistributed, so everyone can read others’ without affecting privacy as answers are anonymous. This is also to trigger a conversation focused on gathering personal experiences related to antimicrobial resistance and suggestions on how to improve the relationship between patients and doctors during consultation, so as to avoid wrong requests o prescriptions.

11. A printed version of the antibiotic resistance manifesto is given to all the participants, depicting the inhibition zones of different antibiotics on different bacteria, highlighting the importance of consuming antibiotics responsibly to preserve their efficacy.

/evaluation

12. The assessment material is used to evaulate the activity in the end. Two posters are hung on the wall close to the exit, asking: How aware do you feel about antimicrobial resistance? and do you feel more confident in promoting better antibiotic consumption? Stickers are provided, so participants can rate the questions by positioning the sticker on the poster.

Tools and material

+ Step-by-step guide

+ Presentation

+ Material list

+ Drawing guide

+ Story card

+ Antibiotic resistance manifesto

+ Assessment material

Limits

Because of safety and security measurements, this workshop activity can only be performed in a microbiology laboratory.

Performed workshops:

5 December, 2022
13 May, 2023
26 September, 2023
27 September, 2023

STORIES

What was the reason to take antibiotics last time? Who did prescribe them and what were you explained? Did the treatment work? Did any side effects occur? Is there any alternative treatment that works for you?
Please fill out the form by answering the questions. If you don’t have an answer for a particular question, feel free to leave it blank. On the other hand, if you have additional insights to share, you are encouraged to elaborate on your response. This is an experimental interface under development, and we welcome any feedback. You may answer in the language you feel most comfortable using. All data is collected anonymously and stored on the university server. It will be reorganised and made accessible in a shared repository for consultation. We are currently working on the next phase, which involves visualising the data to identify potential patterns and insights. Thank you for your contribution!

I decided to (go, see, call, text or speak?) - (who have you consulted regarding your sickness?) because (what symptoms did you have?) . I was feeling (how were you feeling?) every time (when were the symptoms happening?) . I've been told by (who did provide you with the diagnosis?) that I was suffering from (what were you suffering from?) . It happened (again or never again?) for (for how long have you suffered?) . The doctor (explained or not explained?) to me that (what did the doctor say?) . I started (what treatment did you have?) . Ultimately, the cure (did the cure work or not?) . I started feeling (what effect did the treatment have on you?) . I noticed (have you noticed any side effects?) . So, I tried (have you looked for any alternatives?) . Now (how do you feel?)
. I am (is there a gender that best describes you?) (how old are you?) , years old , based in (where do you live?).

Thank you for sharing your story.

Your story has been received and it will be added to our database in the next days, for you and others to explore.

Data is collected anonymised and organised openly on the project repository for others to explore.

Network

MAKEAWARE!

Data pills and workshops to raise awareness on antibiotic consumption and antimicrobial resistance.

DATA PILLS

Question 1

Answer

Visualization

Question 2

Answer

Visualization

Question 3

Answer

Visualization

Question 4

Answer

Visualization

Question 5

Answer

Visualization

WORKSHOPS

PROTOCOLS

Protocol 1

Description

Research areas

Goal

Protocol
/intro

/activity

/post-activity

/evaluation

Tools and material

Limits

Performed workshops:

STORIES

Thank you for sharing your story.

Network

MAKEAWARE!

Data pills and workshops to raise awareness on antibiotic consumption and antimicrobial resistance.

DATA PILLS

Question 1

Answer

Visualization

Question 2

Answer

Visualization

Question 3

Answer

Visualization

Question 4

Answer

Visualization

Question 5

Answer

Visualization

WORKSHOPS

PROTOCOLS

Protocol 1

Description

Research areas

Goal

Protocol /intro

/activity

/post-activity

/evaluation

Tools and material

Limits

Performed workshops:

STORIES

Share your story to help others and inspire the research.

Thank you for sharing your story.

Protocol
/intro