Prevalence of Enterobacterales Producing Extended-Spectrum Beta-Lactamases According to One Health Approach in Burkina Faso: A Systematic Review with Meta-Analysis.

Antimicrobial resistance (AMR) represents a major global health threat, heightened by extensive and often indiscriminate use of antibiotics in livestock production. In Nigeria, pig farming constitutes a significant yet underexamined pathway for the emergence and spread of AMR. This review aimed to examine the role of pig farming in the development and spread of AMR, evaluate the associated public health and economic risks, and propose evidence-based strategies to curb its spread. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Google Scholar, and African Journals Online (AJOL) for studies published between January 2000 to May 2025 and in English language. Relevant publications were screened, and data were extracted on antimicrobial use patterns, resistance prevalence, and associated risk factors. Studies were synthesized narratively and comparatively to identify key trends and policy gaps. The routine administration of antibiotics for therapeutic, prophylactic, and growth-promoting purposes, coupled with insufficient veterinary oversight, inadequate biosecurity measures, and limited regulatory enforcement, has facilitated the proliferation of multidrug-resistant bacteria including Escherichia coli, Salmonella spp., Staphylococcus aureus (including methicillin-resistant Staphylococcus aureus), and Enterococcus spp. The persistence of antibiotic residues in pork products further increases public health risks by increasing the incidence of treatment failures and prolonging infections in humans. Beyond the health implications, AMR in pig farming has profound economic consequences, including reduced livestock productivity, increased production costs, and potential trade restrictions. Addressing this multifaceted challenge requires stringent antibiotic regulations, enhanced veterinary regulation, improved farm hygiene, and targeted farmer education on antimicrobial stewardship. A comprehensive One Health approach integrating veterinary, environment, and public health professionals is imperative to reduce the impact of AMR locally and globally.

Antimicrobial resistance (AMR) is increasingly being highlighted as an urgent public and animal health issue worldwide. This issue is well demonstrated in bacteria that are resistant to last-line antibiotics, suggesting a future with untreatable infections. International agencies have suggested combating strategies against AMR. Saudi Arabia has several challenges that can stimulate the emergence and spread of multidrug-resistant bacteria. Tackling these challenges need efforts from multiple sectors to successfully control the spread and emergence of AMR in the country. Actions should include active surveillance to monitor the emergence and spread of AMR. Infection prevention and control precautions should also be optimized to limit further spread. Raising awareness is essential to limit inappropriate antibiotics use, and the antibiotic stewardship programs in hospital settings, outpatients, and community pharmacies, should regulate the ongoing use of antimicrobials.

Interconnections between the food system and antimicrobial resistance: A systems-informed umbrella review from a One Health perspective.

Countries from across the world gathered in Astana, Kazakhstan, in October 2018, to reaffirm and expand their commitment to prioritise, promote, and protect the health and wellbeing of their populations. This was the opportunity for a new generation of health policy makers and leaders to honour the ideals of the 1978 Alma-Ata Declaration1WHOGlobal Conference on Primary Health Care, 25–26 October 2018.https://www.who.int/primary-health/conference-phcDate: 2018Date accessed: March 20, 2019Google Scholar and to reinterpret these in the current era. Over the past 40 years, many countries have designed health systems that improve access to quality essential services, social stability, and health security, as well as having economic benefits.2WHOTogether on the road to universal health coverage. A call to action.https://apps.who.int/iris/bitstream/handle/10665/258962/WHO-HIS-HGF-17.1-eng.pdf;jsessionid=F247E4CB8C9AEA227138F1844D636EF1?sequence=1Date: 2017Date accessed: March 18, 2019Google Scholar The health-related aspects of the UN Sustainable Development Goals have a strong focus on universal health coverage (UHC), with quality of health services increasingly emphasised as essential for success.3WHODelivering quality health services: a global imperative for universal health coverage.https://www.who.int/servicedeliverysafety/quality-report/en/Date: 2018Date accessed: March 18, 2019Google Scholar When Florence Nightingale, considered the mother of infection prevention and control (IPC), echoed the Hippocratic ideal to "first, do no harm" in the 1860s, she recognised that the first steps to providing organised beneficial health care were inherently risky in nature. Although Florence Nightingale was a late adopter of the germ theory of disease, she was among the first to recognise that a caregiver could be at the origin of patient harm, particularly infection. She was an early pioneer of the practical application of quality improvement at the bedside. Health-care-associated infection remains an ever-present companion, irrespective of where and when it is delivered. Health-care-associated infections are a consequence of poor-quality care and a deadly cause of harm affecting hundreds of millions of patients worldwide every year.4WHOReport on the burden of endemic health-care associated infection worldwide: a systematic review of the literature.https://apps.who.int/iris/bitstream/handle/10665/80135/9789241501507_eng.pdf;jsessionid=B24D98407633F9FEE01C9329D89EDA7B?sequence=1Date: 2011Date accessed: March 18, 2019Google Scholar They generate twice the total burden of disability-adjusted life-years than all other 32 communicable diseases reported in Europe.5Cassini A Plachouras D Eckmanns T et al.Burden of six healthcare-associated infections on European population health. Estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study.PLoS Med. 2016; 13: e1002150Crossref PubMed Scopus (295) Google Scholar Antibiotic-resistant microorganisms are responsible for most infections and 75% of disability-adjusted life-years attributable to antimicrobial resistance (AMR) in Europe are due to health-care-associated infections.6European Centre for Disease Control and Prevention and OECDAntimicrobial resistance. Tackling the burden in the European Union. Briefing note for EU/EAA countries.https://www.oecd.org/health/health-systems/AMR-Tackling-the-Burden-in-the-EU-OECD-ECDC-Briefing-Note-2019.pdfDate: 2019Date accessed: March 18, 2019Google Scholar This places a clear duty on policymakers, health leaders, facility managers, and practitioners who design, build, and operate health systems to ensure that they prevent the spread of infections. Without this essential foundation for quality health services, UHC risks being an empty promise.7Ghebreyesus T How could health care be anything other than high quality?.Lancet Glob Health. 2018; 6: e1140-e1141Summary Full Text Full Text PDF PubMed Scopus (25) Google Scholar IPC is an evidence-based approach to halt the spread of infection and AMR.8Storr J Twyman A Zingg W et al.Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations.Antimicrob Resist Infect Control. 2017; 6: 6Crossref PubMed Scopus (194) Google Scholar It embodies all three core domains of quality care (ie, care that is safe, effective, and people-centred), and strongly supports the attainment of other key global health priorities that will eventually contribute to high-quality UHC (figure). Strong IPC capacity and programmes ensure adequate preparedness and response to protect people from outbreaks. Their reinforcement is an essential pillar for recovery and health system strengthening after the shock of an epidemic. IPC is also complementary to and enhances water, sanitation, and hygiene (WASH) interventions. WASH monitors infrastructure indicators, whereas IPC provides evidence of an effect on health workers' behaviour and patient outcomes through improved infrastructures. Synergies and interconnections are particularly effective when IPC supports strategies aimed at reducing AMR. Notably, the increasing availability of IPC equipment and infrastructure (eg, alcohol-based handrubs) at the point of care and isolation beds are associated with a proportionate reduction of the most common AMR patterns that are associated with health care.8Storr J Twyman A Zingg W et al.Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations.Antimicrob Resist Infect Control. 2017; 6: 6Crossref PubMed Scopus (194) Google Scholar Combining IPC interventions with antimicrobial stewardship programmes is the most effective approach.8Storr J Twyman A Zingg W et al.Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations.Antimicrob Resist Infect Control. 2017; 6: 6Crossref PubMed Scopus (194) Google Scholar, 9Baur D Gladstone BP Burkert F et al.Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis.Lancet Infect Dis. 2017; 17: 990-1001Summary Full Text Full Text PDF PubMed Scopus (389) Google Scholar Among these, hand hygiene is the most crucial, whether implemented as a stand-alone intervention or integrated into multifaceted interventions.9Baur D Gladstone BP Burkert F et al.Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis.Lancet Infect Dis. 2017; 17: 990-1001Summary Full Text Full Text PDF PubMed Scopus (389) Google Scholar, 10Luangasanatip N Hongsuwan M Limmathurotsakul D et al.Comparative efficacy of interventions to promote hand hygiene in hospitals: systematic review and network meta-analysis.BMJ Glob Health. 2015; 351: h3278Google Scholar IPC interventions often provide a starting point for developing a culture of quality improvement in health facilities. Despite this compelling evidence, only 58% of countries report having a national IPC programme or plan and related guidelines. Even more alarmingly, only 15% have a system to assess their compliance and effectiveness.11WHOFood and Agriculture Organization of the United Nations (FAO)World Organisation for Animal Health (OIE)https://apps.who.int/iris/bitstream/handle/10665/273128/9789241514422-eng.pdf?ua=1Date accessed: March 19, 2019Google Scholar These gaps are more striking in low-income countries where surveillance indicators for infections associated with health care are present in only 5% of countries and the monitoring of IPC in only 30% (WHO, unpublished data). In a global call to action in 2017, leaders of the Global IPC Network identified global and country-specific IPC priorities to be achieved by 2022.12Allegranzi B Kilpatrick C Storr J Kelley E Park BJ Donaldson L Global Infection Prevention and Control Network. Global infection prevention and control priorities 2018–22: a call for action.Lancet Glob Health. 2017; 5: e1178-e1180Summary Full Text Full Text PDF PubMed Scopus (58) Google Scholar These priorities require serious reflection and forceful actions. World Health Assembly resolutions can provide a strong basis for policy and regulation development and enforcement. Powerful resolutions on AMR and sepsis prevention already exist and new ones on patient safety and WASH are in the pipeline for full endorsement by the World Health Assembly in 2019. IPC is a key element. None of these resolutions can be implemented without strengthening the size and competencies of health work forces, which are also essential to achieve UHC, because inadequate staffing substantially increases the risk of infection and spread of AMR.7Ghebreyesus T How could health care be anything other than high quality?.Lancet Glob Health. 2018; 6: e1140-e1141Summary Full Text Full Text PDF PubMed Scopus (25) Google Scholar As an immediate tangible action, WHO calls upon everyone this year to be inspired by the global movement to achieve quality UHC and has crafted its global hand hygiene campaign message to achieve this wider goal: "clean care for all—it's in your hands!" The call to action has also been expanded and adapted to facilitate ownership and adoption by specific audiences, including highlighting clean care as a human right for all patients. Additionally, WHO strongly encourages ministries of health and health-care facilities to bridge the gap in the scarcity of IPC data by participating in a global survey on the level of progress of IPC and hand hygiene programmes. Clean and safe care should be universally available to every person worldwide. It can be achieved through improved IPC practices and monitoring everywhere, driving the foundation for quality care in the UHC era. This work is supported by WHO, Geneva, Switzerland, and the Infection Control Programme and WHO Collaborating Centre on Patient Safety (SPCI/WCC), University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Hand hygiene research activities at the SPCI/WCC are supported by the Swiss National Science Foundation (grant 32003B_163262). DP works with WHO on the Private Organizations for Patient Safety—Hand Hygiene initiative. The aim of this WHO initiative is to harness industry strengths to align and improve implementation of WHO recommendations for hand hygiene in health care in different parts of the world, including in the least developed countries. In this instance, companies/industry with a focus on hand hygiene and infection control-related advancement have the specific aim of improving access to affordable hand hygiene products, as well as through education and research. All other authors declare no competing interests. The opinions expressed in this Article are those of the authors and do not reflect the official position of WHO. WHO takes no responsibility for the information provided or the views expressed in this Article. We thank Rosemary Sudan for the professional editing assistance and Maraltro for the figure design. We also thank Safiah Mai for providing background documentation about universal health coverage.

Estimating antimicrobial resistance burden in Europe—what are the next steps?

Kosovo's national action plan for antimicrobial resistance

The emergence and spread of antimicrobial resistance (AMR), including clinically relevant antimicrobial-resistant bacteria, genetic resistance elements, and antibiotic residues, presents a significant threat to human health. Reducing the incidence of infection by improving water, sanitation, and hygiene (WASH) is one of five objectives in the World Health Organization's (WHO) Global Action Plan on AMR. In September 2019, WHO and the Health-Related Water Microbiology specialist group (HRWM-SG) of the International Water Association (IWA) organized its third workshop on AMR, focusing on the following three main issues: environmental pathways of AMR transmission, environmental surveillance, and removal from human waste. The workshop concluded that despite an increase in scientific evidence that the environment may play a significant role, especially in low-resource settings, the exact relative role of the environment is still unclear. Given many antibiotic-resistant bacteria (ARB) can be part of the normal gut flora, it can be assumed that for environmental transmission, the burden of fecal-oral transmission of AMR in a geographical area follows that of WASH-related infections. There are some uncertainties as to the potential for the propagation of particular resistance genes within wastewater treatment plants (WWTPs), but there is no doubt that the reduction in viable microbes (with or without resistance genes) available for transmission via the environment is one of the goals of human waste management. Although progress has been made in the past years with respect to quantifying environmental AMR transmission potential, still more data on the spread of environmental AMR within human communities is needed. Even though evidence on AMR in WWTPs has increased, the reduction in the emergence and spread of AMR by basic sanitation methods is yet unresolved. In order to contribute to the generation of harmonized One Health surveillance data, WHO has initiated an integrated One Health surveillance strategy that includes the environment. The main challenge lies in rolling it out globally including to the poorest regions.

Safeguarding future antimicrobial options: strategies to minimize resistance

BackgroundThe overuse of antimicrobials in food animals and the subsequent contamination of the environment have been associated with development and spread of antimicrobial resistance. This review presents information on antimicrobial use, resistance and status of surveillance systems in food animals and the environment in Africa.MethodsInformation was searched through PubMed, Google Scholar, Web of Science, and African Journal Online databases. Full-length original research and review articles on antimicrobial use, prevalence of AMR from Africa covering a period from 2005 to 2018 were examined. The articles were scrutinized to extract information on the antimicrobial use, resistance and surveillance systems.ResultsA total of 200 articles were recovered. Of these, 176 studies were included in the review while 24 articles were excluded because they were not relevant to antimicrobial use and/or resistance in food animals and the environment. The percentage of farms using antimicrobials in animal production ranged from 77.6% in Nigeria to 100% in Tanzania, Cameroon, Zambia, Ghana and Egypt. The most antibiotics used were tetracycline, aminoglycoside and penicillin groups. The percentage of multi drug resistant isolates ranged from 20% in Nigeria to 100% in South Africa, Zimbabwe and Tunisia. In the environment, percentage of multi drug resistant isolates ranged from 33.3% in South Africa to 100% in Algeria. None of the countries documented national antimicrobial use and resistance surveillance system in animals.ConclusionThere is high level of antimicrobial use, especially tetracycline, aminoglycoside and penicillin in animal production systems in Africa. This is likely to escalate the already high prevalence of antimicrobial resistance and multi drug resistance in the continent. This, coupled with weak antimicrobial resistance surveillance systems in the region is a great concern to the animals, environment and humans as well.

Antimicrobial resistance: time to repurpose the Global Fund

This paper presents the main trends in antimicrobial resistance (AMR), as well as their health and other consequences; current knowledge about the emergence, spread, and mechanisms of AMR; and the progress to date in understanding possible pathways of resistance through the food chain and the role of food as a vector of antibiotic-resistant bacteria. We have reviewed the main approaches to the prevention and control of the development, selection, and spread of AMR in food-producing animals (FPAs) and the meat industry; bacterial AMR in FPA; the most significant and dangerous pathogens that show AMR; transmitted by meat and meat products; strategies to prevent the occurrence of AMR microorganism infections; and, recently, AMR monitoring and surveillance programs in meat production and processing. This study reviews the results of various studies, as well as inspiring and motivating reviews, that address the state of the art of AMR in targeted diverse niches that are integrated by the multidisciplinary “One Health” approach, as well as future strategies for reducing AMR. To successfully address the challenges associated with AMR, it is necessary to integrate monitoring and surveillance across the environment–raw materials–food (meat)–people continuum. It is necessary to permanently improve and expand the NCBI Pathogen Detection Isolate Browser (NPDIB) database and supplement it with the results of future research to identify and investigate genes that coordinate stress response and AMR.

Antimicrobial resistance (AMR) is the resistance of a microorganism to an antimicrobial agent (a substance that kills or stops the growth of microorganisms) that was originally effective for treatment of infections caused by it. As a result standard antimicrobial drug treatments may become ineffective, lead to infections persisting, increasing the risk of spread to others, and negative clinical outcomes. AMR is a major public health issue worldwide and it is estimated that unless action is taken to tackle AMR, the global impact of AMR could be 10 million deaths annually from drug-resistant infections by 2050 and cost up to US $100 trillion in terms of cumulative lost global production (O’Neill, 2016). Addressing the public health threat posed by AMR is a national strategic priority for the UK and led to the Government publishing both a 20-year vision of AMR (Opens in a new window) and a 5-year (2019 to 2024) AMR National Action Plan (NAP) (Opens in a new window), which sets out actions to slow the development and spread of AMR. Intensive food animal production plays an important role in the development and spread of AMR and is one of many routes by which consumers can be exposed to antimicrobial-resistant bacteria. This review was carried out to help increase our understanding of whether, and to what extent, the use of biocides (disinfectants and sanitisers) and heavy metals (used in feed and other uses) in animal production leads to the development and spread of AMR within the food chain (a subject highlighted in the NAP). Whether this could potentially lead to greater consumer exposure to antimicrobial-resistant bacteria present in our food, either directly through consumption of foods derived from animals that have undergone treatment (for example from the use of heavy metals in animal feed) or indirectly (for example from exposure of crops to contaminated soil or ground water) is not known. Focused searching of three literature databases (Web of Science (Opens in a new window), Scopus (Opens in a new window), and MEDLINE (Opens in a new window)) was undertaken, supplemented by additional records identified through other sources. Due to the range of publications identified and different laboratory methodologies used in these studies no statistical analysis was possible, so instead, a narrative approach was taken to their review and to the review of supplementary materials. We conclude that there is published evidence that the release of chemicals like biocides (in particular disinfectants) and/or heavy metals from food animal production have the potential to contribute to the selection, emergence, and spread of AMR (as bacteria or genes) that could be acquired by consumers, and that this could present a potential risk to the consumer as a result. The published evidence is sparse and there are significant knowledge gaps (as detailed in this report). Currently there are insufficient data for a comprehensive and quantitative assessment of risk, and a need for focussed in-field studies (as detailed in this report) to be carried out to fill these knowledge gaps and confirm whether there is an actual risk.

Background:Campylobacter and Salmonella are the leading causes of foodborne diseases worldwide. Recently, antimicrobial resistance (AMR) has become one of the most critical challenges for public health and food safety. To investigate and detect infections commonly transmitted from animals, food, and the environment to humans, a surveillance–response system integrating human and animal health, the environment, and food production components (iSRS), called a One Health approach, would be optimal. Objective: We aimed to identify existing integrated One Health studies on foodborne illnesses in the Middle East and to determine the prevalence, serovars, and antimicrobial resistance phenotypes and genotypes of Salmonella and Campylobacter strains among humans and food-producing animals. Methods: The databases Web of Science, Scopus, and PubMed were searched for literature published from January 2010 until September 2021. Studies meeting inclusion criteria were included and assessed for risk of bias. To assess the temporal and spatial relationship between resistant strains from humans and animals, a statistical random-effects model meta-analysis was performed. Results: 41 out of 1610 studies that investigated Campylobacter and non-typhoid Salmonella (NTS) in the Middle East were included. The NTS prevalence rates among human and food-producing animals were 9% and 13%, respectively. The Campylobacter prevalence rates were 22% in humans and 30% in food-producing animals. The most-reported NTS serovars were Salmonella Enteritidis and Salmonella Typhimurium, while Campylobacter jejuni and Campylobacter coli were the most prevalent species of Campylobacter. NTS isolates were highly resistant to erythromycin, amoxicillin, tetracycline, and ampicillin. C. jejuni isolates showed high resistance against amoxicillin, trimethoprim–sulfamethoxazole, nalidixic acid, azithromycin, chloramphenicol, ampicillin, tetracycline, and ciprofloxacin. The most prevalent Antimicrobial Resistance Genes (ARGs) in isolates from humans included tetO (85%), Class 1 Integrons (81%), blaOXA-61 (53%), and cmeB (51%), whereas in food-producing animals, the genes were tetO (77%), Class 1 integrons (69%), blaOXA-61 (35%), and cmeB (35%). The One Health approach was not rigorously applied in the Middle East countries. Furthermore, there was an uneven distribution in the reported data between the countries. Conclusion: More studies using a simultaneous approach targeting human, animal health, the environment, and food production components along with a solid epidemiological study design are needed to better understand the drivers for the emergence and spread of foodborne pathogens and AMR in the Middle East.

Sir, Antimicrobial resistance refers to the phenomenon under which an antimicrobial drug is no longer effective against the microorganism.[1] This is a major public health concern, as because the standard treatment becomes ineffective, the infection will persist and can be transmitted to others, eventually resulting in a number of complications, disabilities, and mortality.[1,2] In addition, it will result in an enormous financial burden for the individual, the community, and the health system.[1,2] Furthermore, amidst the globalization and increasing trends of trade and travel, no section of the world is immune to the public health menace of antimicrobial resistance.[3] As it is very well-known that not many newer drugs are going to come for treating medical illnesses in the near future, it is very much crucial that the health sector should realize the gravity of the problem.[1,3] Even though, emergence of antimicrobial resistance is a natural evolutionary phenomenon, resulting because of the survival of resistant organisms (and death of susceptible organisms), on exposure to an antimicrobial agent, many human-related factors have aggravated the problem to an enormous extent.[2] These factors include limited commitment from the policy makers and minimal orientation of the treating physicians about the importance of prescription of drugs in right dose for appropriate duration, and to only those patients in which it is indicated.[1,2,3] In addition, factor like inappropriate usage (overuse or underuse or misuse) of medicines; exposure of patients to poor quality medicines and hence suboptimal drug dose; expansion of the counterfeit medicine market; and administration of subtherapeutic dosage of medicines to animals at times of their rearing, have also contributed to the global emergence of the problem.[3,4] However, at no stage the importance of parameters like existence of multiple lacunae's in the infection prevention and control measures; infrastructure constraints (viz., no uniform availability and access to the laboratories where resistant microorganisms can be detected); and weaker surveillance mechanism because of which no comprehensive information is available regarding drug resistance, can be undermined.[1,3,5] Findings of a recently released survey conducted across 133 nations of the world revealed that even though there is a positive intent from the policy makers in some of the nations, multiple gaps such as nonexistence of a holistic action plan to fight antimicrobial resistance; poor infrastructure support with limited laboratory capacity; and poor quality of monitoring and supervision, have been identified.[3,6] In fact, it has been even highlighted that issues such as absence of standardized guidelines for treatment of an illness; over-the-counter sale of drugs without prescription; poor public awareness; and limited number of strategies to combat nosocomial infections have also contributed to a great extent.[3,6] Thus, it is very important to understand that antibiotic resistance has spread to the entire world (viz., resistance to third generation cephalosporins used for treating gonorrhea, drugs used for treating tuberculosis/HIV/malaria/influenza, etc.), and is jeopardizing the act of treating common infections in both community and healthcare establishment settings.[2,6] Acknowledging the role of multiple factors and the complex nature of the problem, the need of the hour is to look for a prompt and coordinated response, in which roles and responsibilities of each stakeholder, namely: Community — by adhering to practice of hand washing, getting immunized, discouraging self-medication, completing the full course of therapy, etc.; Health professionals and pharmacists — implementing measures such as appropriate infection prevention and control measures in hospitals, prescribing antibiotics incorrect dosage and that too only when indicated, supporting public health sector by not selling antibiotics over-the-counter without prescription, etc.; Program managers — by creating awareness among the general population, facilitating epidemiological studies to identify the extent and causes of resistance, strengthening infection control and monitoring practices, regulating and promoting appropriate use of antibiotics; International agencies — by assisting nations to strengthen their ability to tackle antimicrobial resistance, conducting research and trials for development of new drugs or vaccines, development of tools for prompt diagnosis of infection, etc., is clearly specified.[3,4,5,7,8] However, there is an immense need to simultaneously develop linkages with other sectors such as animal husbandry, and food and agriculture, to promote optimal practices so that antibiotics are used only in optimal dosages in both humans and animals.[1,4] To conclude, in order to arrest the progress of the world toward postantibiotic era, it is high time that all the stakeholders should sit together and work out a global action plan to avoid the emergence and spread of antimicrobial resistance. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Prevalence of pathogenic bacteria and their antimicrobial patterns analysis of clinical samples from free-range chickens raised in forest farms in Zhouqu county of Gansu Province, China