Control Of Antimicrobial Resistance Research Articles

Temporal dynamics and persistence of resistance genes to broad spectrum antibiotics in an urban community

The constantly evolving and growing global health crisis, antimicrobial resistance (AMR), endangers progress in medicine, food production, and life expectancy. Limited data on population-level prevalence, including seasonal and temporal variations, hampers accurate risk assessment for AMR transmission, despite its paramount importance on both global and national fronts. In this study, we used quantitative real-time PCR (q-PCR) to analyze 123 antibiotic resistance genes (ARGs) and 13 mobile genetic elements (MGEs) in wastewater of a selected urban community. Sampling was conducted monthly over a 5-month period (December 2021–April 2022) to assess resistance diversity, temporal dynamics, co-abundance of ARGs, MGEs, and resistance mechanisms. Approximately 50% of the tested ARG subtypes were consistently detected in all months, with frequency ranging from 52 to 61% with maximum absolute abundance in the winter months (December and January). In co-abundance analysis, specific genes were clustered into modules, highlighting shared distribution patterns and functional associations among the ARGs and MGEs. Detected clinically significant genes (ndm-1 and cfiA) and other variants (blaoxy, aph, aacC, tet-35, tet M, tet-32) are capable of imparting resistance to 3rd and 4th generation (gen) β-lactam, aminoglycoside, tetracycline, and multidrug classes. These contribute significantly to core/persistent resistance. This study deepens our comprehension of temporal/seasonal fluctuations in ARG and MGE distribution, providing valuable evidence to guide AMR control policies and promote responsible antibiotic/antimicrobial use for preserving effectiveness.

Antibiotics removal and antimicrobial resistance control by ozone/peroxymonosulfate-biological activated carbon: A novel treatment process

Biological activated carbon (BAC) is one of the important treatment processes in wastewater and advanced water treatment. However, the BAC process has been reported to have antimicrobial resistance (AMR) risks. In this study, a new BAC-related treatment process was developed to reduce AMR caused by BAC treatment: ozone/peroxymonosulfate-BAC (O3/PMS-BAC). The O3/PMS-BAC showed better treatment performance on the targeted five antibiotics and dissolved organic matter removal than O3-BAC and BAC treatments. The O3/PMS-BAC process had better control over the AMR than the O3-BAC and BAC processes. Specifically, the amount of targeted antibiotic-resistant bacteria in the effluent and biofilm of O3/PMS-BAC was only 0.01–0.03 and 0.11–0.26 times that of the BAC process, respectively. Additionally, the O3/PMS-BAC process removed 1.76 %–62.83 % and 38.14 %–99.27 % more of the targeted ARGs in the effluent and biofilm than the BAC process. The total relative abundance of the targeted 12 ARGs in the O3/PMS-BAC effluent was decreased by 86 % compared to the effluent after BAC treatment. In addition, Proteobacteria and Bacteroidetes were probably the main hosts for transmitting ARGs in this study, and their relative abundance decreased by 9.6 % and 6.0 % in the effluent of the O3/PMS-BAC treatment compared to that in BAC treatment. The relationship analysis revealed that controlling antibiotic discharge was crucial for managing AMR, as antibiotics were closely related to both ARGs and bacteria associated with their emergence. The results showed that the newly developed treatment process could reduce AMR caused by BAC treatment while ensuring effluent quality. Therefore, O3/PMS-BAC is a promising alternative to BAC treatment for future applications.

Dynamic antimicrobial resistance and phylogenomic structure of Salmonella Typhimurium from 2007 to 2019 in Shanghai, China.

Our study uncovered a widespread distribution of Salmonella enterica serovar Typhimurium isolates in Shanghai accompanied by the increase in antimicrobial resistance (AMR) especially MDR during a 10-year period, which filled in the gap about a long period of continuous monitoring of AMR in this pathogen in Shanghai. Meanwhile, we identified a new clade ST34C2 of S. Typhimurium with the acquisition of IncI (Gamma)-like plasmids mediated by extended-spectrum β-lactamase gene blaCTX-M-14 as well as gyrA 87 mutation, which had not been reported before. It was noted that IncI (Gamma)-like plasmids were reported in S. Typhimurium for the first time and conjugation could accelerate the spread of antimicrobial resistance gene blaCTX-M-14. These findings on the epidemic, antimicrobial resistance, and phylogenomic characterization for S. Typhimurium provide valuable insights into its potential risk to public health and also the basis for AMR prevention and control strategies in Shanghai in the future.

Research progress on the driving factors and mechanisms of antimicrobial resistance production and spread from the perspective of One Health

Antimicrobial resistance poses a serious threat to public health and is one of the major challenges worldwide. As global social, economic, and environmental changes lead to increased exposure of populations to antimicrobials, the antimicrobial resistance of pathogens has accelerated and resulted in weakened clinical infection treatment effects. This article reviews the main mechanisms and driving factors of the production and spread of antimicrobial resistance from the perspective of "One Health"and discusses methods and strategies for controlling antimicrobial resistance from multiple dimensions. It also looks forward to the prospects of research and prevention of drug resistance to explore antimicrobial resistance prevention and control strategies based on "One Health".

Mind the gap: knowledge, attitudes and perceptions on antimicrobial resistance, antimicrobial stewardship and infection prevention and control in long-term care facilities for people with disabilities in the Netherlands

BackgroundAntimicrobial resistance (AMR) has become one of the major public health threats worldwide, emphasizing the necessity of preventing the development and transmission of drug resistant microorganisms. This is particularly important for people with vulnerable health conditions, such as people with intellectual disabilities (ID) and long-term care residents. This study aimed to assess the current status of AMR, antimicrobial stewardship (AMS) and infection prevention and control (IPC) in Dutch long-term care facilities for people with intellectual disabilities (ID-LTCFs).MethodsA web-based cross-sectional survey distributed between July and November 2023, targeting (both nonmedically and medically trained) healthcare professionals working in ID-LTCFs in The Netherlands, to study knowledge, attitudes and perceptions regarding AMR, AMS and IPC.ResultsIn total, 109 participants working in 37 long-term care organizations for people with intellectual disabilities throughout the Netherlands completed the questionnaire. The knowledge levels of AMR and IPC among nonmedically trained professionals (e.g., social care professionals) were lower than those among medically trained professionals (p = 0.026). In particular regarding the perceived protective value of glove use, insufficient knowledge levels were found. Furthermore, there was a lack of easy-read resources and useful information regarding IPC and AMR, for both healthcare professionals as well as people with disabilities. The majority of the participants (> 90%) reported that AMR and IPC need more attention within the disability care sector, but paradoxically, only 38.5% mentioned that they would like to receive additional information and training about IPC, and 72.5% would like to receive additional information and training about AMR.ConclusionAlthough the importance of AMR and IPC is acknowledged by professionals working in ID-LTCFs, there is room for improvement in regards to appropriate glove use and setting-specific IPC and hygiene policies. As nonmedically trained professionals comprise most of the workforce within ID-LTCFs, it is also important to evaluate their needs. This can have a substantial impact on developing and implementing AMR, AMS and/or IPC guidelines and policies in ID-LTCFs.

Identification of antibiotic-resistant, gram-negative bacteria in sewage and bioaerosols from a wastewater treatment plant: A genotypic and phenotypic study

ABSTRACT Antimicrobial resistance (AMR) is a growing global public health concern. This study aimed to investigate the presence of bacteria and antibiotic resistance genes in the environment, more specifically in sewage and bioaerosol samples collected at a Wastewater Treatment Plant (WWTP). Bacterial species were identified and tested for antibiotic sensitivity. In addition, bla CTX-M, bla SHV, bla TEM and bla KPC genotypes, including those related to resistance to carbapenems, were detected by PCR. The results of this research are extremely important for understanding the mechanisms involved in antimicrobial resistance and for preventing the dissemination of these antibiotic-resistant microorganisms. This study contributes to the identification of sources of antibiotic resistance in the environment and implementation of AMR control and prevention strategies while preserving the effectiveness of antibiotics and public health.

β-lactamase and macrolide resistance gene carriage in E. coli isolates among children discharged from inpatient care in western Kenya: a cross-sectional study

Abstract Background Antimicrobial resistance (AMR) is a global threat to infectious disease control, particularly among recently hospitalized children. We sought to determine the prevalence and mitigating factors of resistance in enteric Escherichia coli among children discharged from health facilities in western Kenya. Methods Between June 2016 and November 2019, children aged 1-59 months were enrolled at the point of discharge from hospital. E. coli was isolated by microbiological culture from rectal swabs at baseline. β-lactamases and macrolide resistance-conferring genes were detected by PCR. The modified Poisson regression model was used to assess the predictors mph(A) and CTX-M-type ESBL. Results Of the 238 children whose E. coli isolates were tested, 91 (38.2%) and 109 (45.8%) had detectable CTX-M-type ESBL and mph(A) genes, respectively. Antibiotic treatment during hospitalization (adjusted prevalence ratio [aPR]=2.47; 95%CI:1.12-5.43, p=0.025), length of hospitalization (aPR=1.42; 95%CI:1.00-2.01, p=0.052), and the practice of open defecation (aPR=2.47; 95%CI:1.40-4.36, p=0.002) were independent predictors for CTX-M-type ESBL and for mph(A) genes. Pneumococcal vaccination was associated with a 43% lower likelihood of CTX-M-type ESBL (aPR=0.57; 95%CI:0.38-0.85, p=0.005), whilst measles vaccination was associated with a 32% lower likelihood of mph(A) gene (aPR=0.68; 95%CI:0.49-0.93, p=0.017) in E. coli isolates. Conclusions Among children discharged from hospital, history of vaccination, shorter hospital stay, lack of in-hospital antibiotic exposure and improved sanitation were associated with lower likelihood of AMR genes. AMR control programs should consider strategies beyond antimicrobial stewardship, including improvements in sanitation, increased vaccine coverage and the development of novel vaccines, to mitigate the continued spread of AMR.

Unraveling the determinants of antibiotic resistance evolution in farmland under fertilizations

Organic fertilization is a major driver potentiating soil antibiotic resistance in farmland. However, it remains unclear how bacterial antibiotic resistance evolves in fertilized soils and even spreads to crops. Compared with no fertilizer and commercial fertilizer treatments, organic fertilizers markedly increased the abundance of soil antibiotic resistance genes (ARGs) but the relatively weaker transfer of resistance genes from soil to crops. The introduction of organic fertilizers enriches the soil with nutrients, driving indigenous microorganisms towards a K-strategy. The pH, EC, and nutrients as key drivers influenced the ARGs abundance. The neutral (pH 7.2), low salt (TDS 1.4 %) and mesotrophic (carbon content 3.54 g/L) habitats similar to the soil environment conditioned by organic fertilizers. These environmental conditions clearly prolonged the persistence of resistant plasmids, and facilitated their dissemination to massive conjugators soil microbiome but not to plant endophytes. This suggested that organic fertilizers inhibited the spread of ARGs to crops. Moreover, the composition of conjugators showed differential selection of resistant plasmids by endophytes under these conditions. This study sheds light on the evolution and dissemination of antibiotic resistance in farmlands and can aid in the development of antimicrobial resistance control strategies in agriculture.

Attitudes of South Korean consumers toward the prudent use of antimicrobials in livestock animals

Antimicrobial resistance (AMR) in livestock is a complicated and multi-sectoral risk that threatens public health in the interactions between humans, animals, and environment. Through their increased awareness of AMR issues, consumers can make a significant impact on regulations and strategies to reduce or eliminate the use of antimicrobials use. This study aims to provide evidence-based data for promoting the prudent use of antimicrobials (PUA) in the livestock industry to reduce the risk of AMR and increase animal welfare by identifying consumers' intentions to support PUA practices in livestock farming. An online survey was conducted on 1000 respondents in South Korea to examine their intention to pay more for PUA practices in livestock farming at state and individual levels against their pro-animal attitude, risk perception of antimicrobial overuse, trust in antimicrobial overuse control, and perceived value of PUA practices. The survey data was analyzed using multiple linear regression to identify the determinants of Korean consumers' support for PUA practices. Approximately 86.3% of the respondents supported government-level spending for PUA in livestock farming, and the same portion of respondents intended to pay more for livestock products that complied with the PUA principle. The four attitudinal variables—pro-animal attitude, consumers' risk perception, trust in antimicrobial resistance control, and perceived value of PUA—positively affected both state- and individual-level support. Overall, our findings highlight the Korean consumers' demand for reducing the risk of AMR and their perceived universal value of PUA for humans and animals.

Impact of COVID-19 on antimicrobial stewardship activities in Italy: a region-wide assessment

BackgroundIn the region of Piedmont, in Northern Italy, formal monitoring of antimicrobial stewardship (AMS) programs has been in place since 2012. The objective of our study was to provide an updated assessment of AMS programs operating in our region, and to assess the impact of the COVID-19 pandemic on stewardship activities.MethodsA retrospective observational study was conducted to investigate AMS programs implemented in acute-care trusts participating in a broader healthcare-associated infections and antimicrobial resistance (AMR) prevention and control program, promoted by the regional health department. Within this program, structure, process, and outcome indicators of AMS programs were investigated, using a previously developed scoring system. Differences between scores prior to (2019) and during the pandemic (2021) were assessed. Linear regression was used to assess whether the 5-year trends (2017–2021) in outcome measures in relation to structure and process scores were statistically significant. Compound annual growth rates (CAGR) for each outcome were calculated to illustrate changes in outcome rates over time.ResultsAll public trusts in the Region (20) and a small number of private institutions (3) provided data for this study. A modest, non-significant improvement was found for 2021 structure, process, and total scores compared to respective 2019 scores. A significant improvement was found concerning the definition of a formal mission statement, whereas significantly less trusts included monitoring adherence to antimicrobial policy or treatment guidelines in their programs. Overall consumption of antibiotics for systemic use saw an increase in 2021, with 2021 recording the highest median overall consumption compared to all previous years considered in this study. Methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant enterobacteria (CRE) rates decreased over the 5-year period. Significant downwards trends in MRSA rates were identified for high-outlier structure and process groups.ConclusionsResults of this study suggest AMS programs in Piedmont were not set back following the pandemic. This outcome was possible thanks to well-established programs, coordinated within a regional framework. Continued efforts should be dedicated to supporting AMS programs and contrasting AMR, even when the focus is shifted towards other public health emergencies.

The level of pusblic knowledge regarding how to obtain, use, store andDisposing of Antibiotics in the Kediri City District Area

Antibiotics are drugs used to treat bacterial infections that kill bacteria or prevent bacteria from multiplying. According to data from the antimicrobial resistance control committee, the level of bacterial resistance in Indonesia increased, from 40% in 2013 to 60.4% in 2019, this indicates that the need for antibacterials is still very high among the public. This study aims to evaluate the level of public knowledge regarding how to obtain, use, store and dispose of antibiotics in the Kota sub-district area, Kediri City. This research uses a descriptive method with a quantitative approach, the sample used is the community in the Kota District area, Kediri City which was taken randomly.cluster sampling. The results of the research show that the majority of respondents in Kota sub-district, Kediri City have a sufficient level of knowledge of antibiotic use with a percentage of 38.5%, it is known that the majority of respondents have an average knowledge of antibiotic storage between good and sufficient with a percentage of 37.0%, the majority of respondents have low knowledge of antibiotic disposal. with a percentage of 69.0%, then regarding how to get antibiotics the majority had good knowledge with a percentage of 49.3%. From the research results, it was concluded that the level of public knowledge regarding the use, storage, disposal and methods of obtaining antibiotics is still lacking. Then, from the results of respondents' answers, there is no significant relationship between gender and age, with respect to respondents' knowledge about use, storage, disposal and how to obtain them, whereas based on education there is a significant relationship with knowledge of storage and for work there is a significant relationship with knowledge of how to obtain antibiotics in the sub-district area. City, Kediri City.

Long-Term Co-Circulation of Host-Specialist and Host-Generalist Lineages of Group B Streptococcus in Brazilian Dairy Cattle with Heterogeneous Antimicrobial Resistance Profiles.

Group B Streptococcus (GBS) is a major cause of contagious bovine mastitis (CBM) in Brazil. The GBS population is composed of host-generalist and host-specialist lineages, which may differ in antimicrobial resistance (AMR) and zoonotic potential, and the surveillance of bovine GBS is crucial to developing effective CBM control and prevention measures. Here, we investigated bovine GBS isolates (n = 156) collected in Brazil between 1987 and 2021 using phenotypic testing and whole-genome sequencing to uncover the molecular epidemiology of bovine GBS. Clonal complex (CC) 61/67 was the predominant clade in the 20th century; however, it was replaced by CC91, with which it shares a most common recent ancestor, in the 21st century, despite the higher prevalence of AMR in CC61/67 than in CC91, and high selection pressure for AMR from indiscriminate antimicrobial use in the Brazilian dairy industry. CC103 also emerged as a dominant CC in the 21st century, and a considerable proportion of herds had two or more GBS strains, suggesting poor biosecurity and within-herd evolution due to the chronic nature of CBM problems. The majority of bovine GBS belonged to serotype Ia or III, which was strongly correlated with CCs. Ninety-three isolates were resistant to tetracycline (≥8 μg/mL; tetO = 57, tetM = 34 or both = 2) and forty-four were resistant to erythromycin (2.0 to >4 μg/mL; ermA = 1, ermB = 38, mechanism unidentified n = 5). Only three isolates were non-susceptible to penicillin (≥8.0 μg/mL), providing opportunities for improved antimicrobial stewardship through the use of narrow-spectrum antimicrobials for the treatment of dairy cattle. The common bovine GBS clades detected in this study have rarely been reported in humans, suggesting limited risk of interspecies transmission of GBS in Brazil. This study provides new data to support improvements to CBM and AMR control, bovine GBS vaccine design, and the management of public health risks posed by bovine GBS in Brazil.

Real-time genomic surveillance for enhanced control of infectious diseases and antimicrobial resistance

This article advocates for mobilizing pathogen genomic surveillance to contain and mitigate health threats from infectious diseases and antimicrobial resistance (AMR), building upon successes achieved by large-scale genome sequencing analysis of SARS-CoV-2 variants in guiding COVID-19 monitoring and public health responses and adopting a One Health approach. Capabilities of laboratory-based surveillance and epidemic alert systems should be enhanced by fostering (i) universal access to real-time whole genome sequence (WGS) data of pathogens to inform clinical practice, infection control, public health policies, and vaccine and antimicrobial drug research and development; (ii) integration of diagnostic microbiology data, data from testing asymptomatic individuals, pathogen sequence data, clinical data, and epidemiological data into surveillance programs; (iii) stronger cross-sectorial collaborations between healthcare, public health, animal health, and environmental surveillance and research using One Health approaches, toward understanding the ecology and transmission pathways of pathogens and AMR across ecosystems; (iv) international collaboration and interconnection of surveillance networks, harmonization of laboratory methods, and standardization of surveillance methods for global reporting, including on pathogen genomic variant or strain nomenclature; (v) responsible data sharing between surveillance networks, databases, and platforms according to FAIR (findability, accessibility, interoperability, and reusability) principles; and (vi) research on genomic surveillance system implementation and its cost-effectiveness for different pathogens and AMR threats across different settings. Regional and global One Health policies and governance initiatives should foster the concerted development and efficient utilization of pathogen genomic surveillance to protect the health of humans, animals, and the environment.

Brazilian Study on the Prevalence of Carbapenemase Producing Organisms and Their Relation with Patients’ Death Rate

Aims: Determine the clinical characteristics of patients and the microbiological characteristics of the isolated Gram-negative microorganisms; Analyze the relationship between hospitalization sectors and the occurrence of bacteria resistant to carbapenems; Determine the prevalence of Gram-negative in clinical sectors of a University Hospital from Fortaleza, Brazil; Relate the prevalence to resistent Gram-negative bacteria with patients’ death rate.
 Study Design: This is a descriptive, retrospective and cross-sectional study, carried out between January and December 2022 at a university hospital in Fortaleza, Brazil.
 Place and Duration of Study: Microbiology Sector of the Central Laboratory of the Walter Cantídio University Hospital between January 2022 and December 2022.
 Methodology: All reports that showed a positive culture for Gram-negative bacilli and that carried out antibiotic sensitivity testing were included in the study. Their identification (ID) and the Antibiotic Sensitivity Test (TSA) were carried out using the automated system VITEK® 2 (BioMérieux®, Marcyl’Etoile, France), which uses the OBSERVA system for data archiving. The data was collected on a specific form and collected through patient reports issued by the hospital system. The forms were reviewed by a microbiologist pharmacist from the microbiology service. The data were analyzed and audited in the Excel® program for statistical validation using the SPSS Statistics® program, version 17.0.
 Results: 398 samples positive for Gram-negative microorganisms were collected. These samples referred to 236 patients admitted to different sectors of the hospital. It was seen that the Surgical Center concentrated a greater number of patients, representing 66 individuals (28%). The most frequently isolated species (n=217) were Klebsiella pneumoniae (n= 70; 23%) and Pseudomonas aeruginosa (n= 70; 23%), followed by Escherichia coli (n= 43; 14%) and Acinetobacter baumannii (n = 34; 11%), respectively. It was observed that 29.9% of GNB were isolated from blood samples, this being the most prevalent biological site. Bloodstream infection (BSI) was identified as the biological site with the highest number of cases, recording 65 (29.9%) positive isolates in the blood. It was found that 131 isolates of Gram-negative bacteria presented resistance mechanisms, with resistance to carbapenems being the most prevalent, corresponding to 42.75% of cases originating from enterobacteria. It was found that admission to the adult ICU increases the chances of death by 6.017 (OR) times in patients who isolated carbapenem-resistant GNBs (p <0.001).
 Conclusion: The study analyzed the microbial profile of patients at a university hospital, identifying a significant association between death and microbial resistance, especially with Klebsiella pneumoniae. Bloodstream infections were frequent, being the site with the highest number of cases. The predominant resistance mechanism was Carbapenem-Resistant Enterobacteriaceae (CRE). The results highlight the need for continuous monitoring and control of antimicrobial resistance to guide epidemiological strategies.

Characterization of antibiotic resistance genes and mobile genetic elements in Escherichia coli isolated from captive black bears

The objective of this study was to analyze the antimicrobial resistance (AMR) characteristics produced by antibiotic resistance genes (ARGs), mobile genetic elements (MGEs) and gene cassettes in Escherichia coli isolated from the feces of captive black bears. Antimicrobial susceptibility testing was performed by using the disk diffusion method, and both MGEs and integron gene cassettes were detected by polymerase chain reaction. Our results showed that 43.7% (62/142) of the isolates were multidrug resistant strains and 97.9% (139/142) of the isolates were resistant to at least one antibiotic. The highest AMR phenotype was observed for tetracycline (79.6%, 113/142), followed by ampicillin (50.0%, 71/142), trimethoprim-sulfamethoxazole (43.7%, 62/142) and cefotaxime (35.9%, 51/142). However, all isolates were susceptible to tobramycin. tetA had the highest occurrence in 6 ARGs in 142 E. coli isolates (76.8%, 109/142). Ten mobile genetic elements were observed and IS26 was dominant (88.0%, 125/142). ISECP1 was positively associated with five β-lactam antibiotics. ISCR3/14, IS1133 and intI3 were not detected. Seventy-five E. coli isolates (65 intI1-positive isolates, 2 intI2-positive isolates and 8 intI1 + intI2-positive isolates) carried integrons. Five gene cassettes (dfrA1, aadA2, dfrA17-aadA5, aadA2-dfrA12 and dfrA1-aadA1) were identified in the intI1-positive isolates and 2 gene cassettes (dfrA1-catB2-sat2-aadA1 and dfrA1-catB2-sat1-aadA1) were observed in the intI2-positive isolates. Monitoring of ARGs, MGEs and gene cassettes is important to understand the prevalence of AMR, which may help to introduce measures to prevent and control of AMR in E. coli for captive black bears.

Invasive Streptococcus suis isolated in Spain contain a highly promiscuous and dynamic resistome.

Streptococcus suis is a major pathogen for swine and human. Here we aimed to know the rates of antimicrobial resistance (AMR) in invasive S. suis isolates recovered along Spain between 2016 - 2021 and elucidate their genetic origin. Antibiotic susceptibility testing was performed for 116 isolates of different genetic backgrounds and geographic origins against 18 antibiotics of 9 families. The association between AMR and genotypes and the origin of the isolates were statistically analyzed using Pearson´s chi-square test and the likelihood ratio. The antimicrobial resistant genes were identified by whole genome sequencing analysis and PCR screenings. High AMR rates (>80%) were detected for tetracyclines, spectinomycin, lincosamides, and marbofloxacin, medium (20-40%) for sulphonamides/trimethoprim, tiamulin, penicillin G, and enrofloxacin, and low (< 20%) for florfenicol, and four additional β-lactams. The occurrence of multidrug resistance was observed in 90% of isolates. For certain antibiotics (penicillin G, enrofloxacin, marbofloxacin, tilmicosin, and erythromycin), AMR was significantly associated with particular sequence types (STs), geographic regions, age of pigs, and time course. Whole genome sequencing comparisons and PCR screenings identified 23 AMR genes, of which 19 were previously reported in S. suis (aph(3')-IIIa, sat4, aadE, spw, aac(6')-Ie-aph(2'')-Ia, fexA, optrA, erm(B), mef(A/E), mrs(D), mph(C), lnu(B), lsa(E), vga(F), tet(M), tet(O), tet(O/W/32/O), tet(W)), and 4 were novel (aph(2'')-IIIa, apmA, erm(47), tet(T)). These AMR genes explained the AMR to spectinomycin, macrolides, lincosamides, tiamulin, and tetracyclines. Several genes were located on mobile genetic elements which showed a variable organization and composition. As AMR gene homologs were identified in many human and animal pathogens, the resistome of S. suis has a different phylogenetic origin. Moreover, AMR to penicillin G, fluoroquinolones, and trimethoprim related to mutations in genes coding for target enzymes (pbp1a, pbp2b, pbp2x, mraY, gyrA, parC, and dhfr). Bioinformatic analysis estimated traits of recombination on target genes, also indicative of gene transfer events. Our work evidences that S. suis is a major contributor to AMR dissemination across veterinary and human pathogens. Therefore, control of AMR in S. suis should be considered from a One Health approach in regions with high pig production to properly tackle the issue of antimicrobial drug resistance.

A qualitative study of the factors impacting implementation of the national action plan to contain antimicrobial resistance (2016-2020) in medical institutions.

Antimicrobial resistance (AMR) has emerged as a serious global public health crisis. In response, 2016, 14 ministries in China, under the leadership of the National Health Commission, collaboratively issued the National Action Plan (NAP) to Contain Antibacterial Resistance (2016-2020). The NAP outlines strategies for medical institutions to adopt stewardship and implement AMR control. The purpose of this study was to comprehend stakeholders' perceptions of the NAP and explore the factors that influence its implementation in medical institutions. Semi-structured interviews were conducted with practitioners from medical institution in March and April 2021. Interviews were audio-recorded, transcribed and analyzed using thematic analysis via the framework approach. Twenty practitioners, representing diverse roles (4 administrators, 7 clinicians, 3 microbiologists, 3 pharmacists, 3 nosocomial infection management personnel) from seven institutions, participated in the study. Substantial efforts have been undertaken to regulate the rational use of antibiotics and enhance the management of hospital infections. Participants demonstrated awareness and concern regarding antimicrobial resistance, with widespread support expressed for the NAP. Among all professions, there were varying opinions on whether they felt restricted in their daily work. The tertiary hospitals have established multidisciplinary cooperation mechanisms. Six main themes were identified as both barriers and facilitators to the implementation of the NAP in the medical institutions: individual factors, leadership, multidisciplinary collaboration, patient factors, trainingand culture. The capacity for administrative attention is constrained or limited, poor enforcement of guidelines, insufficient specialist staff and the liability pressure on clinicians were perceived barriers. To containing AMR in medical institutions, management of hospital infections, the public's knowledge of antibiotics' usage, routine education and multidisciplinary support would be facilitators. Practitioners from medical institutions were highly supportive for the NAP. Consideration of practitioners' perceived barriers and facilitators might enhance implementation of the NAP to contain antimicrobial resistance.

Antimicrobial resistance, virulence profile, and genetic analysis of ESBL-producing Escherichia coli isolated from Nile tilapia in fresh markets and supermarkets in Thailand.

This study investigated the prevalence and antimicrobial resistance (AMR) of Escherichia coli (E. coli) in Nile tilapia from fresh markets and supermarkets. A total of samples (n = 828) were collected from Nile tilapia including fish flesh (n = 276), liver and kidney (n = 276), and intestine (n = 276). Overall prevalence of fecal coliforms (61.6%) and E. coli (53.0%) were observed. High prevalence of E. coli was found in the intestine (71.4%), followed by the liver and kidney (45.7%). The highest prevalence of resistance was commonly found against tetracycline (78.5%), ampicillin (72.8%), and sulfamethoxazole (45.6%) with resistance to only tetracycline (15.2%) as the most common antibiogram. The prevalence of multidrug resistance (MDR) (54.4%) and Extended-spectrum beta-lactamases (ESBLs) (5.7%) were examined. The predominant virulence genes (n = 158) were st (14.6%), followed by eaeA (0.6%). The blaTEM (73.4%), tetA (65.2%), and qnrS (57.6%). There is statistical significance between Nile tilapia from fresh markets and supermarkets. Based on logistic regression analysis, ampicillin-resistant E. coli was statistically associated with the phenotypic resistance to tetracycline and trimethoprim, and the presence of blaTEM and tetA (p < 0.05). Further investigation of AMR transference and their mechanisms is needed for AMR control.

P07 Antimicrobial stewardship in Ireland 2009–22: a scoping review

Abstract Objectives The aim of this scoping review is to examine the current literature to evaluate progress related to the implementation of the Strategy for the Control of Antimicrobial Resistance in Ireland (SARI) Hospital Antimicrobial Stewardship (AMS) Working Group guidance (2009) on antimicrobial stewardship in hospitals in Ireland. Methods Systematic searches were carried out on four electronic databases (PubMed, CINAHL, Embase, Web of Science) and five targeted websites for grey literature sources. Titles and abstracts were screened independently by two reviewers. The remaining full-text publications were reviewed by all authors. Studies were mapped into at least one of four categories defined by recommendation headings from the SARI Hospital Antimicrobial Stewardship Working Group guidance: (A) structure and organization of AMS; (B) roles and responsibilities for prescribers; (C) antimicrobial stewardship interventions; (D) recommendations for non-acute residential healthcare institutions. Results The search yielded 545 peer reviewed papers for screening of which 35 were included and 327 grey reports of which 26 were included. Most articles were mapped to (C) antimicrobial stewardship interventions, with the least number mapped to (A) structure and organization of AMS. The most consistent findings in (C) were numerous implementation challenges requiring commitment by hospital leadership to provide human and financial resources, need for improved diagnostic capacity, and educational pathways for prescribers, pharmacists, nurses and patients. The findings in (A) included inadequate staffing across hospitals to implement stewardship programmes (regardless of hospital acuity) and investment required for information and communication technology resources to further support AMS and infection prevention and control. Conclusions There has been progress on AMS over the last 20 years and implementation remains a significant challenge. Clear identification of AMS programme management, use of data, education and communication need to be considered for the success of future implementation in all healthcare settings.

The Role of Bee Products in the Control of Antimicrobial Resistance and Biofilm Formation

The Role of Bee Products in the Control of Antimicrobial Resistance and Biofilm Formation