Prevention Of Antimicrobial Resistance Research Articles

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

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

Investigating Antimicrobial Resistance and ESBL Producing Gene in Klebsiella Isolates among Neonates and Adolescents in Southern Bangladesh.

Background Multidrug-resistant (MDR) clones of Klebsiella pneumoniae (Kpn) have been increasingly documented in community-acquired and nosocomial infections all around the globe. Extended-spectrum β-lactamases (ESBLs) are a rapidly evolving group of β-lactamase enzymes derived from SHV genes by mutations. This research work aimed to investigate and analyze the widespread prevalence of Kpn antibiotic resistance in different areas of the southern part of Bangladesh. Methods This particular study was executed and implemented by using 501 clinical samples or isolates from two different hospitals in Chattogram. The disk diffusion method was used to detect Kpn's sensitivity to 16 antibiotics in a drug susceptibility test. By using the PCR technique, the widespread prevalence of antibiotic-resistant gene blaSHV-11 was studied. Sequencing along with phylogenetic analysis was utilized to verify isolates with the blaSHV-11 gene. Results Almost all of the Kpn isolates were spotted to be antibiotic-resistant. These Kpn isolates were resistant to β-lactams, aminoglycosides, and quinolones at high levels. The spatial analysis displayed that infections involving Kpn were more common in the urban areas (70%) than in the rural areas (30%). Neonates had substantially higher levels (p < 0.001) of resistance to multidrug than other age groups. Cefepime was identified as the most frequent antibiotic-resistant to all age groups (56.68%). The highest numbers of resistant isolates (36.92%) were found in urine samples. The ESBL gene blaSHV-11 was found in 38% isolates. Conclusion The significant frequency of MDR Kpn harboring β-lactamases and AMR genes strongly suggests the requirement to develop effective antimicrobial resistance control and prevention measures in Bangladesh.

Assessment of Factors Associated With Community-Acquired Extended-Spectrum β-Lactamase–Producing Escherichia coli Urinary Tract Infections in France

Extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is considered a leading pathogen contributing to the global burden of antimicrobial resistance. To better understand factors associated with the heterogeneity of community-acquired ESBL-producing E coli urinary tract infections (UTIs) in France. This cross-sectional study performed from January 1 to December 31, 2021, was based on data collected via PRIMO (Surveillance and Prevention of Antimicrobial Resistance in Primary Care and Nursing Homes), a nationwide clinical laboratory surveillance system in France. Strains of E coli isolated from community urine samples from January 1 to December 31, 2019, from 59 administrative departments of metropolitan France were included. Quasi-Poisson regression models were used to assess the associations between several ecological factors available on government and administration websites between 2010 and 2020 (demographic population structure, living conditions, baseline health care services, antibiotic consumptions, economic indicators, animal farming density, and environmental characteristics) and the number of ESBL-producing E coli strains isolated from urine samples of individuals with community-acquired UTI in 2019. Among 444 281 E coli isolates from urine samples tested in 1013 laboratories, the mean prevalence of ESBL-producing E coli was 3.0% (range, 1.4%-8.8%). In an adjusted model, the number of community-acquired ESBL-producing E coli UTIs in each department was positively associated with the percentage of children younger than 5 years (adjusted β1 coefficient, 0.112 [95% CI, 0.040-0.185]; P = .004), overcrowded households (adjusted β1 coefficient, 0.049 [95% CI, 0.034 to 0.062]; P < .001), consumption of fluoroquinolones (adjusted β1 coefficient, 0.002 [95% CI, 0.001-0.002]; P < .001), and tetracyclines (adjusted β1 coefficient, 0.0002 [0.00004 to 0.00039]; P = .02), and poultry density (adjusted β1 coefficient, 0.0001 [95% CI, 0.0001-0.0002]; P < .001). The social deprivation index (adjusted β1 coefficient, -0.115 [95% CI, -0.165 to -0.064]; P < .001) and the proportion of water surface area (adjusted β1 coefficient, -0.052 [-0.081 to -0.024]; P = .001) were negatively associated with a higher number of community-acquired ESBL-producing E coli UTIs. The findings of this cross-sectional study suggest that multiple human health, animal health, and environmental factors are associated with the occurence of community-acquired ESBL E coli UTI. Strategies to mitigate ESBL in the community should follow the One Health approach and address the role played by fluoroquinolones, tetracycline use, poultry density, overcrowded households, and preschool-aged children.

Prevention of antibiotic resistance created by experimental evolutionary microbiology in Staphylococcus aureus and Escherichia coli with herbal substances

Background and Aims: Recently, one of the biggest problems of the world is a bacterial antimicrobial resistance, that is developing against most of the existing antibiotics. In addition to conducting studies that continue to discover new antimicrobial agents for combating multidrug resistant bacteria, steps should be taken for the protection of existing antibiotics. With this in mind, many modern and classical strategies have been developed, and among them, using essential oils or extracts obtained from plants, which may be a practical and effective alternative. Methods: We used the experimental evolutionary microbiology method to determine the effects of herbal substances, such as cinnamaldehyde from cinnamon, epigallocatechin gallate from greentea, curcumin from turmeric, punicalagin from pomegranate, and clove oil from clove, on the prevention or delay of antimicrobial resistance. In this study, Staphylococcus aureus and Escherichia coli standard and clinical strains were gradually exposed to increasing sub-inhibitory concentrations of meropenem and ciprofloxacin with or without the presence of herbal substances. Results: Resistance was developed in the E. coli and S. aureus control groups which were exposed only to ciprofloxacin, but, when herbal substances were included to the test, there was no resistance development. When the control groups were exposed only to meropenem, there was only an increase in the minimum inhibitory concentrations (MIC), but they did not become resistant, and we observed similar MIC values when we added the herbal substances to the test. Conclusion: These results showed that herbal substances might contribute to lowering MIC values of antibiotics and may help prevent the development of resistance in the studied bacteria.

Pseudomonas fluorescens Cells' Recovery after Exposure to BAC and DBNPA Biocides.

A proper assessment of the effects of biocides on bacterial cells is key to the prevention of antimicrobial resistance and the implementation of suitable biocidal programmes. It is particularly relevant regarding the ability of dead-labelled cells to recover their functional processes once the biocide is removed. In the present work, we studied how Pseudomonas fluorescens cells previously exposed to different concentrations of BAC (benzalkonium chloride) and DBNPA (2,2-Dibromo-3-nitrilopropionamide) behave upon the restoration of optimum growth conditions. The following indicators were evaluated: culturability, membrane integrity, metabolic activity (resazurin), cellular energy (ATP), and cell structure and morphology (transmission electron microscopy (TEM)). The results demonstrated that cells previously labelled as ‘dead’ recovered to a greater extent in all indicators. Only cells previously exposed to BAC at 160 mg/L (concentration above the MBC) showed significant reductions on all the evaluated indicators. However, the obtained values were much higher than the ‘death’ thresholds found for the autoclaved cells. This suggests that cells exposed to this concentration take more time to rebuild their functional processes. The recovery of DBNPA-treated cells did not seem to be related to the biocide concentration. Finally, a reflection on what kind of cells were able to recover (remaining cells below the detection limit and/or dormant cells) is also presented.

Antimicrobial Stewardship in Tropical Infectious Diseases: Focusing on Dengue and Malaria.

Acute undifferentiated febrile illness (AUFI) is the presenting symptom of various tropical and infectious diseases. Viral infection is generally the most common cause of AUFI, accounting for 8–11.8% of cases; thus, antibiotics might be unnecessary. Dengue and malaria are common tropical infectious diseases requiring effective supportive treatment and antimalarial agents, respectively. The uncertainty of early diagnosis results in widespread empirical antimicrobial treatment in high -income as well as in low-and middle-income countries. Although rapid diagnostic tests (RDTs) have been shown to limit antibiotic prescriptions in dengue and malaria, we observed a wide range of antibiotic prescriptions for 13–92.7% of cases in previous literature, particularly in RDT-negative malaria cases. Given several RDT limitations, antimicrobial stewardship (AMS) appears to be an effective strategy for controlling unnecessary antibiotic use and antimicrobial resistance (AMR) prevention. This program should be endorsed by a multidisciplinary team in tropical diseases to control collateral damage of inappropriate antimicrobial use. Empirical antibiotic treatment should be administered based on clinical judgement, microbiological evidence, and local epidemiological data. Rapid termination of antibiotic therapy, including disease control or elimination, is the mainstay of AMS in tropical diseases. Local and international sectors should implement an AMS programme to reduce AMR in the Tropics.

Antimicrobial Resistance: Unexplained Failure to Antibiotic Therapy in a Case at Maluti Adventist Hospital Berea Lesotho

Aim: The aim of the present study was to highlight the presence and problem of antimicrobial resistance in our setting.&#x0D; Case Presentation: We present a 17-year old female with yellow offensive vaginal discharge, itchiness and lower abdominal pain of about two-weeks duration. She was treated with antibiotics based on laboratory results of urine and high vaginal swabs. However, the symptoms persisted despite the treatment and high adherence to the medications.&#x0D; Discussion: Antimicrobial Resistance (AMR) presents a painful risk to human health and life around the globe. The efficacy and effectiveness of antimicrobial agents are now under massive threat from increasing resistance of disease pathogens to antimicrobial agents. The unexplained failure of antibiotic therapy occurred despite the prescription being based on sensitivity results from swab culture on two separate occasions.&#x0D; Conclusion: There is need for high index of suspicion of antimicrobial resistance by health workers. There is also need for rational prescription, dispensing and use of antimicrobial agents. Patients need increased access to high quality antimicrobial medicines and more awareness of the development, spread and prevention of antimicrobial resistance.

Assessment of Community Pharmacists Knowledge on dispensing of Antimicrobial drugs and Prevention of Antimicrobial Resistance in Community practice

The antimicrobial resistance has more impact on the health care division which would increase the mortality and hospital readmission duration. Our objective is to assess the community pharmacist’s knowledge on dispensing of antimicrobial drugs and prevention of antimicrobial resistance in community practice. A cross-sectional study was conducted for six months. A sample size of 150 registered community pharmacists participated in the study. We have used simple random techniques to select the community pharmacists. Questionnaire were distributed to the community pharmacists at pre and post visits and the response was analyzed. The collected data was analyzed using graph pad prism software. The mean and standard deviation was calculated and P&lt;0.005 was considered to be statistically significant. For 25-30 years of age , community pharmacists were more 68 (45.33%) as compared to other ages. Pre visit before and after average mean antimicrobial resistance score was found to be 4.87. Proper implementation of antimicrobial resistance prevention programmes would drastically increases the rational use of antimicrobials could and minimizes the health care cost.

Prevalence of ESBL genes in Klebsiella pneumoniae from individuals with community-acquired urinary tract infection in rural communities of Enugu State, Nigeria

Background: The emergence and spread of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae is now a major challenge in treating urinary tract infections. This study was conducted to determine the Prevalence of ESBL genes in Klebsiella pneumoniae and the influence of these genes on the antimicrobial susceptibility patterns of the isolates, obtained from community acquired urinary tract infection in Enugu state rural communities. Method: A total of 735 clean catch mid-stream urine samples were collected from February, 2021 to June, 2021. The urine samples were cultured and Klebsiella pneumoniae were identified morphologically, biochemically, and then typed down, using PCR, Gel electrophoresis, and Sanger Sequencing by Genewiz. Antibiotic susceptibility testing was done by modified Kirby-Bauer disc diffusion method and interpretation was done following Clinical and Laboratory Standard Institute (CLSI) guidelines. ESBL screening was done by the phenotypic method, using the standard disk diffusion method, whereas the phenotypic confirmation of ESBL producers was done by the double-disk synergy method, and interpreted according to CLSI guidelines. Multiplex PCR was used to detect the genes for SHV and CTX-M while conventional linear PCR was done for TEM and blas GES type ESBL genes. Results: A total of 77 isolates were identified as Klebsiella pneumoniae, and the prevalence of positive ESBL in them were 10(12.9%). Of the 77 isolates that were tested for antibiogram, 29 isolates were multidrug-resistance (MDR). Out of the MDR isolates, 10 were ESBL positive, whereas 19 were not. Of this 29 MDR isolates, 6 were extensively-drug resistant (XDR). Of the 6 XDR isolates, 3 do not possess ESBL enzymes, whereas 3 of them do. Age range of 31-40 contributed the highest prevalence of ESBL genes (60%), whereas age range of 10-20, 21-30, and 51-70 did not produce any ESBL gene. bla TEM gene was the most prevalent ESBL resistant genes with a prevalence of 10 (100%), followed by SHV 9(90%), whereas bla GES gene and bla CTX-M have the least prevalence of 4 (40%) each. Conclusion: Higher prevalence of MDR, XDR, and ESBL-producing Klebsiella pneumoniae were observed, thus the need for public health intervention for effective prevention and control of antimicrobial resistance, and proper treatment of UTIs.

The in vitro activity of danofloxacin plus ceftiofur combination: implications for antimicrobial efficacy and resistance prevention.

Due to the high prevalence of multi-drug resistant bacteria, combination therapy is an efficient choice for treatment of infections caused by highly resistant strains. In this study, the efficacy of ceftiofur plus danofloxacin combination was investigated against resistant Escherichia coli. The interaction between the two drugs was determined by checkerboard tests and time-kill assays. The combination was defined as bactericidal or bacteriostatic based on the minimum bactericidal concentration test results. Mutant prevention concentration test was used to evaluate the resistance tendency suppression potential of the combination. The combination had a synergistic effect against 83.00% of the isolates as verified by the checkerboard and time-kill assays. The combination was defined as bactericidal against all E. coli strains, since minimum bactericidal concentration: minimum inhibitory concentration ratios were below four thresholds and also markedly reduced mutant prevention concentration values of ceftiofur up to 4000-fold compared to its single use. Ceftiofur plus danofloxacin combination inhibited growth of E. coli strains which were resistant to ceftiofur or newer generation of fluoroquinolones. Our results suggest that ceftiofur plus danofloxacin combination has a bactericidal characteristic and can be an important alternative for the treatment of infections caused by resistant E. coli.

A quarterly Survey of antibiotic prescribing in small animal and equine practices-Minnesota and North Dakota, 2020.

Antimicrobials are critical for medicine, but the problem of antimicrobial resistance (AMR) threatens the effectiveness of these valuable drugs. In USA, there are no national- or state-level programs or policies in place to track antibiotic use (AU) in dogs, cats, and horses, despite acknowledgement of this sector's importance to both the AMR problem and its solution. AU measurement is a key part of antibiotic stewardship and AMR prevention. This study aimed to fill existing gaps in the veterinary professions' knowledge of antibiotic prescribing in small animals and horses. To address this aim, medical record data were collected on a single day per quarter for 1 year from 19 Minnesota and North Dakota small animal and equine practices, totaling 1,899 veterinarian consults of dogs, cats, and horses. Overall, 25.8% of all canine, feline, and equine consults involved an antibiotic prescription. Third-generation cephalosporins were the most commonly prescribed systemic antibiotic drug class, and the long-acting injectable drug, cefovecin, was the most commonly prescribed antibiotic for cats (34.5%). Topical antibiotic preparations were prescribed frequently, especially in dogs (42.5% of canine prescriptions), though systemic antibiotics were often prescribed concurrently. Common general indications, based on problem or diagnosis recorded in the medical record, for antibiotics in all species combined were skin conditions (24.4%), otitis (22.1%), ophthalmic (9.4%), gastrointestinal (8.3%), respiratory (8.3%), and urinary tract (7.6%) diseases. While 44.2% of patients for which antibiotics were prescribed had cytology performed, only 3.9% had bacterial culture and susceptibility performed. In a pre-study survey, veterinarians' recommendations for AU differed from actual prescribing, suggesting collection of AU data provides more accurate assessments of veterinary prescribing behaviour than surveys. This study shows feasibility of AU measurement in small animals and horses. The data collection tool and standard operating procedures described prove suitable for national AU data collection.

Prevention and control of antimicrobial resistance using CRISPR-Cas system: a review

Bacterial multi-drug resistance (MDR) is a global challenge in the fields of medicine and health, agriculture and fishery, ecology and environment. The cross-region spread of antibiotic resistance genes (ARGs) among different species is one of the main cause of bacterial MDR. However, there is no effective strategies for addressing the intensifying bacterial MDR. The CRISPR-Cas system, consisting of clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR associated proteins, can targetedly degrade exogenous nucleic acids, thus exhibiting high application potential in preventing and controlling bacterial MDR caused by ARGs. This review briefly introduced the working mechanism of CRISPR-Cas systems, followed by discussing recent advances in reducing ARGs by CRISPR-Cas systems delivered through mediators (e.g. plasmids, bacteriophages and nanoparticle). Moreover, the trends of this research field were envisioned, providing a new perspective on preventing and controlling MDR.

How COVID-19 Has Influenced Public Interest in Antimicrobials, Antimicrobial Resistance and Related Preventive Measures: A Google Trends Analysis of Italian Data.

Google Trends analytics is an innovative way to evaluate public interest in antimicrobial resistance (AMR) and related preventive measures. In the present study, we analyzed Google Trends data in Italy, from 2016 to 2021. A joinpoint analysis was performed to assess whether and how annual campaigns and the COVID-19 pandemic affected public interest in antimicrobials, AMR, hand hygiene, and the use of disinfectant. For the terms “antimicrobials” and “antimicrobial resistance”, no joinpoints were detected around the time of the World Antimicrobial Awareness Week. Similarly, the COVID-19 pandemic seems to have had no effect on public interest in this term. For the term “handwashing”, no joinpoints were detected around World Hand Hygiene Day or Global Handwashing Day. However, three joinpoints were detected around the peak of interest observed in March 2020, after the beginning of the COVID-19 pandemic. Comparable results were obtained for the term “disinfectant”. These findings show that the influence of annual campaigns on public interest in AMR and preventive measures was modest and not long-term. The COVID-19 pandemic, meanwhile, had no effect on AMR but raised awareness on preventive measures. However, this was a temporary rather than long-term outcome. Thus, different policies, strategies, and measures should be designed to advocate prevention of AMR in the COVID-19 era.

Современные аспекты контроля антибиотикоустойчивости микробных загрязнителей пищи с учетом особенностей оценки связанного с ней риска здоровью. Часть 1

Antimicrobials are widely used in agriculture to prevent and treat diseases and to stimulate growth of food-producing animals. However, this induces developing antimicrobial resistance among animal bacteria, and this resistance is then transmitted along food chains and spreads in the environment. It is commonly accepted at the moment that effective measures should be taken to contain it in food production, to prevent it from spreading on the global scale and to minimize related negative health outcomes. This can be achieved, among other things, due to intensifying inter-branch interactions. This review aimed to consider contemporary aspects in preventing development of antimicrobial resistance in micro-organisms that contaminate raw materials and processed food products; to dwell on how the issue is controlled in food production both in Russia and abroad; to focus on trends and prospects of developing new effective measures in the sphere. The review involved analyzing domestic and foreign regulatory and legal documents concerning prevention of antimicrobial resistance and analysis of related risks; generalizing and analyzing latest scientific research works published in reference databases including Web of Science, Scopus, PubMed, Google scholar. As a result, we described the experience accumulated in organizing monitoring over prevalence of antimicrobial resistance in foreign countries, to generalize international recommendations as well as regional and national ones on monitoring over microorganisms that are resistant to antimicrobials, and to highlight practical activities aimed at preventing occurrence and spread of antimicrobial resistance in food production. We substantiated certain peculiarities of related health risk assessment, namely, occurrence of genetic determinants of antimicrobial resistance and antibiotic residues in food together with resistant microorganisms. We also formulated basic principles of organizing and conducting monitoring over antimicrobial resistance in food chains (with the focus on antimicrobial medications that are crucially important in medicine). These principles can be applied in the Russian Federation within programs aimed at preventing antimicrobial resistance.

Contemporary aspects in control over resistant to antibiotics microbial contaminants of food, taking into account peculiarities of related health risk assessment. Part 1

Antimicrobials are widely used in agriculture to prevent and treat diseases and to stimulate growth of food-producing animals. However, this induces developing antimicrobial resistance among animal bacteria, and this resistance is then transmitted along food chains and spreads in the environment. It is commonly accepted at the moment that effective measures should be taken to contain it in food production, to prevent it from spreading on the global scale and to minimize related negative health outcomes. This can be achieved, among other things, due to intensifying inter-branch interactions. This review aimed to consider contemporary aspects in preventing development of antimicrobial resistance in micro-organisms that contaminate raw materials and processed food products; to dwell on how the issue is controlled in food production both in Russia and abroad; to focus on trends and prospects of developing new effective measures in the sphere. The review involved analyzing domestic and foreign regulatory and legal documents concerning prevention of antimicrobial resistance and analysis of related risks; generalizing and analyzing latest scientific research works published in reference databases including Web of Science, Scopus, PubMed, Google scholar. As a result, we described the experience accumulated in organizing monitoring over prevalence of antimicrobial resistance in foreign countries, to generalize international recommendations as well as regional and national ones on monitoring over microorganisms that are resistant to antimicrobials, and to highlight practical activities aimed at preventing occurrence and spread of antimicrobial resistance in food production. We substantiated certain peculiarities of related health risk assessment, namely, occurrence of genetic determinants of antimicrobial resistance and antibiotic residues in food together with resistant microorganisms. We also formulated basic principles of organizing and conducting monitoring over antimicrobial resistance in food chains (with the focus on antimicrobial medications that are crucially important in medicine). These principles can be applied in the Russian Federation within programs aimed at preventing antimicrobial resistance.

Carbapenem-resistant Enterobacteriaceae in sink drains of 40 healthcare facilities in Sindh, Pakistan: A cross-sectional study

In Pakistan, antimicrobial resistance (AMR) is expected to greatly increase the already high mortality and morbidity rates attributed to infections, making AMR surveillance and prevention a priority in the country. The aims of the project were to characterize the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in healthcare facility sink drains in Pakistan and to characterize how physical characteristics of sinks and healthcare facility rooms were associated with CRE in those sinks. The study took place in 40 healthcare facilities in Jamshoro Pakistan. Swabs were collected from sink drains in each facility that had a sink, and structured observations of sinks and facilities were performed at each facility. Swabs were plated on CHROMagar KPC to screen for carbapenem-resistant Enterobacteriaceae, which were then isolated on Mueller-Hinton agar plates. Antibiotic susceptibility was determined using the disk diffusion method to assess resistance to carbapenems, cephalosporins, and fluoroquinolones. Thirty-seven of the healthcare facilities had at least one sink, and thirty-nine total sinks were present and sampled from those healthcare facilities. Sinks in these facilities varied in quality; at the time of sampling 68% had water available, 51% had soap/alcohol cleanser at the sink, 28% appeared clean, and 64% drained completely. Twenty-five (64%) of the sink samples grew Enterobacteriaceae on CHROMagar KPC, sixteen (41%) of which were clinically non-susceptible to ertapenem. Seven of the 39 sampled sinks (18%) produced Enterobacteriaceae that were resistant to all three antibiotic classes tested. Several facilities and sink characteristics were associated with CRE. Sinks and drains can serve as undetected reservoirs for carbapenem-resistant Enterobacteriaceae. Control and remediation of such environments will require both systemic strategies and physical improvements to clinical environments.

Policy and strategies addressing prevention and control of antimicrobial resistance in Brazil: A scoping review protocol.

IntroductionAntimicrobial resistance (AMR) is considered one of the biggest health challenges of the 21st century. It has both social and economic consequences; therefore, timely review of public health policies that have been designed to manage AMR is essential. Brazil too has developed and implemented various polices for the prevention and control of AMR. However, till date, no study provides insights regarding the various public health policies or other programs implemented by Brazilian institutes.ObjectiveThe objective is to define a scoping review protocol of policies that were developed to address prevention and control of antimicrobial resistance in Brazil, from a human health perspective.MethodThis protocol has been registered in the Open Science Framework (DOI 10.17605/OSF.IO/EC9ZJ). Indexed literature in English, Spanish and Portuguese published till December 2020 in Lilacs, PubMed, Embase, and official websites of the Brazilian government will be reviewed. This review considers all studies identified through a comprehensive search of peer-reviewed and grey literature databases that have a reference for policies made for managing AMR in Brazil. The criteria for the scoping review will be set by two evaluators. A third evaluator will be consulted, if there is any disagreement between the two primary evaluators. A standardized form will be used for data extraction from the selected studies. The results will be presented in a tabular form with narrative abstracts related to the topics identified through the scoping review protocol. The PRISMA extension for Scoping Reviews tool will be used.

Antimicrobial Resistance and Environmental Health: A Water Stewardship Framework for Global and National Action.

Antimicrobial resistance (AMR) is a global health crisis that affects all life on Earth. In 2015, the World Health Organization developed guidance to combat AMR in accordance with a One Health framework considering human, animal, and environment sectors of planetary health. This study reviewed global guidance and 25 National Action Plans to evaluate thematic priorities in One Health AMR approaches using a novel framework that additionally facilitated the identification of water-related stewardship gaps, as water resources are recognized as the primary environmental AMR reservoir and dissemination pathway. This review found that global and national stewardship primarily focuses on mitigating antibiotic use in the human and animal sectors, overlooking environmental drivers, particularly diverse environmental waters. The findings of this study highlight the need to broaden the scope of water-related AMR concerns beyond water, sanitation, and hygiene (WASH) infrastructure for water supply and wastewater treatment, and account for environmental waters in AMR development and dissemination, particularly in low-income countries where half a billion people rely on environmental waters to meet daily needs. Equitably accounting for water environments, supplies, and waste in AMR prevention, mitigation, surveillance, and innovation can significantly enhance the integration of environmental objectives in One Health AMR stewardship.

Antimicrobial tolerance and its role in the development of resistance: Lessons from enterococci.

Bacteria have developed resistance against every antimicrobial in clinical use at an alarming rate. There is a critical need for more effective use of antimicrobials to both extend their shelf life and prevent resistance from arising. Significantly, antimicrobial tolerance, i.e., the ability to survive but not proliferate during antimicrobial exposure, has been shown to precede the development of bona fide antimicrobial resistance (AMR), sparking a renewed and rapidly increasing interest in this field. As a consequence, problematic infections for the first time are now being investigated for antimicrobial tolerance, with increasing reports demonstrating in-host evolution of antimicrobial tolerance. Tolerance has been identified in a wide array of bacterial species to all bactericidal antimicrobials. Of particular interest are enterococci, which contain the opportunistic bacterial pathogens Enterococcus faecalis and Enterococcus faecium. Enterococci are one of the leading causes of hospital-acquired infection and possess intrinsic tolerance to a number of antimicrobial classes. Persistence of these infections in the clinic is of growing concern, particularly for the immunocompromised. Here, we review current known mechanisms of antimicrobial tolerance, and include an in-depth analysis of those identified in enterococci with implications for both the development and prevention of AMR.

Bring it on: Top five antimicrobial stewardship challenges in transplant infectious diseases and practical strategies to address them.

Antimicrobial therapies are essential tools for transplant recipients who are at high risk for infectious complications. However, judicious use of antimicrobials is critical to preventing the development of antimicrobial resistance. Treatment of multidrug-resistant organisms is challenging and potentially leads to therapies with higher toxicities, intravenous access, and intensive drug monitoring for interactions. Antimicrobial stewardship programs are crucial in the prevention of antimicrobial resistance, though balancing these strategies with the need for early and frequent antibiotic therapy in these immunocompromised patients can be challenging. In this review, we summarize 5 frequently encountered transplant infectious disease stewardship challenges, and we suggest strategies to improve practices for each clinical syndrome. These 5 challenging areas are: asymptomatic bacteriuria in kidney transplant recipients, febrile neutropenia in hematopoietic stem cell transplantation, antifungal prophylaxis in liver and lung transplantation, treatment of left-ventricular assist device infections, and Clostridioides difficile infection in solid-organ and hematopoietic stem-cell transplant recipients. Common themes contributing to these challenges include limited data specific to transplant patients, shortcomings in diagnostic testing, and uncertainties in pharmacotherapy.