Field Of Antimicrobial Resistance Research Articles

Fosfomycin in the treatment of New Delhi Metallo-β-Lactamase-5 (blaNDM-5)-producing Escherichia coli infection

The worldwide spread of Gram-negative bacteria showing pan-drug resistance raises significant concerns. The World Health Organization (WHO) designated carbapenem-resistant Enterobacteriaceae (CRE) as a critical priority on the global pathogen list in 2017. This issue has captured increased attention to research in the field of antimicrobial resistance, specifically concentrating on the discovery of novel antibiotics. The primary mechanism of carbapenem resistance revolves around the production of acquired carbapenemase, including class A Klebsiella pneumoniae carbapenem-resistant (KPC), class B New Delhi Metallo-β-Lactamase (NDM), or class D, such as OXA-48 β-lactamases. These carbapenemases are especially prevalent in Enterobacterales. Given that these various resistance mechanisms are frequently widespread, the available therapeutic options can be severely restricted. The high susceptibility rates to fosfomycin in strains with acquired resistance to carbapenems indicate the potential effectiveness of fosfomycin against such strains. The present study aimed to determine the in-vitro activity of aztreonam, aztreonam-avibactam, and fosfomycin against 64 E. coli isolates exhibiting diverse blaNDM genes. From the data obtained, it can be inferred that resistance to aztreonam is 70% and drops with the combined use of avibactam. However, this combination cannot be used in the treatment of patients with diseases triggered by E. coli that produce blaNDM-5 . Meanwhile, all strains tested were susceptible to fosfomycin. Therefore, a remedy for elevated minimal inhibitor concentration of aztreonam, aztreonam-avibactam among blaNDM-5 -producing E. coli may be fosfomycin.

A bibliometric analysis of One Health approach in research on antimicrobial resistance

BackgroundAntimicrobial resistance (AMR) is a global public health threat that requires actions through One Health intervention. This study aims to trace the historical development of One Health research on AMR to provide evidence supporting future research and actions. MethodsA bibliometric analysis is conducted with One Health articles in the field of antimicrobial resistance (AMR-OH articles) retrieved from the Web of Science Core Collection (WoSCC). AMR-OH articles refer to articles in the field of AMR that simultaneously involve elements from human health and at least one other domain, including animals, environment, or plants. Three research periods were identified based on the development of global actions in combating AMR. Descriptive analysis of publications, keyword cluster analysis, annual trending topic analysis, and co-authorship analysis were conducted using R software, VOSViewer, and Pajek. ResultsThe results indicated that the percentage of AMR-OH articles among all AMR articles increased from 5.21% in 1990 to 20.01% in 2023. Key topics in the current AMR-OH articles included the mechanism of AMR, AMR epidemiology, and public health control strategies. Epidemiological research initially focused on human and animal health and then shifted to environmental factors in the third period. Research at the molecular level focused on the mechanisms of AMR transmission in various domains, along with the dynamics and diversity of antibiotic resistance genes (ARGs). The co-authorship analysis suggested a significant increase in cooperation among low- and middle-income countries in the third period. ConclusionThe scope of epidemiological research on AMR has expanded by including human, animal, and environmental areas. Moreover, genetic and molecular level research represents the forefront of this field, offering innovative tools to combat AMR in the future. This study suggests further research to translate existing findings into practical implementation of the One Health strategy, and to support globally consistent action in combating AMR.

Infectious Diseases Society of America 2023 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections.

The Infectious Diseases Society of America (IDSA) is committed to providing up-to-date guidance on the treatment of antimicrobial-resistant infections. This guidance document focuses on infections caused by extended-spectrum β-lactamase producing Enterobacterales (ESBL-E), AmpC β-lactamase-producing Enterobacterales (AmpC-E), carbapenem-resistant Enterobacterales (CRE), Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa), carbapenem-resistant Acinetobacter baumannii (CRAB), and Stenotrophomonas maltophilia. This updated document replaces previous versions of the guidance document. A panel of six infectious diseases specialists with expertise in managing antimicrobial-resistant infections formulated questions about the treatment of infections caused by ESBL-E, AmpC-E, CRE, DTR-P. aeruginosa, CRAB, and S. maltophilia. Because of differences in the epidemiology of resistance and availability of specific anti-infectives internationally, this document focuses on the treatment of infections in the United States. Preferred and alternative suggested treatment approaches are provided with accompanying rationales, assuming the causative organism has been identified and antibiotic susceptibility results are known. Approaches to empiric treatment, transitioning to oral therapy, duration of therapy, and other management considerations are also discussed briefly. Suggested approaches apply for both adult and pediatric populations, although suggested antibiotic dosages are provided only for adults. The field of antimicrobial resistance is highly dynamic. Consultation with an infectious diseases specialist is recommended for the treatment of antimicrobial resistant infections. This document is current as of December 31, 2022 and will be updated periodically. The most current version of this document, including date of publication, is available at www.idsociety.org/practice-guideline/amr-guidance/.

EDUKASI PENGGUNAAN ANTIBIOTIK PADA SISWA/SISWI SMA NEGERI 1 STM HILIR, JLN. PENDIDIKAN DUSUN I TALUN KENAS, KEC. SINEMBAH TANJUNG MUDA HILIR, KAB. DELI SERDANG, SUMATERA UTARA

Overuse of antibiotics has the potentiall for irrational use. This is one of the factorss that cause resistances. WHO in the field of antimicrobial resistance:According to the Global Surveillance Report, Southeast Asia has the highest level of antimicrobial resistance in the world, especially against methicillin-resistant Staphylococcus aureus (Ministry of Health, 2015). Results of the AMRIN (Antimicrobial Resistance in Indonesia) study conducted from 2000 to 2005 showed that approximately 43% of E. coli are resistant to various types of antibiotics, including:
 ampicillin (34%), co-trimoxazole (29%), chloramphenicol (25%) (Minister of Health of the Republic, 2015). Irrational use is a major factor in high antibiotic resistance rates. Lack off publicc knowledges about antibiotics can affect attitudes and healths behaviorss, including irrationall use of antibiotics. Knowledge plays an important rolee in shaping beliefs and attitudess about certain behaviors, such as behavior when taking antibioticss. Education level is thought to have a significant impact on this behavior (Ivoryanto, 2017). 
 Keywords : antibiotics, resistance, student

Occurrence of Antibiotic Resistance Genes, Antibiotics-Resistant and Multi-Resistant Bacteria and Their Correlations in One River in Central-Western Brazil

(1) Background: The uncontrolled increase in pollutants in the aquatic environment results in antibiotic-resistant bacteria and antibiotic resistance genes (ARBs and ARGs). The overuse and misuse of antibiotics is also a crucial factor for public health. (2) Methods: In this study, the presence of ARBs and the presence of 24 resistance genes from eight different classes of antibiotics were evaluated in addition to performing statistical correlations and intercorrelations. Samples of water and sediment were collected from a river in central-western Brazil, responsible for supplying water to more than 3 million people. Physicochemical analyses were performed on the water samples, as well as methodological approaches based on culture and molecular biology, such as real-time polymerase chain reaction (qPCR). (3) Results: The results of the analysis of apparent color, turbidity, thermotolerant coliforms and E. coli were not in accordance with Brazilian legislation. A total of 203 bacterial strains were isolated, of which 30.54% were from the Entero-bacteriaceae family and 29.06% from the Staphylococcaceae family. For the ARBs found, a higher prevalence of resistance to lyconsamides and β-lactams was detected. Among all isolated strains, a multi-drug resistance profile of 59.37% was found. The presence of ARGs was detected in all water and sediment samples; of the 24 genes searched, the presence of 22 was found, and the sul2 and ermC genes were detected in all samples. According to the statistical analysis, the Meia Ponte River is suffering a great anthropogenic impact, and the current Brazilian legislation is not sufficient to prevent it. This water environment is serving as a reservoir of resistance genes, and measures such as monitoring, depollution, management and preservation must be taken, so that the population does not suffer great damage. (4) Conclusions: This is the first study in the State of Goiás, Brazil, to indicate the existence of ARGs in samples of raw water and river sediments, supporting the worldwide investigation of ARBs and ARGs in a water environment. In addition, few studies address the correlations between the ARBs and ARGs groups, which is an important factor in the field of antimicrobial resistance.

Antimicrobial peptides against polymyxin-resistant Klebsiella pneumoniae: a patent review

The spread of polymyxin-resistant Klebsiella pneumoniae strains represents an emerging health challenge, limiting treatment options for the patients. Thus, the development of new antimicrobials is an urgent requirement. Antimicrobial peptides (AMPs) are a large class of compounds that are part of innate immune response; these peptides are promising compounds in the field of antimicrobial resistance and are present in all organisms. The present review evaluated patents on antimicrobial peptides tested against polymyxin-resistant K. pneumoniae, available on Espacenet as of September 2022. A total of 1313 patents were examined and 1197 excluded as they were out of focus for this review; 104 patents of peptides tested against K. pneumoniae were included; of which only 14 were tested against polymyxin-resistant K. pneumoniae strains. The results indicated that all AMPs evaluated were in the experimental or pre-clinical phase; the clinical phase is pending. Furthermore, a few peptides were tested effectively against polymyxin-resistant K. pneumoniae. Although, the research and patent filing alone are not enough to develop a suitable antimicrobial therapy, they can represent good starting point upon which to develop new antimicrobials. More investment is required to push these pharmaceuticals through the stages of development to introduce them into the market.

Carriers and Antigens: New Developments in Glycoconjugate Vaccines.

Glycoconjugate vaccines have proven their worth in the protection and prevention of infectious diseases. The introduction of the Haemophilus influenzae type b vaccine is the prime example, followed by other glycoconjugate vaccines. Glycoconjugate vaccines consist of two components: the carrier protein and the carbohydrate antigen. Current carrier proteins are tetanus toxoid, diphtheria toxoid, CRM197, Haemophilus protein D and the outer membrane protein complex of serogroup B meningococcus. Carbohydrate antigens have been produced mainly by extraction and purification from the original host. However, current efforts show great advances in the development of synthetically produced oligosaccharides and bioconjugation. This review evaluates the advances of glycoconjugate vaccines in the last five years. We focus on developments regarding both new carriers and antigens. Innovative developments regarding carriers are outer membrane vesicles, glycoengineered proteins, new carrier proteins, virus-like particles, protein nanocages and peptides. With regard to conjugated antigens, we describe recent developments in the field of antimicrobial resistance (AMR) and ESKAPE pathogens.

Germany's Burden of Disease of Bloodstream Infections Due to Vancomycin-Resistant Enterococcus faecium between 2015-2020.

In Germany, there is an increasing amount of vancomycin-resistant Enterococcus faecium (VREfm) isolates in bloodstream infections (BSIs); however, estimates on recent incidences and disease burden are missing. We aim to estimate the incidence and calculate the annual disease burden in disease-adjusted life years (DALYs) for BSIs due to VREfm in Germany between 2015 and 2020 to support informed decision-making in the field of antimicrobial resistance (AMR). We used the Antibiotic Resistance Surveillance (ARS) system data to obtain incidence estimates. The estimated incidences were used in the Burden of Communicable Disease in Europe (BCoDE) toolkit to calculate the attributable DALYs. A total of 3417 VREfm blood culture-positive isolates were observed within ARS. The estimated incidence of VREfm-BSIs per 100,000 inhabitants increased from 1.4 (95% Uncertainty Interval [UI]: 0.8-1.9) in 2015 to 2.9 (95% UI: 2.4-3.3) in 2020. The estimated burden, expressed in DALYs per 100,000 inhabitants, increased from 8.5 (95% UI: 7.3-9.7; YLD = 0.9, YLL = 7.6) in 2015 to 15.6 (95% UI: 14.6-16.6; YLD = 1.6, YLL = 14) in 2020. The most affected groups within the observed period are the 65-69-year-old males with 262.9 DALYs per 100,000 inhabitants, and in the younger age groups (<30 years), the under-one-year-old with 43.1 DALYs per 100,000 inhabitants and 34.5 DALYs for male and female, respectively. The increasing DALYs of BSIs due to VREfm require targeted prevention and control measures to address their unequal distribution across gender and age, especially for older hospitalized patients, neonates, and infants in Germany.

Infectious Diseases Society of America Guidance on the Treatment of AmpC β-Lactamase-Producing Enterobacterales, Carbapenem-Resistant Acinetobacter baumannii, and Stenotrophomonas maltophilia Infections.

The Infectious Diseases Society of America (IDSA) is committed to providing up-to-date guidance on the treatment of antimicrobial-resistant infections. A previous guidance document focused on infections caused by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa). Here, guidance is provided for treating AmpC β-lactamase-producing Enterobacterales (AmpC-E), carbapenem-resistant Acinetobacter baumannii (CRAB), and Stenotrophomonas maltophilia infections. A panel of 6 infectious diseases specialists with expertise in managing antimicrobial-resistant infections formulated questions about the treatment of AmpC-E, CRAB, and S. maltophilia infections. Answers are presented as suggested approaches and corresponding rationales. In contrast to guidance in the previous document, published data on the optimal treatment of AmpC-E, CRAB, and S. maltophilia infections are limited. As such, guidance in this document is provided as "suggested approaches" based on clinical experience, expert opinion, and a review of the available literature. Because of differences in the epidemiology of resistance and availability of specific anti-infectives internationally, this document focuses on the treatment of infections in the United States. Preferred and alternative treatment suggestions are provided, assuming the causative organism has been identified and antibiotic susceptibility results are known. Approaches to empiric treatment, duration of therapy, and other management considerations are also discussed briefly. Suggestions apply for both adult and pediatric populations. The field of antimicrobial resistance is highly dynamic. Consultation with an infectious diseases specialist is recommended for the treatment of antimicrobial-resistant infections. This document is current as of 17 September 2021 and will be updated annually. The most current version of this document, including date of publication, is available at www.idsociety.org/practice-guideline/amr-guidance-2.0/.

Infectious Diseases Society of America Guidance on the Treatment of Extended-Spectrum β-lactamase Producing Enterobacterales (ESBL-E), Carbapenem-Resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with Difficult-to-Treat Resistance (DTR-P. aeruginosa).

Antimicrobial-resistant infections are commonly encountered in US hospitals and result in significant morbidity and mortality. This guidance document provides recommendations for the treatment of infections caused by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa). A panel of 6 infectious diseases specialists with expertise in managing antimicrobial-resistant infections formulated common questions regarding the treatment of ESBL-E, CRE, and DTR-P. aeruginosa infections. Based on review of the published literature and clinical experience, the panel provide recommendations and associated rationale for each recommendation. Because of significant differences in the molecular epidemiology of resistance and the availability of specific anti-infective agents globally, this document focuses on treatment of antimicrobial-resistant infections in the United States. Approaches to empiric treatment selection, duration of therapy, and other management considerations are briefly discussed. The majority of guidance focuses on preferred and alternative treatment recommendations for antimicrobial-resistant infections, assuming that the causative organism has been identified and antibiotic susceptibility testing results are known. Treatment recommendations apply to both adults and children. The field of antimicrobial resistance is dynamic and rapidly evolving, and the treatment of antimicrobial-resistant infections will continue to challenge clinicians. This guidance document is current as of 17 September 2020. Updates to this guidance document will occur periodically as new data emerge. Furthermore, the panel will expand recommendations to include other problematic gram-negative pathogens in future versions. The most current version of the guidance including the date of publication can be found at www.idsociety.org/practice-guideline/amr-guidance/.

Genomic and Phenotypic Analysis of Multidrug-Resistant Acinetobacter baumannii Clinical Isolates Carrying Different Types of CRISPR/Cas Systems.

Acinetobacter baumannii is an opportunistic pathogen being one of the most important causative agents of a wide range of nosocomial infections associated with multidrug resistance and high mortality rate. This study presents a multiparametric and correlation analyses of clinical multidrug-resistant A. baumannii isolates using short- and long-read whole-genome sequencing, which allowed us to reveal specific characteristics of the isolates with different CRISPR/Cas systems. We also compared antibiotic resistance and virulence gene acquisition for the groups of the isolates having functional CRISPR/Cas systems, just CRISPR arrays without cas genes, and without detectable CRISPR spacers. The data include three schemes of molecular typing, phenotypic and genotypic antibiotic resistance determination, as well as phylogenetic analysis of full-length cas gene sequences, predicted prophage sequences and CRISPR array type determination. For the first time the differences between the isolates carrying Type I-F1 and Type I-F2 CRISPR/Cas systems were investigated. A. baumannii isolates with Type I-F1 system were shown to have smaller number of reliably detected CRISPR arrays, and thus they could more easily adapt to environmental conditions through acquisition of antibiotic resistance genes, while Type I-F2 A. baumannii might have stronger “immunity” and use CRISPR/Cas system to block the dissemination of these genes. In addition, virulence factors abaI, abaR, bap and bauA were overrepresented in A. baumannii isolates lacking CRISPR/Cas system. This indicates the role of CRISPR/Cas in fighting against phage infections and preventing horizontal gene transfer. We believe that the data presented will contribute to further investigations in the field of antimicrobial resistance and CRISPR/Cas studies.

Antimicrobial resistance \u2013 moving forward?

BackgroundWhen microorganisms (such as bacteria or viruses) are highly exposed to antimicrobial drugs, they can develop the capacity to defeat the drugs designed to eradicate them. Long-term accumulation of adaptations to survive drug exposure can lead to the development of antimicrobial resistance (AMR). The success of antibiotics has led to their widespread overuse and misuse in humans, animals and plants.Main textAMR is a global concern and solutions are not vertical actions in a single buy business model.Even if a transectoral approach is key, there is a lack of multi-disciplinary partnerships that allow for strategic cooperation between different sectors such as the pharmaceutical industry, agro-alimentary complex, patient care and education, NGOs and research and development. Global public health voices should lead this integration to align the progress of existing AMR successes. Maintaining the public’s trust in preventive medicine, health systems and food production safety, together with public health driven, non-profit drug development, is a key factor. In its “Call for integrated action on AMR”, signed by about 70 national and international organizations the World Federation of Public Health Associations (WFPHA) called “on all governments, the private sector, non-governmental organizations, health professionals, public and private research organizations, and all stakeholders to ensure that public health remains at the centre of all policy and scientific endeavours in the field of antimicrobial resistance”.ConclusionsThe “Global Charter for the Public’s Health”, developed by the WFPHA in association with WHO, is proposed in this article as a tool for implementation of complex public health actions such as AMR.

Contributions and Challenges of High Throughput qPCR for Determining Antimicrobial Resistance in the Environment: A Critical Review.

Expansion in whole genome sequencing and subsequent increase in antibiotic resistance targets have paved the way of high throughput qPCR (HT-qPCR) for analyzing hundreds of antimicrobial resistance genes (ARGs) in a single run. A meta-analysis of 51 selected studies is performed to evaluate ARGs abundance trends over the last 7 years. WaferGenTM SmartChip is found to be the most widely used HT-qPCR platform among others for evaluating ARGs. Up till now around 1000 environmental samples (excluding biological replicates) from different parts of the world have been analyzed on HT-qPCR. Calculated detection frequency and normalized ARGs abundance (ARGs/16S rRNA gene) reported in gut microbiome studies have shown a trend of low ARGs as compared to other environmental matrices. Disparities in the HT-qPCR data analysis which are causing difficulties to researchers in precise interpretation of results have been highlighted and a possible way forward for resolving them is also suggested. The potential of other amplification technologies and point of care or field deployable devices for analyzing ARGs have also been discussed in the review. Our review has focused on updated information regarding the role, current status and future perspectives of HT-qPCR in the field of antimicrobial resistance.

Systematic review of the use of time series data in the study of antimicrobial consumption and Pseudomonas aeruginosa resistance.

In the field of antimicrobial resistance, the number of studies using time series data (TSD) has increased recently. The purpose of this study was to systematically review all studies on antimicrobial consumption and Pseudomonas aeruginosa antimicrobial resistance in healthcare settings that have used TSD. A systematic review of the literature up to June 2017 was conducted. All studies that have used TSD and have examined in-hospital antimicrobial consumption and P. aeruginosa resistance rates or incidence were eligible for inclusion; no other exclusion criteria were applied. Data on the structure, terminology used, methods and results for each article were recorded and analysed where possible. A total of 36 studies were retrieved from PubMed, of which 23 were in accordance with the inclusion criteria. Thirteen studies were quasi-experimental studies and ten were ecological observational studies. Twenty studies collected TSD for both parameters, and the statistical methodology time series analysis was applied in nine studies. Most of the studies were published in the last 8 years. The interrupted time series design was the most widespread. As expected, there was high heterogeneity with regard to study design, terminology and statistical methods applied.

Bayesian estimation of multivariate normal mixtures with covariate-dependent mixing weights, with an application in antimicrobial resistance monitoring.

Bacteria with a reduced susceptibility against antimicrobials pose a major threat to public health. Therefore, large programs have been set up to collect minimum inhibition concentration (MIC) values. These values can be used to monitor the distribution of the nonsusceptible isolates in the general population. Data are collected within several countries and over a number of years. In addition, the sampled bacterial isolates were not tested for susceptibility against one antimicrobial, but rather against an entire range of substances. Interest is therefore in the analysis of the joint distribution of MIC data on two or more antimicrobials, while accounting for a possible effect of covariates. In this regard, we present a Bayesian semiparametric density estimation routine, based on multivariate Gaussian mixtures. The mixing weights are allowed to depend on certain covariates, thereby allowing the user to detect certain changes over, for example, time. The new approach was applied to data collected in Europe in 2010, 2012, and 2013. We investigated the susceptibility of Escherichia coli isolates against ampicillin and trimethoprim, where we found that there seems to be a significant increase in the proportion of nonsusceptible isolates. In addition, a simulation study was carried out, showing the promising behavior of the proposed method in the field of antimicrobial resistance.

A new semi-parametric mixture model for interval censored data, with applications in the field of antimicrobial resistance

Antimicrobial resistance has become one of the main public health burdens of the last decades, and monitoring the development and spread of non-wild-type isolates has therefore gained increased interest. Monitoring is performed, based on the minimum inhibitory concentration (MIC) values, which are collected through the application of dilution experiments. For a given antimicrobial, it is common practice to dichotomize the obtained MIC distribution according to a cut-off value, in order to distinguish between susceptible wild-type isolates and non-wild-type isolates exhibiting reduced susceptibility to the substance. However, this approach hampers the ability to further study the characteristics of the non-wild type component of the distribution as information on the MIC distribution above the cut-off value is lost. As an alternative, a semi-parametric mixture model is presented, which is able to estimate the full continuous MIC distribution, thereby taking all available information into account. The model is based on an extended and censored-adjusted version of the penalized mixture approach often used in density estimation. A simulation study was carried out, indicating a promising behaviour of the new semi-parametric mixture model in the field of antimicrobial susceptibility testing.

Surfing The Web: World Wide Web Resources on Antimicrobial Resistance

Advances of modern technology, including the development of the Internet and the World Wide Web, have given clinicians and researches the opportunity to have immediate access to continuously updated information in various scientific fields. We compiled a list of World Wide Web resources of data from surveillance studies on antimicrobial resistance that may be useful to practitioners--especially infectious diseases specialists--as well as to scientists with a research interest in the field of antimicrobial resistance.

Revenge of the Microbes: How Bacterial Resistance is Undermining the Antibiotic Miracle

Professional journals days brim with new developments in field of antimicrobial resistance, and scarcely a week goes by without a flurry of new reports on super bugs in popular media. Given unrelenting blitz of information, that 2 self-proclaimed fusty old pedants could produce a fresh perspective in ongoing arms race between man and microbe is all more noteworthy. Although their traditional milieu is microbiology textbooks, Salyers and Whitt have provided a concise yet readable history of rise of resistant organisms, as well as social and economic effect of these indomitable little critters. The history, from first hints of penicillin resistance to recent rise of vancomycin resistance, is as insightful as it is entertaining. Lay readers will get a digestible dose of basic science often missing from mass media. And professionals will find kind of incisive analysis—and even a touch of humor—that is often missing from scientific journals. Both audiences will find eminently compact descriptions of major mechanisms that enable bacteria to develop and pass on resistant traits, hurdles that pharmaceutical companies face in developing new antimicrobial drugs, dilemmas doctors and patients face in finding better ways to use drugs, and a thoughtful appraisal of possible trends. In contrast to prophecies of an approaching post-antibiotic era, authors' own realistic vision of future is far from apocalyptic. Still, they worry that increasing numbers of treatment failures like those occurring in hospitals and community settings will erode confidence in healthcare system. Some diseases, they believe, will remain treatable, some new drugs will emerge, and bacteria, with 3 billion years of evolution on their side, will continue to adapt. So perhaps, they suggest, the best we can hope for is detente, a running standoff between science and bugs' remarkable ability to adapt to their changing environment.

Role of the microbiology laboratory in infectious disease surveillance, alert and response

Surveillance is usually defined as the ongoing and systematic collection, analysis and interpretation of health data essential to the planning, implementation and evaluation of public health practice. During recent years, most of these programmes have been developed in the field of antimicrobial resistance and nosocomial infections, but efforts have also been made in other areas. Recent experiences of emerging microbial threats, including severe acute respiratory syndrome and new influenza variants affecting humans, the re-emergence of infectious disease problems and the possibility of bioterrorism have evidenced the need for implementation of infectious disease surveillance programmes. Clinical microbiology laboratories play a pivotal role in these programmes. They have the first opportunity to detect these problems and should participate in the design of reporting strategies and dissemination of this information. Policies for the flow of data to national and international authorities should be established using passive surveillance strategies. However, active surveillance programmes taking advantage of new methodologies, including virtual tools and mathematical programs, should be the goal for early detection of unusual patterns of microbial pathogens, outbreaks and healthcare-associated infections. In addition, early implementation of response strategies should be designed and performed with the cooperation of microbiology laboratories, and intervention and response protocols should be defined with the participation of clinical microbiologists.

Quinolone Antimicrobial Agents, 3rd Edition

The quinolone class is one of the more important classes of antimicrobial agents discovered in recent years and one of the most widely used classes of antimicrobial drugs in clinical medicine. Their broad spectrum of activity and pharmacokinetic properties make the quinolone agents ideal for treating a variety of infections. Their clinical importance is further demonstrated by their activity against a wide range of diseases of public health importance such as anthrax, tuberculosis, bacterial pneumonia, and sexually transmitted diseases. Recent research has provided new data on the agent's structure-function relationships, modes of action, resistance, pharmacokinetics, and drug interactions. The third edition of Quinolone Antimicrobial Agents nicely addresses these advances. The book is organized into four sections, each containing chapters written by leading experts. Mechanisms and Spectrum of Activity and Resistance, the first major section, explores the basic biology of the quinolone class. The interrelationships between structure, antimicrobial activity, and side effects associated with various side chain positions of the quinolones are discussed here. Pertinent information on the bacterial topoisomerases and DNA gyrases, quinolone binding, DNA/RNA synthesis inhibition, cell death in the absence of protein synthesis, specific mutations within the quinolone resistance–determining region, and mutations that lead to altered access to target enzymes (efflux systems) is also highlighted. In the next section, Pharmacology, the intricate field of quinolone pharmacokinetics (PK) and pharmacodynamics (PD) is evaluated. Information regarding absorption, distribution, metabolism, and excretion in a range of patient types is provided, followed by data gathered from pharmacokinetic/pharmacodynamic studies in a variety of models. This section also provides a review of the role of pharmacologic evaluation in optimizing therapy. The last two sections of the book, Clinical Applications and Adverse and Other Effects, will be of particular interest to clinicians. The chapters in this section include a comprehensive reference on general considerations, antimicrobial aspects, treatment models, clinical and comparative studies, and suggested treatment regimens for a host of infections. The chapter on adverse effects has been greatly expanded from the second edition because a substantial body of new information has since been gathered. Topics covered here include allergic reactions, effects on connective tissue structures and pregnancy, phototoxicity, and central nervous system and immune system toxicity. The organization and content of this text make it a superlative reference. The discussions on treatments and adverse effects contain some of the most current data available. The field of antimicrobial resistance, however, is one of the most rapidly evolving areas with constant discoveries of new cases and data. Users should understand that while this text serves as a valuable reference, other sources should be consulted to ensure that the most comprehensive data are obtained. The references provided throughout, however, give the reader starting points to other literature.