Global Antimicrobial Surveillance System Research Articles

Antibiotic resistance in wastewater: Indian scenario

The surge of Antibiotic Resistant Bacteria (ARB) in the environment is poised to be the next health threat. World Health Organisation's (WHO's) Global Antimicrobial Surveillance System (GLASS) report indicates that developing countries may be at a greater risk. Among various factors, the major driver here could be untreated wastewater and poor sanitation. Bacteria are extremely adaptable to their surroundings and develop Antimicrobial Resistance (AMR) when exposed to antibiotics and other pollutants that cause microbial stress. Thus, untreated domestic wastewater drains could easily become hotspots for the occurrence of ARBs. This study reports surveillance of sewage-carrying drains across four urban cities in India and demonstrated the presence of ARBs in the bacterial community against 7 classes of antibiotics, namely, β-Lactams, Chloramphenicol, Glycopeptides, Macrolides, Tetracycline, Third Generation Cephalosporin, and Quinolones. Untreated domestic wastewater flowing in target drains was collected twice a month, for a period of six months and the microbial community was subjected to Antibiotic Susceptibility Testing (AST) by plate assays. The zone of inhibition was recorded and interpreted as per the interpretive chart of The Clinical & Laboratory Standards Institute (CLSI) & The European Committee on Antimicrobial Susceptibility Testing (EUCAST). The total number of samples showing resistance against antibiotics was used to define an Antibiotic Resistance Index (ARI), calculated for all 20 sampling sites (drains). Results demonstrated that the highest ARI was observed in Delhi and Mumbai, ranging from 0.81 to 0.92 in Delhi and 0.49–0.56 in Mumbai. This surveillance study reveals the antibiotic resistance pattern of the representative bacterial community in the drains and goes beyond few targeted bacterial species. The alarming presence of antibiotic resistant bacterial community highlights the concern of ARBs being the next looming health threat. This report aims to demonstrates the importance of considering sewage surveillance on routine basis by state authorities.

Antimicrobial activity of homoeopathic remedies: Case series

In this century, one of the major public health problems is Antimicrobial resistance (AMR). It threatens the effective treatment and prevention of an ever-increasing range of infections caused by bacteria, viruses, parasites, and fungi which are no longer susceptible to the common medicines used to treat them so it leads to prolonged hospital stays, high medical costs, and increased mortality rate. In recent years the issue has become even graver. World Health Organization launched the Global Antimicrobial Surveillance System (GLASS), bears witness to the growing emergence of antibiotic-resistant microorganisms. This article is about evidence based case studies in such antibiotic resistant cases which given fruitful results with Homeopathy.

Systematic Review on the Antibacterial Resistance of Vibrio Cholerae

Background: Vibrio cholerae is the causative agent of cholera illness. Antibacterial resistance of V. cholerae is frequently experienced due to the environmental pressure from human and animal overuse and misuse of antibacterials. Among such antibacterials include Tetracycline, Chloramphenicol, Furazolidone, Ampicillin, and Trimethoprim-Cotrimoxazole as used against V. cholerae O1, O139 and non O1, O139 strains. Objectives: This systematic review was aimed at providing an overview of Antibacterial resistant strains of Vibrio cholerae in terms of year, location and factors responsible for the resistance. Material and Method: Systematic Electronic database search of PubMed (NCBI) by means of the key terms MeSH “Antimicrobial resistance of Vibrio cholerae” between the period of January 2000 to October 2018 was used. Results: From the findings it showed that many factors are responsible for Antibacterial resistance of Vibrio cholerae which include genetic composition, mutation, enzymes. Also V. cholerae, both O1, O139, environmental and non O1/ non O139 such as V. anginiloticus, paraheamolytcus were incriminated in transferring resistance genes from one another. Antimimicrobial Susceptibility Testing phenotypic and Polymerase Chain Reaction (PCR) molecular procedure were employed in detecting the resistance and equally the use of Global Antimicrobial Surveillance System (GLASS) and Centre for Disease control (CDC) AR threat report 2019 was used successfully in the management of Vibrio cholerae epidemic. Conclusions: Drug-resistant Vibrio cholarae is a problem that needs to be dealt with as soon as possible

Current status of multidrug-resistant bacteria

Background: The dissemination of multidrug-resistant (MDR) pathogen is of major public health concern as it leads to increased mortality rate, length of hospital stays, and medical expenses.Current Concepts: Korean Government enacted an Infectious Disease Control and Prevention Act in 2009, and 6 MDR bacteria including methicillin-resistant Staphylococcus aureus, vancomycin-resistant S. aureus (VRSA), vancomycin-resistant enterococci, multidrug-resistant Pseudomonas aeruginosa, multidrug-resistant Acinetobacter baumannii, and carbapenem-resistant Enterobacterales (CRE) have been legally declared as infectious diseases. According to the amendment of the Infectious Disease Control and Prevention Act in 2020, CRE and VRSA were classified as class 2 infectious diseases, and all cases of CRE and VRSA should be reported to the Korea Disease Control and Prevention Agency (KDCA). Methicillin-resistant S. aureus, vancomycin-resistant enterococci, multidrug-resistant P. aeruginosa, and multidrug-resistant A. baumannii were classified as class 4 infectious diseases, and cases that occur need to be monitored at KDCA-designated sentinel hospitals to prevent further dissemination.Discussion and Conclusion: In this review, the current antimicrobial resistance status of six types of MDR bacteria, legally declared as infectious diseases, was investigated.. The Korean government is operating national antimicrobial resistance surveillance systems such as the Korean Antimicrobial Resistance Monitoring System and Korean Global Antimicrobial Surveillance System, as a foundation for preventing the spread of antimicrobial resistance. Certain steps need to be taken, such as establishing a surveillance system for antimicrobial usages, strengthening antimicrobial stewardship and infection control systems, and developing new antimicrobials in order for us to achieve the national goal.

Extending political will into action in African LMICs: abating global antimicrobial resistance

Extending political will into action in African LMICs: abating global antimicrobial resistance

Antimicrobial resistance among GLASS priority pathogens from Pakistan: 2006\u20132018

BackgroundIn 2018 Pakistan initiated its national antimicrobial resistance (AMR) surveillance aligned with Global Antimicrobial Surveillance System (GLASS). To complement this surveillance, we conducted a situational analysis of AMR rates among GLASS organisms in the country. Data from published studies and from antibiograms was compared and role of antibiograms as potential contributors to national AMR surveillance explored.MethodsAMR rates for GLASS specified pathogen/antimicrobials combination from Pakistan were reviewed. Data sources included published studies (2006–2018) providing AMR rates from Pakistan (n = 54) as well as antibiograms (2011–2018) available on the Pakistan Antimicrobial Resistance Network (PARN) website. Resistance rates were categorized as follows: Very low: 0–10%, Low: 11–30%, Moderate: 30–50% and High: > 50%.ResultsPublished data from hospital and community/laboratory-based studies report resistance rates of > 50% and 30–50% respectively to 3rd generation cephalosporins, fluoroquinolones and cotrimoxazole amongst Klebsiella pneumoniae and Escherichia coli. Carbapenem resistance rates amongst these organisms remained below 30%. High (> 50%) resistance was reported in Acinetobacter species to aminoglycosides and carbapenems among hospitalized patients. The evolution of ceftriaxone resistant Salmonella Typhi and Shigella species is reported. The data showed > 50% to fluoroquinolones amongst Neisseria gonorrhoeae and the spread of methicillin resistant Staphylococcus aureus (< 30%; 2008) to (> 50%; 2010) in hospital settings. Resistance reported in published studies aligned well with antibiogram data. The latter also captured a clear picture of evolution of resistance over the study period.ConclusionBoth published studies as well antibiograms suggest high rates of AMR in Pakistan. Antibiogram data demonstrating steady increase in AMR highlight its potential role towards supplementing national AMR surveillance efforts particularly in settings where reach of national surveillance may be limited.

MANAGEMENT OF ANTIBIOTIC RESISTANCE BY AYURVEDA – A LITERARY REVIEW

Background – Antibiotic resistance is rising to dangerously high levels worldwide. WHO’s new Global Antimi- crobial Surveillance System (GLASS) reveals widespread occurrence of Antibiotic resistance among 500000 people with suspected bacterial infections across 22 countries. India is no different from it, facing the problem of rising cases of multidrug-resistant TB which adds to the burden of infectious disease in India. Aim – In this literary review problem, current scenario, causes and solution on Antibiotic Resistance from an Ayurvedic perspective will be assessed. Methodology - Articles on Antibiotic Resistance from research papers, journals, and various sites and basic principles from Samhitas and various Ayurvedic Journals, Articles and Research papers on this perspective will be reviewed. Conclusion – Conclusion will be drawn after a thorough literature review on the above subject. Keywords- Antibiotic Resistance, Panchkarma, Rasayana

Surveillance of Phenotypic Extended Spectrum Beta-Lactamase Resistance in Blood Isolates at a Hospital in East Trinidad

Background The Centres for Disease Control and Prevention (CDC) and World Health Organization (WHO) list extended spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae as serious threats and priority pathogens. This study identified phenotypic resistance patterns to these pathogens in east Trinidad, West Indies. We also aimed to set up and test a pilot surveillance system aligned to WHO’s Global Antimicrobial Surveillance System (WHO-GLASS). Methods Two key bacterial isolates, Escherichia coli and Klebsiella pneumoniae were used and one specimen, blood, was used to test a pilot surveillance system. Data for resistance patterns, for Sangre Grande Hospital (SGH), for ESBL producing E. coli and K. pneumoniae were downloaded from the Microscan Autoscan© for the period 2013 – 2016. ESBL presence in bacteria resistant to Cefotaxime (CTX), Ceftazidime (CAZ) and Ceftriaxone (CRO) were recorded. Data were stored in a Microsoft Excel© spreadsheet and inputted into IBM© SPSSv22. Data were displayed as resistance percentages for the year. No patient data were collected. Simple descriptive statistics were used. Results The number of organisms recovered from the database for the period 2013 to 2016 were:134E. coli and 59K. pneumoniae. Phenotypic resistance rates for ESBLs for 2013 to 2016 were: Ecoli: 2013: Resistance ranged from 22.2-29.6% with maximum resistance seen for CTX. 2014: Resistance ranged from 12.9- 22.2%, with maximum resistance seen for CRO. 2015: Resistance ranged from 21.4- =26.2%, with maximum resistance seen for CTX. 2016: Resistance ranged from 29.4- 32.4%, with maximum resistance seen for CRO and CTX. K pneumoniae: 2013: Resistance was 40% for all 3rd generation Cephalosporins. 2014: Resistance was 16.7% for all 3rd generation Cephalosporins. 2015: Resistance was 16.7% for all 3rd generation Cephalosporins. 2016: Resistance ranged from 52.6 – 63.2%, with maximum resistance seen for CAZ. Conclusion Phenotypic resistance rates in K. pneumoniae and E. coli were generally high. There was an overall increase in resistance from 2013 to 2016 for both K. pneumoniae and E. coli with greater resistance being seen in K. pneumoniae.

Multifunctional Antimicrobial Polypeptide-Selenium Nanoparticles Combat Drug-Resistant Bacteria.

Antibiotic-resistant bacteria are a severe threat to human health. The World Health Organization's Global Antimicrobial Surveillance System has revealed widespread occurrence of antibiotic resistance among half a million patients across 22 countries, with Staphylococcus aureus, Escherichia coli, and Klebsiella pneumoniae being the most common resistant species. Antimicrobial nanoparticles are emerging as a promising alternative to antibiotics in the fight against antimicrobial resistance. In this work, selenium nanoparticles coated with the antimicrobial polypeptide, ε-poly-l-lysine, (Se NP-ε-PL) were synthesized and their antibacterial activity and cytotoxicity were investigated. Se NP-ε-PL exhibited significantly greater antibacterial activity against all eight bacterial species tested, including Gram-positive, Gram-negative, and drug-resistant strains, than their individual components, Se NP and ε-PL. The nanoparticles showed no toxicity toward human dermal fibroblasts at the minimum inhibitory concentrations, demonstrating a therapeutic window. Furthermore, unlike the conventional antibiotic kanamycin, Se NP-ε-PL did not readily induce resistance in E. coli or S. aureus. Specifically, S. aureus began to develop resistance to kanamycin from ∼44 generations, whereas it took ∼132 generations for resistance to develop to Se NP-ε-PL. Startlingly, E. coli was not able to develop resistance to the nanoparticles over ∼300 generations. These results indicate that the multifunctional approach of combining Se NP with ε-PL to form Se NP-ε-PL is a highly efficacious new strategy with wide-spectrum antibacterial activity, low cytotoxicity, and significant delays in development of resistance.

Strategic approach for combating antimicrobial resistance (AMR).

During the past 70 years, there has been a continued incremental worsening of antimicrobial resistance (AMR) by a combination of abusing antimicrobials in humans and animals as well as insufficient research and investment for new antimicrobial agents. The current trend of worsening AMR is likely to result in increased mortality and morbidity, longer stays in hospitals and accelerated health care costs. It is estimated that the global mortality attributed by AMR could reach 10 million per year by 2050, which is a massive increase from the current estimated mortality of 700, 000 per year. The year 2014 was the turning point of more than a half century of AMR history, transforming it from technical issue to a political agenda. Major progress includes adoption of the Global Action Plan on AMR at the WHO World Health Assembly in May 2015, followed by completion of a National Action Plan in most parts of the world, enactment of the Global Antimicrobial Surveillance System (GLASS) in October 2015, launch of the World Antibiotic Awareness Week in November 2015, and G20 Leaderscommitment to create the AMR Global Collaboration Hub in July 2017. Moreover, a comprehensive program against AMR has been implemented in some countries, such as UK, USA, and Germany. The strategic approach through coordination led by WHO with relevant international agencies and other entities was one of the key enabling factors for sustained political commitment on AMR.

Homeopathy and Antibiotic Resistance

Summary Antibiotic resistance (AR) has long been a problem for doctors and healthcare organizations worldwide. In recent years the issue has become even more pressing: the Global Antimicrobial Surveillance System (GLASS), launched by the World Health Organization in October 2015, bears witness to the growing emergence of antibiotic-resistant microorganisms. In Italy, AR levels are still among the highest in Europe. This is presumably due to over-use of antibiotics. According to the recent Italian National Surveillance Report on bacteriemia, the incidence of AR is on average, for the most widespread bacteria, 25-30%. The causes of the development of AR are complex, but undoubtedly include the excessive and inappropriate use of antibiotics then each strategy to correct these misconducts will be effective. Complementary and alternative medicine (CAM) offers a conceptual alternative to the use of conventional treatments, but in recent years a different model, that of integrated medicine (IM), has been gaining ground. Several studies show that CAM can allow to reduce the recourse to antibiotics in the treatment of respiratory symptoms, without increasing the incidence of complications. A recent study conducted by our Italian Paediatric Society's CAM research group investigated the efficacy of homeopathy in the treatment of acute otitis in children. Ninety children were enrolled and randomized to a homeopathy treatment group or to a control group, each of 45 patients. Antibiotics were prescribed in 33.3% of children in the treatment group and 62.2% of children in the control group (p = 0.006). In conclusion, there is evidence in the literature demonstrating that the use of CAM in general, and homeopathy in particular, can reduce recourse to antibiotics, with positive repercussions for strategies to combat antibiotic resistance.

Risk factors of community-onset extended-spectrum β-lactamase-producing Klebsiella pneumoniae bacteraemia in South Korea using national health insurance claims data

Although it is essential to know the particular causes of antibiotic-resistant infections in the community, there is lack of evidence regarding risk factors for community-onset extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) bacteraemia in South Korea. As such, this study aimed to identify risk factors for community-onset ESBL-KP bacteraemia. From May 2016 to April 2017, patients with community-onset KP bloodstream infection (BSI) (n = 408) from six sentinel hospitals participating in the Global Antimicrobial Surveillance System in South Korea were included in this study. Risk factors of ESBL-KP BSI were assessed. Polymerase chain reaction and sequencing to identify genes encoding ESBLs and multi-locus sequence typing were performed. Of the 408 patients with community-onset KP BSI, 70 (17%) had ESBL-KP BSI. Admission to a long-term-care hospital within the previous 3 months [odds ratio (OR) 5.7, 95% confidence interval (CI) 2.1-15.6; P = 0.001], previous use of trimethoprim/sulfamethoxazole (TMP/SMT; OR 11.5, 95% CI 2.7-48.6; P = 0.001) or extended-spectrum cephalosporin (OR 2.2, 95% CI 1.2-3.9; P = 0.01), and previous use of a urinary catheter (OR 2.3, 95% CI 1.1-4.5; P = 0.02) were independent risk factors for community-onset ESBL-KP BSI. ESBL-KP isolates most frequently carried the CTX-M-1 group ESBL (74%, n = 52). The most prevalent sequence type (ST) among the ESBL-KP isolates was ST48 (14%, n = 10). Among non-ESBL-KP isolates, ST23 was most prevalent (21%, n = 70). Previous admission to a long-term-care hospital, use of a urinary catheter and use of TMP/SMT or extended-spectrum cephalosporin within the previous 3 months were identified as risk factors for community-onset ESBL-KP BSI. Strict antibiotic stewardship and infection control measures are needed for long-term-care hospitals.

Antimicrobial resistance surveillance in the South African private sector report for 2016

Aim: The relevance of surveillance for antimicrobial resistance is increasingly recognised in the light of a global action plan to combat resistance. This report presents antimicrobial susceptibility testing on ESKAPE pathogens from private sector laboratories in South Africa for 2016.Methods: Antimicrobial susceptibility testing (AST) performed on ESKAPE organisms (Enterococcus faecium, Enterococcus faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter cloacae and Escherichia coli) isolated from blood cultures at four private pathology laboratories in 2016 were analysed. Analysis and reporting of data were done via a uniform platform created by the NICD for national AST data.Results: AST were reported on 9 029 ESKAPE organisms including 58% Enterobacteriaceae, 28% Gram-positive bacteria and 14% Gram-negative bacteria and drug-bug combination was performed following the Global Antimicrobial Surveillance System (GLASS) guidelines by the World Health Organization.Conclusions: The most important resistance to address is a high level of ESBL in Enterobacteriaceae, which necessitates the use of carbapenems for treatment. Resistance to carbapenems is recorded in this report but not confirmation of genes by genotypic methods. During this period, no increase in vancomycin-resistant Enterococci was observed.

Rapid detection and quantification of aminoglycoside phosphorylation products using direct-infusion high-resolution and ultra-high-performance liquid chromatography/mass spectrometry.

Worldwide efforts are underway to determine the extent of antimicrobial resistance (AMR). In 2015, the World Health Organization (WHO) founded the Global Antimicrobial Surveillance System (GLASS) focusing on surveillance and dissemination of data. In addition, the WHO advocates method development focused on rapid determination and close to real-time monitoring of antibiotic usage and its effectiveness. Rapid determination of aminoglycoside modification by O-phosphorylation, the most prevalent mechanism of clinical resistance, was performed using direct flow and liquid chromatography/mass spectrometry (LC/MS). A strain of Escherichia coli carrying a plasmid encoding an aminoglycoside modification enzyme (O-phosphotransferase) was incubated with kanamycin, an aminoglycoside. The antibiotic and its modified form were observed using direct flow and LC/MS. Direct flow high-resolution mass spectrometry (HRMS) using a Thermo Fisher Q-Exactive hybrid quadrupole-orbitrap mass spectrometer was employed for quantitative analysis and structural elucidation. Liquid chromatography coupled with the AB Sciex QTRAP 6500+ was also used for quantitative analysis. Detection of phosphorylated kanamycin was achieved in less than 4 h of incubation. Calibration curves for modified kanamycin from 2.5-250 and 10-200 μg mL-1 μg mL-1 were obtained for LC/MS and direct injection high-resolution experiments, respectively. The high-resolution measurements were employed for conformation and structural elucidation of the novel precursor and product ion biomarkers with high mass accuracy (≤7 ppm). These results confirm previous in vitro O-phosphotransferase metabolite measurements. A new analytical method capable of determination and quantification of the most common form of aminoglycoside resistance (via phosphorylation) was developed requiring short incubation times for a positive confirmation 100-fold lower than the minimum inhibitory concentration (MIC). High-resolution data simultaneously revealed quantitative abilities and provided numerous novel product ions confirming placement of the phosphate group on kanamycin.

Referee report. For: AMR Surveillance in low and middle-income settings - A roadmap for participation in the Global Antimicrobial Surveillance System (GLASS) [version 1; referees: 1 approved

Drug-resistant infections caused by bacteria with increasing antimicrobial resistance (AMR) threaten our ability to treat life-threatening conditions. Tackling AMR requires international collaboration and partnership. An early and leading priority to do this is to strengthen AMR surveillance, particularly in low-income countries where the burden of infectious diseases is highest and where data are most limited. The World Health Organization (WHO) has developed the Global AMR Surveillance System (GLASS) as one of a number of measures designed to tackle the problem of AMR, and WHO member states have been encouraged to produce National Action Plans for AMR by 2017. However, low-income countries are unlikely to have the resources or capacity to implement all the components in the GLASS manual. To facilitate their efforts, we developed a guideline that is aligned to the GLASS procedures, but written specifically for implementation in low-income countries. The guideline allows for flexibility across different systems, but has sufficient standardisation of core protocols to ensure that, if followed, data will be valid and comparable. This will ensure that the surveillance programme can provide health intelligence data to inform evidence-based interventions at local, national and international levels.

AMR Surveillance in low and middle-income settings - A roadmap for participation in the Global Antimicrobial Surveillance System (GLASS).

Drug-resistant infections caused by bacteria with increasing antimicrobial resistance (AMR) threaten our ability to treat life-threatening conditions. Tackling AMR requires international collaboration and partnership. An early and leading priority to do this is to strengthen AMR surveillance, particularly in low-income countries where the burden of infectious diseases is highest and where data are most limited. The World Health Organization (WHO) has developed the Global AMR Surveillance System (GLASS) as one of a number of measures designed to tackle the problem of AMR, and WHO member states have been encouraged to produce National Action Plans for AMR by 2017. However, low-income countries are unlikely to have the resources or capacity to implement all the components in the GLASS manual. To facilitate their efforts, we developed a guideline that is aligned to the GLASS procedures, but written specifically for implementation in low-income countries. The guideline allows for flexibility across different systems, but has sufficient standardisation of core protocols to ensure that, if followed, data will be valid and comparable. This will ensure that the surveillance programme can provide health intelligence data to inform evidence-based interventions at local, national and international levels.