Impact Of Antimicrobial Resistance Research Articles

Impact of Antimicrobial Resistance in Health and Economic Outcomes: A Review

Background: Antimicrobial resistance (AMR) observed when microorganism adapt and multiply in the presence of drugs to which they are exposed. Antibiotic resistance is a global health problem, with the current trend of inappropriate and overuse of antibiotics predicted to cause 10 million deaths by 2050. However, resistant bacteria are multiplying worldwide, infecting healthy people, animals, and human environment, affecting countries with low- and middle-income countries. Although the discovery of antibiotics has saved many lives in recent years, increasing bacterial resistance to antibiotics threatens clinical and agricultural progress, and even treatable bacterial infections can be life-threatening. Strategies: In the present review we discuss the global burden of social and economic impact of antibiotic resistance, common mechanisms of antibiotic resistance, microbiological health and treatment resistance, patient attitudes, hospital and cancer outcomes. Summarize the impact of AMR. Potential strategies to overcome AMR such as Targeting antimicrobial-resistant enzymes, Targeting antimicrobial-resistant bacteria, Drug delivery systems, Physiochemical methods, Unconventional strategies. Conclusion: The devastating effect of antibiotic resistance is clear by way of the sudden boom inside the quantity of cases in which microorganism are immune to typically prescribed antibiotics in clinical practice. Although the superiority of bacterial resistance is growing, there is limited statistics at the impact of this hassle on the fitness and economic consequences of the clinical network.

The Impact of Antimicrobial Resistance in Cystic Fibrosis.

The phenomenon of antimicrobial resistance (AMR) is a critical global health challenge, with prospects indicating its potential to become the leading cause of death worldwide in the coming years. Individuals with pre-existing conditions, such as neoplastic disease undergoing chemotherapy, those on immunosuppressive therapy, and individuals with rare diseases like cystic fibrosis (CF), face heightened challenges due to AMR. CF is a rare disease caused by a deficiency in the synthesis of the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) channel protein, resulting in multi-organ clinical symptoms, particularly in the respiratory system. PwCF experience recurrent pulmonary exacerbations triggered by bacterial or viral infections, making them particularly vulnerable to the impact of AMR. This review delves into the complex relationship between AMR and climate dynamics, focusing on the unique challenges faced by individuals with CF. It discusses the methods employed to measure AMR, its global impact on antibiotic resistance, and the specific microbial communities present in the CF airway. The review also explores the intricacies of antimicrobial resistance within the context of cystic fibrosis, emphasizing the urgent need for research in this field.

Understanding bacterial pathogenicity: a closer look at the journey of harmful microbes.

Bacteria are the most prevalent form of microorganisms and are classified into two categories based on their mode of existence: intracellular and extracellular. While most bacteria are beneficial to human health, others are pathogenic and can cause mild to severe infections. These bacteria use various mechanisms to evade host immunity and cause diseases in humans. The susceptibility of a host to bacterial infection depends on the effectiveness of the immune system, overall health, and genetic factors. Malnutrition, chronic illnesses, and age-related vulnerabilities are the additional confounders to disease severity phenotypes. The impact of bacterial pathogens on public health includes the transmission of these pathogens from healthcare facilities, which contributes to increased morbidity and mortality. To identify the most significant threats to public health, it is crucial to understand the global burden of common bacterial pathogens and their pathogenicity. This knowledge is required to improve immunization rates, improve the effectiveness of vaccines, and consider the impact of antimicrobial resistance when assessing the situation. Many bacteria have developed antimicrobial resistance, which has significant implications for infectious diseases and favors the survival of resilient microorganisms. This review emphasizes the significance of understanding the bacterial pathogens that cause this health threat on a global scale.

Epidemiology of bloodstream infections and the impact of antimicrobial resistance in pediatric hematopoietic cell transplant.

Bloodstream infections (BSI) pose a substantial threat to the well-being and survival of patients undergoing hematopoietic stem cell transplantation (HSCT). Risk factors for these infections vary across the different post-HSCT phases. In the pre-engraftment period, patients are particularly susceptible to infection due to prolonged neutropenia, mucosal damage, and extensive use of central venous line (CVL). In the post-engraftment phase, the emergence of graft versus host diseases further compounds the risk. The epidemiology of these infections has undergone notable changes over the years due to multifactorial reasons, including the evolution of protocols that intensify immunosuppression. In this context, the emergence of multi-drug resistance (MDR) microorganisms can be a challenge due to the elevated risk of mortality in these vulnerable patients. Unfortunately, there is a lack of comprehensive data on this topic, particularly in pediatrics. This article aims to provide a summary of the epidemiology of BSI in the different post-transplant phases and the impact of MDR pathogens. Having knowledge about the local epidemiology of BSI can be instrumental in tailoring targeted therapies, leading to improved survival rates in HSCT recipients.

The Impact of Antimicrobial Resistance and Stewardship Training Sessions on Knowledge of Healthcare Students of Wah Cantonment, Pakistan.

Promoting awareness regarding antimicrobial resistance (AMR) and stewardship (AMS) is crucial as it results in treatment failures and an economic burden on a country. This study was conducted to determine the baseline knowledge of healthcare students and the impact of conducting training sessions regarding AMR and AMS on the knowledge of healthcare students. This study was conducted using a quasi-experimental design at Wah Medical College, Pakistan, and its subsidiary institutes in 4 months. Two hundred twenty-six healthcare students were selected via stratified sampling through a proportional allocation from 3 academic student groups. Training sessions were conducted and data were collected using a structured questionnaire. Data analysis was done using Statistical Package for the Social Sciences version 23. The median age of the participants was 22 while most were females (54.9%). There was a significant difference in means of AMR score between BScN and AD-BTM student groups and among AD-BTM and MBBS student groups. In the case of AMS scores, the difference in means was significant among all student groups. The training sessions were found effective as the mean AMR and AMS knowledge scores among all the student groups increased significantly after the intervention.

Antimicrobial resistance as a super wicked problem: how do we engage the public to be part of the solution

Antimicrobial resistance (AMR) is now regarded as one of the greatest global challenges of the 21st century. The complexity, urgent timeframe, and lack of clear solution to AMR have contributed to its classification as a 'super wicked problem'. Yet knowledge surveys of the general public have found that they still harbour numerous misconceptions linked to both the sources and impact of AMR. This confusion is compounded by AMR being a One Health issue, and therefore a factor in not just human health but in other industries, such as farming. This can further inhibit understanding and knowledge transfer around AMR for those without a prior knowledge base. In order to address the escalating risk that AMR presents, however, it is essential to address this knowledge gap and engage with the public to support wide scale changes in behaviour and consumer choice. The WHO now requires national action plans tackling AMR to include patient and public involvement/engagement (PPI/E) to support changing the trajectory of AMR. Despite this, little detail is available as part of strategic plans on how PPI/E should be undertaken in order to aid implementation. This paper discusses a number of approaches to support the design and delivery of PPI/E in relation to AMR, including the different social behaviour models underlying successful PPI/E strategies, and key considerations linked to specific activity types. The framework produced includes features for steps from initial planning and design through to evaluation. The aim is to help improve the ability of scientists and healthcare professionals to produce high quality AMR PPI/E.

Role of Antimicrobial Resistance in Outcomes of Acute Endophthalmitis.

This study explores local trends in antimicrobial resistance and its influence on long-term visual outcomes following treatment with broad-spectrum empiric intravitreal antibiotics. All patients undergoing intraocular sampling for endophthalmitis from Auckland between January 2006-May 2023 were included. The impact of antimicrobial resistance on the final visual outcome was analysed using logistic regression models. 389 cases of endophthalmitis were included, and 207 eyes (53.2%) were culture positive. When tested, all Gram-positive microorganisms were fully susceptible to Vancomycin, and all Gram-negative microorganisms demonstrated full or intermediate susceptibility to Ceftazidime. Resistance to at least one antimicrobial agent was present in 89 culture results (43.0%), and multidrug resistance (resistant to ≥3 antimicrobials) in 23 results (11.1%). No increase in resistance was observed over time. The primary procedure was a tap and inject in 251 eyes (64.5%), and early vitrectomy was performed in 196 eyes (50.3%). Severe vision loss (≤20/200) occurred in 167 eyes (42.9%). Antimicrobial resistance was associated with an increased risk of retinal detachment (OR 2.455 p = 0.048) but not vision loss (p = 0.288). High sensitivity to Vancomycin and Ceftazidime was present in our population, reinforcing their role as first-line empiric treatments. Resistant microorganisms were associated with an increased risk of retinal detachment but no alteration in final visual outcome.

Mapping the effect of antimicrobial resistance in poultry production in Senegal: an integrated system dynamics and network analysis approach.

The impact of antimicrobial resistance (AMR) extends beyond the farm-level to other stakeholders warranting the need for a collaborative approach to combat AMR while optimising production objectives and safeguarding human health. This study maps out the effect of AMR originating from poultry production in Senegal and highlights the entry points for interventions from stakeholders' perspectives. A causal loop diagram (CLD) was developed following a group model building procedure with 20 stakeholders and integrated with network analysis by translating the CLD into an unweighted directed network. Results indicate that with an eigenvector centrality of 1, 0.85, and 0.74, the production cost, on-farm profit, and on-farm productivity, respectively are the most ranked influential variables driving the complexity of AMR in the poultry production system. Two reinforcing feedback loops highlight the dual benefits of improving on-farm productivity and increasing on-farm profit. However, one balancing feedback loop that revolves around the causal link between producers' investment in qualified human resource personnel to ensure good farm management practices underline the financial implication of producers' investment decisions. The findings provide precursory groundings for the development of a quantitative SD model, the formulation of intervention scenarios and ex-ante impact assessment of the cost-effectiveness of the interventions.

Neonatal sepsis: Challenges in data access, harmonisation and analysis to inform empirical antibiotic recommendations in South African neonatal units


 
 
 Severe bacterial and fungal infections (sepsis) are a leading cause of mortality among neonates in sub-Saharan Africa. In African neonatal units, most sepsis episodes are hospital acquired, and caused by Gram-negative, antimicrobial-resistant pathogens. With rising rates of antimicrobial resistance (AMR) in neonatal sepsis pathogens, there is an increasing probability of inappropriate empirical antibiotic therapy (so called ‘bug-drug’ mismatch or discordant therapy), as confirmation of pathogen identity and antibiotic susceptibility pattern is either not available or delayed. The impact of AMR and discordant empirical treatment on neonatal sepsis outcomes in Africa is largely unknown owing to the lack of the infection surveillance data needed to derive empirical antibiotic treatment recommendations. The Antibiotics for Neonatal Sepsis in Africa (ANSA) study will address this data gap by pooling and harmonising available single-centre research datasets and/or routine laboratory blood culture data to determine which antibiotics should be used for empirical treatment of neonatal sepsis. However, many challenges hamper these datasets, including: variable laboratory methods for pathogen identification and susceptibility testing; difficulty in collating and harmonising data from multiple sites; problems of record linkage in the absence of a single patient identifier; lack of centralised health data capturing systems; and difficulty accessing data due to complex data sharing agreements and custodian permissions. To overcome some of these challenges, minimum guidelines for the collection of neonatal sepsis data need to be defined, to ensure consistency between datasets. Greater collection of, access to and sharing of neonatal sepsis data from institutional, provincial and national laboratories, as well as individual neonatal units, would enable the establishment of a neonatal surveillance network. Development of a sustainably-funded neonatal sepsis surveillance network is a national priority, to ensure effective, evidence-based antimicrobial treatment of hospitalised neonates in South Africa.
 
 

Neonatal sepsis: Challenges in data access, harmonisation and analysis to inform empirical antibiotic recommendations in South African neonatal units


 
 
 Severe bacterial and fungal infections (sepsis) are a leading cause of mortality among neonates in sub-Saharan Africa. In African neonatal units, most sepsis episodes are hospital acquired, and caused by Gram-negative, antimicrobial-resistant pathogens. With rising rates of antimicrobial resistance (AMR) in neonatal sepsis pathogens, there is an increasing probability of inappropriate empirical antibiotic therapy (so called ‘bug-drug’ mismatch or discordant therapy), as confirmation of pathogen identity and antibiotic susceptibility pattern is either not available or delayed. The impact of AMR and discordant empirical treatment on neonatal sepsis outcomes in Africa is largely unknown owing to the lack of the infection surveillance data needed to derive empirical antibiotic treatment recommendations. The Antibiotics for Neonatal Sepsis in Africa (ANSA) study will address this data gap by pooling and harmonising available single-centre research datasets and/or routine laboratory blood culture data to determine which antibiotics should be used for empirical treatment of neonatal sepsis. However, many challenges hamper these datasets, including: variable laboratory methods for pathogen identification and susceptibility testing; difficulty in collating and harmonising data from multiple sites; problems of record linkage in the absence of a single patient identifier; lack of centralised health data capturing systems; and difficulty accessing data due to complex data sharing agreements and custodian permissions. To overcome some of these challenges, minimum guidelines for the collection of neonatal sepsis data need to be defined, to ensure consistency between datasets. Greater collection of, access to and sharing of neonatal sepsis data from institutional, provincial and national laboratories, as well as individual neonatal units, would enable the establishment of a neonatal surveillance network. Development of a sustainably-funded neonatal sepsis surveillance network is a national priority, to ensure effective, evidence-based antimicrobial treatment of hospitalised neonates in South Africa.
 
 

Impact of antimicrobial resistance on health and economy: A comprehensive review

Antibiotics have historically revolutionized medical science; however, the rise of multidrug-resistant pathogenic bacteria puts their worth at risk. The problem of antibiotic resistance has been attributed to both the excessive use of already available drugs and the absence of newer treatments as a result of stringent regulatory requirements and weakened corporate incentives. Resistant infections often need more comprehensive and costly treatments, resulting in longer hospital admissions, higher healthcare costs, and a larger demand for specialized healthcare resources. The expenses are exacerbated by the need for new antimicrobial drug research and development, which is becoming more complex and expensive as a result of resistance mechanisms. Comprehensive efforts are needed to limit the rate of resistance development and include research into new bacteria, resistance mechanisms, and antimicrobial medications. Multidisciplinary approaches are required in the sectors of agriculture, the environment, and healthcare. Probiotics, antibodies, and vaccines are a few examples of progressive complementary therapies that have shown promising outcomes in research and may one day serve as preventive or supplementary treatments. The purpose of this review article is to give an in-depth review of the influence of antibiotic resistance on both the health of individuals and economic stability.

Factors influencing Scottish dairy farmers' antibiotic use.

Good stewardship of antibiotics can reduce the development and impact of antimicrobial resistance (AMR); therefore, understanding farmers' antibiotic use is of interest to stakeholders. To date, few qualitative studies have looked at farmers' antibiotic use on dairy farms in the UK. Semi-structured interviews were used to explore 15 Scottish dairy farmers' antibiotic use behaviours and the factors influencing their antibiotic use on farms. Using an inductive process, the results from the interviews were analysed, and four key themes were extracted: use of antibiotics, awareness of AMR, determinants of antibiotic use and future aspirations. Some of the farmers interviewed were wary about discussing their antibiotic use, which could mean that some contentious issues were not discussed. The farmers also all belonged to a single milk-buying group, which may limit the generalisability of the findings. The quantities of antibiotics used were felt to be driven by the disease prevalence on farms, cows being indoors more, increasing herd sizes resulting in increased stocking densities, retention of poorer cows and substandard housing. Farmer knowledge of antibiotics varied, and not all farmers interviewed were aware of AMR. The farm veterinarian, the press and peers were found to be the main sources of antibiotic information.

Antimicrobial resistance, Extended-Spectrum β-Lactamase production and virulence genes in Salmonella enterica and Escherichia coli isolates from estuarine environment.

The impact of antimicrobial resistance (AMR) on global public health has been widely documented. AMR in the environment poses a serious threat to both human and animal health but is frequently overlooked. This study aimed to characterize the association between phenotype and genotype of AMR, virulence genes and Extended-Spectrum β-Lactamase (ESBL) production from estuarine environment. The Salmonella (n = 126) and E. coli (n = 409) were isolated from oysters and estuarine water in Thailand. The isolates of Salmonella (96.9%) and E. coli (91.4%) showed resistance to at least one antimicrobial agent. Multidrug resistance (MDR) was 40.1% of Salmonella and 23.0% of E. coli. Resistance to sulfamethoxazole was most common in Salmonella (95.2%) and E. coli (77.8%). The common resistance genes found in Salmonella were sul3 (14.3%), followed by blaTEM (11.9%), and cmlA (11.9%), while most E. coli were blaTEM (31.5%) and tetA (25.4%). The ESBL production was detected in Salmonella (1.6%, n = 2) of which one isolate was positive to blaTEM-1. Eight E. coli isolates (2.0%) were ESBL producers, of which three isolates carried blaCTX-M-55 and one isolate was blaTEM-1. Predominant virulence genes identified in Salmonella were invA (77.0%), stn (77.0%), and fimA (69.0%), while those in E. coli isolates were stx1 (17.8%), lt (11.7%), and stx2 (1.2%). Logistic regression models showed the statistical association between resistance phenotype, virulence genes and ESBL production (p < 0.05). The findings highlighted that estuarine environment were potential hotspots of resistance. One Health should be implemented to prevent AMR bacteria spreading.

The Impact of Antimicrobial Resistance on Outcomes for Patients Undergoing Coronary Artery Bypass Graft and Valve Surgery: A Retrospective Cohort Study of Hospital Admissions Data from the National Inpatient Sample

Background: There is uncertainty regarding the impact of multidrug-resistant organisms on patients that undergo cardiac surgery. Methods: A retrospective cohort study was performed by using 2016–2019 data from the National Inpatient Sample in the United States to evaluate the proportion of admissions with a diagnosis of antimicrobial resistance who also underwent coronary artery bypass graft or valve surgery. Results: A total of 1,260,630 admissions were included in the analysis, of which 2045 (0.16%) had antimicrobial resistance. Compared to patients without resistance, those with antimicrobial resistance were more likely to be female (52.8% vs. 31.5%, p &lt; 0.001), and die in a hospital (7.1% vs. 2.4%, p &lt; 0.001). The length of stay and cost were significantly higher for patients with antimicrobial resistance (15 vs. 7 days and USD 69,135 vs. USD 43,740, respectively). Antimicrobial resistance was not associated with increased in-hospital mortality (OR 1.38; 95% CI 0.86–2.21, p = 0.18), although it was associated with an increase in length of stay (coefficient 7.65; 95% CI 6.91–8.39, p &lt; 0.001), and cost (coefficient USD 25,240 [21,626–28,854], p &lt; 0.001). Conclusions: Antimicrobial resistance in patients that undergo cardiac surgery is not common, yet its burden is substantial as it can double the length of stay and increase costs by more than USD 20,000.

Scoping review protocol on the impact of antimicrobial resistance on cancer management and outcomes

IntroductionAntimicrobial resistance (AMR) is a growing global public health concern and is becoming a significant challenge in the management of patients with cancer. Due to the immunosuppressive nature of cancer...

Antimicrobial use among paediatric inpatients in a Nigerian tertiary hospital: A three-year point prevalence survey.

Antimicrobials are among the most widely prescribed therapeutic agents among paediatric population. Irrational use of these agents increases the risk of antimicrobial resistance. We described the prevalence and pattern of antimicrobial use among paediatric inpatients from 2017 to 2019. The study was a repeated point prevalence survey over a 3-year period using the global point prevalence standardized tools among all paediatric inpatients. The prevalence of antimicrobial use, the prescription indicators and patterns of antimicrobial use were estimated. Among 191 paediatric inpatients assessed, the 3-year period prevalence antimicrobial use was 85.9% (164/191) with prevalence of 80.6% in 2017, 94.6% in 2018, and 83.6% in 2019. Antimicrobial agents used ranged from one agent (20.1%) to five different agents (5.5%). Parenteral route (66.6%) was the preferred route of administration. The reason for the use of antimicrobial agents (92.6%) and the stop/review date (99.5%) were mostly well documented. Only 4.5% of the antimicrobial use were targeted. There were no antimicrobial guidelines or policy guiding the use of antimicrobial agents, except the national guideline on the treatment of malaria and tuberculosis. Ceftriaxone, a third generation cephalosporin was the most commonly used agent across the period under review. Community-acquired infection was the commonest indication for antimicrobial use. Our findings of high antimicrobial prevalence has raised the attention for the need to develop hospital-based antimicrobial guideline and antimicrobial stewardship program to protect the vulnerable children, their contacts and the environment from the impact of antimicrobial resistance.

Knowledge and perception of doctors regarding antibiotic stewardship in a tertiary care hospital of Southern Punjab.

Background: Pakistan has been working on Antimicrobial Resistance (AMR) for a decade; unfortunately, there is a lack of concept of antibiotic stewardship in most health setups, especially in the public sector. This study aims to analyze the knowledge and perception of junior physicians towards antibiotic stewardship programs. The need for this knowledge and impact of antimicrobial resistance on antibiotic stewardship ascertain barriers to stewardship acceptance. Methodology: A cross-sectional study was conducted at different clinical departments of Sheikh Zayed Hospital, Rahim Yar Khan, including 50 junior physicians recruited via convenience sampling technique. The data was collected using a structured questionnaire comprising physician's hospital associated data and questions regarding the knowledge, perspectives, and practices concerning antibiotic stewardship programs (ASP) to reduce AMR. Statistical analysis was done using SPSS version 22.0, and data were presented using frequencies and percentages. Results: Most of the enrolled physicians knew AMR and agreed that it is a serious global health issue. However, all the medical officers were completely unaware of the antibiotic stewardship program, while 42.9% of house officers and only 25.7% of PGs knew about the program. Conclusion: Our study shows support from doctors for expanded stewardship implementation and provides an important understanding of the current attitudes of doctors regarding stewardship execution. A better understanding of perceptions and attitudes is dire for healthcare stakeholders to expand stewardship activities into healthcare settings.

Prevalence and Therapeutic Management of Infections by Multi-Drug-Resistant Organisms (MDROs) in Patients with Liver Cirrhosis: A Narrative Review.

Bacterial infections are common events that significantly impact the clinical course of patients with cirrhosis. As in the general population, infections caused by multi-drug-resistant organisms (MDROs) are progressively increasing in cirrhotic patients, accounting for up to 30–35% of all infections. Nosocomial acquisition and prior exposure to antimicrobial treatment or invasive procedures are well-known risk factors for MDRO infections. Several studies have demonstrated that infections due to MDROs have a poorer prognosis and higher rates of treatment failure, septic shock, and hospital mortality. Due to the increasing rate of antimicrobial resistance, the approach to empirical treatment in cirrhotic patients with life-threatening infections has become significantly more challenging. In order to ensure a prompt administration of effective antibiotic therapy while avoiding unnecessary antibiotic exposure at the same time, it is of utmost importance to choose the correct antimicrobial therapy and administration schedule based on individual clinical characteristics and risk factors and rapidly adopt de-escalation strategies as soon as microbiological data are available. In the present paper, we aimed to provide an overview of the most frequent infections diagnosed in cirrhotic patients, the prevalence and impact of antimicrobial resistance, and potential therapeutic options in this population.

Antimicrobial resistance in Libya: A systematic literature review of two decades

Background: In low- and middle-income countries, antimicrobial resistance (AMR) imposes a significant burden on patients and health-care systems. Due to a lack of data, the overall impact of AMR in Libya is not well known or documented. As a result, this study presents the results of a review of available data on AMR in Libya over the past 20 years (from 2002 to 2021) to aid understanding of the current AMR situation in this portion of the continent. Methods: Articles related to the topic were researched using databases and search engines such as PubMed, Google Scholar, and ResearchGate websites. These articles were selected based on predetermined inclusion and exclusion criteria. The total number of tested isolates for each of the reported Bacterial spp. was used to calculate antibiotic resistance to a specific bacterium. Results: Studies published in the past 20 years, representing reports of 18,160 AMR tests, showed that Urinary Tract Infection (UTI) was the most reported clinical diagnosis in Libya (61.3%). Out of 43 articles, Staphylococcus aureus was the most common Gram-positive bacteria documented in (31, 61.3%) studies, and was most common in 59.78% of skin infections. Whereas, Pseudomonas spps., were the most common Gram-negative bacteria presented in (23, 53.48%) studies, and were commonly isolated in respiratory infection (9.39%). Among Gram-negative bacteria, Pseudomonas spp. reported a high resistance percentage for penicillin beta-lactam antibiotic, i.e., piperacillin (10.4%) and to the first-generation cephalosporins antibiotics, i.e., cefazolin (7.7%). However, they are susceptible to metronidazole, vancomycin, and colistin. Gram-positive bacteria, S. aureus shows high resistance to oxacillin, followed by gentamycin and cefoxitin (8.5%, 8.3%, and 8.3%, respectively). Effective antibiotics against S. aureus were azithromycin, clarithromycin, and metronidazole, whose susceptibility was 99.9% each, while 1% of S. aureus were vancomycin-resistant S. aureus. Conclusion: This study gives a comprehensive analysis of the state of AMR in Libya with respect to the most regularly prescribed antibiotics. The findings of the research show the alarmingly persistent occurrences of AMR in Libya, as well as the critical need to establish national action, plans to combat AMR and improve surveillance programs.

Prevalence, Pattern, Risks Factors and Consequences of Antibiotic Resistance in COPD: A Systematic Review

A concern of antibiotic use in chronic obstructive pulmonary disease (COPD) is the emergence and propagation of antimicrobial resistance (AMR). A systematic review was conducted to determine prevalence, pattern, risk factors and consequences of AMR in COPD. Bibliographic databases were searched from inception to November 2020, with no language restrictions, including studies of any design that included patients with COPD and reported prevalence and pattern of AMR. 2748 unique titles and abstracts were identified, of which 63 articles, comprising 26,387 patients, met inclusion criteria. Forty-four (69.8%) studies were performed during acute exacerbation. The median prevalence of AMR ranged from 0–100% for Pseudomonas aeruginosa, Moraxella catarrhalis, Klebsiella pneumoniae and Acinetobacter baumannii. Median resistance rates of H influenzae and S pneumoniae were lower by comparison, with maximum rates ≤40% and ≤46%, respectively, and higher for Staphylococcus aureus. There was a trend towards higher rates of AMR in patients with poorer lung function and greater incidence of previous antibiotic exposure and hospitalisation. The impact of AMR on mortality was unclear. Data regarding antimicrobial susceptibility testing techniques and the impact of other risk factors or consequences of AMR were variable or not reported. This is the first review to systematically unify data regarding AMR in COPD. AMR is relatively common and strategies to optimise antibiotic use could be valuable to prevent the currently under-investigated potential adverse consequences of AMR. Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.2000957 .