Antimicrobial Resistance Phenomenon Research Articles

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.

[Antimicrobial resistance and genomic characterization of Campylobacter isolates recovered from retailed poultry meat samples in 20 provinces of China in 2020].

Objective: To understand the antimicrobial resistance and genome characteristics of Campylobacter isolates recovered from retailed poultry meat samples in 20 provinces in China in 2020. Methods: In 2020, 265 Campylobacter strains including 244 Campylobacter jejuni and 21 Campylobacter coli collected from retailed poultry meat samples in China were tested for antimicrobial resistance to 9 antimicrobial compounds by using the agar dilution method. Forty-two selected isolates were sent for whole genome sequencing and 38 high-quality genomes were analyzed for their antimicrobial resistance genes, virulence genes, sequence types and genetic diversity. Results: The resistance rates of Campylobacter isolates from poultry meats to tetracycline, nalidixic acid and ciprofloxacin were the highest (84%-100%), with 53.2% of the isolates showing multidrug resistance in this study. The resistance rates of C. coli to erythromycin, azithromycin, telithromycin, gentamicin and clindamycin were significantly higher than those of C. jejuni (P<0.05). The resistance genes conferring resistance to β-lactams (100%, 38/38), quinolones (94.7%, 36/38), tetracycline (81.6%, 31/38) and aminoglycosides (50%, 19/38) were the most frequently detected among 38 Campylobacter genomes. C. jejuni carried more virulence genes than C. coli. In total, 19 and 17 sequence types (ST) were obtained from 20 sequenced C. jejuni and 18 C. coli isolates, respectively, including 5 novel STs. The isolates showed a high genetic diversity based on their sequence types. Conclusion: The phenomenon of antimicrobial resistance in Campylobacter from poultry meat sources in China is relatively serious, and resistance and virulence genes are widely distributed in Campylobacter. There is genetic diversity in Campylobacter.

Comparative antibacterial efficacies of the extracts of &lt;i&gt;Enantia chlorantha&lt;/i&gt; (Awopa) on selected clinical isolates

Researchers and health scientists are challenged by the phenomenon of antimicrobial resistance which has necessitated the need for the  discovery of novel antimicrobial agents. This study evaluated the antimicrobial efficacy of the bark of Enantia chlorantha (Awopa) based  on extractions using selected polar and non-polar solvents (Aqueous, Dichloromethane, Petroleum ether, and N-hexane). Antimicrobial  activities were investigated against six clinical isolates (Candida albicans, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus,  Streptococcus pneumoniae, and Pseudomonas aeruginosa) via the agar well diffusion assay. Minimum inhibitory concentration (MIC)  and Minimum Bactericidal Concentration (MBC) were also determined by the macro broth dilution method. The phytochemical  components of the extracts were analyzed qualitatively and quantitatively. The dichloromethane extract of E. chlorantha expressed the  highest antimicrobial activity against all the test organisms with K. pneumonia being the most susceptible with (21.50 mm zone of inhibition) at a concentration of 50mg/mL; while C. albicans was the least susceptible organism with 3.00 mm zone of inhibition at concentration of 500mg/mL. On the other hand, extract from the petroleum ether expressed no antimicrobial activities, based on the absence of the zones of inhibition around the cultures of the respective organisms. Mainly the Dichloromethane and aqueous extracts of  E. chlorantha expressed varying organism-dependent MIC on the test isolates. While the lowest MIC of dichloromethane extract was  expressed on S. aureus at 6.25mg/mL; the highest MIC (50mg/mL) was exerted on C. albicans. Phytochemical screening of the extracts  revealed the presence of glycosides, oxalates, steroids, alkaloids, tannins, flavonoids, phenol, triterpenes, saponin and phytate; while  terpenoid was not found in all the plant’s extracts. Findings in this study suggest that the bioactive ingredients of E. chlorantha barks  could be best extracted by polar solvents which are evident in the superior antimicrobial activities of dichloromethane and aqueous  extracts. The non-polar solvents such as n-hexane and petroleum ether are poor extractant, thus necessitating the need to carefully  select suitable solvent for the extraction of any plant’s bioactive compounds.   

ANALYSIS OF HOSPITAL ANTIBIOTIC PRESCRIPTIONS AFTER THE IMPLEMENTATION OF STEWARDSHIP: A RETROSPECTIVE OBSERVATIONAL STUDY IN TWO HOSPITALS IN NORTH-EASTERN SICILY

Introduction: Antimicrobial resistance is a global problem caused by the inappropriate use of antibiotics. To combat this phenomenon, multidisciplinary antimicrobial stewardship programmes have been initiated, the primary objectives of which include improving both the level of appropriateness of prescription and clinicians’ awareness of the correct use of antibiotics. Objective/Purpose: The objective of the work was to conduct an analysis of antibiotic consumption at hospital level to assess the appropriateness of antibiotic prescription in a number of Operational Units. Method: From 01/01/2021 to 31/12/2022, data were extracted from the Pharmacy Operational Unit’s management software on the dispensing of antibiotics (injectable and oral use), the Defined Daily Doses, and the number of dosage units dispensed to the General Medicine, Intensive Care, General Surgery and Neurorehabilitation Operational Units of two hospitals. Results: Total antibiotic consumption was 7,845 dosage units in 2021 and 10,182 in 2022. The comparison of the defined daily dose values (4,565,485 in 2021 and 5,079,671 in 2022) is indicative of the use of antibiotics with different dosages, with a percentage increase of 11.3%. A comparison was also made between the Defined Daily Doses/100 bed-days delivered in 2021 and the regional and national figures, yielding a significantly lower figure than these latter figures. Conclusions: The loss of antibiotic efficacy threatens to throw healthcare systems into crisis, leading to in an increase in morbidity and mortality from infections. The implementation of antimicrobial stewardship programmes remains, at present, the best tool to harness in order to curb the phenomenon of antimicrobial resistance. There is therefore a need for increasingly specialised professionals in the field of infectious diseases. Nurses and pharmacists play a crucial role in antimicrobial stewardship programmes, as they collaborate not only in the implementation of antimicrobial guidelines, but also in the review of individual patient regimens in order to optimise treatment and in the training of healthcare personnel on the appropriate use of antimicrobials.

De novo peptides as potential antimicrobial agents

The phenomenon of antimicrobial resistance threatens our ability to treat common infections. The clinical pipeline for new antimicrobials is pretty much dry and hence, there is a need for the development of new antimicrobial agents with low toxicities to help fight resistant microorganisms. This work aimed to design antimicrobial peptides with low toxicities using a database filtering technology and evaluate their bioactivities. The physicochemical properties of the designed peptides were explored with molecular dynamics (MD) simulations. Microbroth dilution and hemolytic assays were used to assess the peptides' antimicrobial activity and toxicity. The activity of combinations of the peptides and some standard antibiotics was tested by the checkerboard method. In general, the designed peptides had a charge of +2, chain length of 13, and hydrophobicity of 61%. The predicted secondary structures of the peptides were either extended conformations or alpha-helices, and these structures were found to fluctuate during the MD simulations, where coils, bends, and helices dominated. , of the peptides, BRG003, BRG004 and BRG002 had the greatest aggregation propensities, whereas BRG001, BRG005, and BRG006 exhibited lower aggregation propensities. The minimum inhibitory concentration (MIC) of the peptides ranged from 0.015 to >1.879 μM, with BRGP-001 exhibiting high activity against MRSA with an MIC of 15 nM. BRGP-005 and BRGP-006 exhibited synergistic effects against Escherichia coliR when used in combination with erythromycin. At the minimum hemolytic concentration, the percentage of lysed erythrocytes was lower for all the peptides in comparison to the reference peptide, indicating low hemolytic activity. The study revealed the importance of peptide self-association in the antimicrobial activity of the peptides. These peptides provide a basis for the design of potent antimicrobial peptides that can further be developed for use in antimicrobial therapy.

Antibiotics in Dentistry: A Narrative Review of the Evidence beyond the Myth.

Antibiotics have undoubtedly revolutionized medicine and the health and survival of patients with life-threatening infections, being nonetheless free from potential adverse effects, and the risk of intestinal dysbiosis, antimicrobial resistance, and the resulting consequences for the patient's health and the public purse. The present study narratively reviewed the epidemiological data on worldwide antibiotic consumption and administration in dental practice, patients' adherence to prescriptions, the antimicrobial resistance phenomenon in dentistry, and the evidence supporting and recommending appropriate antibiotic use in dental care. Eligible systematic reviews and original studies in humans published in the English language from January 2000 to 26 January 2023 were considered. A total of 78 studies, 47 on the epidemiology of antibiotic use and prescription in dentistry, 6 on antibiotic therapy in dentistry, 12 on antibiotic prophylaxis in dentistry, 0 on adherence of dental patients to antibiotic prescription, and 13 on antimicrobial resistance in dentistry, were presently considered. Retrieved evidence revealed that antibiotics are frequently overused and misused in dental practice, dental patients frequently do not adhere to prescriptions, and antimicrobial resistance in dentistry is a still rising phenomenon also secondary to improper oral antiseptics use. The present findings highlighted the need to establish more evidence-based and accurate antibiotic prescriptions to sensitize dentists and dental patients to minimize and rationalize the use of antibiotics only when it is indicated and necessary, improve patients' adherence, and enhance knowledge and awareness of the antimicrobial resistance in dentistry.

Advances in efficacy enhancement of photosensitizer-mediated photodynamic antimicrobial chemotherapy

The fight against pathogenic microorganisms has in recent decades been met with fierce setbacks owing to the antimicrobial resistance phenomenon. Conventional antimicrobials have thus weakened in their effectiveness against microbes, calling for the development of innovative strategies to combat the emerging global health crisis. A promising therapy for filling this gap is photodynamic antimicrobial chemotherapy which destroys microorganisms by making use of the combined action of a photosensitizer, light, and oxygen. The modality inactivates a wide range of pathogens, including bacteria, fungi, protozoa, and viruses. Of greater interest in photodynamic antimicrobial chemotherapy is the ability to destroy resistant strains of microbes without encouraging selection for resistance genes, thus immensely contributing to the fight against antimicrobial resistance. Different PSs vary in their microbial inactivation efficacies. Therefore, various structural modification approaches are being adopted to improve their respective activities. In this paper, recent studies focusing on strategies employed to improve the effectiveness and efficacies of PSs used in photodynamic antimicrobial chemotherapy are reviewed.

Cefotaxime-, Ciprofloxacin-, and Extensively Drug-Resistant Escherichia coli O157:H7 and O55:H7 in Camel Meat.

The present study aimed to explore for the first time the occurrence and the antimicrobial resistance profiles of E. coli O157:H7 and O55:H7 isolates in camel meat in Egypt. Among the 110 camel meat samples examined using standardized microbiological techniques, 10 (9.1%) and 32 (29.1%) were positive for E. coli O157:H7 and E. coli O55:H7, respectively. In total, 24 isolates were verified as E. coli O157:H7, while 102 isolates were confirmed serologically as E. coli O55:H7. Multiplex PCR revealed the existence of eaeA, stx1, stx2, and EHEC-hlyA among E. coli O157:H7 and O55:H7 isolates (n = 126) at various percentages. According to their resistance against 14 antibiotics, 16.7% and 83.3% of O157:H7 isolates and 8.6% and 76.5% of O55:H7 isolates were classified into extensively drug-resistant and multi-drug-resistant, respectively, whereas 29.4% and 22.2% of E. coli isolates were resistant to cefotaxime and ciprofloxacin, respectively. The study results emphasize that camel meat may be a vehicle for multi- and extensively drug-resistant E. coli O157:H7 and O55:H7 strains, indicating a potential threat to public health. Further studies based on the molecular evidence of the antimicrobial resistance genes and enrolling a larger number of samples are recommended for a better understanding of the antimicrobial resistance phenomenon of camel-meat-originating pathogenic E. coli strains.

New polyimidazole ligands against subclass B1 metallo-β-lactamases: Kinetic, microbiological, docking analysis

Beta-lactam antibiotics are one of the most commonly used drug classes in managing bacterial infections. However, their use is threatened by the alarming phenomenon of antimicrobial resistance, which represents a worldwide health concern. Given the continuous spread of metallo-β-lactamases (MBLs) producing pathogens, the need to discover broad-spectrum β-lactamase inhibitors is increasingly growing. A series of zinc chelators have been synthesized and investigated for their ability to hamper the Zn-ion network of interactions in the active site of MBLs. We assessed the inhibitory activity of new polyimidazole ligands N,N′-bis((imidazol-4-yl)methyl)-ethylenediamine, N,N,N′-tris((imidazol-4-yl)methyl)-ethylenediamine, N,N,N,N′-tetra((imidazol-4-yl-methyl)-ethylenediamine toward three different subclasses B1 MBLs: VIM-1, NDM-1 and IMP-1 by in vitro assays. The activity of known zinc chelators such as 1,4,7,10,13-Pentaazacyclopentadecane, 1,4,8,11-Tetraazacyclotetradecane and 1,4,7,10-Tetraazacyclododecane-1,4,7,10-tetraacetic acid was also assessed. Moreover, a molecular docking study was carried to gain insight into the interaction mode of the most active ligands.

Systematic Survey of Vibrio spp. and Salmonella spp. in Bivalve Shellfish in Apulia Region (Italy): Prevalence and Antimicrobial Resistance

The emergence of antimicrobial resistance (AMR) is increasingly common across the globe and aquatic ecosystems could be considered a reservoir of antibiotic-resistant bacteria. This study aimed to determine prevalence and antibiotic susceptibility of the potential pathogenic bacteria Salmonella spp. and Vibrio spp. in bivalve molluscs intended for human consumption, collected over a period of 19 months along the northern coast of Apulia region. The AMR profile was also determined in non-pathogenic Vibrio species, common natural inhabitants of seawater and a useful indicator for the surveillance of AMR in the environment. The current study presents data on the AMR of 5 Salmonella and 126 Vibrio isolates by broth microdilution MIC. Multidrug resistance (MDR) was observed in one S. Typhimurium strain towards sulfamethoxazole, trimethoprim, tetracycline, gentamicin, and ampicillin and in 41.3% of the Vibrio strains, mostly towards sulphonamides, penicillin, and cephems. All Vibrio isolates were sensitive to azithromycin, chloramphenicol, tetracycline, amoxicillin/clavulanic acid, gentamicin, streptomycin, amikacin, and levofloxacin. The AMR phenomenon in the investigated area is not highly worrying but not entirely negligible; therefore, in-depth continuous monitoring is suggested. Results concerning the antibiotic agents without available specific clinical breakpoints could be useful to upgrade the MIC distribution for Vibrio spp. but, also, the establishment of interpretative criteria for environmental species is necessary to obtain a more complete view of this issue.

How Does Hospital Microbiota Contribute to Healthcare-Associated Infections?

Healthcare-associated infections (HAIs) are still a global public health concern, associated with high mortality and increased by the phenomenon of antimicrobial resistance. Causative agents of HAIs are commonly found in the hospital environment and are monitored in epidemiological surveillance programs; however, the hospital environment is a potential reservoir for pathogenic microbial strains where microorganisms may persist on medical equipment surfaces, on the environment surrounding patients, and on corporal surfaces of patients and healthcare workers (HCWs). The characterization of hospital microbiota may provide knowledge regarding the relatedness between commensal and pathogenic microorganisms, their role in HAIs development, and the environmental conditions that favor its proliferation. This information may contribute to the effective control of the dissemination of pathogens and to improve infection control programs. In this review, we describe evidence of the contribution of hospital microbiota to HAI development and the role of environmental factors, antimicrobial resistance, and virulence factors of the microbial community in persistence on hospital surfaces.

Physiological Characteristics of Putative Enterobacteria Associated with Meat and Fish Available in Southern Brazilian Retail Markets: Antimicrobial Susceptibility, Toxic Metal Tolerance and Expression of Efflux Pumps.

Multidrug-resistant (MDR) mesophilic facultatively anaerobic Gram-negative rods are a public health issue and their spread from animal-source foods to humans is of concern worldwide. Hence, the aim of this study was to examine the antibiotic susceptibility patterns and physiological aspects of such rods, including their tolerance to toxic metals and the screening of efflux pumps expressing isolates among enterobacteria isolated from meat (chicken, beef and pork) and fish samples acquired from retail establishments in a Brazilian urban Centre of over 2,300,000 inhabitants. The study revealed that 62.9% of isolated bacteria were resistant to at least one antimicrobial, of which 32.3% and 8.1% were resistant to one and two of the tested drugs, respectively. A resistance of up to six antimicrobials was also observed (0.9%). Out of the total amount, 22.7% were classified as MDR. Chicken was the meat that harbored most MDR isolates, and fish harbored the least. It was not possible to distinguish the different types of meat or fish considering the resistance patterns. The MDR isolates showed a higher tolerance to mercury and cadmium salts and the increased activity of the efflux mechanisms compared to other susceptible or resistant strains. In One Health. the perspective occurrence of putative MDR bacteria in fresh meat and fish draws attention to the antimicrobial resistance phenomenon in an open environment.

Determinants of Infection as Genetic Indicators in Cows Mastitis

The resistance to antimicrobial substances severely impacts public health and the abuse of antibiotics leads to antimicrobial resistance (AMR) or the antibiotic "resistome" (Wright, 2007). Bovine mastitis is largely diagnosed in dairy farms and is caused by a variety of pathogens including Streptococcus spp., Staphylococcus spp. and Escherichia coli. AMR gene expression testing in bacteria involved in mastitis in dairy cows was performed. Milk samples were subjected to the California Mastitis Test. Positive samples were transferred using eSwab, cultured on Columbia blood agar and on MacConkey agar. The Qiagen DNeasy kit was used for DNA extraction and qPCRs were run using an Agilent thermocycler. In most of the samples tested (n = 42, from three different lactating farms), the presence of ampC (36 out of 42; 85.7%) and blaZ (95.2%), correlated with confirmed resistance to beta-lactam and cephalosporin antibiotics. A variable presence of other tested AMR genes was detected, including ermB, resistance to lincosamide, macrolide (35.7%), ermC (28.6%), erythromycin resistance, mecA,methicillinresistance (42.9%), and tetK, tetracyclineresistance (78.6%). The phenomenon of antimicrobial resistance is present in dairy farms in West Romania. Multiple AMR genes were detected intested samples, with the highest resistance observed to beta-lactam antibiotics and cephalosporins.

Attitudes towards Antibiotic Prescription and Antimicrobial Resistance Awareness among Italian Dentists: What Are the Milestones?

Antimicrobial resistance is a growing phenomenon, often associated with the improper prescription of antibiotics, prescribed by those who do not follow the guidelines for antibiotic stewardship. The aim of this study was to evaluate the current attitude towards antibiotic prescribing and antimicrobial resistance awareness among Italian dentists. An online questionnaire was distributed to Italian dentists from September to December 2021. The questionnaire was composed of three main sections. The first part was focused on demographic characteristics, the second part on prescription habits, and the third part on the dentists’ knowledge regarding the phenomenon of antimicrobial resistance. A chi-square test was used to find associations between different variables. The level of significance was set at p < 0.05. A total of 382 dentists completed the questionnaire. The main reasons for antibiotic prescribing were for abscesses (39.6%), extractions (24.5%), and pulpitis (14.1%). The majority of participants (85.3%) reported prescribing macrolides in the case of a penicillin allergy. Most dentists (98.9%) were aware of the antimicrobial resistance phenomenon, but only 7.4% of them consulted the guidelines for prescribing antibiotics. This study demonstrates that the same trend exists in Italy as in other countries in terms of the high prevalence of misuse and overuse of antibiotics, and that Italian dentists utilize a range of antibiotic management strategies.

β-LACTAMASE PRODUCING GRAM NEGATIVE BACTERIA: MAIN ISSUES, DIAGNOSTIC METHODS AND MEANS OF REDUCING THEIR BURDEN IN ROMANIA

Bacterial resistance to antibiotics is a globally recognized healthcare problem. Β-lactam resistance în Gram negative bacteria, mediated through mecanisms like ESBLs (extended spectrum beta-lactamases), cephalosporinases and carbapenemases, is one of the most important. This study aims to identify the most important tests which can be applied in the laboratory in order to correctly identify Gram-negative bacteria (Enterobacterales, Pseudomonas spp., Acidentobacter spp.) which are resistant to this class of antibiotics and their resistance mechanisms, apply them on the microorganisms isolated in a clinical hospital from Bucharest, Romania, describe and report the findings, followed by the proposal of measures that can reduce the burden of these bacteria and their resistance mechanisms. In order to support the national effort in the fight against the antimicrobial resistance phenomenon, a new phenotipic laboratory identification test is proposed, using resources available in Romania. Keywords: antimicrobial resistance, β-lactamase, carbapenemase

Contribution of Aldehydes and Their Derivatives to Antimicrobial and Immunomodulatory Activities.

Essential oils (EOs) are intricate combinations of evaporative compounds produced by aromatic plants and extracted by distillation or expression. EOs are natural secondary metabolites derived from plants and have been found to be useful in food and nutraceutical manufacturing, perfumery and cosmetics; they have also been found to alleviate the phenomenon of antimicrobial resistance (AMR) in addition to functioning as antibacterial and antifungal agents, balancing menstrual cycles and being efficacious as an immune system booster. Several main aldehyde constituents can be found in different types of EOs, and thus, aldehydes and their derivatives will be the main focus of this study with regard to their antimicrobial, antioxidative, anti-inflammatory and immunomodulatory effects. This brief study also explores the activity of aldehydes and their derivatives against pathogenic bacteria for future use in the clinical setting.

Invited review: strategic adoption of antibiotic-free pork production: the importance of a holistic approach.

The discovery of the use of antibiotics to enhance growth in the 1950s proved to be one of the most dramatic and influential in the history of animal agriculture. Antibiotics have served animal agriculture, as well as human and animal medicine, well for more than seven decades, but emerging from this tremendous success has been the phenomenon of antimicrobial resistance. Consequently, human medicine and animal agriculture are being called upon, through legislation and/or marketplace demands, to reduce or eliminate antibiotics as growth promotants and even as therapeutics. As explained in this review, adoption of antibiotic-free (ABF) pork production would represent a sea change. By identifying key areas requiring attention, the clear message of this review is that success with ABF production, also referred to as “no antibiotics ever,” demands a multifaceted and multidisciplinary approach. Too frequently, the topic has been approached in a piecemeal fashion by considering only one aspect of production, such as the use of certain feed additives or the adjustment in health management. Based on the literature and on practical experience, a more holistic approach is essential. It will require the modification of diet formulations to not only provide essential nutrients and energy, but to also maximize the effectiveness of normal immunological and physiological capabilities that support good health. It must also include the selection of effective non-antibiotic feed additives along with functional ingredients that have been shown to improve the utility and architecture of the gastrointestinal tract, to improve the microbiome, and to support the immune system. This holistic approach will require refining animal management strategies, including selection for more robust genetics, greater focus on care during the particularly sensitive perinatal and post-weaning periods, and practices that minimize social and environmental stressors. A clear strategy is needed to reduce pathogen load in the barn, such as greater emphasis on hygiene and biosecurity, adoption of a strategic vaccine program and the universal adoption of all-in-all-out housing. Of course, overall health management of the herd, as well as the details of animal flows, cannot be ignored. These management areas will support the basic biology of the pig in avoiding or, where necessary, overcoming pathogen challenges without the need for antibiotics, or at least with reduced usage.

Microbial Resistance to Antibiotics and Effective Antibiotherapy.

Currently, the efficacy of antibiotics is severely affected by the emergence of the antimicrobial resistance phenomenon, leading to increased morbidity and mortality worldwide. Multidrug-resistant pathogens are found not only in hospital settings, but also in the community, and are considered one of the biggest public health concerns. The main mechanisms by which bacteria develop resistance to antibiotics include changes in the drug target, prevention of entering the cell, elimination through efflux pumps or inactivation of drugs. A better understanding and prediction of resistance patterns of a pathogen will lead to a better selection of active antibiotics for the treatment of multidrug-resistant infections.

Surgical Antimicrobial Prophylaxis in Patients of Neonatal and Pediatric Age Subjected to Eye Surgery: A RAND/UCLA Appropriateness Method Consensus Study.

Ocular surgery encompasses a wide range of procedures, including surgery of the tear ducts, eyelid, cornea and conjunctiva, lens, ocular muscle, and vitreoretinal and iris surgery. Operations are also performed for the removal of tumors, repairs of ocular trauma and, finally, corneal transplantation. Antibiotic prophylaxis for the prevention of surgical site infections (SSIs) in ocular surgery is a complex field in which shared lines of action are absent. In light of the scarcity of shared evidence in the use of ocular antimicrobial prophylaxis for the pediatric population, this consensus document aims to provide clinicians with a series of recommendations on antimicrobial prophylaxis for patients of neonatal and pediatric age undergoing eye surgery. The following scenarios are considered: (1) intraocular surgery; (2) extraocular surgery; (3) ocular trauma; (4) ocular neoplasm; (5) ocular surface transplantations; (6) corneal grafts. This work has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies and represents, in our opinion, the most complete and up-to-date collection of recommendations regarding clinical actions in the peri-operative environment in eye surgery. The application of uniform and shared protocols aims to improve surgical practice, through the standardization of procedures, with a consequent reduction of SSIs, also limiting the phenomenon of antimicrobial resistance.

Hiding in plain sight—wildlife as a neglected reservoir and pathway for the spread of antimicrobial resistance: a narrative review

Antimicrobial resistance represents a global health problem, with infections due to pathogenic antimicrobial resistant bacteria (ARB) predicted to be the most frequent cause of human mortality by 2050. The phenomenon of antimicrobial resistance has spread to and across all ecological niches, and particularly in livestock used for food production with antimicrobials consumed in high volumes. Similarly, hospitals and other healthcare facilities are recognized as significant 'hotspots' of ARB and antimicrobial resistance genes (ARGs); however, over the past decade, new and previously overlooked ecological niches are emerging as hidden reservoirs of ARB/ARGs. Increasingly extensive and intensive industrial activities, degradation of natural environments, burgeoning food requirements, urbanization, and global climatic change have all dramatically affected the evolution and proliferation of ARB/ARGs, which now stand at extremely concerning ecological levels. While antimicrobial resistant bacteria and genes as they originate and emanate from livestock and human hosts have been extensively studied over the past 30 years, numerous ecological niches have received considerably less attention. In the current descriptive review, the authors have sought to highlight the importance of wildlife as sources/reservoirs, pathways and receptors of ARB/ARGs in the environment, thus paving the way for future primary research in these areas.