Resistance In Europe Research Articles

A monitoring framework for reinforcing policies against antimicrobial resistance in Europe

Abstract In an attempt to overcome barriers to the effective implementation of policies against antimicrobial resistance (AMR) in the EU Member States, Norway and Iceland, One Health national action plans (NAPs) need to show improvements in both their formulation and their implementation. Research conducted by Tetra Tech, funded by the EU4Health Programme, has identified shortcomings to One Health national policies across all countries, such as limited political focus and awareness of the challenges brought by AMR; lack of operational plans for delivering on the NAPs; and lack of harmonised indicators and inadequate information systems for monitoring the implementation of plans. On this last issue, subsequent reseach by Tetra Tech has supported the design and development of monitoring indicators for reinforcing the expected improvements of NAPs and the implementation of policies aimed at EU Member States in the 2023 “Council Recommendation on stepping up EU actions to combat antimicrobial resistance in a One Health approach”. While drawing on existing data sources at EU and global level, the study has also worked with Member States representatives in identifying indicators for the monitoring framework and proposed new data collection activities at the national level. Key messages • EU countries face common barriers to the effective implementation of One health policies against AMR, and need to reinforce their national action plans. • Stepping up the fight against AMR in the EU requires a strong monitoring framework for following up on EU recommendations.

Techno-pessimistic and techno-optimistic visions of surveillance and resistance in Europe

Techno-pessimistic and techno-optimistic visions of surveillance and resistance in Europe

«Қазақтар Екінші дүниежүзілік соғыста: шетел архивтерінен жаңа құжаттар» (2018-2020 жж.) мемлекеттік гранты бойынша жаңа табыстар

The participation of Kazakhs in the movement of resistance in Europe is a glorious page of both Kazakh and European history. The study and use of archival documents that shed light on the participation of Kazakhs in the fight against fascism, on the fate of people who were captured by the fascists, the discovery of the burials of fallen heroes, the restoration of the names of people who were officially considered missing, is an important part of the formation and preservation of the historical memory of the Kazakh people. Complex interdisciplinary study of the problems of the participation of Kazakhs in the Second World War in European countries, is a priority task of the International Research Project “Kazakhs in the Second World War: new documents from foreign archives” under the leadership of a doctor of historical sciences, professor G.M. Mendikulova. In the article, documents about the participation of Kazakhs in the movement of resistance in Europe, identified by the authors in foreign archives, are analyzed. Thousands of Soviet people, prisoners of war and civilians, who were taken to the West by the fascists, ended up in camps, forced labor in Belgian mines, factories, and farms. However, many of them did not accept their participation. People entered into an unequal struggle with fascist invaders, escaped from concentration camps, created partisan detachments. They defeated the enemy together with European patriots. The testimonies of eyewitnesses, certificates, reports on the actions of partisan detachments, documents on losses and burials found in the archives allow to restore and make public the history of the exploits of Kazakhs who heroically fought against fascism in Europe

Integrated Plan of Insecticide Resistance Surveillance in Mosquito Vectors in France

Mosquito-borne diseases such as malaria, dengue, or chikungunya have been re-emerging all over the world, including in Europe. Managing resistance to public health pesticides in mosquitoes is essential and requires global, integrated, and coordinated actions and strong engagement of decision-makers, scientists, and public health operators. In this context, the present work aims at proposing an integrated plan of resistance surveillance in France and in the French Overseas territories in order to provide graduated and appropriate responses according to the situation. Briefly, the plan relies on periodic monitoring of insecticide resistance at the population level in predefined sites using adequate biological, molecular, and/or biochemical approaches and a stratification of the level of resistance risk at the scale of territory to adjust surveillance and vector control actions. The plan relies on the latest methods and indicators used for resistance monitoring as recommended by the World Health Organization in order to prevent or slow down its extension in space and time. The plan has been developed for France but can be easily adapted to other countries in order to provide a coordinated response to the growing problem of mosquito resistance in Europe.

Robert Gildea and Ismee Tames, eds. Fighters across Frontiers: Transnational Resistance in Europe, 1936–48.

Resistance in Europe during the Second World War has long suffered from being studied through a predominantly national lens. The weight of postwar narratives of national reconstruction, the logics of funding bodies and of archives, as well as the wish of many historians to locate resistance within national triptychs of defeat, resistance, and liberation, have all deflected attention from the evident reality that resistance was a phenomenon that spilled beyond state borders in its structures and operations, its personnel, and its mentalities. Indeed, much resistance occurred in spaces outside the nation: within local communities and specific social milieux, and among those whose loyalties and experiences transcended state boundaries. It is this last group—the transnational resistance of those who by choice or circumstance found themselves outside the nation—who are the focus of Robert Gildea and Ismee Tames’s Fighters Across Frontiers: Transnational Resistance in Europe, 1936–48. Written collectively by a team of twenty-three historians of fourteen nationalities, it is the first Europe-wide attempt to explore the resistance against fascism, the Third Reich, and its allies by foreign fighters, political exiles, economic migrants, refugees from persecution, and the agents of external powers. This transnational resistance was almost infinitely diverse, and the editors very wisely eschew any attempt to impose a definition on their subject matter, preferring to allow the wealth of primary material to speak for itself. The series of loosely chronological chapters trace the emergence of the multiple forms and spaces of transnational resistance from the International Brigades in the Spanish Civil War to the military campaigns of the early war years, the camps of political detainees and POWs, the escape lines created for downed airmen and Jewish civilians, and the armed resistance movements that emerged in German-occupied Europe during the latter war years. Transnational resistance flourished especially in the spaces in between—among the partisan groups that operated in the free zones of the western Balkans, and of Italy after the collapse of Fascist rule, or behind the fluid battle lines of the eastern front. These improvised military units received material and organizational support from the Soviet, British, and American forces. But the primary driving forces behind their development was the social chaos generated by the escalation of the war, the policies of repression imposed by the Nazi rulers and their local allies, and the effective collapse of government in large areas of German-occupied Europe. As national structures disappeared, they created opportunities for new armed groups, often highly local and personalized in character, that operated outside the boundaries of state authority. These drew on the large numbers of exiles and migrants displaced over the previous years by persecution and war, for whom resistance was the expression of their political and ideological beliefs as well as a response to their marginal and illegal status. But their ranks were greatly swelled during the final years of the war by former prisoners of war, Jewish refugees, and labor conscripts, as well as by the many civilians obliged to flee their homes to escape ethnic and military conflict. These formed highly heterogenous units, where the labels of national identity were more symbolic than real. Spanish Republicans featured prominently among the Free French units who marched into Paris with the Allied troops; former Italian soldiers fought in the partisan units that wrested Belgrade from German control; while the Slovak National Uprising in 1944 was carried out by a heterogenous coalition of local fighters, Soviet partisans, and British and American agents, supplemented by diverse groups of escaped POWs and displaced conscript workers.

Industrial Embeddedness and Regional Economic Resistance in Europe

We study the role of local industrial embeddedness (the share of regional interindustry economic activity that is anchored to a region) on regional resistance (the difference between pre- and postcrisis employment) to the 2008 Great Recession (GR) in EU and UK NUTS-2 regions. The recession had profound effects in regional economies, which showed diverse performance based on their capacity to absorb the shock. The concept of economic resilience has been brought to the center of attention with several contributions exploring its determinants. However, the impact of the embeddedness of local economic systems in terms of sales and supplies has been largely unexplored. We use regional input–output tables to approximate the embeddedness of local economies, and we use fixed-effects and quantile regressions to test its relationship to regional resistance between 2008 and 2011. We find that during the GR, regional industries opted to change input rather than output markets. Additionally, embeddedness has a curvilinear relationship to regional resistance that varies across the distribution of regional resistance performance. Finally, at the industry level, we find regional embeddedness to be important to the resistance of manufacturing and financial and business services, and sectoral embeddedness to matter more for the resistance of construction and wholesale, retail, and information technology. Our findings highlight nuances that policy makers should be aware of in planning for resilience.

Civil Resistance from the End of the Cold War to the 21st Century: A Historical Perspective

Civil resistance made a significant contribution to the largely peaceful end of the Cold War and has become an increasingly important factor of post-Cold War international politics. This essay proposes a historical reflection of civil resistance from the end of the Cold War to the present, in relation to some crucial issues on the contemporary international scenario. Taking 1989 as the starting point, the main aim of this study is to explore the legacy of the “Long 1989” in the evolution of civil resistance. The essay focuses on three main issues: i) the rise and decline of the post-1989 liberal cycle of civil resistance in Europe; ii) the consequences of the Tiananmen Square Massacre and the emergence of a new Chinese authoritarian state capitalism; and iii) the impact of the technological and digital revolution on post-1989 civil resistance.

Impact de la première année de la pandémie de COVID-19 sur l’épidémiologie des infections invasives (bactériémies) dans les hôpitaux de l’Assistance Publique–Hôpitaux de Paris

The COVID-19 pandemic has led to a massive influx of patients suffering from severe forms of the disease into hospitals, often requiring intensive care (vascular catheters, ventilation, etc.) which exposes them to high risks of nosocomial infections, particularly invasive infections (bacteremia). The impact of the COVID-19 pandemic on the epidemiology of bacteremia in 2020 was analysed in 25 hospitals of the Assistance Publique-Hôpitaux de Paris (AP-HP, approximately 14,000 beds, covering the Île-de-France region). Up to a quarter of patients admitted to AP-HP during the March-April period (peak of the 1st wave) were infected with COVID-19. The incidence over 100 admissions of bacteraemia increased overall compared to previous years: by 24% in March 2020 and by 115% in April. The evolution of the incidence of bacteremia was not the same for 2 groups of microorganisms with very different ecologies. For the "hospital" type microorganisms classically responsible for nosocomial infections, the incidence increased significantly in March-April 2020: Klebsiella pneumoniae (×2.3), Pseudomonas aeruginosa (×2.4), Staphylococcus aureus (×2.4), enterococci (×3.4), yeasts (×2.7). Two thirds of the bacteremias caused by these microorganisms were considered as acquired during hospitalization. Importantly, there was also a sharp increase in the incidence of bacteremia caused by antibiotic-resistant strains. The antibiotics used as indicators were the 3rd generation cephalosporins (3GCs), major antibiotics in the treatment of serious infections used for monitoring bacterial resistance in Europe. For example, the incidence of bacteremia with 3GC-resistant strains increased threefold in April 2020 for K. pneumoniae. During the same period, the consumption of 3GC increased sharply in the same hospitals (+131% in March and +148% in April). For Streptococcus pneumoniae (pneumococcus) and Streptococcus pyogenes (group A hemolytic streptococcus), two pathogens responsible for mainly community and respiratory-transmitted infections, the pandemic had the opposite effect. There was a decrease in incidence in 2020 by 34% and 28% respectively for these two species, particularly in the spring when strict containment, physical distancing and mask-wearing measures were in place. A slight re-emergence of infections with these two species occurred in the summer of 2020 after the relaxation of prevention measures. In contrast to what was seen above, 4/5 of the bacteremias caused by these two species were considered as community-acquired. The COVID-19 pandemic which had a strong impact on hospital management and social organization in the general population, had opposite impacts on the incidence of bacteremia depending on the pathogens and their mode of transmission.

Trends of Transmitted and Acquired Drug Resistance in Europe From 1981 to 2019: A Comparison Between the Populations of Late Presenters and Non-late Presenters.

BackgroundThe increased use of antiretroviral therapy (ART) has decreased mortality and morbidity of HIV-1 infected people but increasing levels of HIV drug resistance threatens the success of ART regimens. Conversely, late presentation can impact treatment outcomes, health costs, and potential transmission of HIV.ObjectiveTo describe the patterns of transmitted drug resistance (TDR) and acquired drug resistance (ADR) in HIV-1 infected patients followed in Europe, to compare its patterns in late presenters (LP) vs non-late presenters (NLP), and to analyze the most prevalent drug resistance mutations among HIV-1 subtypes.MethodsOur study included clinical, socio-demographic, and genotypic information from 26,973 HIV-1 infected patients from the EuResist Integrated Database (EIDB) between 1981 and 2019.ResultsAmong the 26,973 HIV-1 infected patients in the analysis, 11,581 (42.9%) were ART-naïve patients and 15,392 (57.1%) were ART-experienced. The median age was 37 (IQR: 27.0–45.0) years old and 72.6% were males. The main transmission route was through heterosexual contact (34.9%) and 81.7% of patients originated from Western Europe. 71.9% of patients were infected by subtype B and 54.8% of patients were classified as LP. The overall prevalence of TDR was 12.8% and presented an overall decreasing trend (p for trend < 0.001), the ADR prevalence was 68.5% also with a decreasing trend (p for trend < 0.001). For LP and NLP, the TDR prevalence was 12.3 and 12.6%, respectively, while for ADR, 69.9 and 68.2%, respectively. The most prevalent TDR drug resistance mutations, in both LP and NLP, were K103N/S, T215rev, T215FY, M184I/V, M41I/L, M46I/L, and L90M.ConclusionOur study showed that the overall TDR (12.8%) and ADR (68.5%) presented decreasing trends during the study time period. For LP, the overall TDR was slightly lower than for NLP (12.3 vs 12.6%, respectively); while this pattern was opposite for ADR (LP slightly higher than NLP). We suggest that these differences, in the case of TDR, can be related to the dynamics of fixation of drug resistance mutations; and in the case of ADR with the more frequent therapeutic failure in LPs.

A Phase 3 Randomized Controlled Trial (MICROCARE) to Evaluate the Efficacy of DAV132 in Preventing Clostridioides Difficile Infection in Patients with Newly Diagnosed Acute Myeloid Leukemia or High-Risk Myelodysplastic Syndrome and Treated with Intensive Chemotherapy

A Phase 3 Randomized Controlled Trial (MICROCARE) to Evaluate the Efficacy of DAV132 in Preventing Clostridioides Difficile Infection in Patients with Newly Diagnosed Acute Myeloid Leukemia or High-Risk Myelodysplastic Syndrome and Treated with Intensive Chemotherapy

Can financial rewards for stewardship in primary care curb antibiotic resistance?

Antibiotic use in primary care remains highly frequent, variable, and is often unnecessary. Hence, in principle, effective outpatient antibiotic stewardship might be an impactful intervention. Countries such as the Netherlands and Sweden where antibiotic stewardship has been applied in the outpatient setting also have some of the lowest rates of antibiotic resistance in Europe. However, for a variety of reasons, antibiotic stewardship in primary care has been challenging in most other world regions.

Short Communication: Prevalence of Transmitted Resistance to Non-Nucleoside Reverse Transcriptase Inhibitors in European and North American Countries Over 20 Years: An Updated Meta-Analysis.

The prevalence of transmitted non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance around the world has been estimated up to 2010. Treatment recommendations have since evolved from NNRTIs to integrase strand inhibitors (INSTIs). This analysis estimates more recent trends in transmitted NNRTI resistance given emerging INSTI use. Studies reporting prevalence of transmitted NNRTI resistance in Europe, the United States, and Canada were meta-analyzed to generate yearly estimates in four regions. Overall prevalence of transmitted resistance continued to rise in the United States to >10% in 2015. Prevalence in European countries with larger surveillance networks was consistent at ∼4% from 2000 through 2012, increasing to 7% in 2016. Prevalence in European countries with fewer available data was generally <5%. Two publications with Canadian data were identified, reporting 0%-3% resistance. This analysis showed increasing prevalence of transmitted NNRTI resistance up to 2016, despite the availability of newer classes of treatments.

In vitro activity of cefiderocol and comparators against isolates of Gram-negative bacterial pathogens from a range of infection sources: SIDERO‑WT‑2014−2018 studies in Spain

The incidence of antimicrobial resistance in Europe is rising. Cefiderocol is approved in Europe for treatment of aerobic Gram-negative bacterial (GNB) infections in adults with limited treatment options. We report the in vitro activity of cefiderocol versus comparators against GNB clinical isolates from Spain. MICs were determined by broth microdilution according to International Organization for Standardization guidelines. Cefiderocol was tested using iron-depleted cation-adjusted Mueller-Hinton broth. Susceptibility rates were based on EUCAST breakpoints; if a species-specific breakpoint was unavailable, pharmacokinetic/pharmacodynamic breakpoints were used. Of 2303 isolates [1502 (65.2%) Enterobacterales and 801 (34.8%) non-fermenters], 2260 (98.1%) were susceptible to cefiderocol compared with 80.8-86.9% for comparators. By infection source, susceptibility to cefiderocol ranged from 97.3% (721/741) in isolates from patients with nosocomial pneumonia to 98.9% (349/353) in bloodstream infection isolates and was greater than susceptibility to comparators (70.7-93.6% across infection sources). Overall, 368/2303 isolates (16.0%) were meropenem-resistant. A high proportion of meropenem-resistant Acinetobacter baumannii [169/175 (96.6%)] and Pseudomonas aeruginosa [48/50 (96.0%)] were cefiderocol-susceptible, similar to colistin [169/175 (96.6%) and 47/50 (94.0%), respectively] but higher than ceftazidime/avibactam [26/175 (14.9%) and 20/50 (40.0%), respectively] and ceftolozane/tazobactam [17/175 (9.7%) and 25/50 (50.0%), respectively]. All meropenem-resistant Stenotrophomonas maltophilia isolates [120/120 (100%)] were cefiderocol-susceptible, including one trimethoprim/sulfamethoxazole-resistant isolate, with fewer susceptible to colistin [86/120 (71.7%)], ceftazidime/avibactam [42/120 (35.0%)] and ceftolozane/tazobactam [35/120 (29.2%)]. A high proportion of clinical isolates from Spain, representing a wide range of pathogens across multiple infection sources, were susceptible to cefiderocol. Cefiderocol retained activity against meropenem-resistant isolates.

Book Review: Fighters across Frontiers: Transnational Resistance in Europe, 1936–48 by Robert Gildea and Ismee Tames

Book Review: <i>Fighters across Frontiers: Transnational Resistance in Europe, 1936–48</i> by Robert Gildea and Ismee Tames

Enhanced metabolism and target gene overexpression confer resistance against acetolactate synthase-inhibiting herbicides in Bromus sterilis.

Intensive application of acetolactate synthase (ALS)-inhibiting herbicides has resulted in herbicide-resistance in many weeds, including Bromus sterilis. The present study was conducted to identify the mechanisms conferring resistance to ALS-inhibiting herbicides in a Bromus sterilis biotype. Dose-response studies revealed the resistant biotype to be 288 times less sensitive to pyroxsulam than the susceptible biotype. Furthermore, experiment with a single-dose, proved this biotype was also cross-resistant to propoxycarbazone, iodosulfuron plus mesosulfuron and sulfosulfuron. Prior treatment with malathion, a known inhibitor of cytochrome P450s, reduced the level of resistance to pyroxsulam. No mutations were detected from the partial ALS gene sequencing. Flow cytometry and chromosome counting rejected ploidy level variation between the susceptible and resistant biotypes. Relative copy number variation ruled out gene amplification. Quantitative real-time polymerase chain reaction (PCR) detected a significant difference in ALS gene expression between the susceptible and resistant biotypes. Target gene overexpression and enhanced metabolism by cytochrome P450s are likely mechanisms of resistance to pyroxsulam in Bromus sterilis. The current findings highlight the need to monitor additional brome populations for herbicide resistance in Europe and endorse the need for alternate herbicides in integrated weed management to delay the possible evolution of herbicide resistance in these species. © 2020 Society of Chemical Industry.

1486. Phylogenetic and alpha toxin variant analyses of Staphylococcus aureus strains isolated from patients during the SAATELLITE study

BackgroundSuvratoxumab is a human monoclonal antibody that neutralizes S. aureus (SA) alpha toxin (AT). SAATELLITE, a phase 2 study of the safety and efficacy of suvratoxumab for reducing the incidence of SA pneumonia (NCT02296320), was conducted within the consortium for Combatting Bacterial Resistance in Europe.MethodsA total of 304 SA isolates (baseline, onset and last available isolates from suspected serious bacterial infections, SSBIs) collected from the lower respiratory tract samples from 165 subjects during SAATELLITE were subjected to whole genome sequencing.AT gene (hla) sequences were translated and amino acid variation was identified in comparison to the reference SA USA300 FPR3757. Phylogenetic analysis, genomic annotation and ST analysis were performed.AT expression in SA culture supernatants was performed by ELISA. Representative isolates with novel AT subtypes that had not been identified in previous studies were tested for hemolytic activity and suvratoxumab neutralizing activity.Wilcoxon rank sum test and Fisher’s exact test were performed, respectively: a) to compare difference in baseline AT expression in relation to SA pneumonia incidence; b) to evaluate the association between occurrence of AT stop codons and incidence of SA pneumonia at baseline, as well as the association between occurrence of AT stop codons and treatment arms at post baseline.ResultsWe identified a total of 44 sequence types (STs) and 21 unique AT subtypes, 7 of which have not been described previously. No substitutions were located in the suvratoxumab binding region and all novel AT subtypes displaying lytic activity were neutralized by suvratoxumab.We detected stop codons Q113B and W205B in AT sequences in 53 and 2 SA isolates, respectively. We uncovered no significant associations of: 1) baseline AT expression with SA pneumonia incidence [p=0.967]; 2) occurrence of AT gene stop codon with either SA pneumonia incidence [p >0.999] or suvratoxumab treatment [p=0.103; lower frequency of stop codons in suvratoxumab arm versus placebo].ConclusionOur data indicated that: 1) suvratoxumab target region in (AT) remains conserved; 2) suvratoxumab is active against all AT variants identified to date; 3) suvratoxumab did not exert pressure on SA clinical isolates for selection of escape mutants.DisclosuresDavid E. Tabor, PhD, AstraZeneca (Employee, Shareholder) Andrey Tovchigrechko, PhD, AstraZeneca (Employee, Shareholder)KitePharma, a Gilead company (Employee, Shareholder) Bret R. Sellman, PhD, AstraZeneca (Employee, Shareholder) Michael McCarthy, n/a, AstraZeneca (Employee) Kathryn Shoemaker, MS, AstraZeneca (Employee) Hasan S. Jafri, MD, FAAP, AstraZeneca (Employee) Mark T. Esser, PhD, AstraZeneca (Employee) Alexey Ruzin, PhD, AstraZeneca (Employee, Shareholder)

Intercontinental trials reveal stable QTL for Northern corn leaf blight resistance in Europe and in Brazil

Key messageNCLB is the most devastating leaf disease in European maize, and the introduction of Brazilian resistance donors can efficiently increase the resistance levels of European maize germplasm.Northern corn leaf blight (NCLB) is one of the most devastating leaf pathogens in maize (Zea mays L.). Maize cultivars need to be equipped with broad and stable NCLB resistance to cope with production intensification and climate change. Brazilian germplasm is a great source to increase low NCLB resistance levels in European materials, but little is known about their effect in European environments. To investigate the usefulness of Brazilian germplasm as NCLB resistance donors, we conducted multi-parent QTL mapping, evaluated the potential of marker-assisted selection as well as genome-wide selection of 742 F1-derived DH lines. The line per se performance was evaluated in one location in Brazil and six location-by-year combinations (= environments) in Europe, while testcrosses were assessed in two locations in Brazil and further 10 environments in Europe. Jointly, we identified 17 QTL for NCLB resistance explaining 3.57–30.98% of the genotypic variance each. Two of these QTL were detected in both Brazilian and European environments indicating the stability of these QTL in contrasting ecosystems. We observed moderate to high genomic prediction accuracies between 0.58 and 0.83 depending on population and continent. Collectively, our study illustrates the potential use of tropical resistance sources to increase NCLB resistance level in applied European maize breeding programs.

Antimicrobial Resistance of Campylobacter spp. Causing Human Infection in Australia: An International Comparison.

The study investigates the prevalence of antimicrobial resistance in Campylobacter jejuni and Campylobacter coli in gastroenteritis patients in the eight most populous regions in Australia and compares the prevalence of antimicrobial resistance in Europe and North America. A total of 164 Campylobacter isolates were collected from patients with campylobacteriosis and tested for susceptibility to six antimicrobials using ETEST® strips and compared with reports from Europe and the United States. Genomes were sequenced on Illumina NextSeq to identify genetic determinants of resistance. Phenotypically, 1.8%, 14.0%, 14.6%, and 20.1% of isolates were resistant to erythromycin (ERY), ampicillin, tetracycline (TET), and ciprofloxacin (CIP), respectively. Comparing published phenotypic results of antimicrobial resistance in several European countries and the United States with these Australian isolates reveals that rates observed in Australia are among the lowest observed for ERY, CIP, and TET for both C. coli and C. jejuni. For each antimicrobial tested, concordance between resistance phenotype and genotype ranged from 66.6% to 100.0%. This study highlights that, among industrialized countries, Portugal and Spain have very high levels of antimicrobial resistance in C. jejuni and C. coli, especially when compared with the United Kingdom, United States, and Australia.

A Survey on National Pediatric Antibiotic Stewardship Programs, Networks and Guidelines in 23 European Countries.

Misuse, overuse of antimicrobials and increasing rates of antimicrobial resistance are well-recognized problems throughout Europe. The aim of this survey was to describe the current pediatric antibiotic stewardship (PAS) landscape across Europe and identify gaps, in terms of national programs, networks and guidelines. A survey of 17 questions was circulated in July 2019 among 24 European pediatric infectious disease researchers and clinicians, professors and heads of department on the existence of PAS programs, national networks and meetings, established competencies, metrics and guidelines. We received responses from 23 countries. National guidelines on the management of children with common infections treated in hospital settings exist in 15 of 23 (70%); only 8 of 15 (53%) had been updated within the previous 4 years. Most provide guidance on antibiotic initiation and duration (14 of 15, 93%), but few on when to transition from intravenous to oral antibiotics (7 of 15, 47%). National PAS competencies have only been developed in 4 countries; only 1 addressed both community and hospital prescribing. Organized national PAS networks are only established in the United Kingdom and Germany; 21 of 23, 91% countries had no agreed metric for antibiotic prescribing in children; 2 of 23 were based on daily defined doses. Fragmented implementation of PAS programs, no agreed metrics, lack of established PAS competencies and national PAS networks along with inexistent funding is alarming in view of existing high rates of antimicrobial resistance in Europe.

ПРОБЛЕМА ПРОИСХОЖДЕНИЯ И ПЕРИОДИЗАЦИИ АНТИГЛОБАЛИСТСКОГО ДВИЖЕНИЯ

В данной статье подробно исследуется проблема появления и генезиса антиглобалистского движения. При этом наибольшее внимание уделяется выявлению его нижних хронологических рамок. Для этого автор подробно рассматривает все основные версии происхождения данного явления, а в качестве вывода предлагает собственную периодизацию. Автор доказывает, что в основе антиглобализма как социального явления лежало движение мексиканских сапатистов, став идейной платформой антиглобалисткого сопротивления в Европе. Европейский антиглобализм приобрел экономическую направленность против неолиберализма. С течением времени движение антиглобалистов приобретало все более широкий международный характер и в то же время теряло популярность в массах. Однако его идеи до сих пор актуальны.