Risk Of Antibiotic Resistance Research Articles

Which organic contaminants should be paid more attention: Based on an improved health risk assessment framework

The increasing chemical pollution of the drinking water is widely concerned. Large number of organic contaminants cannot be removed by conventional water treatment technology due to their low concentration, and long-term exposure may pose significant risks to human health. Which organic contaminants in drinking water should be given more attention has been a topic of great concern in recent years. To identify the organic contaminants that need attention, this research proposes an improved health risk screening method to quantitatively analyze the risks of accumulation, persistence, toxicity, and antibiotic resistance. Compared with conventional method, 26 compounds were added to the improved screening list, including 9 DBPs (e.g., NDMA), 3 antibiotics (e.g., oxytetracycline), PFNA and other compounds. Overall, antibiotics and plasticizers rose in the risk rankings. From the perspective of the proportion of total risk value, a single risk plays a decisive role (more than 99%) in the ranking. This change suggests that antibiotic resistance and the accumulation of organic matter are as important as their toxic risks to humans. 58 compounds were recommended for the priority control organic contaminants list in drinking water. This list provides the necessary information for authoritative regulations to monitor, control, assess, and manage the risks of environmentally relevant compounds in drinking water in China.

Non-antibiotic pharmaceutical phenylbutazone binding to MexR reduces the antibiotic susceptibility of Pseudomonas aeruginosa

Antimicrobial resistance has been an increasingly serious threat to global public health. The contribution of non-antibiotic pharmaceuticals to the development of antibiotic resistance has been overlooked. Our study found that the anti-inflammatory drug phenylbutazone could protect P. aeruginosa against antibiotic mediated killing by binding to the efflux pump regulator MexR. In this study, antibiotic activity against P. aeruginosa alone or in combination with phenylbutazone was evaluated in vitro and in vivo. Resazurin accumulation assay, transcriptomic sequencing, and PISA assay were conducted to explore the underlying mechanism for the reduced antibiotic susceptibility caused by phenylbutazone. Then EMSA, ITC, molecular dynamic simulations, and amino acid substitutions were used to investigate the interactions between phenylbutazone and MexR. We found that phenylbutazone could reduce the susceptibility of P. aeruginosa to multiple antibiotics, including parts of β-lactams, fluoroquinolones, tetracyclines, and macrolides. Phenylbutazone could directly bind to MexR, then promote MexR dissociating from the mexA-mexR intergenic region and de-repress the expression of MexAB-OprM efflux pump. The overexpressed MexAB-OprM pump resulted in the reduced antibiotic susceptibility. And the His41 and Arg21 residues of MexR were involved in the phenylbutazone-MexR interaction. We hope this study would imply the potential risk of antibiotic resistance caused by non-antibiotic pharmaceuticals.

Mg doped ZnO containing silk nanocomposite scaffolds for biofilm prevention during alveolar bone regeneration

Biofilms are created when micro-colonies adhere to a solid surface and produce a strong extracellular matrix which increases the risk of infection and impedes the healing process of bone defects. Although post-operative antibiotics are commonly prescribed to prevent infections, they carry the risk of side effects and antibiotic resistance. Current research explored the potential of magnesium doped zinc oxide incorporated silk fibroin scaffolds to prevent the biofilms formation for alveolar bone regeneration applications. Novel silk fibroin (SF)/hydroxyapatite (HA) scaffolds incorporated with magnesium-doped zinc oxide nanoparticles (Mg–ZnO NPs with 0.5, 1 and 2 % Mg) were fabricated by freeze gelation method. The data suggested that new materials exhibit remarkable antibacterial activity against Staphylococcus aureus. Moreover, these materials are also found to be both biodegradable and biocompatible. The study revealed that scaffolds displayed excellent antibacterial activity that was increased with increasing concentration of Mg in ZnO, with a maximum of 49.39 % was observed for 2 % of Mg doped ZnO. Additionally, biodegradation of the material also increases with the increase in concentration of Mg doping in ZnO. The adequate porosity in the range of 67 %–74.3 % was recorded of new materials substituted with Mg–ZnO, which led to improved cell viability (99.6 %) and uniform deposition of apatite over the surface of scaffolds, making it an excellent candidate for biomedical applications that require antibacterials properties with high cell viability.

Sewerage surveillance tracking characteristics of human antibiotic resistance genes in sewer system

Sewage surveillance is widely applied to track valid human excretion information and identify public health conditions during COVID-19 pandemic. This approach can be applied to monitor the antibiotic resistance level in sewers and to assess the risk of spreading antibiotic resistance in municipal wastewater systems. However, there is still little information about human antibiotic resistance occurrence characteristics in sewerage system. This study conducted a field trial for whole year to advance understanding on spatial and temporal occurrence of antibiotic resistance genes (ARGs) in gravity sewerage. The spatial distribution of ARGs along the drainage pipe line (from human settlements to WWTP) was insignificant, which may be affected by irregular human emission alongside the pipeline. The correlation between ARGs and antibiotics in sewage was insignificant, which suggested that antibiotics have limited effects on the induction and transfer of ARGs. The temporal distribution showed that the effect of temperature on ARGs abundance was evident, the ARGs abundance in sewage was generally higher during the cold season. Metagenomic analysis revealed that the detected ARGs were mainly distributed in Proteobacteria (47.51 %) and Antinobacteria (20.11 %). Potential hosts of ARGs in sewage were mainly identified as human gut microorganisms, including human pathogenic bacteria, such as Prevotella, Kocuria, and Propionibacterium, etc. This study provides a new insight into the sewerage surveillance tracking characteristics of human ARGs in sewer system, and suggesting that the sewage-carried ARGs surveillance is a promising method for assessment and management of antibiotic resistance level on population size.

Cilostazol is a promising anti-pseudomonal virulence drug by disruption of quorum sensing

Resistance to antibiotics is a critical growing public health problem that desires urgent action to combat. To avoid the stress on bacterial growth that evokes the resistance development, anti-virulence agents can be an attractive strategy as they do not target bacterial growth. Quorum sensing (QS) systems play main roles in controlling the production of diverse virulence factors and biofilm formation in bacteria. Thus, interfering with QS systems could result in mitigation of the bacterial virulence. Cilostazol is an antiplatelet and a vasodilator FDA approved drug. This study aimed to evaluate the anti-virulence activities of cilostazol in the light of its possible interference with QS systems in Pseudomonas aeruginosa. Additionally, the study examines cilostazol’s impact on the bacterium’s ability to induce infection in vivo, using sub-inhibitory concentrations to minimize the risk of resistance development. In this context, the biofilm formation, the production of virulence factors and influence on the in vivo ability to induce infection were assessed in the presence of cilostazol at sub-inhibitory concentration. Furthermore, the outcome of combination with antibiotics was evaluated. Cilostazol interfered with biofilm formation in P. aeruginosa. Moreover, swarming motility, biofilm formation and production of virulence factors were significantly diminished. Histopathological investigation revealed that liver, spleen and kidney tissues damage was abolished in mice injected with cilostazol-treated bacteria. Cilostazol exhibited a synergistic outcome when used in combination with antibiotics. At the molecular level, cilostazol downregulated the QS genes and showed considerable affinity to QS receptors. In conclusion, Cilostazol could be used as adjunct therapy with antibiotics for treating Pseudomonal infections. This research highlights cilostazol’s potential to combat bacterial infections by targeting virulence mechanisms, reducing the risk of antibiotic resistance, and enhancing treatment efficacy against P. aeruginosa. These findings open avenues for repurposing existing drugs, offering new, safer, and more effective infection control strategies.

Antibiotic resistance risk assessment in Mymensingh, Bangladesh: Current scenario from human-animal-environmental interfaces viewpoint

The imprudent use of antibiotics increases the environmental microflora's resistance to various drugs, particularly antibiotics. Prescription data is crucial for understanding antibiotic usage frequency and dosage. This health-focused study aims to analyze antibiotic prescription patterns in human and veterinary practices to identify emerging trends in environmental antibiotic resistance.For this survey, A total of 6550 prescriptions were randomly collected from hospitals and pharmacies in Mymensingh sadar upazila, Bangladesh, between August and October 2022. Of these, 5123 (78 %) were for human cases and 1427 (22 %) for veterinary purposes. Photos of the prescriptions were taken and analyzed to understand prescribing habits. Additionally, 30 water samples from rivers, ponds, sewage, and households in Mymensingh City Corporation were collected to assess environmental antibiotic levels and resistance patterns of microorganisms.The analysis showed that Cephalosporins were the most prescribed antibiotics, found in 570 (56.27 %) of human prescriptions and 230 (42.99 %) of veterinary prescriptions. Aminoglycosides had the lowest frequency, with 13 (1.2 %) for humans and 46 (8.6 %) for animals. Macrolides (12.24 %), carboxylic acids (1.87 %), and rifamycins (1.28 %) were only found in human prescriptions, while sulfa drugs (10.84 %), tetracyclines (5.42 %), and combinations of antibiotics (14.77 %) were only in animal prescriptions. Quinolones were prescribed 4.06 times more for humans, while aminoglycosides were used 3.54 times more for animals. Environmental samples showed E. coli had the highest resistance (MAR Value: 0.625) against eight antibiotics.This study illuminates the human-animal prescription patterns that are influenced by environmental factors which drive antibiotic stewardship in Bangladesh. It is imperative for practitioners to exercise caution and adhere to guidelines when prescribing antibiotics, both in human and veterinary practices, given the alarming trend of antibiotic resistance. Additionally, measures must be taken to restrict the influx of antibiotics residue into the environment.

High-throughput profiling of antibiotic resistance genes in the Yellow River of Henan Province, China

Profiling antibiotic resistance genes (ARGs) in the Yellow River of China’s Henan Province is essential for understanding the health risks of antibiotic resistance. The profiling of ARGs was investigated using high-throughput qPCR from water samples in seven representative regions of the Yellow River. The absolute and relative abundances of ARGs and moble genetic elements (MGEs) were higher in summer than in winter (ANOVA, p < 0.001). The diversity and abundance of ARGs were higher in the Yellow River samples from PY and KF than the other sites. Temperature (r = 0.470 ~ 0.805, p < 0.05) and precipitation (r = 0.492 ~ 0.815, p < 0.05) positively influenced the ARGs, while pH had a negative effect (r = − 0.462 ~ − 0.849, p < 0.05). Network analysis indicated that the pathogenic bacteria Rahnella, Bacillus, and Shewanella were the possible hub hosts of ARGs, and tnpA1 was the potential MGE hub. These findings provide insights into the factors influencing ARG dynamics and the complex interaction among the MGEs, pathogenic bacteria and environmental parameters in enriching ARGs in the Yellow River of Henan Province.

Comparison of Chinese medicine additives for antibiotic resistance risks in the Wuding chickens under high stocking density: Advantages and drawbacks

Traditional Chinese medicines (TCMs) with anti-pathogenic properties have been increasingly utilized in animal husbandry as substitutes for antibiotics. However, lingering uncertainties persist regarding the mobility, bacterial hosts, and potential human hazards associated with antibiotic resistance genes (ARGs) in animal husbandry when TCMs are introduced. In this study, cecal digesta from Wuding chickens subjected to varying stocking densities (moderate and high) and treated with different TCMs (dihydroartemisinin, berberine hydrochloride, and oligomeric proanthocyanidins) were collected and subjected to metagenomics-based analysis. A total of 280 ARG subtypes were identified, with multidrug and aminoglycoside resistance genes being the most diverse and abundant. The primary antibiotic resistance bacteria identified belonged to the phyla of Firmicutes (38.68%), Bacteroidetes (22.74%), and Proteobacteria (12.71%); however, some pathogenic antibiotic-resistant bacteria (PARB) were also identified across different samples. Surprisingly, high stocking density was not observed to propagate ARGs, which could be due to the restricted usage of antibiotics. Furthermore, higher proportions of mobile genetic elements and some multidrug-resistant PARB (∼4 times) were observed in high-stocking-density chickens fed berberine hydrochloride than in high-stocking-density chickens fed other TCMs, which could facilitate the horizontal gene transfer (HGT) of ARGs and pose potential human health risks. In contrast, dihydroartemisinin reduced the total abundance of ARGs and the resistome risks to human health (∼10% decrease compared to control). Moreover, rank I ARGs with higher human health risk and the risk index based on ARG risk also ranked lowest (p < 0.05) in high-stocking-density chickens fed dihydroartemisinin. The reduction effect of dihydroartemisinin was achieved by regulating the cecal microbiome of broilers and inhibiting HGT (reducing the contribution from 17.7% to 4.0%). This study provides metagenomic evidence of the development of ARGs in broiler breeding environments. The findings highlight the distinct characteristics of TCMs as feed additives on regulating the antibiotic resistome during broiler farming and demonstrate dihydroartemisinin as an effective additive complying with the environmental safety.

Environmentally persistent microbial contamination in agricultural soils: High risk of pathogenicity and antibiotic resistance

Persistent microbial contamination commonly occurs in the environment. However, the characteristics and associated risks remain largely unknown. The coexistence of virulence factor genes (VFGs) and “last-resort” antibiotic resistance genes (LARGs) on human bacterial pathogens (HBPs) are notorious, creating ecological concerns and health risks. Herein, we explored the pathogenicity and antibiotic resistance levels of LARG-harboring HBPs in agricultural soils. Our findings revealed a high distribution level of VFGs and LARGs in soils (an absolute abundance up to 4.7 × 107 gene copies/g soil) by quantitative PCR (qPCR). Furthermore, most isolated LARG-harboring HBPs exhibited a 100 % lethality rate to Galleria mellonella. LARG-carrying plasmids had a low fitness cost to their host bacteria, implying the high adaptation of these plasmids within the HBPs. Most importantly, multiple LARG and VFG plasmid fusion and core genetic arrangements suggested that these LARG/VFG-linked plasmids endowed the stable and persistent horizontal spread of these genes in and/or cross the species and environments. This study not only unveiled high risk, multisource, compliance and stability aspects of environmentally persistent microbial contamination but also illuminated the importance of linking the phenotype-genotype-niche colonization of environmental microbial contamination within “One Health” framework.

Fabrication of ZnO[sbnd]Cu3SnS4 NCs for enhanced visible light-induced photocatalytic degradation of carvedilol

The widespread use of pharmaceutical drugs like carvedilol (CAR) has raised concerns regarding antibiotic resistance, environmental pollution, and potential human health risks. This study addresses these issues by employing advanced pristine nanomaterials, including ZnO and Cu3SnS4 to intricately engineer ZnOCu3SnS4 nanocomposite (NCs). These NCs are designed for enhanced photocatalytic degradation of CAR. Detailed characterization through SEM, and elemental mapping reveals the nanocluster morphology, amorphous nature, proper deposition distribution, and heterojunction formation. XRD studies confirm the purity of the synthesized materials, while XPS validate their chemical states and bonding nature. BET and BHJ analyses demonstrate the enhanced surface area and mesoporous nature of the NCs respectively. UV–visible DRS illustrates successful visible-light sensitization of the ZnOCu3SnS4 NCs with a bandgap of 2.96 eV. Photoluminescence studies indicate reduced charge carrier recombination in the NCs. .OH being the dominant radical involved in photodegradation. The photocatalytic degradation of CAR by ZnOCu3SnS4 NCs achieves a remarkable degradation efficiency of 98 % under optimal condition. These NCs also show outstanding stability across several cycles and remain to function in the presence of ions. Finally, GC–MS analysis suggests the potential CAR degradation routes that result in less hazardous end products. In conclusion, the present research highlights the potential of ZnOCu3SnS4 NCs for efficient wastewater treatment and highlights their capacity to tackle issues related to pharmaceutical drug contamination.

Antibiotic resistance partitioning during on-farm manure separation and high temperature rotary drum composting

Manure application as fertilizer can increase environmental exposure risk, as antibiotics, antibiotic resistance bacteria (ARB), and antibiotic resistant genes (ARGs) can be transmitted to agricultural fields, and adjacent natural systems. Understanding how specific antibiotics and ARGs respond within different manure fractions during on-farm management is limited. The study objective was to conduct a mass flow analysis determining the fate of antibiotic resistance factors (antibiotics, ARGs, and ARB) through solid-liquid separation, with the solid fraction continuing through a bedding recovery unit (BRU) via high temperature rotary composting for use of the manure solids as dairy cow bedding. The results show that most of the manure mass containing the antibiotic resistance factors went untreated following solid-liquid separation, with 95 % of the mass leaving the separator as a liquid and pumped to a storage lagoon for field application and 5 % proceeding to BRU processing. The tetracyclines and tulathromycin sorbed to the manure solids, while the beta lactams, ampicillin, and benzylpenicilloic acid were only found in the liquid fraction. The removal of antibiotic residuals during the BRU composting was insignificant, yet 40 %-73 % of the antibiotics were in the liquid fraction. The BRU composting was 100 % effective in removing the ARB examined. Five of the eight ARGs (Intl1, sul1, tetQ, tetX, and tetM) had significant reduction (>95 %) following the BRU composting treatment. While the three other ARGs (tetW, ermB, and bla2) remained constant despite treatment. This study highlighted the importance of examining manure management from a mass balance perspective and understanding antibiotic resistance risk factors.

Plant-derived essential oil contributes to the reduction of multidrug resistance genes in the sludge composting process

Multidrug-resistant bacteria and multi-resistance genes in sludge have become a serious issue for public health. It is imperative to develop feasible and environmentally friendly methods of sludge composting to alleviate multidrug resistance genes. Plant-derived essential oil is an effective natural and eco-friendly antibacterial, which has great utilization in inhibiting pathogens in the agricultural industry. Nevertheless, the application of plant-derived essential oil to control pathogenic bacteria and antibiotic resistance in composting has not been reported. This study conducted a composting system by adding plant-derived essential oil i.e., oregano essential oil (OEO), to sludge composting. The findings indicated that multidrug resistance genes and priority pathogens (critical, high, and medium categories) were reduced by (17.0 ± 2.2)% and (26.5 ± 3.0)% in the addition of OEO (OH treatment) compared to control. Besides, the OH treatment changed the bacterial community and enhanced the gene sequences related to carbohydrate metabolism in compost microorganisms. Mantel test and variation partitioning analysis revealed that the target virulence factors (VFs), target mobile genetic elements (MGEs), and priority pathogens were the most important factors affecting multidrug resistance in composting. The OH treatment could significantly inhibit the target VFs, target MGEs, and priority pathogens, which were helpful for the suppression and elimination of multidrug resistance genes. These findings provide new insights into the regulation of multidrug resistance genes during sludge composting and a novel way to diminish the environmental risk of antibiotic resistance.

Advanced interpenetrating polymer networks for innovative gastroretentive formulations targeting Helicobacter pylori gastric colonization

The escalating challenges of Helicobacter pylori-induced gastric complications, driven by rising antibiotic resistance and persistent cancer risks, underscore the demand for innovative therapeutic strategies. This study addresses this urgency through the development of tailored semi-interpenetrating polymer networks (semi-IPN) serving as gastroretentive matrices for amoxicillin (AMOX). They are biodegradable, absorb significant volume of simulated gastric fluid (swelling index > 360 %) and exhibit superporous microstructures, remarkable mucoadhesion, and buoyancy. The investigation includes assessment at pH 1.2 for comparative analysis with prior studies and, notably, at pH 5.0, reflecting the acidic environment in H. pylori-infected stomachs. The semi-IPN demonstrated gel-like structures, maintaining integrity throughout the 24-hour controlled release study, and disintegrating upon completing their intended function. Evaluated in gastroretentive drug delivery system performance, AMOX release at pH 1.2 and pH 5.0 over 24 h (10 %-100 %) employed experimental design methodology, elucidating dominant release mechanisms. Their mucoadhesive, buoyant, three-dimensional scaffold stability, and gastric biodegradability make them ideal for accommodating substantial AMOX quantities. Furthermore, exploring the inclusion of the potassium-competitive acid blocker (P-CAB) vonoprazan (VONO) in AMOX-loaded formulations shows promise for precise and effective drug delivery. This innovative approach has the potential to combat H. pylori infections, thereby preventing the gastric cancer induced by this pathogen.

Dynamic migration and risk of cephalosporin antibiotic resistance genes: Move from pharmaceutical plants through wastewater treatment plants to coastal tidal flats sediments

The migration and dissemination of antibiotics and their corresponding antibiotic resistance genes (ARGs) from pharmaceutical plants through wastewater treatment to the environment introduce exogenous ARGs, increasing the risk of antibiotic resistance. Cephalosporin antibiotics (Ceps) are among the most widely used antibiotics with the largest market scale today, and the issue of resistance is becoming increasingly severe. In this study, a cephalosporin pharmaceutical plant was selected and metagenomic analysis was employed to investigate the dissemination patterns of cephalosporin antibiotics (Ceps) and their ARGs (CepARGs) from the pharmaceutical plant through the wastewater treatment plant to tidal flats sediments. The findings revealed a significant reduction in the total concentration of Ceps by 90.32 % from the pharmaceutical plant's Pioneer Bio Reactor (PBR) to the effluent of the wastewater treatment plant, and a notable surge of 172.13 % in the relative abundance of CepARGs. It was observed that CepARGs originating from the PBR could migrate along the dissemination chain, contributing to 60 % of the CepARGs composition in tidal flats sediments. Microorganisms play a crucial role in the migration of CepARGs, with efflux-mediated CepARGs, as an intrinsic resistance mechanism, exhibiting a higher prospensity for migration due to their presence in multiple hosts. While Class I risk CepARGs are present at the pharmaceutical and wastewater plant stages, Class I ina-CepARGs are completely removed during wastewater treatment and do not migrate to the environment. This study reveals the dynamic migration characteristics and potential risk changes regarding Ceps and CepARGs in real dissemination chains, providing new theoretical evidence for the mitigation, control, and risk prevention of CepARGs.

Hydraulic conditions control the abundance of antibiotic resistance genes and their potential host microorganisms in a frequently regulated river–lake system

Antibiotic resistance genes (ARGs) are a growing problem that is widespread in river–lake ecosystems, where they pose a threat to the aquatic environment's health and public safety. These systems serve as critical nodes in water management, as they facilitate the equitable allocation of water resources through long-term and frequent water diversions. However, hydrological disturbances associated with water-regulation practices can influence the dynamics of their potential host microorganisms and associated resistance genes. Consequently, identifying the key ARGs and their resistance mechanisms in heavily regulated waters is vital for safeguarding human health and that of river–lake ecosystems. In this study, we examined the impact of water-regulation factors on ARGs and their hosts within a river–lake continuum using 16S rRNA and metagenomic sequencing. We found that a significant increase in ARG abundance during regulation periods (p < 0.05), especially in the aquatic environment. Key resistance genes were macB, tetA, evgS, novA, and msbA, with increased efflux pinpointed as their principal resistance mechanism. Network analysis identified Flavobacteriales, Acinetobacter, Pseudomonas, Burkholderiaceae, and Erythrobacter as key potential host microorganisms, which showed increased abundance within the water column during regulation periods (p < 0.05). Flow velocity and water depth both drove the host microorganisms and critical ARGs. Our findings underscore the importance of monitoring and mitigating the antibiotic resistance risk during water transfers in river–lake systems, thereby supporting informed management and conservation strategies.

Assessing the impact of positive cultures in preservation fluid on renal transplant outcomes: a scoping review.

Infection following kidney transplantation is a significant risk factor for adverse outcomes. While the donor may be a source of infection, microbiological assessment of the preservation fluid (PF) can mitigate potential recipient contamination and help curb unnecessary antibiotic use. This scoping review aimed to describe the available literature on the association between culture-positive preservation fluid, its clinically relevant outcomes, and management. Following the Joanna Briggs Institute's scoping review recommendations, a comprehensive search in databases (EMBASE, MEDLINE, and gray literature) was conducted, with data independently extracted by two researchers from selected studies. We analysed 24 articles involving 12,052 samples, predominantly published post-2000, 91%of whichretrospective. The prevalence of culture-positive preservation fluid varied from 0.86 to 77.8%. Coagulase-negative staphylococci emerged as the most frequently isolated pathogen in 14 studies. The presence of ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species), observed in two studies involving 1074 donors, was significantly associated with an increased risk of probable donor-derived infections (p-DDI). Of the reviewed articles, 14 reported on probable donor-derived infections, while 19 addressed the topic of preemptive antibiotic therapy. Routine culturing of preservation fluid is crucial for the identification of pathogenic organisms, facilitates targeted treatment and prevents probable donor-derived infections. Furthermore, this approach helps avoid the treatment of low-virulence contaminants, thereby reducing unnecessary antimicrobial use and the risk of antibiotic resistance. In cases where ESKAPE or Candida species are detected, preemptive therapy appears to be an important strategy. Given that the current evidence primarily stems from retrospective studies, there is a pressing need for large-scale, prospective trials to corroborate these recommendations. This scoping review currently represents the most thorough compilation of evidence on how contamination of preservation fluids affects kidney transplant management.

Preventing New Gram-negative Resistance Through Beta-lactam De-escalation in Hospitalized Patients With Sepsis: A Retrospective Cohort Study.

Whether antibiotic de-escalation reduces the risk of subsequent antibiotic resistance is uncertain. We sought to determine if beta-lactam (BL) antibiotic de-escalation is associated with decreased incidence of new Gram-negative resistance in hospitalized patients with sepsis. In a retrospective cohort study, patients with sepsis who were treated with at least 3 consecutive days of BL antibiotics, the first 2 days of which were with a broad-spectrum BL agent defined as a spectrum score (SS) of ≥7 were enrolled. Patients were grouped into three categories: (1) de-escalation of beta-lactam spectrum score (BLSS), (2) no change in BLSS, or (3) escalation of BLSS. The primary outcome was the isolation of a new drug-resistant Gram-negative bacteria from a clinical culture within 60 days of cohort entry. Fine-Gray proportional hazards regression modeling while accounting for in-hospital death as a competing risk was performed. Six hundred forty-four patients of 7742 (8.3%) patients developed new gram-negative resistance. The mean time to resistance was 23.7 days yielding an incidence rate of 1.85 (95% confidence interval [CI]: 1.71-2.00) per 1000 patient-days. The lowest incidence rate was observed in the de-escalated group 1.42 (95% CI: 1.16-1.68) per 1000 patient-days. Statistically significant reductions in the development of new gram-negative resistance were associated with BL de-escalation compared to no-change (hazards ratio (HR) 0.59 [95% CI: .48-.73]). De-escalation was associated with a decreased risk of new resistance development compared to no change. This represents the largest study to date showing the utility of de-escalation in the prevention of antimicrobial resistance.

A Shotgun Metagenomics Investigation into Labeling Inaccuracies in Widely Sold Probiotic Supplements in the USA.

While probiotics are generally considered safe, concerns persist regarding the accuracy of labels on these supplements and their potential contribution to the spread of antibiotic resistance genes. Given that probiotics are predominantly ingested with a view towards obtaining particular health benefits. The objective of this study is to assess the composition of 50 widely available probiotic supplements in the USA using shotgun metagenome sequencing. The study also determines the potential resistome profile, and the functional characteristics of these products. This study finds that 67% of products does not contain any labeling inaccuracies. Antimicrobial Resistance Genes (ARGs) are identified in several products, particularly Bacillus-based products carrying between 10 and 56 genes. The risk posed by the presence of these ARGs requires further study. Functional analysis reveals differences in metabolic profiles among probiotic supplements, indicating the importance of strain-level selection for personalized probiotics. This study provides updated and comprehensive analysis to evaluate a snapshot of the USA market. The study demonstrates that label inaccuracies occur on approximately one third of popular dietary supplement products sold in the USA, supporting the need for improved approaches to marketing and quality control. Further, the risk of antibiotic resistance, especially in Bacillus-based formulations, should be assessed.

Rapid determination and risk evaluation of multi-class antibiotics in aquatic products by one-step purification process coupled with ultra-high performance liquid chromatography–tandem mass spectrometry

A sensitive and robust multiclass analytical method was established to simultaneously determine 55 antibiotics in aquatic products through liquid chromatography–tandem mass spectrometry. A simple one-step purification process was successfully developed, which combined post-acidic acetonitrile extraction directly by an enhanced matrix removal cartridge. This approach eliminated the need for solvent transition. The established method for 55 antibiotics achieved an excellent linear relationship with R2 values ≥ 0.9921 in the range of 0.05–200 μg/L. The quantitation limits ranged within 0.04–5.0 μg/kg. Satisfactory recoveries (76.2%–99.7 %) were achieved with the relative standard deviations below 13.9 %. Furthermore, the antibiotic residues in aquatic products were analyzed, and the health and antibiotic resistance risk assessments were conducted. Although the health risks of target antibiotics were acceptable, a resistance risk was observed. Therefore, monitoring antibiotic residue levels in aquatic products requires considerable attention and further research to ensure the quality of marine products and consumer safety.

Opinions of Medical Staff Regarding Antibiotic Resistance.

Antibiotic resistance poses a significant threat to public health, that can lead to reduced effectiveness of many therapies, increased morbidity, longer hospitalization times, increased deaths, and additional costs for health care systems. Unreasonable use of antibiotics may result from a lack of adequate knowledge about antibiotic therapy and a lack of knowledge of the risks associated with antibiotic resistance, both among medical personnel and patients. The primary objective of the study was to verify the opinion of medical personnel on the risks associated with antibiotic resistance. The study was conducted in 2023 among 605 Polish sanitary workers. An anonymous survey designed specifically for the purpose of the study was used. The survey was made available on the Internet through the Trade Unions of Pharmacy Workers and directly to hospitals with the support of local authorities. The majority of respondents were women (77.36%). The largest group consisted of individuals over 40 years of age (55.04%). More than half of the respondents were nurses (56.20%), and every fourth of the respondents was a physician (23.64%). Most respondents consider antibiotic resistance to be a very serious (24.13%) or extremely serious (30.75%) problem. The problem of antibiotic resistance on a global scale was mentioned, especially in the opinions of physicians and nurses (p < 0.01), people working in the profession for over a year (p < 0.01), and people with a specialization or undergoing specialist training (p = 0.00). Similarly, these groups most often indicated that antibiotic resistance poses a problem in their workplace. The main problems of antibiotic resistance were the use of antibiotics in farm animals (36.69%), the pressure on patients to take antibiotics (38.84%), and the prophylactic use of antibiotics (43.15%). Medical personnel consider antibiotic resistance a somewhat serious problem, although not all agree in this regard. The risk of antibiotic resistance is much more seriously assessed by physicians and nurses, as well as by people with specializations or undergoing specialization training. Knowledge about antibiotic resistance should be further spread among all groups of medical personnel.