Antimicrobial Resistance Situation Research Articles

Issues and recommendations on antibacterial treatment and post-exposure chemoprophylaxis for pertussis

Pertussis is an important public health and clinical issue in China currently. Macrolide resistance in Bordetella pertussis is a serious challenge to prevent and manage pertussis in China. Early, timely and effective antimicrobial therapy plays an important role in alleviating disease, reducing complications and severe diseases, eliminating carriers and reducing secondary transmission, and implementing post-exposure chemoprophylaxis in special scenarios is also necessary to protect individuals at high risk of severe diseases. In view of the current situation of antimicrobial resistance to Bordetella pertussis in China, combining with the practical needs of clinical treatment and prevention and control of pertussis, this article puts forward evidence-based suggestions on antibiotic treatment and post-exposure chemoprophylaxis strategies for pertussis.

An antimicrobial resistance gene situationer in the backyard swine industry of a Philippine City

Antimicrobial resistance (AMR) as a result of antimicrobial overuse and misuse in agriculture is a growing concern, especially in the predominant but poorly regulated backyard or smallholder swine farms of the Philippines. A city-scale surveillance of antimicrobial resistance genes (ARGs) was conducted through selected backyard swine farms to obtain a comprehensive understanding of the AMR situation in the backyard sector of Davao City, Philippines. The ARGs encoding resistance to four antimicrobial classes (β-lactams: blaCTX−M, blaOXA, blaSHV, blaTEM, mecA; quinolones: qnrS and qnr-A2; macrolides: ermA and ermB; tetracycline: tetM) were quantified in swine feces via real-time PCR, and point maps were generated to visualize the ARG geographic distribution. The ARGs bla-TEM, ermB, qnrS, and tetM were detected in all farms at relatively intermediate to high levels, consistently representing the four most used antimicrobial classes in Philippine farms. All the investigated ARGs were present in some local barangay units, indicating potential emergence of AMR hotspots. A 0.5 quantile regression analysis identified specific backyard farm attributes associated with ARG occurrence and diversity, which may influence the ecological spread of the ARGs. These findings provide support for evidence-based guidelines to reinforce a One Health framework for the Philippine National Action Plan to Combat AMR.

Antimicrobial resistance among common bacterial pathogens in Indonesia: a systematic review

The WHO Global Antimicrobial Resistance Surveillance System (GLASS) aims to describe antimicrobial resistance (AMR) patterns and trends in common bacterial pathogens, but data remain limited in many low and middle-income countries including Indonesia. We systematically searched Embase, PubMed and Global Health Database and three Indonesian databases for original peer-reviewed articles in English and Indonesian, published between January 1, 2000 and May 25, 2023, that reported antimicrobial susceptibility for the 12 GLASS target pathogens from human samples. Pooled AMR prevalence estimates were calculated for relevant pathogen-antimicrobial combinations accounting for the sampling weights of the studies (PROSPERO: CRD42019155379). Of 2182 search hits, we included 102 papers, comprising 19,517 bacterial isolates from hospitals (13,647) and communities (5870). In hospital settings, 21.6% of Klebsiella pneumoniae isolates, 18.3% of Escherichia coli isolates, 35.8% of Pseudomonas aeruginosa isolates and 70.7% of Acinetobacter baumannii isolates were carbapenem-resistant; 29.9% of Streptococcus pneumoniae isolates were penicillin-resistant; and 22.2% of Staphylococcus aureus isolates were methicillin-resistant. Hospital prevalence of carbapenem-resistant K.pneumoniae and E.coli, and penicillin-resistant S.pneumoniae increased over time. In communities, 28.3% of K.pneumoniae isolates and15.7% of E.coli isolates were carbapenem-resistant, 23.9% of S.pneumoniae isolates were penicillin-resistant, and 11.1% of S.aureus isolates were methicillin-resistant. Data were limited for the other pathogens. AMR prevalence estimates were high for critical gram-negative bacteria. However, data were insufficient to draw robust conclusions about the full contemporary AMR situation in Indonesia. Implementation of national AMR surveillance is a priority to address these gaps and inform context-specific interventions. Wellcome Africa Asia Programme Vietnam.

An insights into emerging trends to control the threats of antimicrobial resistance (AMR): an address to public health risks.

Antimicrobial agents are used to treat microbial ailments, but increased use of antibiotics and exposure to infections in healthcare facilities and hospitals as well as the excessive and inappropriate use of antibiotics at the society level lead to the emergence of multidrug-resistant (MDR) bacteria. Antimicrobial resistance (AMR) is considered a public health concern and has rendered the treatment of different infections more challenging. The bacterial strains develop resistance against antimicrobial agents by limiting intracellular drug accumulation (increasing efflux or decreasing influx of antibiotics), modification and inactivation of drugs and its targets, enzymatic inhibition, and biofilm formation. However, the driving factors of AMR include the sociocultural and economic circumstances of a country, the use of falsified and substandard medicines, the use of antibiotics in farm animals, and food processing technologies. These factors make AMR one of the major menaces faced by mankind. In order to promote reciprocal learning, this article summarizes the current AMR situation in Pakistan and how it interacts with the health issues related to the COVID-19 pandemic. The COVID-19 pandemic aids in illuminating the possible long-term impacts of AMR, which are less immediate but not less severe since their measures and effects are equivalent. Impact on other sectors, including the health industry, the economy, and trade are also discussed. We conclude by summarizing the several approaches that could be used to address this issue.

Antimicrobial Resistance Profiles of E. coli Isolated From Pooled Samples of Sick, Farm, and Market Chickens in Nairobi County, Kenya.

Bacterial antimicrobial resistance (AMR) is a global threat to both human and animal health. This is mainly because the same antimicrobial molecules are used for the treatment and prophylaxis of bacterial diseases in both cases, and about 60% of human pathogens are shared with animals. For effective control of AMR in any country, the current situation has to be established; this is done through surveillance exercises. In Kenya, there is scanty data on the prevailing AMR situation, especially in animals. This paper reports on AMR profiles of 54 E. coli strains isolated from chickens in a cross-sectional study, out of which 36/54 (72%) were from clinically ill chickens, 11/54 (22%) were from farm chickens, and 7/54 (9.7%) were from slaughtered chicken, respectively. All 54 isolates exhibited varying antimicrobial resistance profiles with the majority showing resistance to Ampicillin (85.22%), Tetracycline (66.7%), Co-trimoxazole (57.4%), and Streptomycin (40.7%). Very few isolates were resistant to Amoxicillin and Gentamicin (each at 3.7%), Ampicillin (11.1%), and Nalidixic acid (24.1%). A total of 44/54 (81.5%) showed multiple resistance to up to 6 antimicrobial agents. This information will augment current data on the AMR status of bacteria harbored by chickens in Kenya. It will also inform policymakers in their fight against AMR.

Evaluating the contribution of antimicrobial use in farmed animals to global antimicrobial resistance in humans

Antimicrobial resistance (AMR) is currently regarded by the World Health Organization (WHO) as one of the most significant risks to global public health. The most critical causes of AMR infections in humans are the misuse and overuse of antimicrobials in humans and farmed animals. The rising global demand for food of animal origin encourages the increase of animal production worldwide, especially in developing countries. Simultaneously, current farming practices often extensively use antimicrobials on animals, influencing bacterial AMR incidence. This study aims to evaluate the correlation between antimicrobial use (AMU) in farmed animals and the detection of AMR infections in humans, the effects of enforcing laws in animal farming in a country on AMR situation in the neighbors, and the potential of AMR to spread from one country to another. Using data from 30 largest animal-producing countries in different regions of the world, between 2010 and 2020, and a Spatial Durbin Model (SDM), we found that AMU in farmed animals increases AMR in humans and there is a spatial dependence between countries regarding AMR spreading. Such findings indicate that a globally coordinated strategy regulating AMU on farmed animals may reduce AMR emergence and worldwide spreading.

Appropriateness of Empirical Antibiotic Therapy in Hospitalized Patients with Bacterial Infection: A Retrospective Cohort Study.

The incidence of inappropriate and excessive empirical antibiotic therapy is unclear. The aim of this study was to determine the prevalence of different empirical antibiotic therapy prescriptions, related factors, and outcomes in hospitalized patients with bacterial infection. A retrospective cohort study was performed and patients with bacterial infection who were admitted between October 1, 2019, and September 30, 2020, were included. Multivariable analysis was performed by the logistic regression model. A total of 536 (42.6%) of the 1257 included patients received inappropriate empirical antibiotic therapy (IEAT), and 368 (29.3%) patients received appropriate but unnecessarily broad-spectrum empirical antibiotic therapy (AUEAT). MDRO (adjusted OR 2.932 [95% CI 2.201~3.905]; p < 0.001) and fever on admission (adjusted OR 0.592 [95% CI 0.415~0.844]; p = 0.004) were correlates of IEAT; sepsis (adjusted OR 2.342 [95% CI 1.371~3.999]; p = 0.002), age (adjusted OR 1.019 [95% CI 1.008~1.030]; p < 0.001), MDRO (adjusted OR 0.664 [95% CI 0.469~0.941]; p = 0.021), and urinary tract infection (adjusted OR 0.352 [95% CI 0.203~0.611]; p < 0.001) were correlates of AUEAT. Patients who received AUEAT were more likely to have a poor prognosis (63 [17.8%] vs 101 [27.4%]; p = 0.002). Both IEAT (median [IQR], 24,971 [13,135-70,155] vs 31,489 [14,894-101,082] CNY; p = 0.007) and AUEAT (median [IQR], 24,971 [13,135-70,155] vs 30,960 [16,475-90,881] CNY; p = 0.002) increased hospital costs. 45.3% (570/1257) of patients were infected with MDRO and 62.9% of them received IEAT. Inappropriate and excessive empirical antibiotic use was widely prevalent among hospitalized patients. Either inappropriate or excessive use of antibiotics may increase the burden of healthcare costs, the latter of which may be associated with poor prognosis. Clinicians need to be more judicious in choosing antibiotic(s). The MDRO epidemic was severe, especially in patients who received IEAT. It is imperative to take effective measures to improve the current situation of antibiotic abuse and antimicrobial resistance.

Complete sequence of a new conjugative multidrug-resistance encoding IncFII/IncFIA/IncFIB plasmid carrying NDM-6 metallo-β-lactamase from pathogenic Escherichia coli sequence type 167 isolated from sewage in Norway

The aim of the current study was to determine the genomic map of resistance genes and to understand the potential for mobility by a NDM-6-carrying Escherichia coli strain. A complete and closed genome sequence of the E. coli strain was obtained by applying a combination of short-read Illumina and long-read Nanopore-based sequencing. Isolation of E. coli was performed, using ECC CHROMagar™ and antibiotic sensitivity patterns were determined, using Sensititre™ EUVSEC3 plates. Whole-genome sequencing was performed, using Illumina MiSeq- and Oxford Nanopore MinION-based sequencing. Conjugation experiments were performed, using filter-mating and a green fluorescent protein (GFP)-tagged E. coli strain. Two carbapenem-resistant E. coli strains were isolated from sewage. These strains (2-331 and 2-333) belonged to the sequence type (ST) 167 and carried an NDM-6 carbapenemase. The complete genome of isolate 2-331 (GenBank accession no.: CP110117-22.1) was assembled into six contigs, representing a complete circular chromosome of 4,947,178 bp and five plasmids, ranging from 143,596 bp to 1,549 bp. Plasmid p2-331_1 (∼144 kb), belonging to the IncFII/IncFIA/IncFIB group, carries multiple antibiotic resistance genes, including mph(A), mrx(A), blaTEM-1, rmtB1, blaNDM-6, ble, sul1, qacEΔ1, aadAΔ, dfrA12 and tet(A). Plasmid p2-331_1 was transferred from strain 2-331, via conjugation, conferring resistance against nine different classes of antibiotics to a GFP-tagged E. coli strain. Our study shows emergence of a new conjugative plasmid carrying NDM-6 carbapenemase from pathogenic E. coli ST167 for the first time in Norway. The importance of population-based sewage-surveillance for understanding the antimicrobial resistance situation within the community is highlighted.

Microbial Contamination and Antibiotic Resistance in Marketed Food in Bangladesh: Current Situation and Possible Improvements.

Antimicrobial resistance (AMR) is a public health problem worldwide. Bangladesh, like its neighboring countries, faces many public health challenges, including access to safe food, inadequate food surveillance, as well as increasing AMR. This study investigated bacterial contamination and the AMR profile of pathogens in marketed food in Bangladesh and explored barriers to reducing AMR in the country. We collected 366 tomatoes, 359 chicken and 249 fish samples from 732 vendors in traditional markets in urban, peri-urban and rural areas in Bangladesh, as well as from 121 modern retails in Dhaka capital to analyse Vibrio cholerae and Escherichia coli in fish, Salmonella in chicken, and Salmonella and E. coli in tomatoes. Antibiotic susceptibility against 11 antibiotics was tested using a disc diffusion test and interpreted by an automated zone inhibition reader. In addition, a qualitative study using key informant interviews was conducted to explore antimicrobial use and AMR reduction potential in Bangladesh. We found E. coli in 14.21% of tomatoes and 26.91% of fish samples, while 7.38% of tomatoes and 17.27% of chicken were positive for Salmonella, and 44.98% of fish were positive for Vibrio cholerae. In total 231/319 (72.4%) of all pathogens isolated were multidrug-resistant (MDR) (resistant to three or more antibiotic groups). Qualitative interviews revealed an inadequate surveillance system for antibiotic use and AMR in Bangladesh, especially in the agriculture sector. To be able to fully understand the human health risks from bacterial hazards in the food and the AMR situation in Bangladesh, a nationwide study with a one health approach should be conducted, within all sectors, including AMR testing as well as assessment of the antimicrobial use and its drivers.

A qualitative approach for a situation analysis of AMR risks in the food animal production sector.

In response to the need to manage Antimicrobial Resistance (AMR), countries have produced National Action Plans (NAPs), which require detailed information of the AMR situation in all sectors. Considering the limited information that is publicly available for an analysis of the AMR situation in animal production, the FAO Regional Office for Latin America and the Caribbean (FAO RLC) developed the "FAO tool for a situation analysis of AMR risks in the food and agriculture sectors." The objective of this paper is to present the methodology developed for a qualitative evaluation of the risk factors of AMR toward animal and human health, based on terrestrial and aquatic production systems and their associated national public and private mitigation measures. The tool was developed reflecting the AMR epidemiological model and the guidelines to conduct a risk analysis of AMR from the Codex Alimentarius and WOAH. Applied in four stages of progressive development, the objective of the tool is to provide a qualitative and systematic assessment of the risks of AMR from animal production systems, to animal and human health, and to identify gaps in cross cutting factors in AMR management. The tool consists of three instruments: (i) a survey to collect data for a situation analysis of AMR risks; (ii) a methodological procedure for the analysis of the information obtained; (iii) instructions for the preparation of a national roadmap for the containment of AMR at a national level. Based on the results from the information analysis, a roadmap is prepared by guiding and prioritizing the needs and sectoral actions for the containment of AMR under an intersectoral, multidisciplinary and collaborative approach, and according to country priorities and resources. The tool helps to determine, visualize and prioritize the risk factors and challenges that contribute to AMR from the animal production sector and that need to be addressed to manage AMR.

State of Knowledge on the Acquisition, Diversity, Interspecies Attribution and Spread of Antimicrobial Resistance between Humans, Animals and the Environment: A Systematic Review.

Resistance to antibiotics is considered one of the most urgent global public health concerns. It has considerable impacts on health and the economy, being responsible for the failure to treat infectious diseases, higher morbidity and mortality rates, and rising health costs. In spite of the joint research efforts between different humans, animals and the environment, the key directions and dynamics of the spread of antimicrobial resistance (AMR) still remain unclear. The aim of this systematic review is to examine the current knowledge of AMR acquisition, diversity and the interspecies spread of disease between humans, animals and the environment. Using a systematic literature review, based on a One Health approach, we examined articles investigating AMR bacteria acquisition, diversity, and the interspecies spread between humans, animals and the environment. Water was the environmental sector most often represented. Samples were derived from 51 defined animal species and/or their products A large majority of studies investigated clinical samples of the human population. A large variety of 15 different bacteria genera in three phyla (Proteobacteria, Firmicutes and Actinobacteria) were investigated. The majority of the publications compared the prevalence of pheno- and/or genotypic antibiotic resistance within the different compartments. There is evidence for a certain host or compartment specificity, regarding the occurrence of ARGs/AMR bacteria. This could indicate the rather limited AMR spread between different compartments. Altogether, there remains a very fragmented and incomplete understanding of AMR acquisition, diversity, and the interspecies spread between humans, animals and the environment. Stringent One Health epidemiological study designs are necessary for elucidating the principal routes and dynamics of the spread of AMR bacteria between humans, animals and the environment. This knowledge is an important prerequisite to develop effective public health measures to tackle the alarming AMR situation.

Antimicrobial resistance surveillance system mapping in different countries.

Objectives: Excessive use of antibiotics has increased antimicrobial resistance (AMR) worldwide, which is a major public concern among the countries. To control this threat proper monitoring of the antimicrobial usage with increasing rate of AMR is required. Moreover, alternatives for antibiotics are surveyed and are being researched for quick use in the future. Thus, multisector intervention is highly encouraged for better outcomes. In this research article, six different European countries are discussed in terms of antimicrobial usage and AMR in human and livestock sectors with the help of literature study and various reports published by different organizations. Methods. Data study has been conducted to collect data for comparison study. Data sources of AMR and antimicrobial usage are analyzed and both antimicrobial use and AMR are compared. Results: This article provides surveillance systems that are formed to keep a track on the upcoming situation of AMR and the consumption of antimicrobials by humans as well as animals. The article firmly allows the readers to get broad information about the AMR across six countries of Europe. These annual reports have hugely helped the government to decide for alternatives and have focused in many training activities to combat the AMR situation globally. Conclusion: As antibiotic resistance genes persist on an interface between environment and animal and animal health, an approach is required in all three areas that stress the concept of “One Approach to Health.”

Therapeutic approaches to combat the global antibiotic resistance challenge.

Antimicrobial resistance (AMR) has become a major concern for healthcare workers due to the emergence of new variants of resistant markers, especially carbapenemases. Combinational antibiotic therapy is one of the best and easiestapproaches to handle the current situation of AMR. Althoughsome antibiotic combinations are already in clinical use, they remain tobe studied in detail. This review focuses on therapeutic options for AMRmechanisms of resistance in bacteria that can be overcome by combinational therapy andtesting methods for synergy. The integration of diverse approaches may provide information that is imperative in mitigating the threat of AMR.

Influence of the Verordnung über Tierärztliche Hausapotheken on antimicrobial use in dogs and cats in Bavaria

Aim of the study was to collect data concerning the use of antibiotics (AB) in dogs and cats in veterinary practices and clinics in Bavaria, Germany. It was evaluated, whether changes in the use of AB since the amendment of the Verordnung über Tierärztliche Hausapotheken (TÄHAV, German Regulation on the Veterinary In-house Pharmacy) in March 2018 could be documented. Using 2 anonymous online surveys in 2017 and 2020, veterinarians treating dogs and cats in Bavaria were questioned about their usage of AB and their assessment of the current antimicrobial resistance situation. The results of both surveys were evaluated statistically and compared with each other. While in 2017 a total of 238 questionaries were evaluated, 160 could be included in 2020. The three most commonly used antibiotics for systemic therapy were Amoxicillin/Clavulanic acid (74.8 % of veterinarians), Enrofloxacin (56.7 %) and Amoxicillin (53.4 %) in 2017; and Amoxicillin/Clavulanic acid (88.8 %), Amoxicillin (67.5 %) and Metronidazole (33.8 %) in 2020, respectively. The participating veterinarians stated that their overall use of 3 rd and 4th generations cephalosporins (from 20.2 % of veterinarians in 2017 to 9.4 % in 2020, p = 0,005) as well as fluoroquinolones (from 80.3 % to 33.1 %, p < 0.001) had significantly declined. In 2020, the choice of AB in veterinarians was affected by legal requirements (83.8 %), tolerability (81.3 %), way of application (76.9 %), acceptance by the patient (70.0 %), and frequency of application (64.4 %), with the last parameter being significantly more important to veterinarians working in a practice (83.8 %, p = 0.004) than to veterinarians in a clinic. Veterinarians report a significantly reduced usage of fluoroquinolones and 3 rd and 4th generation cephalosporines in dogs and cats compared to 2017. These changes in prescribing practice could be a consequence of the amendment of the TÄHAV, which dictates a prohibition of rededication as well as an obligation for microbial sensitivity testing for these AB classes. Legal restrictions could have a positive influence on the amount and type of antibiotics used and therefore help to prevent antimicrobial resistance.

Antimicrobial Resistance in Libya

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

What Nepalese can Learn about Antimicrobial Resistance?

Antimicrobial Resistance (AMR) is a worldwide public health problem. The sub-therapeutic use of antimicrobials diminishes the significant threat where and how poultry are raised caused by AMR. AMR in critically important drugs may reduce options on antimicrobial use and bring us back to the post-antimicrobial era. Antimicrobial stewardship should be perceived uniformly by every stakeholder for targeted and appropriate antimicrobial use. Out of six criteria prepared by WHO to combat AMR, Nepal has implemented only three of them. Hence, this study aimed to analyze the AMR situation and the scope of antimicrobial use in poultry in Nepal to improve understanding on how to develop actions that address AMR in poultry.

Closing the GAP in Antimicrobial Resistance Policy in Benin and Burkina Faso.

ABSTRACTAntimicrobial resistance (AMR) is a global concern that is geographically unevenly distributed, with low- and middle-income countries and African countries suffering in particular. The World Health Organization (WHO) Global Action Plan (GAP) for antimicrobial resistance identified five key objectives that aim to ensure the continued treatment and prevention of infectious diseases with the use of antibiotics. Countries signatory to the WHO GAP are expected to develop their own national action plans (NAPs) based on the global model. How low-income countries are able to achieve the GAP objectives is not well understood. This paper analyzes the progress of two West African countries in achieving the GAP targets, Benin and Burkina Faso, countries among the lowest bracket in the World Development Index. We present qualitative data from interviews and focus group discussions with local policy-makers, nurses, doctors, animal breeders, veterinarians, and laboratory researchers, supported by participant observations and surveys within rural communities. The analysis is organized according to the five WHO GAP objectives to show the countries’ challenges in fulfilling them. The analysis shows that there are shortcomings in all of the WHO GAP areas in the two countries, making it a compounded and multifactorial problem—a stacking of lacks. In such contexts, calibrating a society toward AMR resilience/prevention requires overall development and attention to interdependencies. Active local research and policy communities with international, sustained financial support are essential for achieving the targets.IMPORTANCE The burden of antimicrobial resistance (AMR) is unequally distributed across the globe. Low-income countries face a more severe AMR situation and have fewer means to solve the problem. This paper brings out the voices of local experts, policy-makers, and members of the community in Benin and Burkina Faso across human health, animal health, and food production sectors, where the majority of antibiotic use is concentrated. We describe the difficulties that they face in implementing global action plans, targets set by the World Health Organization, for securing antibiotics and preventing the spread of antimicrobial resistance. This paper argues that the various deficits in implementation are stacked, multisectoral, and compounded. We highlight the role of active local scientists and policy-maker networks in setting priorities to address the AMR problem; however, their activities need technical and financial support from international partners.

Investigation of Bacterial Isolations and Antimicrobial Susceptibility of Chronic Rhinitis in Cats.

Simple SummaryAlthough rhinitis is a quite common disease in cats, the underlying cause is not easily explored. In addition to responding to the emerging concern regarding antimicrobial resistance and close contact between a pet and its owner, this study investigated bacterial identification and antimicrobial susceptibility in chronic rhinitis in cats. The current study found that rhinitis was more likely in younger and young adult cats, with Pseudomonas spp. being the main bacterial species, as well as multidrug-resistant, followed by Pasteurella spp., Staphylococcus spp., and E. coli. Overall, amikacin, imipenem, and meropenem, which are intravenous antimicrobial agents, exhibited high activity against most bacterial species. However, the use of antimicrobials in categories A and B (EMA) in companion animals are not recommended if other antimicrobial choices are available. Notably, this report reflects on the current antimicrobial resistance situation. Therefore, the appropriate antimicrobial usage and selected drugs should be based on antimicrobial use guidelines, the result of culture, and antimicrobial susceptibility.Chronic rhinitis is a quite common upper respiratory tract (URT) disease in cats. As a result of unclear etiology, frequently, multidrug-resistant bacteria are identified. This study investigated bacterial isolations and an antimicrobial susceptibility test (AST) in chronic rhinitis in cats. The medical records of 395 cats with chronic URT signs were reviewed at the Kasetsart University Veterinary Teaching Hospital (KUVTH) between 2016 and 2021 to survey the underlying causes of URT. Then, apart from rhinitis, other causes were excluded to identify the bacterial species and antimicrobial susceptibility. The results indicated that the most frequent finding was neoplasia, followed by rhinitis and anatomical defects. Furthermore, the only significant association was between the age range and disease group, with gender, FIV, or FeLV infection not being significant. Rhinitis was 4.7 times more likely to occur than neoplasia in younger and young adult cats in the age range < 1–3 years compared to the group > 10 years. The main bacterial species was the Pseudomonas species. Antimicrobials with a susceptibility rate of more than 90% were amikacin, gentamicin, ciprofloxacin, norfloxacin, marbofloxacin, imipenem, and meropenem. In conclusion, rhinitis was the second most common chronic URT disease in cats and was more common in younger and young adult cats. The predominant bacteria with AST in this study reflect the antimicrobial resistance situation. Thus, antimicrobial usage should follow antimicrobial use guidelines first.

Scenario of Antibiotic Resistance in Pakistan: A Systematic Review

Background: A rise in antimicrobial resistance and a decrease in the discovery of novel antibiotics have occurred in recent years. Pakistan is a South Asian developing nation with a high level of antibiotic resistance, which poses a serious regional and global threat. Objective: To determine the situation of antimicrobial resistance in Pakistan Methodology: In the current study the literature was reviewed systematically according to the guidelines of PRISMA. Numerous databases like PUBMED, Embase, Medline and Google scholar were reviewed to determine the prevalence of antimicrobial resistance in Pakistan in the last 10 years from 2012 to 2022. For collection of duplicate data, a standardized extractive datasheet was used. All the data was entered in Microsoft Excel 2019. Results: In the current study, a total of 82 articles were included for final analysis. Multiple drug resistant bacteria were observed in 8 (9.76%) studies while extensive drug resistant bacteria were observed in 2 (2.44%) studies. High median resistance (95% CI) was shown by E. coli to first line antibiotics. Salmonella spp showed high median resistance to ciprofloxacin (90.5%). High median resistance was observed to majority of available antibiotics by Acinetobacter spp. Pseudomonas spp were highly susceptible (86.5%) to cefoperazone-sulbactam. MRSA S. aureus was reported in 13 studies and they were highly resistant to penicillin (98%), cefoxitin (83%) and levofloxacin (80%). Conclusion: Our study concludes that antimicrobial resistance pattern of common pathogens was high against commonly prescribed antibiotics. Regularization of monitoring practices, regular local and national monitoring, molecular investigations, and particular efforts to address the risk associated with the rise in antibiotic resistance are required to combat this issue. Keywords: Antibiotic resistance; Multiple drug resistance, Extensive drug resistance

The Implementation of National Action Plan (NAP) on Antimicrobial Resistance (AMR) in Bangladesh: Challenges and Lessons Learned from a Cross-Sectional Qualitative Study.

This study explored the current situation of the National Action Plan (NAP) on Antimicrobial Resistance (AMR) implementation in Bangladesh and examined how different sectors (human, animal, and environment) addressed the AMR problem in policy and practice, as well as associated challenges and barriers to identifying policy lessons and practices. Informed by a rapid review of the available literature and following the World Health Organization (WHO) AMR situation analysis framework, a guideline was developed to conduct in-depth interviews with selected stakeholders from January to December 2021. Data were analysed using an adapted version of Anderson’s governance framework. Findings reveal the absence of required inter-sectoral coordination essential to a multisectoral approach. There was substantial coordination between the human health and livestock/fisheries sectors, but the environment sector was conspicuously absent. The government initiated some hospital-based awareness programs and surveillance activities, yet no national Monitoring and Evaluation (M&E) framework was established for NAP activities. Progress of implementation was slow, constrained by the shortage of a trained health workforce and financial resources, as well as the COVID-19 pandemic. To summarise, five years into the development of the NAP in Bangladesh, its implementation is not up to the level that the urgency of the situation requires. The policy and practice need to be cognisant of this fact and do the needful things to avoid a catastrophe.