Antibiotic Resistance Surveillance Research Articles

Progression of antibiotic resistance in Neisseria meningitidis.

SUMMARYThe human pathogen Neisseria meningitidis (Nm) is the causative agent of invasive meningococcal disease (IMD), usually presenting as meningitis, bacteremia, or sepsis. Unlike Neisseria gonorrhoeae, antibiotic resistance in Nm has developed slowly. However, in the last two decades and with the reemergence of IMD following the COVID-19 pandemic, antibiotic-resistant Nm isolates, especially to penicillin and fluoroquinolones, have progressively increased. Recent worldwide studies of penicillin intermediate and resistant Nm isolates and the PubMLST global database reveal a notable increase in fully penicillin-resistant isolates since 2016, mediated by mosaic penA alleles or the β-lactamase genes blaROB-1 and blaTEM-1. Fluoroquinolone-resistant isolates, mediated by gyrA mutations, have increased since 2005. Also, while still exceptionally rare, four Nm isolates have been identified with third-generation cephalosporin-resistance since 2011. We review the emergence of antibiotic resistance determinants and lineages in Nm, the resistance to agents previously or currently used in treatment or chemoprophylaxis, and summarize updated treatment and prevention guidelines for IMD. Special populations (e.g., individuals on complement inhibitors) and antibiotic resistance in Nm urethritis isolates are also reviewed. The increasing number of resistant Nm isolates worldwide affects chemoprophylaxis and treatment options for IMD and emphasizes the need for enhanced global surveillance of antibiotic resistance in Nm.

Changes in incidence and epidemiology of antimicrobial resistant pathogens before and during the COVID-19 pandemic in Germany, 2015–2022

BackgroundCarbapenem-resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus (MRSA) are among WHO’s priority pathogens with antimicrobial resistance (AMR). Studies suggest potential impacts of the COVID-19-pandemic on AMR. We described changes in AMR incidence and epidemiology in Germany during the COVID-19-pandemic.MethodsWe used two independent datasets, statutory surveillance and laboratory-based Antibiotic Resistance Surveillance (ARS). We included statutory notifications of infections/colonisations of carbapenem-resistant Acinetobacter spp., Klebsiella pneumoniae, Escherichia coli (CRA/CRKP/CREC) and invasive MRSA. Using Poisson/negative binomial regression and assuming continued pre-pandemic (2015/2017–2020) trends, we projected hypothetical notifications as if the pandemic had not occurred. We quantified annual changes during the pandemic period (2020–2022) by comparing to observed notifications. Additional models considered inpatient reductions, seasonality, infections only, or resistant isolates from ARS.ResultsCRA notified cases were reduced by -30% (95%CI -39%|-20%) in 2020, -23% (-36%|-8%) in 2021, but + 32% (+ 6%|+64%) higher in 2022 relative to hypothetical pre-pandemic projections. Changes were − 35%/-31%/+6% for CRKP, -40%/-61%/-48% for CREC and − 33%/-25%/-20% for MRSA. Statutory-models accounting for fewer inpatients, seasonality and infections only showed similar trends, as did ARS-models for resistant isolates and infections. International mobility for CRA, CRKP and CREC decreased in 2020–2021, then increased in 2022.ConclusionsWe observed significant reductions of AMR notifications and infections during 2020–2021, also when accounting for fewer inpatients. We conclude a genuine reduction of AMR spread occurred during the pandemic. Factors like fewer hospitalisations and reduced international mobility contributed. Rising international mobility may partly explain increases for CRA, CRKP and CREC in 2022. A solid understanding of AMR trends improves infection prevention and control.

Antibiotic Resistance Dissemination and Mapping in the Environment Through Surveillance of Wastewater.

Antibiotic resistance is one of the major health threat for humans, animals, and the environment, according to the World Health Organization (WHO) and the Global Antibiotic-Resistance Surveillance System (GLASS). In the last several years, wastewater/sewage has been identified as potential hotspots for the dissemination of antibiotic resistance and transfer of resistance genes. However, systematic approaches for mapping the antibiotic resistance situation in sewage are limited and underdeveloped. The present review has highlighted all possible perspectives by which the dynamics of ARBs/ARGs in the environment may be tracked, quantified and assessed spatio-temporally through surveillance of wastewater. Moreover, application of advanced methods like wastewater metagenomics for determining the community distribution of resistance at large has appeared to be promising. In addition, monitoring wastewater for antibiotic pollution at various levels, may serve as an early warning system and enable policymakers to take timely measures and build infrastructure to mitigate health crises. Thus, by understanding the alarming presence of antibiotic resistance in wastewater, effective action plans may be developed to address this global health challenge and its associated environmental risks.

Prevalence of Vancomycin-Variable Enterococci from the Bloodstream in the Korea Global Antibiotic Resistance Surveillance System, 2017-2022.

Vancomycin-variable enterococci (VVE), though genetically containing van genes, are phenotypically sensitive to vancomycin. If VVE is undetected or does not grow on the vancomycin-resistant enterococci (VRE) selection medium, or both, it can acquire resistance upon exposure to vancomycin. This characteristic is clinically important for the treatment and prevention of VRE. This study aims to analyze the prevalence and characteristics of VVE in Korea through the Global Antibiotic Resistance Surveillance System (Kor-GLASS) and emphasize the importance of VVE. A total of 3342 enterococcal bloodstream isolates were collected through the Kor-GLASS between 2017 and 2022. Antibiotic susceptibility testing, van gene detection, and multilocus sequence typing were conducted with all the isolates. The trends in the domestic prevalence of VVE were analyzed and compared with global prevalence data. Among the isolates, 197 (5.9%), including 124 Enterococcus faecium and 73 E. faecalis, were identified as VVE. While the VRE incidence has declined in Korea since 2020, the VVE incidence is significantly rising. In Korea, only the vanA gene has been detected in both VRE and VVE, and no other van gene variants have been identified. Most of these isolates belong to CC17 (91.3%), with ST17, ST817, and ST80 as the predominant types. We have shown that continuous surveillance is essential in Korea due to the persistently high prevalence of VRE and the potential evolution of VVE into VRE. Consequently, it is critical to evaluate Enterococcus species isolated from domestic clinical settings for their phenotypic vancomycin resistance and the molecular detection of van genes, irrespective of the strain.

Seafood as a source of antibiotic resistant Enterococcus spp

Seafood is a crucial global food source, but its role as a reservoir for antibiotic-resistant pathogens is concerning. This study focuses on the prevalence of antibiotic resistance in retail seafood, using Enterococcus spp. as an indicator. Seven categories of raw seafood were collected from retail markets in Central Italy. Out of 422 samples, 288 tested positive for Enterococcus spp., resulting in a prevalence rate of 68.25% (CI95%: 63.66%-72.51%). The most common species were E. faecalis (48%) and E. faecium (17.4%). Enterococcus spp. was most frequently found in cephalopods, salmon, bivalves, and crustaceans than in sea bass and bream. The odds of Enterococcus spp. recovery were higher in frozen than in fresh samples, while there was no difference between farm-raised and wild-caught seafood. A subset of 102 isolates was selected for antibiotic resistance testing, showing the highest resistance rates to quinupristin/dalfopristin (52.94%) and tetracycline (27.45%). Over 70% of isolates were multidrug-resistant. Additionally, strains resistant to vancomycin and oxazolidinones, two last-resort antimicrobials, were detected. Vancomycin resistance was observed in E. casseliflavus and E. gallinarum, which are naturally resistant due to the vanC chromosomal cluster. The optrA gene, responsible for resistance to oxazolidinones and phenicols, was found in E. thailandicus and E. faecium, where it was located on to a transferable plasmid. In conclusion, this study confirms the widespread presence of Enterococcus spp. in retail seafood. The detection of multi-resistant isolates and resistance to last-resort antimicrobials highlights significant human health risks, stressing the importance of including Enterococcus spp. in seafood antibiotic resistance surveillance.

Genomic characteristics of Vibrio vulnificus strains isolated from clinical and environmental sources

Vibrio vulnificus, a gram-negative pathogenic bacterium, transmitted via undercooked seafood or contaminated seawater, causes septicemia and wound infections. In this study, we analyzed 15 clinical and 11 environmental isolates. In total, 20 sequence types (STs), including eight novel STs, were identified. Antibiotic resistance gene analysis commonly detected the cyclic AMP receptor protein (CRP) in both the clinical and environmental isolates. Interestingly, clinical and environmental isolates were non-susceptible to third-generation cephalosporins, such as ceftazidime and cefotaxime, complicating the treatment of V. vulnificus infection. Multiple antibiotic resistance (MAR) index ranged from 0.1 to 0.5, with clinical isolates showing a higher mean MAR index than the environmental isolates, indicating their broader spectrum of resistance. Notable, no quantitative (124.3 vs. 126.5) and qualitative (adherence, antiphagocytosis, and chemotaxis/motility) differences in virulence factors were observed between the environmental and clinical strains. The molecular characteristics identified in this study provide insights into the virulence of V. vulnificus strains in South Korea, highlighting the need for continuous surveillance of antibiotic resistance in emerging V. vulnificus strains.

Soiled Toilet Paper for Community-based Surveillance of Antibiotic Resistance and Enteric Pathogens: A Pilot Study

In many countries, soiled toilet paper is placed in trash bins rather than flushed down the toilet. We investigated the use of soiled toilet paper in Guatemalan markets to surveil for pathogenic sequence types (STs) of E. coli and third generation cephalosporin-resistant E. coli (3GCR-EC). We collected used toilet paper from trash bins in the restrooms of three Guatemalan public markets. We screened samples for E. coli and 3GCR-EC. Whole genome sequencing was used to characterize the isolates. E. coli was successfully cultured from all 30 toilet paper samples. Soiled toilet paper was an effective matrix for surveilling multidrug-resistant E. coli and could be an efficient method in certain contexts.

Antibiotic resistance and molecular characterization of non-invasive clinical Haemophilus influenzae isolates in Germany 2019 and 2020.

Haemophilus influenzae (Hi) is known as a cause of invasive and non-invasive diseases. Especially ear, nose and throat (ENT) infections are common reasons for antibiotic prescriptions in outpatient settings in Germany. Therefore, antibiotic resistance surveillance is important to provide the basis of recommendations for the empirical usage of antibiotic agents. To provide data on susceptibility rates of oral antibiotics for non-invasive clinical Hi isolates in Germany and to investigate molecular resistance patterns of β-lactams, ciprofloxacin, doxycycline and trimethoprim/sulfamethoxazole. Isolates were collected from a sentinel network of diagnostic laboratories in a prospective multicentre prevalence study. Antibiotic susceptibility testing was done with a commercial broth microdilution kit. MICs were interpreted according to EUCAST guidelines. Resistance gene sequencing and WGS were performed to analyze molecular antibiotic resistance patterns and genetic relationships between the isolates. In total, 215 Hi isolates were collected from 23 laboratories across Germany. The highest resistance rates were found for amoxicillin (n = 30; 14%), cefuroxime (n = 40; 18.6%) and trimethoprim/sulfamethoxazole (co-trimoxazole) (n = 34; 15.8%). Resistance to amoxicillin was mainly due to blaTEM-1 (n = 29; 96.7%). PBP3 alterations were found in 39 of 40 cefuroxime-resistant isolates (97.5%). Two of the cefuroxime-resistant isolates harboured PBP3 mutation patterns that have not yet been associated with cefuroxime resistance; in one of them, a known lpoA mutation was found. One isolate showed no mutations in PBP3 or lpoA. All co-trimoxazole-resistant isolates (15.8%) showed known mutations in folA and its promoter region. Additionally, point mutations in folP were identified in a subset of these isolates. The most frequent sequence types (STs) were ST57 (n = 10) and ST103 (n = 10). Genetic cluster analysis identified six clusters, but no epidemiological link could be confirmed. Resistance to oral antibiotics in non-invasive clinical Hi isolates in Germany was generally low. Amoxicillin is estimated to cover 86% of infections involving non-invasive Hi and, therefore, is still effective for the first-line empirical treatment for ENT infections in Germany. Further surveillance of antimicrobial susceptibility in non-invasive Hi isolates is important to ensure the data basis for guidelines of antibiotic usage.

Rapid identification of antibiotic resistance gene hosts by prescreening ARG-like reads

Effective risk assessment and control of environmental antibiotic resistance depend on comprehensive information about antibiotic resistance genes (ARGs) and their microbial hosts. Advances in sequencing technologies and bioinformatics have enabled the identification of ARG hosts using metagenome-assembled contigs and genomes. However, these approaches often suffer from information loss and require extensive computational resources. Here we introduce a bioinformatic strategy that identifies ARG hosts by prescreening ARG-like reads (ALRs) directly from total metagenomic datasets. This ALR-based method offers several advantages: (1) it enables the detection of low-abundance ARG hosts with higher accuracy in complex environments; (2) it establishes a direct relationship between the abundance of ARGs and their hosts; and (3) it reduces computation time by approximately 44–96% compared to strategies relying on assembled contigs and genomes. We applied our ALR-based strategy alongside two traditional methods to investigate a typical human-impacted environment. The results were consistent across all methods, revealing that ARGs are predominantly carried by Gammaproteobacteria and Bacilli, and their distribution patterns may indicate the impact of wastewater discharge on coastal resistome. Our strategy provides rapid and accurate identification of antibiotic-resistant bacteria, offering valuable insights for the high-throughput surveillance of environmental antibiotic resistance. This study further expands our knowledge of ARG-related risk management in future.

Department-specific patterns of bacterial communities and antibiotic resistance in hospital indoor environments

The hospital indoor environment has a crucial impact on the microbial exposures that humans encounter. Resistance to antibiotics is a mechanism used by bacteria to develop resilience in indoor environments, and the widespread use of antibiotics has led to changes in the ecological function of resistance genes and their acquisition by pathogens. By integrating the 16S rRNA Illumina sequencing and high-throughput-quantitative PCR approaches with water and air dust samples across seven departments in Peking University Shenzhen Hospital, China, this study yields intriguing findings regarding the department-specific variations, correlations and source tracing of bacteria, antibiotic resistance genes (ARGs) and mobile genetic elements (MGEs) within the hospital indoor environment. A notable observation was the pivotal role played by seasonal variations in shaping the bacterial composition across the entire hospital indoor environment. Another department-specific finding was the correlation between ARGs and MGEs abundance, which was evident in the overall hospital indoor environment, but not found in the blood test room, ophthalmology, and gynecology departments. Notably, as an important source of bacteria and ARGs/MGEs for the blood test room, the gynecology department also presented a close link between bacterial communities and the presence of ARGs/MGEs. Additionally, the results reiterate the importance of surveillance and monitoring of antibiotic resistance, specifically in Legionella spp. in man-made water systems, and highlight the significance of understanding genetic elements like Tp614 involved in gene transfer and recombination, and their impact on antimicrobial treatment efficacy. Key points•The department-specific variations, correlations and source tracing of bacteria, ARGs, and MGEs were uncovered in the hospital’s indoor environment.•Although each department exhibited consistent seasonal impacts on bacterial compositions, the co-occurrence between the presence of ARGs and MGEs was exclusively evident in the emergency, surgery, pneumology and otolaryngology departments.•The gynecology department emerged as a crucial source of bacteria, ARGs and MGEs within the hospital. Additionally, it was found to exhibit a significant correlation between bacterial communities and the presence of ARGs and MGEs.

Resistance Mechanisms of Plant Pathogenic Fungi to Fungicide, Environmental Impacts of Fungicides, and Sustainable Solutions

The significant reduction in agricultural output and the decline in product quality are two of the most glaring negative impacts caused by plant pathogenic fungi (PPF). Furthermore, contaminated food or transit might introduce mycotoxins produced by PPF directly into the food chain. Eating food tainted with mycotoxin is extremely dangerous for both human and animal health. Using fungicides is the first choice to control PPF or their toxins in food. Fungicide resistance and its effects on the environment and public health are becoming more and more of a concern, despite the fact that chemical fungicides are used to limit PPF toxicity and control growth in crops. Fungicides induce target site alteration and efflux pump activation, and mutations in PPF result in resistance. As a result, global trends are shifting away from chemically manufactured pesticides and toward managing fungal plant diseases using various biocontrol techniques, tactics, and approaches. However, surveillance programs to monitor fungicide resistance and their environmental impact are much fewer compared to bacterial antibiotic resistance surveillance programs. In this review, we discuss the PPF that contributes to disease development in plants, the fungicides used against them, factors causing the spread of PPF and the emergence of new strains, the antifungal resistance mechanisms of PPF, health, the environmental impacts of fungicides, and the use of biocontrol agents (BCAs), antimicrobial peptides (AMPs), and nanotechnologies to control PPF as a safe and eco-friendly alternative to fungicides.

Daily defined dose-costs have a stronger influence on antibacterial drug prescriptions in Germany than bacterial resistance: economic factors are more important than scientific evidence

AbstractPrevious research from our group revealed a strong association between daily defined dose (DDD)-costs and -prescriptions of antibacterial drugs in Germany (https://pubmed.ncbi.nlm.nih.gov/38842562/; https://pubmed.ncbi.nlm.nih.gov/39042156/). These data indicate that low costs are major driver of high prescription numbers. This study examines the relationship between bacterial resistance and DDD-prescriptions of antibacterial drugs using data from the Arzneiverordnungsreport (AVR) from 2008 to 2022 and the Antibiotic Resistance Surveillance (ARS) statistics provided by the Robert Koch Institute (RKI). We hypothesized that semi-rational or irrational prescribing behavior of antibacterial drugs is evident in Germany, i.e., prescriptions are driven to a greater extents by low DDD-costs than bacterial resistance. A bivariate correlation analysis was performed to test these models. Our data point to irrational prescribing behavior for amoxicillin, cefuroxime axetil, doxycycline, nitrofurantoin, ciprofloxacin, and clarithromycin. For amoxicillin clavulanic acid and sulfamethoxazole-trimethoprim, data point to semi-rational prescribing. For no antibacterial drug, a model pointing to rational drug prescribing was found. In conclusion, our study shows that DDD-costs exert a more significant influence on DDD-prescriptions than bacterial resistance, indicating that economic factors, rather than scientific evidence, primarily drive antibacterial drug prescriptions in outpatient settings in Germany. It will be important to conduct similar studies on the prescription of antibacterial drugs in other countries. It will also be important to study the relation between DDD-costs and -prescriptions for other drug classes and assess the scientific basis for these relations.

Metagenomic Profiling of Internationally Sourced Sewage Influents and Effluents Yields Insight into Selecting Targets for Antibiotic Resistance Monitoring.

It has been debated whether wastewater treatment plants (WWTPs) primarily act to attenuate or amplify antibiotic resistance genes (ARGs). However, ARGs are highly diverse with respect to their resistance mechanisms, mobilities, and taxonomic hosts and therefore their behavior in WWTPs should not be expected to be universally conserved. We applied metagenomic sequencing to wastewater influent and effluent samples from 12 international WWTPs to classify the behavior of specific ARGs entering and exiting WWTPs. In total, 1079 different ARGs originating from a variety of bacteria were detected. This included ARGs that could be mapped to assembled scaffolds corresponding to nine human pathogens. While the relative abundance (per 16S rRNA gene) of ARGs decreased during treatment at 11 of the 12 WWTPs sampled and absolute abundance (per mL) decreased at all 12 WWTPs, increases in relative abundance were observed for 40% of the ARGs detected at the 12th WWTP. Also, the relative abundance of mobile genetic elements (MGE) increased during treatment, but the fraction of ARGs known to be transmissible between species decreased, thus demonstrating that increased MGE prevalence may not be generally indicative of an increase in ARGs. A distinct conserved resistome was documented in both influent and effluent across samples, suggesting that well-functioning WWTPs generally attenuate influent antibiotic resistance loads. This work helps inform strategies for wastewater surveillance of antibiotic resistance, highlighting the utility of tracking ARGs as indicators of treatment performance and relative risk reduction.

Analysis of Antibiotic Resistance Genes (ARGs) across Diverse Bacterial Species in Shrimp Aquaculture.

There is little information available on antibiotic resistance (ABR) within shrimp aquaculture environments. The aim of this study was to investigate the presence of antibiotic resistance genes (ARGs) in shrimp farming operations in Atacames, Ecuador. Water samples (n = 162) and shrimp samples (n = 54) were collected from three shrimp farming operations. Samples were cultured and a subset of isolates that grew in the presence of ceftriaxone, a third-generation cephalosporin, were analyzed using whole-genome sequencing (WGS). Among the sequenced isolates (n = 44), 73% of the isolates contained at least one ARG and the average number of ARGs per isolate was two, with a median of 3.5 ARGs. Antibiotic resistance genes that confer resistance to the β-lactam class of antibiotics were observed in 65% of the sequenced isolates from water (20/31) and 54% of the isolates from shrimp (7/13). We identified 61 different ARGs across the 44 sequenced isolates, which conferred resistance to nine antibiotic classes. Over half of all sequenced isolates (59%, n = 26) carried ARGs that confer resistance to more than one class of antibiotics. ARGs for certain antibiotic classes were more common, including beta-lactams (26 ARGs); aminoglycosides (11 ARGs); chloramphenicol (three ARGs); and trimethoprim (four ARGs). Sequenced isolates consisted of a diverse array of bacterial orders and species, including Escherichia coli (48%), Klebsiella pneumoniae (7%), Aeromonadales (7%), Pseudomonadales (16%), Enterobacter cloacae (2%), and Citrobacter freundii (2%). Many ARGs were shared across diverse species, underscoring the risk of horizontal gene transfer in these environments. This study indicated the widespread presence of extended-spectrum β-lactamase (ESBL) genes in shrimp aquaculture, including blaCTX-M, blaSHV, and blaTEM genes. Increased antibiotic resistance surveillance of shrimp farms and identification of aquaculture operation-level risk factors, such as antibiotic use, will likely be important for mitigating the spread of ARGs of clinical significance.

Assessment of carbapenem resistance and carbapenemase genes in wastewater from cattle slaughterhouses: Implications for environmental antibiotic resistance surveillance

The objectives of the study were to determine the prevalence of carbapenem-resistant Gram-negative bacteria and assess the potential risks associated with cattle slaughterhouse wastewater. A total of 270 wastewater samples were collected from 10 different cattle slaughterhouses for microbiological analysis. Conventional culture methods were employed, followed by disc diffusion, the Modified Carbapenem Inactivation Method (mCIM), and the Modified Hodge Test (MHT) to identify carbapenem resistance. The Vitek® 2 compact system was used for species identification and antibiotic susceptibility profiling. Conventional and quantitative PCR (qPCR) were performed to detect specific carbapenemase genes (blaKPC, blaNDM, and blaOXA-48). Among the collected 72 carbapenem-resistant isolates, one Pseudomonas fluorescens, one Aeromonas hydrophila, and two Aeromonas sobria exhibited resistance to meropenem. Additionally, six P. fluorescens and two A. hydrophila isolates demonstrated intermediate resistance to meropenem. Furthermore, five carbapenem-resistant isolates were identified as Stenotrophomonas maltophilia, known to be inherently resistant to most antibiotics. Ten different antibiotics were evaluated in the antibiotic resistance panel and all Aeromonas isolates were found to be resistant to cefazolin and one A. hydrophila was detected as multi-drug resistant. The revealed data indicates that slaughterhouse wastewater can serve as a reservoir for antibiotic-resistant opportunistic pathogens. However, it may not pose a substantial risk for the distribution of carbapenemases, thereby mitigating concerns related to potential public health and environmental hazards associated with this aspect of slaughterhouse operations. This study contributes to understanding of antibiotic resistance in livestock-related environments and underscores the importance of continued monitoring and surveillance.

Antimicrobial Resistance: Challenges in Wartime - Ukrainian Perspective

The excessive and uncontrolled use of antibiotics in healthcare and agriculture has become the main cause of antibiotic resistance and the spread of antibiotic-resistant microorganisms in the environment. Every year, antibiotic resistance continues to grow worldwide, posing a significant challenge for humanity. The World Health Organization recognizes antibiotic resistance as one of the top 10 global threats to public health, jeopardizing the achievement of the United Nations Sustainable Development Goal. The consequences of antimicrobial resistance extend beyond the effective treatment of infections; it is a public health issue with global consequences. Socioeconomic losses and environmental threats are closely linked to this problem. Moreover, antibiotic resistance has long-term and unpredictable consequences related to wars and military conflicts. The impact of the war and a clear understanding of the global scope of antibiotic resistance as a result of hostilities can be seen through the outcome of russia's invasion of Ukraine on February 24, 2022. This military conflict not only highlighted the importance of preserving human life and promoting peaceful development at both national and global levels but also revealed potential risks for various global environmental issues, particularly the increasing spread of antibiotic resistance. The disruption caused by the war has transformed the issue of antibiotic resistance in Ukraine from a national concern to a powerful factor that affects the global scale of this problem, transcending borders. During the war, resources and priorities have shifted toward military needs, relegating human health and environmental protection to secondary importance. Migration and loss of highly qualified medical specialists and biologists, deterioration of the environmental situation, sanitary, hygienic conditions, lack of food resources and medicines, and other factors directly and indirectly contribute to the emergence and spread of antibiotic resistance globally. This review demonstrates the relevance of the issue of antibiotic resistance, the main mechanisms of the development and spread of antibiotic resistance, the global scale and consequences of antibiotic resistance due to the war in Ukraine and aims to provide an overview of international initiatives to reduce antibiotic resistance, in particular the “One Health” concept and strategies, which are currently being implemented. Solving the issue of antibiotic resistance globally and at the level of the country affected by war requires a comprehensive approach, which includes mandatory systematic surveillance of antibiotic resistance, control of the use of antimicrobial drugs, informing all segments of society about the use of antimicrobial drugs and the consequences of antibiotic resistance, the introduction of educational programs to prevent an improper use of antibiotics, environmentally safe methods of waste disposal in medical, food, and other enterprises that produce or use antibiotics, safe disposal of antibiotics, etc.

Whole-Genome Sequencing of Human and Porcine Escherichia coli Isolates on a Commercial Pig Farm in South Africa.

Escherichia coli is an indicator micro-organism in One Health antibiotic resistance surveillance programs. The purpose of the study was to describe and compare E. coli isolates obtained from pigs and human contacts from a commercial farm in South Africa using conventional methods and whole-genome sequencing (WGS). Porcine E. coli isolates were proportionally more resistant phenotypically and harbored a richer diversity of antibiotic resistance genes as compared to human E. coli isolates. Different pathovars, namely ExPEC (12.43%, 21/169), ETEC (4.14%, 7/169), EPEC (2.96%, 5/169), EAEC (2.96%, 5/169) and STEC (1.18%, 2/169), were detected at low frequencies. Sequence type complex (STc) 10 was the most prevalent (85.51%, 59/169) among human and porcine isolates. Six STcs (STc10, STc86, STc168, STc206, STc278 and STc469) were shared at the human-livestock interface according to multilocus sequence typing (MLST). Core-genome MLST and hierarchical clustering (HC) showed that human and porcine isolates were overall genetically diverse, but some clustering at HC2-HC200 was observed. In conclusion, even though the isolates shared a spatiotemporal relationship, there were still differences in the virulence potential, antibiotic resistance profiles and cgMLST and HC according to the source of isolation.

Microbial diagnostics in periodontal diseases.

Microbial analytical methods have been instrumental in elucidating the complex microbial etiology of periodontal diseases, by shaping our understanding of subgingival community dynamics. Certain pathobionts can orchestrate the establishment of dysbiotic communities that can subvert the host immune system, triggering inflammation and tissue destruction. Yet, diagnosis and management of periodontal conditions still rely on clinical and radiographic examinations, overlooking the well-established microbial etiology. This review summarizes the chronological emergence of periodontal etiological models and the co-evolution with technological advances in microbial detection. We additionally review the microbial analytical approaches currently accessible to clinicians, highlighting their value in broadening the periodontal assessment. The epidemiological importance of obtaining culture-based antimicrobial susceptibility profiles of periodontal taxa for antibiotic resistance surveillance is also underscored, together with clinically relevant analytical approaches to guide antibiotherapy choices, when necessary. Furthermore, the importance of 16S-based community and shotgun metagenomic profiling is discussed in outlining dysbiotic microbial signatures. Because dysbiosis precedes periodontal damage, biomarker identification offers early diagnostic possibilities to forestall disease relapses during maintenance. Altogether, this review highlights the underutilized potential of clinical microbiology in periodontology, spotlighting the clinical areas most conductive to its diagnostic implementation for enhancing prevention, treatment predictability, and addressing global antibiotic resistance.

PHENOTYPIC DETECTION OF ESBL AND AMPC BETA LACTAMASES AMONG GRAM-NEGATIVE ISOLATES FROM CLINICAL SAMPLES IN A TERTIARY CARE HOSPITAL

Objectives: Drug-resistant Gram-negative bacilli expressing extended-spectrum beta-lactamases (ESBLs) and AmpC pose a serious therapeutic threat in nosocomial infections. Cost-effective screening methods are a boon to patients. This study aims to detect gram-negative bacilli and their antibiotic sensitivity patterns, as well as detect the ESBL and AmpC-producing isolates among Gram-negative bacilli. Methods: A prospective study was conducted with 150 samples. Gram-negative bacilli were isolated, and their antibiotic sensitivity tests were performed by the Kirby–Bauer disk diffusion method. Potential ESBL producers were screened using Ceftazidime disc, and AmpC producers were screened by Cefoxitin discs by the disc diffusion method. ESBL producers were confirmed by the combined disc diffusion assay method using ceftazidime and ceftazidime/Clavulanic acid disc. AmpC producers were confirmed by the Cefoxitin Cloxacillin Double Disc Synergy Test. Results: About 38% of 150 samples were gram-negative bacilli, of which 40.35% were Escherichia coli, followed by Pseudomonas aeruginosa (35.08%). Maximum sensitivity by E. coli was found toward imipenem, meropenem, and cotrimoxazole. P. aeruginosa showed maximum sensitivity toward piperacillin/tazobactam, imipenem, meropenem, and ceftazidime. 28.07% of Gram-negative isolates were ESBL producers, with E. coli (11 isolates) being the maximum, and 15.78% were AmpC producers, with E. coli (four isolates) being the maximum. Seven isolates were both ESBL and AmpC producers. Conclusion: Routine screening and timely reporting of ESBL and AmpC producers help in preventing the spread of multidrug-resistant strains. Antibiotic resistance surveillance helps in the implementation of strict infection control and prevention practices.

Antibiotic resistance spectrums of Escherichia coli and Enterococcus spp. strains against commonly used antimicrobials from commercial meat-rabbit farms in Chengdu City, Southwest China.

Antimicrobial resistance (AMR) is commonly associated with the inappropriate use of antibiotics during meat-rabbit production, posing unpredictable risks to rabbit welfare and public health. However, there is limited research on the epidemiological dynamics of antibiotic resistance among bacteria indicators derived from local healthy meat-rabbits. To bridge the knowledge gap between antibiotic use and AMR distribution, a total of 75 Escherichia coli (E. coli) and 210 Enterococcus spp. strains were successfully recovered from fecal samples of healthy meat-rabbits. The results revealed that diverse AMR phenotypes against seven commonly used antimicrobials, including ampicillin (AMP), amoxicillin-clavulanic acid (A/C), doxycycline (DOX), enrofloxacin (ENR), florfenicol (FFC), gentamicin (GEN), and polymycin B (PMB), were observed among most strains of E. coli and Enterococcus spp. in two rabbit farms, although the distribution pattern of antibiotic resistance between young and adult rabbits was similar. Among them, 66 E. coli strains showed resistance against 6 antimicrobials except for PMB. However, 164 Enterococcus spp. strains only exhibited acquired resistance against DOX and GEN. Notably, the DOX-based AMR phenotypes for E. coli and Enterococcus spp. strains were predominant, indicating the existing environmental stress conferred by DOX exposure. The MICs tests suggested elevated level of antibiotic resistance for resistant bacteria. Unexpectedly, all GEN-resistant Enterococcus spp. strains resistant high-level gentamicin (HLGR). By comparison, the blaTEM, tetA, qnrS and floR were highly detected among 35 multi-resistant E. coli strains, and aac[6']-Ie-aph[2']-Ia genes widely spread among the 40 double-resistant Enterococcus spp. strains. Nevertheless, the presence of ARGs were not concordant with the resistant phenotypes for a portion of resistant bacteria. In conclusion, the distribution of AMR and ARGs are prevalent in healthy meat-rabbits, and the therapeutic antimicrobials use in farming practice may promote the antibiotic resistance transmission among indicator bacteria. Therefore, periodic surveillance of antibiotic resistance in geographic locations and supervisory measures for rational antibiotic use are imperative strategies for combating the rising threats posed by antibiotic resistance, as well as maintaining rabbit welfare and public health.