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Xia X, Mu H, Li Y, Hou Y, Li J, Zhao Z, Zhao Q, You S, Wei L. Which emerging micropollutants deserve more attention in wastewater in the post-COVID-19 pandemic period? Based on distribution, risk, and exposure analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 951:175511. [PMID: 39147043 DOI: 10.1016/j.scitotenv.2024.175511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/25/2024] [Accepted: 08/12/2024] [Indexed: 08/17/2024]
Abstract
Aggravated accumulation of emerging micropollutants (EMs) in aquatic environments, especially after COVID-19, raised significant attention throughout the world for safety concerns. This article reviews the sources and occurrence of 25 anti-COVID-19 related EMs in wastewater. It should be pointed out that the concentration of anti-COVID-19 related EMs, such as antivirals, plasticizers, antimicrobials, and psychotropic drugs in wastewater increased notably after the pandemic. Furthermore, the ecotoxicity, ecological, and health risks of typical EMs before and after COVID-19 were emphatically compared and analyzed. Based on the environmental health prioritization index method, the priority control sequence of typical EMs related to anti-COVID-19 was identified. Lopinavir (LPV), venlafaxine (VLX), di(2-ethylhexyl) phthalate (DEHP), benzalkonium chloride (BAC), triclocarban (TCC), di-n-butyl phthalate (DBP), citalopram (CIT), diisobutyl phthalate (DIBP), and triclosan (TCS) were identified as the top-priority control EMs in the post-pandemic period. Besides, some insights into the toxicity and risk assessment of EMs were also provided. This review provides direction for proper understanding and controlling the EMs pollution after COVID-19, and is of significance to evaluate objectively the environmental and health impacts induced by COVID-19.
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Affiliation(s)
- Xinhui Xia
- State Key Laboratory of Urban Water Resources and Environment (SKLUWRE), School of Environment, Harbin Institute of Technology, Harbin 150090, China
| | - Huizhi Mu
- State Key Laboratory of Urban Water Resources and Environment (SKLUWRE), School of Environment, Harbin Institute of Technology, Harbin 150090, China
| | - Yaqun Li
- State Key Laboratory of Urban Water Resources and Environment (SKLUWRE), School of Environment, Harbin Institute of Technology, Harbin 150090, China
| | - Yanlong Hou
- The 404 Company Limited, CNNC, Lanzhou 732850, China
| | - Jianju Li
- State Key Laboratory of Urban Water Resources and Environment (SKLUWRE), School of Environment, Harbin Institute of Technology, Harbin 150090, China
| | - Zixuan Zhao
- State Key Laboratory of Urban Water Resources and Environment (SKLUWRE), School of Environment, Harbin Institute of Technology, Harbin 150090, China
| | - Qingliang Zhao
- State Key Laboratory of Urban Water Resources and Environment (SKLUWRE), School of Environment, Harbin Institute of Technology, Harbin 150090, China
| | - Shijie You
- State Key Laboratory of Urban Water Resources and Environment (SKLUWRE), School of Environment, Harbin Institute of Technology, Harbin 150090, China
| | - Liangliang Wei
- State Key Laboratory of Urban Water Resources and Environment (SKLUWRE), School of Environment, Harbin Institute of Technology, Harbin 150090, China.
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Iqbal F, Barche A, Shenoy PA, Lewis LES, Purkayastha J, Vandana KE. Gram-Negative Colonization and Bacterial Translocation Drive Neonatal Sepsis in the Indian Setting. J Epidemiol Glob Health 2024:10.1007/s44197-024-00303-8. [PMID: 39347930 DOI: 10.1007/s44197-024-00303-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 09/17/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND The gut microbiota, comprising billions of microorganisms, plays a pivotal role in health and disease. This study aims to investigate the effect of sepsis on gut microbiome of neonates admitted to the Neonatal Intensive Care Unit. METHODS A prospective cohort study was carried out in the NICU of tertiary care hospital in Karnataka, India, from January 2021 to September 2023. Preterm neonates with birth weight < 1500 g and gestational age < 37 weeks were recruited, excluding those with congenital gastrointestinal anomalies, necrotizing enterocolitis, or blood culture-negative infections. The study population was divided into three groups: healthy neonates (Group A), neonates with drug-sensitive GNB sepsis (Group B), and neonates with pan drug-resistant GNB sepsis (Group C). Stool samples were collected aseptically, snapped in liquid nitrogen, and stored at -80⁰C for extraction of DNA and microbiome analysis. RESULTS The gut microbiota of healthy neonates (Group A) was dominated by Proteobacteria (24.04%), Actinobacteria (27.13%), Firmicutes (12.74%), and Bacteroidetes (3%). Predominant genera included Bifidobacterium (55.17%), Enterobacter (12.55%), Enterococcus (50.69%), Streptococcus (7.92%), and Bacteroides (3.58%).Groups B and C, the microbiota exhibited higher Proteobacteria abundance (57.16% and 66.58%, respectively) and reduced diversity of beneficial bacteria. Notably, the presence of sepsis was associated with an increase in pathogenic bacteria and a decrease in beneficial commensal bacteria. CONCLUSION Neonates with sepsis exhibited significant gut microbiome dysbiosis, characterized by increased Proteobacteria and reduced beneficial bacteria diversity. These findings highlight the potential of microbiome profiling as a diagnostic tool and underscore the importance of gut microbiota modulation in managing neonatal sepsis.
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Affiliation(s)
- Faiza Iqbal
- Department of Pediatrics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - Apurv Barche
- Department of Pediatrics, Neonatal/ Perinatal, UMass Memorial Medical Center, Worcester, MA, USA
| | - Padmaja A Shenoy
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - Leslie Edward S Lewis
- Department of Pediatrics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India.
| | - Jayashree Purkayastha
- Department of Pediatrics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - K E Vandana
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
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Naghavi M, Vollset SE, Ikuta KS, Swetschinski LR, Gray AP, Wool EE, Robles Aguilar G, Mestrovic T, Smith G, Han C, Hsu RL, Chalek J, Araki DT, Chung E, Raggi C, Gershberg Hayoon A, Davis Weaver N, Lindstedt PA, Smith AE, Altay U, Bhattacharjee NV, Giannakis K, Fell F, McManigal B, Ekapirat N, Mendes JA, Runghien T, Srimokla O, Abdelkader A, Abd-Elsalam S, Aboagye RG, Abolhassani H, Abualruz H, Abubakar U, Abukhadijah HJ, Aburuz S, Abu-Zaid A, Achalapong S, Addo IY, Adekanmbi V, Adeyeoluwa TE, Adnani QES, Adzigbli LA, Afzal MS, Afzal S, Agodi A, Ahlstrom AJ, Ahmad A, Ahmad S, Ahmad T, Ahmadi A, Ahmed A, Ahmed H, Ahmed I, Ahmed M, Ahmed S, Ahmed SA, Akkaif MA, Al Awaidy S, Al Thaher Y, Alalalmeh SO, AlBataineh MT, Aldhaleei WA, Al-Gheethi AAS, Alhaji NB, Ali A, Ali L, Ali SS, Ali W, Allel K, Al-Marwani S, Alrawashdeh A, Altaf A, Al-Tammemi AB, Al-Tawfiq JA, Alzoubi KH, Al-Zyoud WA, Amos B, Amuasi JH, Ancuceanu R, Andrews JR, Anil A, Anuoluwa IA, Anvari S, Anyasodor AE, Apostol GLC, Arabloo J, Arafat M, Aravkin AY, Areda D, Aremu A, Artamonov AA, Ashley EA, Asika MO, Athari SS, Atout MMW, Awoke T, Azadnajafabad S, Azam JM, Aziz S, Azzam AY, Babaei M, Babin FX, Badar M, Baig AA, Bajcetic M, Baker S, Bardhan M, Barqawi HJ, Basharat Z, Basiru A, Bastard M, Basu S, Bayleyegn NS, Belete MA, Bello OO, Beloukas A, Berkley JA, Bhagavathula AS, Bhaskar S, Bhuyan SS, Bielicki JA, Briko NI, Brown CS, Browne AJ, Buonsenso D, Bustanji Y, Carvalheiro CG, Castañeda-Orjuela CA, Cenderadewi M, Chadwick J, Chakraborty S, Chandika RM, Chandy S, Chansamouth V, Chattu VK, Chaudhary AA, Ching PR, Chopra H, Chowdhury FR, Chu DT, Chutiyami M, Cruz-Martins N, da Silva AG, Dadras O, Dai X, Darcho SD, Das S, De la Hoz FP, Dekker DM, Dhama K, Diaz D, Dickson BFR, Djorie SG, Dodangeh M, Dohare S, Dokova KG, Doshi OP, Dowou RK, Dsouza HL, Dunachie SJ, Dziedzic AM, Eckmanns T, Ed-Dra A, Eftekharimehrabad A, Ekundayo TC, El Sayed I, Elhadi M, El-Huneidi W, Elias C, Ellis SJ, Elsheikh R, Elsohaby I, Eltaha C, Eshrati B, Eslami M, Eyre DW, Fadaka AO, Fagbamigbe AF, Fahim A, Fakhri-Demeshghieh A, Fasina FO, Fasina MM, Fatehizadeh A, Feasey NA, Feizkhah A, Fekadu G, Fischer F, Fitriana I, Forrest KM, Fortuna Rodrigues C, Fuller JE, Gadanya MA, Gajdács M, Gandhi AP, Garcia-Gallo EE, Garrett DO, Gautam RK, Gebregergis MW, Gebrehiwot M, Gebremeskel TG, Geffers C, Georgalis L, Ghazy RM, Golechha M, Golinelli D, Gordon M, Gulati S, Gupta RD, Gupta S, Gupta VK, Habteyohannes AD, Haller S, Harapan H, Harrison ML, Hasaballah AI, Hasan I, Hasan RS, Hasani H, Haselbeck AH, Hasnain MS, Hassan II, Hassan S, Hassan Zadeh Tabatabaei MS, Hayat K, He J, Hegazi OE, Heidari M, Hezam K, Holla R, Holm M, Hopkins H, Hossain MM, Hosseinzadeh M, Hostiuc S, Hussein NR, Huy LD, Ibáñez-Prada ED, Ikiroma A, Ilic IM, Islam SMS, Ismail F, Ismail NE, Iwu CD, Iwu-Jaja CJ, Jafarzadeh A, Jaiteh F, Jalilzadeh Yengejeh R, Jamora RDG, Javidnia J, Jawaid T, Jenney AWJ, Jeon HJ, Jokar M, Jomehzadeh N, Joo T, Joseph N, Kamal Z, Kanmodi KK, Kantar RS, Kapisi JA, Karaye IM, Khader YS, Khajuria H, Khalid N, Khamesipour F, Khan A, Khan MJ, Khan MT, Khanal V, Khidri FF, Khubchandani J, Khusuwan S, Kim MS, Kisa A, Korshunov VA, Krapp F, Krumkamp R, Kuddus M, Kulimbet M, Kumar D, Kumaran EAP, Kuttikkattu A, Kyu HH, Landires I, Lawal BK, Le TTT, Lederer IM, Lee M, Lee SW, Lepape A, Lerango TL, Ligade VS, Lim C, Lim SS, Limenh LW, Liu C, Liu X, Liu X, Loftus MJ, M Amin HI, Maass KL, Maharaj SB, Mahmoud MA, Maikanti-Charalampous P, Makram OM, Malhotra K, Malik AA, Mandilara GD, Marks F, Martinez-Guerra BA, Martorell M, Masoumi-Asl H, Mathioudakis AG, May J, McHugh TA, Meiring J, Meles HN, Melese A, Melese EB, Minervini G, Mohamed NS, Mohammed S, Mohan S, Mokdad AH, Monasta L, Moodi Ghalibaf A, Moore CE, Moradi Y, Mossialos E, Mougin V, Mukoro GD, Mulita F, Muller-Pebody B, Murillo-Zamora E, Musa S, Musicha P, Musila LA, Muthupandian S, Nagarajan AJ, Naghavi P, Nainu F, Nair TS, Najmuldeen HHR, Natto ZS, Nauman J, Nayak BP, Nchanji GT, Ndishimye P, Negoi I, Negoi RI, Nejadghaderi SA, Nguyen QP, Noman EA, Nwakanma DC, O'Brien S, Ochoa TJ, Odetokun IA, Ogundijo OA, Ojo-Akosile TR, Okeke SR, Okonji OC, Olagunju AT, Olivas-Martinez A, Olorukooba AA, Olwoch P, Onyedibe KI, Ortiz-Brizuela E, Osuolale O, Ounchanum P, Oyeyemi OT, P A MP, Paredes JL, Parikh RR, Patel J, Patil S, Pawar S, Peleg AY, Peprah P, Perdigão J, Perrone C, Petcu IR, Phommasone K, Piracha ZZ, Poddighe D, Pollard AJ, Poluru R, Ponce-De-Leon A, Puvvula J, Qamar FN, Qasim NH, Rafai CD, Raghav P, Rahbarnia L, Rahim F, Rahimi-Movaghar V, Rahman M, Rahman MA, Ramadan H, Ramasamy SK, Ramesh PS, Ramteke PW, Rana RK, Rani U, Rashidi MM, Rathish D, Rattanavong S, Rawaf S, Redwan EMM, Reyes LF, Roberts T, Robotham JV, Rosenthal VD, Ross AG, Roy N, Rudd KE, Sabet CJ, Saddik BA, Saeb MR, Saeed U, Saeedi Moghaddam S, Saengchan W, Safaei M, Saghazadeh A, Saheb Sharif-Askari N, Sahebkar A, Sahoo SS, Sahu M, Saki M, Salam N, Saleem Z, Saleh MA, Samodra YL, Samy AM, Saravanan A, Satpathy M, Schumacher AE, Sedighi M, Seekaew S, Shafie M, Shah PA, Shahid S, Shahwan MJ, Shakoor S, Shalev N, Shamim MA, Shamshirgaran MA, Shamsi A, Sharifan A, Shastry RP, Shetty M, Shittu A, Shrestha S, Siddig EE, Sideroglou T, Sifuentes-Osornio J, Silva LMLR, Simões EAF, Simpson AJH, Singh A, Singh S, Sinto R, Soliman SSM, Soraneh S, Stoesser N, Stoeva TZ, Swain CK, Szarpak L, T Y SS, Tabatabai S, Tabche C, Taha ZMA, Tan KK, Tasak N, Tat NY, Thaiprakong A, Thangaraju P, Tigoi CC, Tiwari K, Tovani-Palone MR, Tran TH, Tumurkhuu M, Turner P, Udoakang AJ, Udoh A, Ullah N, Ullah S, Vaithinathan AG, Valenti M, Vos T, Vu HTL, Waheed Y, Walker AS, Walson JL, Wangrangsimakul T, Weerakoon KG, Wertheim HFL, Williams PCM, Wolde AA, Wozniak TM, Wu F, Wu Z, Yadav MKK, Yaghoubi S, Yahaya ZS, Yarahmadi A, Yezli S, Yismaw YE, Yon DK, Yuan CW, Yusuf H, Zakham F, Zamagni G, Zhang H, Zhang ZJ, Zielińska M, Zumla A, Zyoud SHH, Zyoud SH, Hay SI, Stergachis A, Sartorius B, Cooper BS, Dolecek C, Murray CJL. Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050. Lancet 2024; 404:1199-1226. [PMID: 39299261 DOI: 10.1016/s0140-6736(24)01867-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 08/20/2024] [Accepted: 09/03/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Antimicrobial resistance (AMR) poses an important global health challenge in the 21st century. A previous study has quantified the global and regional burden of AMR for 2019, followed with additional publications that provided more detailed estimates for several WHO regions by country. To date, there have been no studies that produce comprehensive estimates of AMR burden across locations that encompass historical trends and future forecasts. METHODS We estimated all-age and age-specific deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 22 pathogens, 84 pathogen-drug combinations, and 11 infectious syndromes in 204 countries and territories from 1990 to 2021. We collected and used multiple cause of death data, hospital discharge data, microbiology data, literature studies, single drug resistance profiles, pharmaceutical sales, antibiotic use surveys, mortality surveillance, linkage data, outpatient and inpatient insurance claims data, and previously published data, covering 520 million individual records or isolates and 19 513 study-location-years. We used statistical modelling to produce estimates of AMR burden for all locations, including those with no data. Our approach leverages the estimation of five broad component quantities: the number of deaths involving sepsis; the proportion of infectious deaths attributable to a given infectious syndrome; the proportion of infectious syndrome deaths attributable to a given pathogen; the percentage of a given pathogen resistant to an antibiotic of interest; and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden attributable to and associated with AMR, which we define based on two counterfactuals; respectively, an alternative scenario in which all drug-resistant infections are replaced by drug-susceptible infections, and an alternative scenario in which all drug-resistant infections were replaced by no infection. Additionally, we produced global and regional forecasts of AMR burden until 2050 for three scenarios: a reference scenario that is a probabilistic forecast of the most likely future; a Gram-negative drug scenario that assumes future drug development that targets Gram-negative pathogens; and a better care scenario that assumes future improvements in health-care quality and access to appropriate antimicrobials. We present final estimates aggregated to the global, super-regional, and regional level. FINDINGS In 2021, we estimated 4·71 million (95% UI 4·23-5·19) deaths were associated with bacterial AMR, including 1·14 million (1·00-1·28) deaths attributable to bacterial AMR. Trends in AMR mortality over the past 31 years varied substantially by age and location. From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years yet increased by over 80% for adults 70 years and older. AMR mortality decreased for children younger than 5 years in all super-regions, whereas AMR mortality in people 5 years and older increased in all super-regions. For both deaths associated with and deaths attributable to AMR, meticillin-resistant Staphylococcus aureus increased the most globally (from 261 000 associated deaths [95% UI 150 000-372 000] and 57 200 attributable deaths [34 100-80 300] in 1990, to 550 000 associated deaths [500 000-600 000] and 130 000 attributable deaths [113 000-146 000] in 2021). Among Gram-negative bacteria, resistance to carbapenems increased more than any other antibiotic class, rising from 619 000 associated deaths (405 000-834 000) in 1990, to 1·03 million associated deaths (909 000-1·16 million) in 2021, and from 127 000 attributable deaths (82 100-171 000) in 1990, to 216 000 (168 000-264 000) attributable deaths in 2021. There was a notable decrease in non-COVID-related infectious disease in 2020 and 2021. Our forecasts show that an estimated 1·91 million (1·56-2·26) deaths attributable to AMR and 8·22 million (6·85-9·65) deaths associated with AMR could occur globally in 2050. Super-regions with the highest all-age AMR mortality rate in 2050 are forecasted to be south Asia and Latin America and the Caribbean. Increases in deaths attributable to AMR will be largest among those 70 years and older (65·9% [61·2-69·8] of all-age deaths attributable to AMR in 2050). In stark contrast to the strong increase in number of deaths due to AMR of 69·6% (51·5-89·2) from 2022 to 2050, the number of DALYs showed a much smaller increase of 9·4% (-6·9 to 29·0) to 46·5 million (37·7 to 57·3) in 2050. Under the better care scenario, across all age groups, 92·0 million deaths (82·8-102·0) could be cumulatively averted between 2025 and 2050, through better care of severe infections and improved access to antibiotics, and under the Gram-negative drug scenario, 11·1 million AMR deaths (9·08-13·2) could be averted through the development of a Gram-negative drug pipeline to prevent AMR deaths. INTERPRETATION This study presents the first comprehensive assessment of the global burden of AMR from 1990 to 2021, with results forecasted until 2050. Evaluating changing trends in AMR mortality across time and location is necessary to understand how this important global health threat is developing and prepares us to make informed decisions regarding interventions. Our findings show the importance of infection prevention, as shown by the reduction of AMR deaths in those younger than 5 years. Simultaneously, our results underscore the concerning trend of AMR burden among those older than 70 years, alongside a rapidly ageing global community. The opposing trends in the burden of AMR deaths between younger and older individuals explains the moderate future increase in global number of DALYs versus number of deaths. Given the high variability of AMR burden by location and age, it is important that interventions combine infection prevention, vaccination, minimisation of inappropriate antibiotic use in farming and humans, and research into new antibiotics to mitigate the number of AMR deaths that are forecasted for 2050. FUNDING UK Department of Health and Social Care's Fleming Fund using UK aid, and the Wellcome Trust.
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4
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Wen SCH, Harris PNA, Forde B, Permana B, Chatfield MD, Lau CL, Spurling G, Bauer MJ, Balch R, Chambers H, Schlapbach LJ, Clark JE, Dougherty S, Blyth CC, Britton PN, Clifford V, Haeusler GM, McMullan B, Wadia U, Paterson DL, Irwin AD. Characterization of Gram-negative Bloodstream Infections in Hospitalized Australian Children and Their Clinical Outcomes. Clin Infect Dis 2024; 79:734-743. [PMID: 38917034 PMCID: PMC11426278 DOI: 10.1093/cid/ciae341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/06/2024] [Accepted: 06/21/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Gram-negative bloodstream infections (GNBSIs) more commonly occur in children with comorbidities and are increasingly associated with antimicrobial resistance. There are few large studies of GNBSIs in children that relate the clinical presentation, pathogen characteristics, and outcomes. METHODS A 3-year prospective study of GNBSIs in children aged <18 years was conducted in 5 Australian children's hospitals between 2019 and 2021. The clinical characteristics, disease severity, and outcomes were recorded. Causative pathogens underwent antibiotic susceptibility testing and whole genome sequencing. RESULTS There were 931 GNBSI episodes involving 818 children. Median age was 3 years (interquartile range, 0.6-8.5). A total of 576/931 episodes (62%) were community onset, though 661/931 (71%) occurred in children with comorbidities and a central venous catheter was present in 558/931 (60%). Central venous catheter (145/931) and urinary tract (149/931) were the most common sources (16% each). One hundred of 931 (11%) children required intensive care unit admission and a further 11% (105/931) developed GNBSIs in intensive care unit. A total of 659/927 (71%) isolates were Enterobacterales, of which 22% (138/630) were third-generation cephalosporin resistant (3GCR). Extended spectrum beta-lactamase genes were confirmed in 65/138 (47%) 3GCR Enterobacterales. Most common extended spectrum beta-lactamase genes were blaCTX-M-15 (34/94, 36%) and blaSHV-12 (10/94, 11%). There were 48 deaths overall and 30-day in-hospital mortality was 3% (32/931). Infections with 3GCR Enterobacterales were independently associated with higher mortality (adjusted odds ratio, 3.2; 95% confidence interval, 1.6-6.4). CONCLUSIONS GNBSIs in children are frequently healthcare associated and affect children younger than age 5 years. Infections with 3GCR Enterobacterales were associated with worse outcomes. These findings will inform optimal management guidelines and help prioritize future antimicrobial clinical trials.
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Affiliation(s)
- Sophie C H Wen
- The University of Queensland, Centre for Clinical Research, Brisbane, Queensland, Australia
- Infection Management Prevention Service, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Patrick N A Harris
- The University of Queensland, Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Brian Forde
- The University of Queensland, Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Budi Permana
- The University of Queensland, Centre for Clinical Research, Brisbane, Queensland, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- The University of Queensland, Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Colleen L Lau
- The University of Queensland, Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Geoffrey Spurling
- The University of Queensland, General Practice Clinical Unit, Brisbane, Queensland, Australia
| | - Michelle J Bauer
- The University of Queensland, Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Ross Balch
- The University of Queensland, Centre for Clinical Research, Brisbane, Queensland, Australia
| | - Henry Chambers
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Luregn J Schlapbach
- The University of Queensland, Child Health Research Centre, Brisbane, Queensland, Australia
| | - Julia E Clark
- Infection Management Prevention Service, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Sonia Dougherty
- Infection Management Prevention Service, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Christopher C Blyth
- Wesfarmer Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Network, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Philip N Britton
- Department of Infectious Diseases and Microbiology, The Children's Hospital Westmead, Sydney, New South Wales, Australia
- Sydney Medical School and Sydney Infectious Diseases, University of Sydney, Sydney, New South Wales, Australia
| | - Vanessa Clifford
- Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Gabrielle M Haeusler
- Infectious Diseases Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
- Clinical Infections Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Brendan McMullan
- Infectious Diseases and Microbiology, Sydney Children's Hospital, Sydney, New South Wales, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ushma Wadia
- Wesfarmer Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - David L Paterson
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Adam D Irwin
- The University of Queensland, Centre for Clinical Research, Brisbane, Queensland, Australia
- Infection Management Prevention Service, Children's Health Queensland, Brisbane, Queensland, Australia
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5
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Venkateswaran N, Swetschinski LR, Fastl C, Bari CD, Criscuolo NG, Mulchandani R, Zhao C, Meštrović T, Ikuta KS, Martins SB, Coyne LA, Afonso JS, Huntington B, Rushton J, Devleesschauwer B, Sartorius B, Van Boeckel TP, Pigott DM. Using priorities between human and livestock bacterial antimicrobial resistance (AMR) to identify data gaps in livestock AMR surveillance. BMC Infect Dis 2024; 24:1027. [PMID: 39327564 PMCID: PMC11425882 DOI: 10.1186/s12879-024-09847-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 08/30/2024] [Indexed: 09/28/2024] Open
Abstract
BACKGROUND Bacterial antimicrobial resistance (AMR) is a global threat to both humans and livestock. Despite this, there is limited global consensus on data-informed, priority areas for intervention in both sectors. We compare current livestock AMR data collection efforts with other variables pertinent to human and livestock AMR to identify critical data gaps and mutual priorities. METHODS We globally synthesized livestock AMR data from open-source surveillance reports and point prevalence surveys stratified for six pathogens (Escherichia coli, Staphylococcus aureus, non-typhoidal Salmonella, Campylobacter spp., Enterococcus faecalis, Enterococcus faecium) and eleven antimicrobial classes important in human and veterinary use, published between 2000 and 2020. We also included all livestock species represented in the data: cattle, chickens, pigs, sheep, turkeys, ducks, horses, buffaloes, and goats. We compared this data with intended priorities calculated from: disability-adjusted life years (DALYs), livestock antimicrobial usage (AMU), livestock biomass, and a global correlation exercise between livestock and human proportion of resistant isolates. RESULTS Resistance to fluoroquinolones and macrolides in Staphylococcus aureus were identified as priorities in many countries but, less than 10% of these reported livestock AMR data. Resistance data for Escherichia coli specific to cattle, chickens, and pigs, which we prioritized, were also well collected. AMR data collection on non-typhoidal Salmonella and other livestock species were often not prioritized. Of 232 categories prioritized by at least one country, data were only collected for 48% (n = 112). CONCLUSIONS The lack of livestock AMR data globally for broad resistance in Staphylococcus aureus could underplay their zoonotic threat. Countries can bolster livestock AMR data collection, reporting, and intervention setting for Staphylococcus aureus as done for Escherichia coli. This framework can provide guidance on areas to strengthen AMR surveillance and decision-making for humans and livestock, and if done routinely, can adapt to resistance trends and priorities.
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Affiliation(s)
- Narmada Venkateswaran
- Global Burden of Animal Diseases Programme, .
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA.
| | - Lucien R Swetschinski
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
| | - Christina Fastl
- Global Burden of Animal Diseases Programme
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Carlotta Di Bari
- Global Burden of Animal Diseases Programme
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | | | | | - Cheng Zhao
- Health Geography and Policy Group, ETH Zürich, Zürich, Switzerland
- School of Public Health, The University of Sydney, Sydney, Australia
| | - Tomislav Meštrović
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
- University Centre Varaždin, University North, Varaždin, Croatia
| | - Kevin S Ikuta
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Division of Infectious Diseases, Veterans Affairs, Los Angeles, CA, USA
| | - Sara Babo Martins
- Global Burden of Animal Diseases Programme
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - Lucy A Coyne
- National Office of Animal Health Ltd, 25 Town Square, Stevenage, SG1 1BP, UK
| | - João Sucena Afonso
- Global Burden of Animal Diseases Programme
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - Ben Huntington
- Global Burden of Animal Diseases Programme
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
- Pengwern Animal Health Ltd, 259 Wallasey Village, Wallasey Wirral, Merseyside, UK
| | - Jonathan Rushton
- Global Burden of Animal Diseases Programme
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, UK
| | - Brecht Devleesschauwer
- Global Burden of Animal Diseases Programme
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Benn Sartorius
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
- Faculty of Medicine, UQ Centre for Clinical Research (UQCCR), University of Queensland, Brisbane, Australia
| | - Thomas P Van Boeckel
- One Health Trust, Washington, D.C., USA
- One Health Institute, University of Zürich, Zürich, Switzerland
- Spatial Epidemiology Lab, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - David M Pigott
- Global Burden of Animal Diseases Programme
- Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences, University of Washington, Seattle, WA, USA
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Elizalde-Jiménez IG, Ruiz-Hernández FG, Carmona-Cruz SA, Pastrana-Arellano E, Aquino-Andrade A, Romo-González C, Arias-de la Garza E, Álvarez-Villalobos NA, García-Romero MT. Global Antimicrobial Susceptibility Patterns of Staphylococcus aureus in Atopic Dermatitis: A Systematic Review and Meta-Analysis. JAMA Dermatol 2024:2823597. [PMID: 39320869 PMCID: PMC11425196 DOI: 10.1001/jamadermatol.2024.3360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
Importance Individuals with atopic dermatitis are frequently colonized and infected with Staphylococcus aureus. Empirical antibiotic therapy for individuals with atopic dermatitis is common, but data about the antimicrobial susceptibility profiles of S aureus strains isolated from these individuals are scarce for those living in particular geographic areas. Objective To determine the antimicrobial susceptibility of S aureus from individuals with atopic dermatitis and analyze differences according to the income level of the country of origin and the data collection period. Data Sources A meta-analysis of the literature was performed from the inception of the included databases (MEDLINE, Embase, Web of Science, Scopus, and Cochrane) to June 20, 2023, using predetermined Medical Subject Headings. Study Selection Studies were included if they reported antibiotic susceptibility profiles of 1 or more S aureus cutaneous isolates from individuals with atopic dermatitis. Articles written in English, Spanish, French, or German were included. Data Extraction and Synthesis Working in pairs, 6 of the authors conducted the data extraction. The guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were followed. Main Outcomes and Measures The outcome of interest was antimicrobial susceptibility. Results A total of 61 studies reported 4091 S aureus isolates from individuals with atopic dermatitis. For 4 of the 11 commonly used antibiotics (36.4%), antimicrobial susceptibility was 85% or less, including for methicillin (binomial proportion, 0.85 [95% CI, 0.76-0.91]), erythromycin (binomial proportion, 0.73 [95% CI, 0.61-0.83]), fusidic acid (binomial proportion, 0.80 [95% CI, 0.62-0.91]), and clindamycin (binomial proportion, 0.79 [95% CI, 0.65-0.89]). Most studies (46; 75.4%) were conducted in high-income countries. Antimicrobial susceptibility to erythromycin, methicillin, and trimethoprim and sulfamethoxazole was significantly lower in lower middle-income countries and upper middle-income countries. Regarding the temporal trends, 33 studies (54.1%) reported data collected from 1998 to 2010. Antimicrobial susceptibility patterns have not changed over time. Conclusions and Relevance In this systematic review and meta-analysis, antimicrobial susceptibility of S aureus to β-lactams, erythromycin, clindamycin, and fusidic acid may be suboptimal for empirical use in individuals with atopic dermatitis. Significant differences in antimicrobial susceptibility patterns were found in high-income countries and in lower middle-income countries and upper middle-income countries for some antibiotics.
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Affiliation(s)
| | - Fernando Gerardo Ruiz-Hernández
- Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, México
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic, Monterrey, México
| | - Silvia Angélica Carmona-Cruz
- Dermatology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
- Now with Dermatology, Hospital MAC, Mexico City, Mexico
| | - Elena Pastrana-Arellano
- Dermatology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
- Now with Hospital Adolfo López Mateos ISSSTE, Mexico City, Mexico
| | | | - Carolina Romo-González
- Experimental Bacteriology Laboratory, Instituto Nacional de Pediatría, Mexico City, Mexico
| | | | - Neri Alejandro Álvarez-Villalobos
- Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, México
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic, Monterrey, México
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Maria Teresa García-Romero
- Dermatology Department, Instituto Nacional de Pediatría, Mexico City, Mexico
- Editorial Fellow, JAMA Dermatology
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7
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Ghaith A, Bennour S, Ali YM. Enhancing antibiotic prescribing practices at the main military training hospital of Tunis: A study of pharmaceutical interventions. ANNALES PHARMACEUTIQUES FRANÇAISES 2024:S0003-4509(24)00139-1. [PMID: 39276967 DOI: 10.1016/j.pharma.2024.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 09/10/2024] [Accepted: 09/10/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Bacterial infections have historically posed significant challenges until the discovery of antibiotics, which revolutionized infectious disease treatment. However, bacterial adaptation mechanisms over time have led to increased antimicrobial resistance, necessitating judicious antibiotic use. OBJECTIVES This study aims to comprehensively analyze pharmaceutical interventions related to antibiotic prescriptions governed by antibiotic order forms to identify and rectify medication errors, optimizing antibiotic prescribing practices. MATERIAL AND METHODS Approval for this research was obtained from the institutional review board of the Main Military Training Hospital of Tunis, Tunisia. A retrospective study was conducted at the main military training hospital of Tunis over 4 months. Pharmaceutical validation of antibiotic prescriptions through antibiotic order forms was conducted by a pharmacy resident. Pharmaceutical interventions were initiated upon detection of errors, and patient records were accessed through institutional software. RESULTS Out of 1100 prescription forms analyzed, 41 pharmaceutical interventions were conducted for 7 antibiotics. Twenty-four percent of all interventions were related to antibiotic order forms, with the intensive care unit accounting for the highest number of errors. Under-dosage and prescription errors were common. CONCLUSION Our pharmaceutical interventions related to antibiotic order forms are crucial for optimizing antibiotic therapy. Feedback mechanisms to healthcare teams are essential for enhancing prescription quality and patient care outcomes. Ongoing surveillance and improvement efforts are necessary to address medication errors and enhance antimicrobial stewardship.
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Affiliation(s)
- Aloui Ghaith
- Department of Pharmacy, Pharmacology and Pharmaceutical technology of the Main Military Training Hospital of Tunis, Tunis, Tunisia.
| | - Sana Bennour
- Department of Pharmacy, Pharmacology and Pharmaceutical technology of the Main Military Training Hospital of Tunis, Tunis, Tunisia
| | - Yousfi Mohamed Ali
- Department of Pharmacy, Pharmacology and Pharmaceutical technology of the Main Military Training Hospital of Tunis, Tunis, Tunisia; Faculty of Pharmacy of Monastir, Monastir, Tunisia
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8
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Sundar S, Singh VK, Agrawal N, Singh OP, Kumar R. Investigational new drugs for the treatment of leishmaniasis. Expert Opin Investig Drugs 2024:1-18. [PMID: 39225742 DOI: 10.1080/13543784.2024.2400139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 08/05/2024] [Accepted: 08/30/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION Over the past 20 years, significant progress has been made in anti-leishmanial therapy. Three new drugs/formulations are available for the treatment of various forms of leishmaniasis, namely oral miltefosine, paromomycin and liposomal amphotericin B. However, these advances in drug development have added considerable complexity for clinicians including toxicity, emergence of resistance and decreased sensitivity of available drugs. The development of newer drugs with less toxicity and more efficacy is urgently needed. AREAS COVERED This review comprehensively examines the latest developments and current status of antileishmanial drugs for the treatment of leishmaniasis across the world. Several new investigational drugs that showed anti-leishmanial activity under in vitro or in vivo conditions and either underwent the phase-I/II clinical trials or are on the verge of entering the trials were reviewed. We also delve into the challenges of drug resistance and discuss the emergence of new and effective antileishmanial compounds. EXPERT OPINION The available treatments for leishmaniasis are limited in number, toxic, expensive, and demand extensive healthcare resources. Every available antileishmanial drug is associated with several disadvantages, such as drug resistance and toxicity or high cost. Miltefosine is potentially teratogenic. New antileishmanial drugs/treatment modalities are sorely needed for expanding future treatment options.
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Affiliation(s)
- Shyam Sundar
- Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Vishal Kumar Singh
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Neha Agrawal
- Department of Medicine, University of Florida, Jacksonville, FL, USA
| | - Om Prakash Singh
- Department of Biochemistry, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Rajiv Kumar
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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9
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Gleeson B, Ferreyra C, Palamountain K, Jacob ST, Spotswood N, Kissoon N, Nisar YB, Fitzgerald F, Murless-Collins S, Okomo U, Cross JH, Molyneux E, Piriou E, Iloh KK, Santorino D, Goldfarb D, Stevenson A, Kirby R, Nichols BE, Blumel B, Kelly-Cirino C, Walsh T, Lloyd L, Liaghati-Mobarhan S. A call to bridge the diagnostic gap: diagnostic solutions for neonatal sepsis in low- and middle-income countries. BMJ Glob Health 2024; 9:e015862. [PMID: 39260829 PMCID: PMC11404204 DOI: 10.1136/bmjgh-2024-015862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/19/2024] [Indexed: 09/13/2024] Open
Affiliation(s)
| | | | | | | | - Naomi Spotswood
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne VCCC, Parkville, Victoria, Australia
| | - Niranjan Kissoon
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Yasir Bin Nisar
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneve, Switzerland
| | - Felicity Fitzgerald
- Imperial College London, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Sarah Murless-Collins
- Maternal Adolescent Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Uduak Okomo
- Vaccines and Immunity Theme, Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - James H Cross
- Maternal Adolescent Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Erwan Piriou
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Kenechukwu K Iloh
- University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Data Santorino
- Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - David Goldfarb
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | - Lizel Lloyd
- Stellenbosch University, Stellenbosch, South Africa
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10
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Hambolu DA, Olatoye OI, Besong MA, Call DR. Low-cost biosecurity measures are associated with reduced detection of non-Typhoidal Salmonella in Nigerian poultry while inappropriate antibiotic use is widespread. Sci Rep 2024; 14:20974. [PMID: 39251698 PMCID: PMC11385543 DOI: 10.1038/s41598-024-72317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 09/05/2024] [Indexed: 09/11/2024] Open
Abstract
Large-scale poultry production in low- and middle-income countries may be a source of adulterated products (e.g., Salmonella contamination, antibiotic residues) that can be disseminated over wide areas. We employed a cross-sectional survey of 199 randomly selected poultry farms in Lagos State, Nigeria, to estimate the prevalence of non-typhoidal Salmonella (NTS), and biosecurity and antibiotic use practices. Pooled fecal samples were collected from laying chickens and from poultry handlers. Selective culture, biochemical assays, and PCR (invA) were used to isolate and confirm NTS isolates. NTS was detected at 14% of farms (28/199) and from 10% of farm workers (6/60). Multivariate logistic regression analysis indicated that antiseptic foot dips reduced the odds ratio (OR) for detecting NTS in chicken feces [OR: 0.55; 95% confidence interval (CI) 0.07-0.58]. Most farms (94.5%, 188/199) used antibiotics for treatment and prophylaxis, but no farms (0/199) exercised withdrawal before sale of products. Most farms (86.4%, 172/199) reported using antibiotic cocktails that included medically important colistin, ciprofloxacin, chloramphenicol, and gentamicin. Egg production in Lagos State relies heavily on antibiotics and antibiotic residues are likely passed to consumers through poultry products, but there is evidence that low-cost biosecurity controls are effective for limiting the presence of NTS on farms.
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Affiliation(s)
- Dupe Arinola Hambolu
- Department of Veterinary and Pest Control Services, Federal Ministry of Agriculture and Food Security, Abuja, Nigeria
| | - Olufemi Isaac Olatoye
- Department of Veterinary Public Health and Preventive Medicine, University of Ibadan, Ibadan, Nigeria
- Paul G. Allen School for Global Health, Washington State University, 240 SE Ott Road, Pullman, WA, 99164-7090, USA
| | - Mathias Ayuk Besong
- Department of Veterinary and Pest Control Services, Federal Ministry of Agriculture and Food Security, Abuja, Nigeria
| | - Douglas Ruben Call
- Paul G. Allen School for Global Health, Washington State University, 240 SE Ott Road, Pullman, WA, 99164-7090, USA.
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11
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Guimarães FS, Dal-Pizzol TDS, Silveira MPT, Bertoldi AD. Prevalence of systemic antibacterial use during pregnancy worldwide: A systematic review. PLoS One 2024; 19:e0309710. [PMID: 39240933 PMCID: PMC11379220 DOI: 10.1371/journal.pone.0309710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/18/2024] [Indexed: 09/08/2024] Open
Abstract
OBJECTIVES In this study, we aimed to systematically review the literature of the prevalence of systemic antibacterial use during pregnancy and to perform a descriptive analysis focused on methodological characteristics. MATERIALS AND METHODS This study was registered in PROSPERO under protocol number CRD42022376634. Medline, Embase, Scientific Electronic Library Online, Biblioteca Virtual em Saúde, Cumulative Index to Nursing and Allied Health Literature, and Web of Science databases were searched (published studies until November 3rd, 2022). Selected studies were population-based cross-sectional or cohort, carried out with pregnant women, and providing information about the prevalence of systemic antibacterial use at least in one trimester of pregnancy. Reviewers conducted in pairs the title and abstract screening, eligibility criteria check, and data extraction of selected studies. Quality appraisal was performed with an adapted version of the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Data of included studies were pooled into a graphical and tabular summary. RESULTS A total of 16,251,280 pregnant women and 5,169,959 pregnancy registers were identified. The prevalence estimates of systemic antibacterial use during pregnancy ranged from 2.0% (95%CI 2.0-2.0) to 64.3% (95%CI not reported) in the 79 included studies. The majority were performed in high-income countries (91.5%). Overall, the studies revealed considerable prevalence heterogeneity in terms of study type and dataset used. The 95% confidence intervals were not reported in 41% of studies. CONCLUSION The disparities in the prevalence of systemic antibacterial use during pregnancy can be related to methodological issues and different health policies. Lack of uniform databases and changes in data collection methods over time should be taken into account in public health strategy planning. The scarce evidence in low- and middle-income settings hampers the comprehensiveness of the global prevalence of antibacterial use during pregnancy.
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12
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Zykova MV, Karpova MR, Zhang Y, Chubik MV, Shunkova DM, Azarkina LA, Mihalyov DA, Konstantinov AI, Plotnikov EV, Pestryakov AN, Perminova IV, Belousov MV. The Influence of Silver-Containing Bionanomaterials Based on Humic Ligands on Biofilm Formation in Opportunistic Pathogens. NANOMATERIALS (BASEL, SWITZERLAND) 2024; 14:1453. [PMID: 39269114 PMCID: PMC11397557 DOI: 10.3390/nano14171453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2024] [Revised: 08/26/2024] [Accepted: 09/02/2024] [Indexed: 09/15/2024]
Abstract
The uncontrolled use of antibiotics has led to a global problem of antimicrobial resistance. One of the main mechanisms of bacterial resistance is the formation of biofilms. In order to prevent the growth of antimicrobial resistance, it is crucial to develop new antibacterial agents that are capable of inhibiting the formation of biofilms. This makes this area of research highly relevant today. Promising candidates for these antibacterial agents are new bionanomaterials made from natural humic substances and silver nanoparticles. These substances have the potential to not only directly kill microorganisms but also penetrate biofilms and inhibit their formation. The goal of this study is to synthesize active pharmaceutical substances in the form of bionanomaterials, using ultradispersed silver nanoparticles in a matrix of coal humic substances, perform their characterization (NMR spectroscopy, TEM, and ICP-AES methods), and research their influence on biofilm formation in the most dangerous opportunistic pathogens (E. coli, Methicillin-resistant St. Aureus, K. pneumoniae, P. aeruginosa, St. aureus, A. baumannii, and K. Pneumonia). The results showed that all of the studied bionanomaterials had antibacterial activity against all of the opportunistic pathogens. Furthermore, they were found to have a suppressive effect on both pre-existing biofilms of these bacteria and their formation.
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Affiliation(s)
- Maria V Zykova
- Pharmaceutical Faculty, Siberian State Medical University, Tomsk 634050, Russia
| | - Maria R Karpova
- Pharmaceutical Faculty, Siberian State Medical University, Tomsk 634050, Russia
| | - Yu Zhang
- Department of Chemistry, Lomonosov Moscow State University, Leninskiye Gory 1-3, Moscow 119991, Russia
| | - Marianna V Chubik
- Pharmaceutical Faculty, Siberian State Medical University, Tomsk 634050, Russia
| | - Daria M Shunkova
- Pharmaceutical Faculty, Siberian State Medical University, Tomsk 634050, Russia
| | - Lyudmila A Azarkina
- Pharmaceutical Faculty, Siberian State Medical University, Tomsk 634050, Russia
| | - Dmitrii A Mihalyov
- Pharmaceutical Faculty, Siberian State Medical University, Tomsk 634050, Russia
| | - Andrey I Konstantinov
- Department of Chemistry, Lomonosov Moscow State University, Leninskiye Gory 1-3, Moscow 119991, Russia
| | - Evgenii V Plotnikov
- Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, Tomsk 634050, Russia
| | - Alexey N Pestryakov
- Research School of Chemistry and Applied Biomedical Sciences, Tomsk Polytechnic University, Tomsk 634050, Russia
| | - Irina V Perminova
- Department of Chemistry, Lomonosov Moscow State University, Leninskiye Gory 1-3, Moscow 119991, Russia
| | - Mikhail V Belousov
- Pharmaceutical Faculty, Siberian State Medical University, Tomsk 634050, Russia
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13
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Gonçalves Pereira J, Fernandes J, Mendes T, Gonzalez FA, Fernandes SM. Artificial Intelligence to Close the Gap between Pharmacokinetic/Pharmacodynamic Targets and Clinical Outcomes in Critically Ill Patients: A Narrative Review on Beta Lactams. Antibiotics (Basel) 2024; 13:853. [PMID: 39335027 PMCID: PMC11428226 DOI: 10.3390/antibiotics13090853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/30/2024] [Accepted: 09/04/2024] [Indexed: 09/30/2024] Open
Abstract
Antimicrobial dosing can be a complex challenge. Although a solid rationale exists for a link between antibiotic exposure and outcome, conflicting data suggest a poor correlation between pharmacokinetic/pharmacodynamic targets and infection control. Different reasons may lead to this discrepancy: poor tissue penetration by β-lactams due to inflammation and inadequate tissue perfusion; different bacterial response to antibiotics and biofilms; heterogeneity of the host's immune response and drug metabolism; bacterial tolerance and acquisition of resistance during therapy. Consequently, either a fixed dose of antibiotics or a fixed target concentration may be doomed to fail. The role of biomarkers in understanding and monitoring host response to infection is also incompletely defined. Nowadays, with the ever-growing stream of data collected in hospitals, utilizing the most efficient analytical tools may lead to better personalization of therapy. The rise of artificial intelligence and machine learning has allowed large amounts of data to be rapidly accessed and analyzed. These unsupervised learning models can apprehend the data structure and identify homogeneous subgroups, facilitating the individualization of medical interventions. This review aims to discuss the challenges of β-lactam dosing, focusing on its pharmacodynamics and the new challenges and opportunities arising from integrating machine learning algorithms to personalize patient treatment.
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Affiliation(s)
- João Gonçalves Pereira
- Grupo de Investigação e Desenvolvimento em Infeção e Sépsis, Clínica Universitária de Medicina Intensiva, Faculdade de Medicina, Universidade de Lisboa, 1649-004 Lisbon, Portugal
- Serviço de Medicina Intensiva, Hospital Vila Franca de Xira, 2600-009 Vila Franca de Xira, Portugal
| | - Joana Fernandes
- Grupo de Investigação e Desenvolvimento em Infeção e Sépsis, Serviço de Medicina Intensiva, Centro Hospitalar de Trás-os-Montes e Alto Douro, 5000-508 Vila Real, Portugal
| | - Tânia Mendes
- Serviço de Medicina Interna, Hospital Vila Franca de Xira, 2600-009 Vila Franca de Xira, Portugal
| | - Filipe André Gonzalez
- Serviço de Medicina Intensiva, Hospital Garcia De Orta, Clínica Universitária de Medicina Intensiva, Faculdade de Medicina, Universidade de Lisboa, 1649-004 Lisbon, Portugal
| | - Susana M Fernandes
- Grupo de Investigação e Desenvolvimento em Infeção e Sépsis, Serviço de Medicina Intensiva, Hospital Santa Maria, Clínica Universitária de Medicina Intensiva, Faculdade de Medicina, Universidade de Lisboa, 1649-004 Lisbon, Portugal
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14
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Cao Z, Wong F, Choudhury AK, Kamath PS, Topazian M, Torre A, Hayes PC, George J, Idilman R, Seto WK, Desalegn H, Alvares-da-Silva MR, Bush BJ, Thacker LR, Xie Q, Bajaj JS. Global prevalence and characteristics of infections and clinical outcomes in hospitalised patients with cirrhosis: a prospective cohort study for the CLEARED Consortium. Lancet Gastroenterol Hepatol 2024:S2468-1253(24)00224-3. [PMID: 39243795 DOI: 10.1016/s2468-1253(24)00224-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 06/30/2024] [Accepted: 07/03/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Infections have a poor prognosis in inpatients with cirrhosis. We aimed to determine regional variations in infections and their association with clinical outcomes in a global cohort of inpatients with cirrhosis. METHODS In this prospective cohort study initiated by the CLEARED Consortium, we enrolled adults (aged >18 years) with cirrhosis who were non-electively admitted to 98 hospitals from 26 countries or regions across six continents between Nov 5, 2021, and Dec 10, 2022. Data at admission, during hospitalisation, and for 30 days after discharge were collected through patient reports and chart reviews. Collected data included demographics; country and country income level per World Bank classifications (high-income countries [HICs], upper-middle-income countries [UMICs], and low-income or lower-middle-income countries [L-LMICs]); comorbidities; characteristics related to cirrhosis and the infections, including types, culture results, and drug resistance profile; antibiotic use; and disease course while hospitalised and for 30 days post-discharge. The primary outcome was in-hospital death or hospice referral in those with versus those without an admission infection (defined by the presence of infection on or within 48 h of admission). Multivariable log-binomial regression for in-hospital death or hospice referral was performed to identify risk factors. FINDINGS Of 4550 patients screened, 4238 patients (mean age 56·1 years [SD 13·3]; 2711 [64·0%] male and 1527 [36·0%] female) with complete data were enrolled. 1351 (31·9%) had admission infections. A higher proportion of patients in L-LMICs had infections (318 [41·7%] of 762 vs 444 [58·3%] without infection) than in UMICs (588 [30·6%] of 1922 vs 1334 [69·4%]) or HICs (445 [28·6%] of 1554 vs 1109 [71·4%]). Patients with admission infections had worse severity of cirrhosis and were more likely to have had an infection or been hospitalised in the preceding 6 months. The most common specific infection types were spontaneous bacterial peritonitis (391 [28·9%] of 1351), pneumonia (233 [17·2%]), and urinary tract infections (193 [14·3%]). 549 (40·6%) patients were culture-positive for bacterial or fungal infections, with the lowest culture-positive rates in Africa and mainland China. Most of the isolated organisms were Gram-negative (345 [63%] of 549), then Gram-positive (157 [29%]), and then fungi or mixed (47 [9%]), with Escherichia coli, Klebsiella pneumoniae, and Enterococcus spp being the top three isolated pathogens. The overall rate of drug resistance was 40% (220 of 549 with positive cultures), being highest in UMICs. The most used empirical antimicrobials were third-generation cephalosporins (453 [37%] of 1241), followed by the broad-spectrum β-lactams and β-lactamase inhibitors (289 [23%]). De-escalation was observed in 62 (20%) of 304 patients who had their antibiotics changed. Patients with versus without admission infections had a higher rate of in-hospital death or hospice transfer (299 [22·1%] of 1351 vs 232 [8·0%] of 2887; p<0·0001), a result replicated in multivariable analysis (adjusted risk ratio 1·75 [95% CI 1·42-2·06]; p<0·0001). Older age, self-reported female gender, not being in a HIC, lactulose use, and higher MELD-Na score were also associated with in-hospital death or hospice transfer on multivariable analysis. INTERPRETATION In the CLEARED Consortium cohort of inpatients with cirrhosis, the rates and types of infections, causative organisms, and culture-positivity varied substantially across regions, and infections were associated with a higher mortality risk. Culture positivity, which guides appropriate antibiotic use, was low. Taking a global perspective, considering regional variations in infections, drug resistance, and resources, could help to alleviate disparities in burden and outcomes. FUNDING US Department of Veterans Affairs, the Richmond Institute for Veterans Research, the National Natural Science Foundation of China, Shanghai Rising-Star Program, the National Council for Scientific and Technological Development of Brazil, and Shanghai Municipal Key Clinical Specialty.
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Affiliation(s)
- Zhujun Cao
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Florence Wong
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ashok K Choudhury
- Department of Hepatology, Institute for Liver and Biliary Sciences, New Delhi, India
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Mark Topazian
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Gastroenterology and Hepatology Unit, St Paul's Hospital, Millennium Medical College, Addis Ababa, Ethiopia
| | - Aldo Torre
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Peter C Hayes
- Hepatology, Division of Health Sciences, Deanery of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research and Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Ramazan Idilman
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Wai-Kay Seto
- Department of Medicine, School of Clinical Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hailemichael Desalegn
- Gastroenterology and Hepatology Unit, St Paul's Hospital, Millennium Medical College, Addis Ababa, Ethiopia
| | - Mario Reis Alvares-da-Silva
- Department of Hepatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Brian J Bush
- Department of Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Leroy R Thacker
- Department of Population Health, Virginia Commonwealth University, Richmond, VA, USA
| | - Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Jasmohan S Bajaj
- Division of Gastroenterology, Hepatology, and Nutrition and Richmond VA Medical Center, Virginia Commonwealth University, Richmond, VA, USA.
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15
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Saini R, Kumar V, Sourirajan A, Dev K. Fruit Extract and Phenolic Compounds of Phyllanthus emblica Fruits as Bioactivity Enhancer of Chloramphenicol Against Bacterial Species. PLANT FOODS FOR HUMAN NUTRITION (DORDRECHT, NETHERLANDS) 2024; 79:656-661. [PMID: 38951374 DOI: 10.1007/s11130-024-01206-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 07/03/2024]
Abstract
Phyllanthus emblica L. (syn. Emblica officinalis) fruits have been traditionally exploited to enhance the immune system and provide protection against bacterial and fungal diseases. The present study aimed to evaluate the synergistic interactions between chloramphenicol and several phenolic compounds found in P. emblica fruits against bacterial strains. The combination of P. emblica fruit extracts and its phenolic compounds demonstrated synergistic antibacterial activity when used in conjunction with chloramphenicol against both Gram-positive and Gram-negative bacteria. The combination of MICGA with ½MICChl exhibited a significant increase in bioactivity, with a 333.33-fold enhancement against B. subtilis. Similarly, the combination of MICGA with 2MICChl displayed a bioactivity enhancement of 16.02 folds against S. aureus. The co-administration of ½MICQ and ½MICChl resulted in a significant 35.71-fold increase in bioactivity against P. aeruginosa. Similarly, the combination of MIC GA and ½MICChl exhibited a remarkable 166.66-fold enhancement in bioactivity against E. coli. The combinations of 2MICFPE and ½MICChloramphenicol, as well as ½MICGA and ½MICChl demonstrated the highest bioactivity enhancement of 17.85 folds for K. pneumoniae. This study claimed that the fruit extracts of P. emblica and its phenolic compounds could be utilized to augment the effectiveness of conventional antibiotics, which have acquired resistance to bacterial infections.
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Affiliation(s)
- Rakshandha Saini
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, PO Sultanpur, Distt. Solan-173229 HP, Bajhol, India
| | - Vikas Kumar
- University Institute of Biotechnology, Chandigarh University, Gharuan, Mohali, Punjab, 140413, India.
| | - Anuradha Sourirajan
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, PO Sultanpur, Distt. Solan-173229 HP, Bajhol, India
| | - Kamal Dev
- Faculty of Applied Sciences and Biotechnology, Shoolini University of Biotechnology and Management Sciences, PO Sultanpur, Distt. Solan-173229 HP, Bajhol, India.
- Department of Pharmacology and Toxicology, Wright State University, Dayton, OH, 45435, USA.
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16
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Wang J, Wu W, Chen Y. Analysis of a diffusive two-strain malaria model with the carrying capacity of the environment for mosquitoes. Infect Dis Model 2024; 9:931-962. [PMID: 38813135 PMCID: PMC11134547 DOI: 10.1016/j.idm.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/06/2024] [Accepted: 05/06/2024] [Indexed: 05/31/2024] Open
Abstract
We propose a malaria model involving the sensitive and resistant strains, which is described by reaction-diffusion equations. The model reflects the scenario that the vector and host populations disperse with distinct diffusion rates, susceptible individuals or vectors cannot be infected by both strains simultaneously, and the vector population satisfies the logistic growth. Our main purpose is to get a threshold type result on the model, especially the interaction effect of the two strains in the presence of spatial structure. To solve this issue, the basic reproduction number (BRN) R 0 i and invasion reproduction number (IRN) R ˆ 0 i of each strain (i = 1 and 2 are for the sensitive and resistant strains, respectively) are defined. Furthermore, we investigate the influence of the diffusion rates of populations and vectors on BRNs and IRNs.
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Affiliation(s)
- Jinliang Wang
- Engineering Research Center of Agricultural Microbiology Technology, Ministry of Education & Heilongjiang Provincial Key Laboratory of Ecological Restoration and Resource Utilization for Cold Region & School of Mathematical Science, Heilongjiang University, Harbin, 150080, PR China
| | - Wenjing Wu
- Engineering Research Center of Agricultural Microbiology Technology, Ministry of Education & Heilongjiang Provincial Key Laboratory of Ecological Restoration and Resource Utilization for Cold Region & School of Mathematical Science, Heilongjiang University, Harbin, 150080, PR China
| | - Yuming Chen
- Department of Mathematics, Wilfrid Laurier University, Waterloo, Ontario, N2L 3C5, Canada
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17
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Deng J, Zhang W, Zhang L, Qin C, Wang H, Ling W. Micro-interfacial behavior of antibiotic-resistant bacteria and antibiotic resistance genes in the soil environment: A review. ENVIRONMENT INTERNATIONAL 2024; 191:108972. [PMID: 39180776 DOI: 10.1016/j.envint.2024.108972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 08/11/2024] [Accepted: 08/19/2024] [Indexed: 08/26/2024]
Abstract
Overutilization and misuse of antibiotics in recent decades markedly intensified the rapid proliferation and diffusion of antibiotic resistance genes (ARGs) within the environment, thereby elevating ARGs to the status of a global public health crisis. Recognizing that soil acts as a critical reservoir for ARGs, environmental researchers have made great progress in exploring the sources, distribution, and spread of ARGs in soil. However, the microscopic state and micro-interfacial behavior of ARGs in soil remains inadequately understood. In this study, we reviewed the micro-interfacial behaviors of antibiotic-resistant bacteria (ARB) in soil and porous media, predominantly including migration-deposition, adsorption, and biofilm formation. Meanwhile, adsorption, proliferation, and degradation were identified as the primary micro-interfacial behaviors of ARGs in the soil, with component of soil serving as significant determinant. Our work contributes to the further comprehension of the microstates and processes of ARB and ARGs in the soil environments and offers a theoretical foundation for managing and mitigating the risks associated with ARG contamination.
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Affiliation(s)
- Jibao Deng
- Institute of Organic Contaminant Control and Soil Remediation, College of Resources and Environmental Sciences, Nanjing Agricultural University, Nanjing 210095, China
| | - Wenkang Zhang
- Institute of Organic Contaminant Control and Soil Remediation, College of Resources and Environmental Sciences, Nanjing Agricultural University, Nanjing 210095, China
| | - Lingyu Zhang
- Institute of Organic Contaminant Control and Soil Remediation, College of Resources and Environmental Sciences, Nanjing Agricultural University, Nanjing 210095, China
| | - Chao Qin
- Institute of Organic Contaminant Control and Soil Remediation, College of Resources and Environmental Sciences, Nanjing Agricultural University, Nanjing 210095, China
| | - Hefei Wang
- Institute of Organic Contaminant Control and Soil Remediation, College of Resources and Environmental Sciences, Nanjing Agricultural University, Nanjing 210095, China.
| | - Wanting Ling
- Institute of Organic Contaminant Control and Soil Remediation, College of Resources and Environmental Sciences, Nanjing Agricultural University, Nanjing 210095, China.
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18
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Legge AA, Middleton JL, Fiander M, Cracknell J, Osborn DA, Gordon A. Shorter versus longer duration antibiotic regimens for treatment of suspected neonatal sepsis. Cochrane Database Syst Rev 2024; 8:CD016006. [PMID: 39212160 DOI: 10.1002/14651858.cd016006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the safety and effectiveness of shorter versus longer duration antibiotic regimens for the treatment of suspected neonatal sepsis.
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Affiliation(s)
- Alexandra A Legge
- Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Michelle Fiander
- Cochrane Neonatal Group, Vermont Oxford Network, Burlington, Vermont, USA
| | - Jane Cracknell
- Cochrane Neonatal Group, Vermont Oxford Network, Burlington, Vermont, USA
| | - David A Osborn
- Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, School of Medicine, The University of Sydney, Sydney, Australia
| | - Adrienne Gordon
- Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Institute of Women, Children and Families, Sydney Local Health District, Sydney, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
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19
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Su Z, Cui S, Wen D, Chen L. Metagenomic insights into resistome, mobilome and virulome in different fecal waste. ENVIRONMENTAL RESEARCH 2024; 262:119861. [PMID: 39208976 DOI: 10.1016/j.envres.2024.119861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 08/13/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
Fecal waste is a significant source of antimicrobial resistance (AMR) pollution and provides valuable insights into the AMR development in animal and human populations within the "One health" framework. Various genetic elements, including antibiotic resistance genes (ARGs), biocide and metal resistance genes (BMGs), mobile genetic elements (MGEs), and virulence factor genes (VFGs), are crucial AMR risk determinants (ARDs). However, few studies focused on compositional characteristics of ARDs in different feces. Here, we analyzed 753 public metagenomes from human, pig, chicken, and cattle feces, revealing significant differences in ARD richness and abundance across fecal types, notably lowest in cattle samples. Tetracycline, multi-metal, and -biocide resistance genes were dominant resistome. A few core genes contributed to 25.6%-91.1% of gene abundance, and their correlations were stronger in cattle samples. Procrustes analysis showed that microbial composition had higher correlations with ARGs (M2 = 0.579) and BMGs (M2 = 0.519). Gammaproteobacteria was identified as major ARD-hosts especially in human and pig feces, and they mainly carried multi-resistance genes. MGEs exhibited direct positive effects on ARGs and BMGs, indirectly impacting VFGs. Utilizing random forest methods, we identified 42 indicator genes for tracking AMR pollution originating from fecal sources in the environments. This study offers new insights into understanding and controlling the AMR pollution of fecal waste from human and food animals.
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Affiliation(s)
- Zhiguo Su
- School of Environment, Tsinghua University, Beijing 100084, China
| | - Saishi Cui
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - Donghui Wen
- College of Environmental Sciences and Engineering, Peking University, Beijing 100871, China.
| | - Lyujun Chen
- School of Environment, Tsinghua University, Beijing 100084, China.
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20
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Wang B, Xu H, Liu Y, Zhou K, Li X, Kong D, Chen J, He Y, Ji R. Unraveling phytoremediation mechanisms of the common reed (Phragmites australis) suspension cells towards ciprofloxacin: Xenobiotic transformation and metabolic reprogramming. WATER RESEARCH 2024; 266:122347. [PMID: 39216127 DOI: 10.1016/j.watres.2024.122347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Revised: 08/14/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
Phytoremediation is an effective solution to treat pollution with antibiotic compounds in aquatic environments; however, the underlying mechanisms for plants to cope with antibiotic pollutants are obscure. Here we used cell suspension culture to investigate the distribution and transformation of ciprofloxacin (CIP) in common reed (Phragmites australis) plants, as well as the accompanying phenotypic and metabolic responses of plants. By means of radioactive isotope labelling, we found that in total 68 % of CIP was transformed via intracellular Phase I transformation (reduction and methylation), Phase Ⅱ conjugation (glycosylation), and Phase Ⅲ compartmentalization (cell-bound residue formation mainly in cell walls, 23 %). The reduction and glycosylation products were secreted by the cells. To mitigate stress induced by CIP and its transformation products, the cells activated the defense system by up-regulating both intra- and extra-cellular antioxidant metabolites (e.g., catechin, l-cystine, and dehydroascorbic acid), anti-C/N metabolism disorder metabolites (e.g., succinic acid), secreting signaling (e.g., nicotinic acid), and anti-stress (e.g., allantoin) metabolites. Notably, the metabolic reprogramming could be involved in the CIP transformation process (e.g., glycosylation). Our findings reveal the strategy of wetland plants to cope with the stress from CIP by transforming the xenobiotic compound and reprogramming metabolism, and provide novel insights into the fate of antibiotics and plant defense mechanisms during phytoremediation.
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Affiliation(s)
- Bin Wang
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China
| | - Hang Xu
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China
| | - Yu Liu
- Jiangsu Jinling Environment Co., Ltd., Nanjing 210003, China
| | - Kaiping Zhou
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China
| | - Xinyu Li
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China
| | - Deyang Kong
- Nanjing Institute of Environmental Science, Key Laboratory of Pesticide Environmental Assessment and Pollution Control, Nanjing 210042, China
| | | | - Yujie He
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China; Key Laboratory of the Three Gorges Reservoir Region's Eco-Environment, Ministry of Education, Chongqing University, Chongqing 400044, China.
| | - Rong Ji
- State Key Laboratory of Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210023, China.
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21
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Sendra E, Fernández-Muñoz A, Zamorano L, Oliver A, Horcajada JP, Juan C, Gómez-Zorrilla S. Impact of multidrug resistance on the virulence and fitness of Pseudomonas aeruginosa: a microbiological and clinical perspective. Infection 2024; 52:1235-1268. [PMID: 38954392 PMCID: PMC11289218 DOI: 10.1007/s15010-024-02313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024]
Abstract
Pseudomonas aeruginosa is one of the most common nosocomial pathogens and part of the top emergent species associated with antimicrobial resistance that has become one of the greatest threat to public health in the twenty-first century. This bacterium is provided with a wide set of virulence factors that contribute to pathogenesis in acute and chronic infections. This review aims to summarize the impact of multidrug resistance on the virulence and fitness of P. aeruginosa. Although it is generally assumed that acquisition of resistant determinants is associated with a fitness cost, several studies support that resistance mutations may not be associated with a decrease in virulence and/or that certain compensatory mutations may allow multidrug resistance strains to recover their initial fitness. We discuss the interplay between resistance profiles and virulence from a microbiological perspective but also the clinical consequences in outcomes and the economic impact.
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Affiliation(s)
- Elena Sendra
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain
| | - Almudena Fernández-Muñoz
- Research Unit, University Hospital Son Espases-Health Research Institute of the Balearic Islands (IdISBa), Microbiology Department, University Hospital Son Espases, Crtra. Valldemossa 79, 07010, Palma, Spain
| | - Laura Zamorano
- Research Unit, University Hospital Son Espases-Health Research Institute of the Balearic Islands (IdISBa), Microbiology Department, University Hospital Son Espases, Crtra. Valldemossa 79, 07010, Palma, Spain
| | - Antonio Oliver
- Research Unit, University Hospital Son Espases-Health Research Institute of the Balearic Islands (IdISBa), Microbiology Department, University Hospital Son Espases, Crtra. Valldemossa 79, 07010, Palma, Spain
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Pablo Horcajada
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Juan
- Research Unit, University Hospital Son Espases-Health Research Institute of the Balearic Islands (IdISBa), Microbiology Department, University Hospital Son Espases, Crtra. Valldemossa 79, 07010, Palma, Spain.
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
| | - Silvia Gómez-Zorrilla
- Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Hospital del Mar Research Institute, Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Passeig Marítim 25-27, 08003, Barcelona, Spain.
- Center for Biomedical Research in Infectious Diseases Network (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
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22
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Ximenes G, Saha SK, Guterres H, Vieira A, Harris L, Mahony M, Dos Santos A, Toto L, Amaral E, Spargo JC, Tay SY, Amaral S, Champlin K, Draper ADK, Francis JR, Yan J, Lynar SA. Antimicrobial prescribing in referral hospitals in Timor-Leste: results of the first two national point prevalence surveys, 2020-21. JAC Antimicrob Resist 2024; 6:dlae123. [PMID: 39091690 PMCID: PMC11293431 DOI: 10.1093/jacamr/dlae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/08/2024] [Indexed: 08/04/2024] Open
Abstract
Objectives To describe antimicrobial use (AMU) in patients admitted to hospitals in Timor-Leste. Methods In 2020 and 2021, we undertook antimicrobial prescribing point prevalence surveys across all six hospitals in Timor-Leste (one national and five municipal) to describe AMU and appropriateness in admitted patients. Results In 2020, 291/394 (73.9%) surveyed patients had been prescribed antimicrobials, compared with 260/403 (64.5%) in 2021 (P = 0.004). Most (309/551; 56.1%) were prescribed one antimicrobial, and 179/551 (32.5%) were prescribed two. The most commonly prescribed antibiotics were ceftriaxone (38.5% in 2020, 41.5% in 2021) and ampicillin (35.7% in 2020, 32.3% in 2021), followed by gentamicin, metronidazole and cloxacillin. Reserve antibiotics like meropenem and vancomycin were minimally used. Of all antimicrobial prescriptions, 70.8% were deemed appropriate in 2020 and 69.1% in 2021. Antimicrobial prescriptions for surgical and post-partum prophylaxis were frequently deemed inappropriate [37/50 (74.0%) and 39/44 (88.6%) prescriptions, respectively]. Conclusions Most patients admitted to hospital in Timor-Leste are prescribed antimicrobials, and approximately one-third of these prescriptions are inappropriate. However, this was in the context of limited local guideline availability at the time of surveys and limited microbiological culture capacity outside of the capital, Dili. Improved microbiological guidance, iterative guideline revisions based on local antimicrobial resistance (AMR) surveillance data, and enhanced stewardship activities including further point prevalence studies, could improve antimicrobial use, optimize patient outcomes and reduce AMR in Timor-Leste.
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Affiliation(s)
- Guilherme Ximenes
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Pharmacy Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Sajal K Saha
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Department of Infectious Diseases, Melbourne Medical School, National Centre for Antimicrobial Stewardship (NCAS), University of Melbourne, Melbourne, 3010 Victoria, Australia
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), IMPACT, Deakin University, Geelong 3220, VIC, Australia
| | - Helio Guterres
- Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Adriano Vieira
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Lisa Harris
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Michelle Mahony
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Department of Paediatrics, Royal Darwin Hospital, Darwin 0810, Northern Territory, Australia
| | - Agata Dos Santos
- Pharmacy Department, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Lucia Toto
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Elfiana Amaral
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Department of Internal Medicine, Hospital Nacional Guido Valadares, Dili, Timor-Leste
| | - Jessie C Spargo
- Department of Paediatrics, Royal Darwin Hospital, Darwin 0810, Northern Territory, Australia
| | - Sze Yen Tay
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin 0810, Northern Territory, Australia
| | - Salvador Amaral
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Karen Champlin
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Anthony D K Draper
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Northern Territory Centre for Disease Control, Darwin 0810, Northern Territory, Australia
- National Centre for Epidemiology and Population Health, College of Health and Medicine, Australian National University, Canberra 0200, Australian Capital Territory, Australia
| | - Joshua R Francis
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Department of Paediatrics, Royal Darwin Hospital, Darwin 0810, Northern Territory, Australia
| | - Jennifer Yan
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Department of Paediatrics, Royal Darwin Hospital, Darwin 0810, Northern Territory, Australia
| | - Sarah A Lynar
- Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin 0810, Northern Territory, Australia
- Northern Territory Centre for Disease Control, Darwin 0810, Northern Territory, Australia
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23
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Nurjadi D, Chalin A, Hauswaldt S, Olson L, Larsson M, Östholm Å, Velavan TP, Boutin S, Rupp J, Nilsson LE, Hanberger H. A proof-of-principle study for the point-of-care detection of ESBL (CTX-M) by NG-Test ® CTX-M MULTI lateral flow assay in urine samples using a simplified method for use in a resource-limited setting. JAC Antimicrob Resist 2024; 6:dlae103. [PMID: 38966331 PMCID: PMC11220667 DOI: 10.1093/jacamr/dlae103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/13/2024] [Indexed: 07/06/2024] Open
Abstract
Background The rise of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) in low- and middle-income countries limits treatment options, leading to the frequent use of broad-spectrum antibiotics. Reducing time-to-result for a urinary infection can facilitate correct antibiotic treatment and support antimicrobial and diagnostic stewardship measures. This study compared two simplified enrichment methods for detecting CTX-M directly from urine specimens. Methods Two enrichment methods, namely centrifugation of 2 mL urine and filtration of 1 mL urine using the DirecTool adaptor, were compared using 20 culture-positive urine samples (20 suspected ESBL-E and 20 non-ESBL-E). CTX-M production was detected using a lateral flow assay (LFA), NG-Test® CTX-MMULTI. The presence of bla CTX-M genes was confirmed by whole-genome sequencing (WGS). Results The results of both enrichment methods were identical, with a sensitivity of 87.5% and a specificity of 100%. In 19/20 (95%) of the urine samples, the results of the CTX-M LFA were identical with the phenotypic confirmation and WGS. Both methods could detect ESBL-E bacteriuria with ≥104 cfu/mL. All ESBL-E-negative samples were identified accurately. Both enrichment methods yielded negative results in one ESBL-E-positive (CTX-M-15) sample despite phenotypic and genotypic confirmation of ESBL production. High leukocyte count (>500 cells/µL), the presence of boric acid or polymicrobial samples did not appear to impact the performance of both enrichment methods. Conclusions Our study underscores the feasibility of directly detecting CTX-M in urine. Simplified enrichment methods, particularly with a filtration kit, enhance the assay's practicality, rendering it suitable for use in primary care, emergency departments or remote laboratories without sophisticated equipment.
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Affiliation(s)
- Dennis Nurjadi
- Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany
- Vietnamese German Center for Medical Research (VG-CARE), Hanoi, Vietnam
| | | | - Susanne Hauswaldt
- Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Linus Olson
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Training and Research Academic Collaboration (TRAC), Sweden, Vietnam
| | - Mattias Larsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Training and Research Academic Collaboration (TRAC), Sweden, Vietnam
| | - Åse Östholm
- Department of Infectious Diseases in Region Östergötland, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Thirumalaisamy P Velavan
- Vietnamese German Center for Medical Research (VG-CARE), Hanoi, Vietnam
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, Tübingen, Germany
- Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Sébastien Boutin
- Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Lübeck, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein Campus Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany
| | - Lennart E Nilsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Håkan Hanberger
- Training and Research Academic Collaboration (TRAC), Sweden, Vietnam
- Department of Infectious Diseases in Region Östergötland, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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24
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Lundin V, Lam F, Akinjeji A, Kabunga L, Eriksen J. Prevalence of antibiotic use for childhood diarrhoea in Uganda after an ORS scale-up intervention: a repeated cross-sectional study. BMC Public Health 2024; 24:2084. [PMID: 39090599 PMCID: PMC11295441 DOI: 10.1186/s12889-024-19613-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 07/26/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Diarrhoea kills 500,000 children every year despite availability of cheap and effective treatment. In addition, a large number are inappropriately treated with antibiotics, which do not benefit the patient but can contribute to the development of antibiotic resistance. We investigated whether the prevalence of antibiotic use among children under the age of five with diarrhoea in Uganda changed following a national intervention to increase the use of oral rehydration salts (ORS), and whether any socioeconomic characteristics were associated with antibiotic use. METHODS A cross-sectional survey was conducted among caregivers of children under the age of five and among private health care providers and drug sellers in Uganda in 2014. This was compared to a similar survey among private health care providers, and the national demographic and health survey in Uganda in 2016. Logistic regression was used to find associations between antibiotic use and socioeconomic characteristics, and chi-square test and independent sample t-test were used to find significant differences between groups. RESULTS The prevalence of antibiotic use among children under the age of five with diarrhoea in Uganda decreased from 30.5% in 2014 to 20.0% (p < 0.001) in 2016. No associations between socioeconomic characteristics and the use of antibiotics were significant in both 2014 and 2016. CONCLUSIONS The use of antibiotics in children with diarrhoeal disease decreased significantly in Uganda between 2014 and 2016. However, the extent of the contribution of the ORS scale-up programme to this decrease cannot be determined from this study.
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Affiliation(s)
- Viktor Lundin
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Felix Lam
- Clinton Health Access Initiative, Boston, USA
| | - Adewale Akinjeji
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- ICAP Global Health Nigeria, Abuja, Nigeria
| | | | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Unit of infectious diseases/Venhälsan, Stockholm South Hospital, Stockholm, Sweden.
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25
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Lotto T, Renggli S, Kaale E, Masanja H, Ternon B, Décosterd LA, D'Acremont V, Genton B, Kulinkina AV. Prevalence and predictors of residual antibiotics in children's blood in community settings in Tanzania. Clin Microbiol Infect 2024; 30:1042-1048. [PMID: 38740136 DOI: 10.1016/j.cmi.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVES Children account for a significant proportion of antibiotic consumption in low- and middle-income countries, with overuse occurring in formal and informal health sectors. This study assessed the prevalence and predictors of residual antibiotics in the blood of children in the Mbeya and Morogoro regions of Tanzania. METHODS The cross-sectional community-based survey used two-stage cluster sampling to include children aged under 15 years. For each child, information on recent illness, healthcare-seeking behaviour, and use of antibiotics, as well as a dried blood spot sample, were collected. The samples underwent tandem mass spectrometry analysis to quantify the concentrations of 15 common antibiotics. Associations between survey variables and the presence of residual antibiotics were assessed using mixed-effects logistic regression. RESULTS In total, 1742 children were surveyed, and 1699 analysed. The overall prevalence of residual antibiotics in the blood samples was 17.4% (296/1699), the highest among children under the age of 5 years. The most frequently detected antibiotics were trimethoprim (144/1699; 8.5%), sulfamethoxazole (102/1699; 6.0%), metronidazole (61/1699; 3.6%), and amoxicillin (43/1699; 2.5%). The strongest predictors of residual antibiotics in the blood were observed presence of antibiotics at home (adjusted odds ratio [aOR] = 2.9; 95% CI, 2.0-4.1) and reported consumption of antibiotics in the last 2 weeks (aOR = 2.5; 95% CI, 1.6-3.9). However, half (145/296) of the children who had residual antibiotics in their blood, some with multiple antibiotics, had no reported history of illness or antibiotic consumption in the last 2 weeks, and antibiotics were not found at home. DISCUSSION This study demonstrated a high prevalence of antibiotic exposure among children in Tanzanian communities, albeit likely underestimated, especially for compounds with short half-lives. A significant proportion of antibiotic exposure was unexplained and may have been due to unreported self-medication or environmental pathways. Incorporating biomonitoring into surveillance strategies can help better understand exposure patterns and design antibiotic stewardship interventions.
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Affiliation(s)
- Theopista Lotto
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland; Ifakara Health Institute, Dar es Salaam, Tanzania.
| | - Sabine Renggli
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Eliangiringa Kaale
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Beatrice Ternon
- Laboratory of Clinical Pharmacology, University Hospital, Lausanne
| | - Laurent Arthur Décosterd
- Laboratory of Clinical Pharmacology, University Hospital, Lausanne; University of Lausanne, Lausanne, Switzerland
| | - Valérie D'Acremont
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland; University of Lausanne, Lausanne, Switzerland; Centre for Primary Care and Public Health, Lausanne, Switzerland
| | - Blaise Genton
- University of Lausanne, Lausanne, Switzerland; Centre for Primary Care and Public Health, Lausanne, Switzerland
| | - Alexandra V Kulinkina
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland; University of Basel, Basel, Switzerland
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26
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Ramos-Llorens M, Bello-Madruga R, Valle J, Andreu D, Torrent M. PyAMPA: a high-throughput prediction and optimization tool for antimicrobial peptides. mSystems 2024; 9:e0135823. [PMID: 38934543 PMCID: PMC11264690 DOI: 10.1128/msystems.01358-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/27/2024] [Indexed: 06/28/2024] Open
Abstract
The alarming rise of antibiotic-resistant bacterial infections is driving efforts to develop alternatives to conventional antibiotics. In this context, antimicrobial peptides (AMPs) have emerged as promising candidates for their ability to target a broad range of microorganisms. However, the development of AMPs with optimal potency, selectivity, and/or stability profiles remains a challenge. To address it, computational tools for predicting AMP properties and designing novel peptides have gained increasing attention. PyAMPA is a novel platform for AMP discovery. It consists of five modules, namely AMPScreen, AMPValidate, AMPSolve, AMPMutate, and AMPOptimize, that allow high-throughput proteome inspection, candidate screening, and optimization through point-mutation and genetic algorithms. The platform also offers additional tools for predicting and evaluating AMP properties, including antimicrobial and cytotoxic activity, and peptide half-life. By providing innovative and accessible inroads into AMP motifs in proteomes, PyAMPA will enable advances in AMP development and potential translation into clinically useful molecules. PyAMPA is available at: https://github.com/SysBioUAB/PyAMPA. IMPORTANCE This paper introduces PyAMPA, a new bioinformatics platform designed for the discovery and optimization of antimicrobial peptides (AMPs). It addresses the urgent need for new antimicrobials due to the rise of antibiotic-resistant infections. PyAMPA, with its five predictive modules -AMPScreen, AMPValidate, AMPSolve, AMPMutate and AMPOptimize, enables high-throughput screening of proteomes to identify potential AMP motifs and optimize them for clinical use. Its unique approach, combining prediction, design, and optimization tools, makes PyAMPA a robust solution for developing new AMP-based therapies, offering a significant advance in combatting antibiotic resistance.
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Affiliation(s)
- Marc Ramos-Llorens
- Systems Biology of Infection Lab, Department of Biochemistry and Molecular Biology, Biosciences Faculty, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Roberto Bello-Madruga
- Systems Biology of Infection Lab, Department of Biochemistry and Molecular Biology, Biosciences Faculty, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Valle
- Barcelona Biomedical Research Park, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - David Andreu
- Barcelona Biomedical Research Park, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Marc Torrent
- Systems Biology of Infection Lab, Department of Biochemistry and Molecular Biology, Biosciences Faculty, Universitat Autònoma de Barcelona, Barcelona, Spain
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Feng J, Zheng Y, Ma W, Weng D, Peng D, Xu Y, Wang Z, Wang X. A synthetic antibiotic class with a deeply-optimized design for overcoming bacterial resistance. Nat Commun 2024; 15:6040. [PMID: 39019927 PMCID: PMC11255307 DOI: 10.1038/s41467-024-50453-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 07/10/2024] [Indexed: 07/19/2024] Open
Abstract
The lack of new drugs that are effective against antibiotic-resistant bacteria has caused increasing concern in global public health. Based on this study, we report development of a modified antimicrobial drug through structure-based drug design (SBDD) and modular synthesis. The optimal modified compound, F8, was identified, which demonstrated in vitro and in vivo broad-spectrum antibacterial activity against drug-resistant bacteria and effectively mitigated the development of resistance. F8 exhibits significant bactericidal activity against bacteria resistant to antibiotics such as methicillin, polymyxin B, florfenicol (FLO), doxycycline, ampicillin and sulfamethoxazole. In a mouse model of drug-resistant bacteremia, F8 was found to increase survival and significantly reduce bacterial load in infected mice. Multi-omics analysis (transcriptomics, proteomics, and metabolomics) have indicated that ornithine carbamoyl transferase (arcB) is a antimicrobial target of F8. Further molecular docking, Isothermal Titration Calorimetry (ITC), and Differential Scanning Fluorimetry (DSF) studies verified arcB as a effective target for F8. Finally, mechanistic studies suggest that F8 competitively binds to arcB, disrupting the bacterial cell membrane and inducing a certain degree of oxidative damage. Here, we report F8 as a promising candidate drug for the development of antibiotic formulations to combat antibiotic-resistant bacteria-associated infections.
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Affiliation(s)
- Jin Feng
- National Reference Laboratory of Veterinary Drug Residues (HZAU) and MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Youle Zheng
- MAO Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Wanqing Ma
- MAO Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Defeng Weng
- MAO Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Dapeng Peng
- National Reference Laboratory of Veterinary Drug Residues (HZAU) and MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, Hubei, China
- MAO Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China
| | - Yindi Xu
- Institute of Animal Husbandry and Veterinary Research, Henan Academy of Agricultural Sciences, Zhengzhou, Henan, China
| | - Zhifang Wang
- Institute of Animal Husbandry and Veterinary Research, Henan Academy of Agricultural Sciences, Zhengzhou, Henan, China
| | - Xu Wang
- National Reference Laboratory of Veterinary Drug Residues (HZAU) and MAO Key Laboratory for Detection of Veterinary Drug Residues, Huazhong Agricultural University, Wuhan, Hubei, China.
- MAO Laboratory for Risk Assessment of Quality and Safety of Livestock and Poultry Products, Huazhong Agricultural University, Wuhan, Hubei, China.
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Legge AA, Middleton JL, Fiander M, Cracknell J, Osborn DA, Gordon A. Shorter versus longer duration antibiotic regimens for treatment of culture-positive neonatal sepsis. Cochrane Database Syst Rev 2024; 7:CD015555. [PMID: 38989924 PMCID: PMC11238623 DOI: 10.1002/14651858.cd015555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
OBJECTIVES This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the safety and effectiveness of shorter versus longer duration antibiotic regimens for the treatment of culture-positive neonatal sepsis with or without meningitis.
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Affiliation(s)
- Alexandra A Legge
- Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia
| | | | | | | | - David A Osborn
- Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, School of Medicine, The University of Sydney, Sydney, Australia
| | - Adrienne Gordon
- Department of Newborn Care, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Institute of Women, Children and Families, Sydney Local Health District, Sydney, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, Australia
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29
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Zavaleta-Monestel E, Hasselmyr Hasselmyr S, García-Montero J, Arguedas-Chacón S, Rojas-Chinchilla C, Díaz-Madriz JP. The Impact of Vaccination as a Strategy to Combat Bacterial Antimicrobial Resistance. Cureus 2024; 16:e65840. [PMID: 39219910 PMCID: PMC11363808 DOI: 10.7759/cureus.65840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
Antimicrobial resistance (AMR) poses a significant threat to global health, impairing the efficacy of treatments against various infections. The World Health Organization highlights the impact of AMR on healthcare outcomes, including increased morbidity, mortality, and costs. Vaccination is a pivotal strategy to counter AMR, promoting immune defenses against infections and subsequently reducing the need for antimicrobials. This article assesses the role of vaccination in managing AMR, particularly within the scope of antimicrobial stewardship programs (ASPs), by reviewing the effectiveness of existing vaccination strategies and their integration into the community. A comprehensive literature review was concluded using databases such as Google Scholar, Scielo, and PubMed, analyzing studies from 2005 to 2024. A total of 13 studies were included after screening 132 articles for relevance and eligibility. The studies highlight the substantial role of vaccines in reducing the reliance on antibiotics, especially for vulnerable populations, such as the elderly, children, and those with chronic conditions. For instance, the introduction of conjugate pneumococcal vaccines significantly decreased rates of drug-resistant Streptococcus pneumoniae infections. The review also discusses the indirect benefits of widespread vaccination, including herd immunity and decreased transmission of resistant strains. Vaccination is a critical element in the fight against AMR. Well-coordinated ASPs, by facilitating comprehensive vaccination programs, can significantly mitigate the rise of resistant infections, optimize antimicrobial usage, and improve patient outcomes in healthcare settings. The strategies outlined reflect global health objectives and emphasize the need for sustained efforts to enhance vaccine coverage and acceptance.
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30
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Madhukar MK, Singh N, Iyer VR, Sowpati DT, Tallapaka KB, Mishra RK, Moharir SC. Antimicrobial resistance landscape in a metropolitan city context using open drain wastewater-based metagenomic analysis. ENVIRONMENTAL RESEARCH 2024; 252:118556. [PMID: 38503380 DOI: 10.1016/j.envres.2024.118556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/21/2024]
Abstract
One Health concept recognizes the inextricable interactions of diverse ecosystems and their subsequent effect on human, animal and plant health. Antimicrobial resistance (AMR) is a major One Health concern and is predicted to cause catastrophes if appropriate measures are not implemented. To understand the AMR landscape in a south Indian metropolitan city, metagenomic analysis of open drains was performed. The data suggests that in January 2022, macrolide class of antibiotics contributed the highest resistance of 40.1% in the city, followed by aminoglycoside- 24.4%, tetracycline- 11.3% and lincosamide- 6.7%. The 'mutations in the 23S rRNA gene conferring resistance to macrolide antibiotics' were the major contributor of resistance with a prevalence of 39.7%, followed by '16s rRNA with mutation conferring resistance to aminoglycoside antibiotics'- 22.2%, '16S rRNA with mutation conferring resistance to tetracycline derivatives'- 9.2%, and '23S rRNA with mutation conferring resistance to lincosamide antibiotics'- 6.7%. The most prevalent antimicrobial resistance gene (ARG) 'mutations in the 23S rRNA gene conferring resistance to macrolide antibiotics' was present in multiple pathogens including Escherichia coli, Campylobacter jejuni, Acinetobacter baumannii, Streptococcus pneumoniae, Pseudomonas aeruginosa, Neisseria gonorrhoeae, Klebsiella pneumoniae and Helicobacter pylori. Most of the geographical locations in the city showed a similar landscape for AMR. Considering human mobility and anthropogenic activities, such an AMR landscape could be common across other regions too. The data indicates that pathogens are evolving and acquiring antibiotic resistance genes to evade antibiotics of multiple major drug classes in diverse hosts. The outcomes of the study are relevant not only in understanding the resistance landscape at a broader level but are also important for identifying the resistant drug classes, the mechanisms of gaining resistance and for developing new drugs that target specific pathways. This kind of surveillance protocol can be extended to regions in other developing countries to assess and combat the problem of antimicrobial resistance.
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Affiliation(s)
| | - Nirupama Singh
- Tata Institute for Genetics and Society, Bengaluru, 560065, India
| | - V Rajesh Iyer
- Tata Institute for Genetics and Society, Bengaluru, 560065, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Divya Tej Sowpati
- Centre for Cellular and Molecular Biology, Hyderabad, 500007, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Karthik Bharadwaj Tallapaka
- Centre for Cellular and Molecular Biology, Hyderabad, 500007, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Rakesh Kumar Mishra
- Tata Institute for Genetics and Society, Bengaluru, 560065, India; Centre for Cellular and Molecular Biology, Hyderabad, 500007, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India.
| | - Shivranjani Chandrashekhar Moharir
- Tata Institute for Genetics and Society, Bengaluru, 560065, India; Centre for Cellular and Molecular Biology, Hyderabad, 500007, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India.
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Yang D, Dyar OJ, Yin J, Ma W, Sun Q, Lundborg CS. Antimicrobial resistance in China across human, animal, and environment sectors - a review of policy documents using a governance framework. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 48:101111. [PMID: 38948912 PMCID: PMC11214315 DOI: 10.1016/j.lanwpc.2024.101111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 07/02/2024]
Abstract
Antimicrobial resistance (AMR) poses a multifaceted threat to the human, animal, and environment sectors. In response, China has formulated a series of policies since the 2000s. Thus far, there has been no comprehensive assessment of these policy documents. This study aims to review the content of AMR policy documents at the national level using a governance framework covering three areas: Policy Design; Implementation Tools; and Monitoring and Evaluation. We identified 44 AMR documents from 2003 to 2022 sourced from government agency websites. Our findings have revealed noticeable discrepancies across the three governance areas. The Policy Design and Monitoring and Evaluation areas should be strengthened, particularly in the domains of 'Coordination', 'Accountability', 'Sustainability', and 'Effectiveness'. From a 'One Health' perspective, the environment sector has received less attention compared to the human and animal sectors. Effectively addressing these challenges requires a stronger commitment and widespread support from diverse stakeholders.
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Affiliation(s)
- Ding Yang
- Department of Global Public Health, Karolinska Institutet, 17177, Stockholm, Sweden
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Oliver James Dyar
- Department of Public Health and Caring Sciences, Uppsala University, 75122, Uppsala, Sweden
| | - Jia Yin
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Wenwen Ma
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Qiang Sun
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
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Sartaliya S, Sharma R, Sharma A, Chopra V, Neethu KM, Solanki AK, Ghosh D, Jayamurugan G. Biocidal polymer derived near white light-emitting polymeric carbon particles for antibacterial and bioimaging applications. Photochem Photobiol 2024; 100:1010-1019. [PMID: 38263579 DOI: 10.1111/php.13912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/29/2023] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Abstract
A growing antimicrobial crisis has increased demand for antimicrobial materials. It has become increasingly popular to convert polymeric macromolecules into polymeric carbon particles (PCP) in order to achieve highly biocompatible materials with unique properties as a result of the ability to synthesize nanomaterials of the right size and add value to existing stable polymers. This work presents the tuning of PCP for antibacterial application by combining a biocidal polymer with one-pot solvothermal synthesis. PCP displayed broad-spectrum antibacterial activity via various mechanisms, including inhibition of bacterial cell walls, ROS generation, and antibiotic resistance. Furthermore, these biocidal PCP were observed to show excitation-independent near-white light emission which on the other hand is generally possible due to mixed sizes, doping, and surface effects. As opposed to the parent biocidal polymer, PCP added ROS-mediated bactericidal activity, increased cytocompatibility, and nanofibers with anti-adhesive effects and potential of imaging bacterial cells.
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Affiliation(s)
- Shaifali Sartaliya
- Energy and Environment Unit, Institute of Nano Science and Technology, Mohali, Punjab, India
| | - Raina Sharma
- Energy and Environment Unit, Institute of Nano Science and Technology, Mohali, Punjab, India
| | - Anjana Sharma
- Chemical Biology Unit, Institute of Nano Science and Technology, Mohali, Punjab, India
| | - Vianni Chopra
- Chemical Biology Unit, Institute of Nano Science and Technology, Mohali, Punjab, India
| | - K M Neethu
- Energy and Environment Unit, Institute of Nano Science and Technology, Mohali, Punjab, India
| | - Arun Kumar Solanki
- Energy and Environment Unit, Institute of Nano Science and Technology, Mohali, Punjab, India
| | - Deepa Ghosh
- Chemical Biology Unit, Institute of Nano Science and Technology, Mohali, Punjab, India
| | - Govindasamy Jayamurugan
- Energy and Environment Unit, Institute of Nano Science and Technology, Mohali, Punjab, India
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Bhuvaraghan A, King R, Walley J, Thiruvenkatachari B, Aggarwal VR. Dental antibiotic policies, stewardship, and implementation in India: A policy document analysis. Community Dent Oral Epidemiol 2024. [PMID: 38887900 DOI: 10.1111/cdoe.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 05/10/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Dental antibiotic stewardship is crucial in low- and middle-income countries where the burden of antimicrobial resistance (AMR) is high and antibiotic misuse is common. Given that India is the most populous country, the largest antibiotic consumer and has a large dental prescriber population, this study investigated the extent to which current Indian policy and practice for dental antibiotic prescribing and stewardship aligns with the global policy and best practice. METHODS The READ approach was used to identify and extract data and synthesize the findings. Policy documents on dental antimicrobial stewardship were identified using a systematic search strategy involving nine medical and grey literature databases (Medline, Global Health, Web of Science, Cochrane, CINAHL, Eldis, Global Index Medicus, Proquest and Opengrey), targeted websites (government organizations and dental regulatory bodies) and contact with experts. Framework analysis was used to code extracted data into themes related to dental antimicrobial stewardship. RESULTS Of the 3039 records screened, 25 documents were included in the final analysis. The analysis showed a lack of guidelines or toolkits for appropriate antibiotic prescribing in dentistry in India. The treatment guidelines for antimicrobial use in common syndromes published by the Indian Council of Medical Research had no section or content for dental practitioners. Furthermore, the undergraduate dental curriculum developed by the Dental Council of India (DCI), included little content on appropriate antibiotic prescribing and no mention of AMR or stewardship. There were no educational resources either for dental practitioners or patients in the documents. CONCLUSION This document analysis showed that there was little or no mention of dental antibiotic prescribing guidelines in key policy documents such as the National Action Plan on AMR. In addition, contradictory and subjective information provided in some policy documents could encourage dentists and other health professionals such as general practitioners to prescribe antibiotics for common dental conditions for which they are contra-indicated. There is an urgent need to develop relevant guidelines and include these in Indian policy documents on AMR particularly the National Action Plan on AMR.
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Affiliation(s)
- Aarthi Bhuvaraghan
- School of Dentistry, University of Leeds, Leeds, UK
- Sree Balaji Dental College and Hospital, Bharat Institute of Higher Education and Research, Chennai, India
| | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - John Walley
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Badri Thiruvenkatachari
- Sree Balaji Dental College and Hospital, Bharat Institute of Higher Education and Research, Chennai, India
- University of Manchester, Manchester, UK
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Abejew AA, Wubetu GY, Fenta TG. Assessment of challenges and opportunities in antibiotic stewardship program implementation in Northwest Ethiopia. Heliyon 2024; 10:e32663. [PMID: 38912506 PMCID: PMC11193037 DOI: 10.1016/j.heliyon.2024.e32663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 06/25/2024] Open
Abstract
Background Indiscriminate use of antibiotics leads to antibiotic resistance (AMR) and results in mortality, morbidity, and financial burden. Antibiotic stewardship programs (ASPs) with education can resolve a number of barriers recognized in the implementation of successful ASPs. The aim of this study was to assess health professionals' perceptions and status of ASPs in hospitals in 2022. Methods A cross-sectional study was conducted from September 1, 2022 to October 30, 2022. A total of 181 health professionals were included, and a self-administered questionnaire was used to collect data. The status of hospitals was assessed using a checklist. The data were analyzed using SPSS version 23, and descriptive statistics and Chi-square tests (X2) at a P-value of <0.05 were used. Results Of the 181 respondents, 163 (90.1 %), and 161 (89.0 %) believed that AMR is a significant problem in Ethiopia and globally, respectively. Easy access to antibiotics 155 (85.6 %), and inappropriate use 137 (75.7 %) were perceived as key contributors to AMR. Antibiotics were believed to be prescribed/dispensed without laboratory results 86 (47.5 %), and antibiotic susceptibility patterns were not considered to guide empiric therapy 81 (44.8 %). ASP was believed to reduce the duration of hospital stays and associated costs 137 (75.7 %), and improve the quality of patient care 133 (73.5 %), whereas 151 (83.4 %), 143 (79 %), and 142 (78.5 %) suggested education, institutional guidelines, and prospective audits with feedback interventions to combat AMR in their hospitals, respectively. There were significant differences in perception among professionals based on professional category and attempts by hospitals to implement ASPs. Although ASPs were not functioning according to standard, there have been attempts to implement it in three hospitals. The issue of ASP had never been heard in general hospitals. Currently, it is feasible to implement ASPs in four hospitals. Conclusion The status of ASP in hospitals was very poor. Despite a lack of prior knowledge on ASPs, most respondents do have a positive perception of AMR and the implementation of ASPs. Pharmacist-led prospective audits and feedback with education and institutional guidelines for empiric antibiotic use can be better implemented in hospitals. Involvement of representatives from infection prevention and control, and collaboration among hospitals in ASP implementation will help establish a strong ASP in the area.
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Affiliation(s)
- Asrat Agalu Abejew
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Teferi Gedif Fenta
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Regassa DA, Nagaash RS, Habtu BF, Haile WB. Diagnostic significance of complete blood cell count and hemogram-derived markers for neonatal sepsis at Southwest Public Hospitals, Ethiopia. World J Clin Pediatr 2024; 13:92392. [PMID: 38947992 PMCID: PMC11212765 DOI: 10.5409/wjcp.v13.i2.92392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/11/2024] [Accepted: 04/12/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Neonatal sepsis is defined as an infection-related condition characterized by signs and symptoms of bacteremia within the first month of life. It is the leading cause of mortality and morbidity among newborns. While several studies have been conducted in other parts of world to assess the usefulness of complete blood count parameters and hemogram-derived markers as early screening tools for neonatal sepsis, the associations between sepsis and its complications with these blood parameters are still being investigated in our setting and are not yet part of routine practice. AIM To evaluate the diagnostic significance of complete blood cell count hemogram-derived novel markers for neonatal sepsis among neonates attending public hospitals in the southwest region of Oromia, Ethiopia, through a case control study. METHODS A case control study was conducted from October 2021 to October 2023 Sociodemographic, clinical history, and laboratory test results data were collected using structured questionnaires. The collected data were entered into Epi-data 3.1 version and exported to SPSS-25 for analysis. Chi-square, independent sample t-test, and receiver operator characteristics curve of curve were used for analysis. A P-value of less than 0.05 was considered statistically significant. RESULTS In this study, significant increases were observed in the following values in the case group compared to the control group: In white blood cell (WBC) count, neutrophils, monocyte, mean platelet volume (MPV), neutrophils to lymphocyte ratio, monocyte to lymphocyte ratio (MLR), red blood cell width to platelet count ratio (RPR), red blood width coefficient variation, MPV to RPR, and platelet to lymphocyte ratio. Regarding MLR, a cut-off value of ≥ 0.26 was found, with a sensitivity of 68%, a specificity of 95%, a positive predictive value (PPV) of 93.2%, and a negative predictive value (NPV) of 74.8%. The area under the curve (AUC) was 0.828 (P < 0.001). For WBC, a cut-off value of ≥ 11.42 was identified, with a sensitivity of 55%, a specificity of 89%, a PPV of 83.3%, and a NPV of 66.4%. The AUC was 0.81 (P < 0.001). Neutrophils had a sensitivity of 67%, a specificity of 81%, a PPV of 77.9%, and a NPV of 71.1%. The AUC was 0.801, with a cut-off value of ≥ 6.76 (P = 0.001). These results indicate that they were excellent predictors of neonatal sepsis diagnosis. CONCLUSION The findings of our study suggest that certain hematological parameters and hemogram-derived markers may have a potential role in the diagnosis of neonatal sepsis.
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Affiliation(s)
- Dereje Abebe Regassa
- Department of Medical Laboratory Sciences, Wolkite University, Wolkite 11330, Ethiopia
| | - Rahel Shumi Nagaash
- Department of Medical Laboratory Sciences, Wolkite University, Wolkite 11330, Ethiopia
| | - Bisirat Fikadu Habtu
- Department of Medical Laboratory Sciences, Wolkite University, Wolkite 11330, Ethiopia
| | - Woyesa Beyene Haile
- Department of Medical Laboratory Sciences, Dire Dawa University, Dire Dawa 3000, Ethiopia
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Laxminarayan R, Impalli I, Rangarajan R, Cohn J, Ramjeet K, Trainor BW, Strathdee S, Sumpradit N, Berman D, Wertheim H, Outterson K, Srikantiah P, Theuretzbacher U. Expanding antibiotic, vaccine, and diagnostics development and access to tackle antimicrobial resistance. Lancet 2024; 403:2534-2550. [PMID: 38797178 DOI: 10.1016/s0140-6736(24)00878-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/13/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024]
Abstract
The increasing number of bacterial infections globally that do not respond to any available antibiotics indicates a need to invest in-and ensure access to-new antibiotics, vaccines, and diagnostics. The traditional model of drug development, which depends on substantial revenues to motivate investment, is no longer economically viable without push and pull incentives. Moreover, drugs developed through these mechanisms are unlikely to be affordable for all patients in need, particularly in low-income and middle-income countries. New, publicly funded models based on public-private partnerships could support investment in antibiotics and novel alternatives, and lower patients' out-of-pocket costs, making drugs more accessible. Cost reductions can be achieved with public goods, such as clinical trial networks and platform-based quality assurance, manufacturing, and product development support. Preserving antibiotic effectiveness relies on accurate and timely diagnosis; however scaling up diagnostics faces technological, economic, and behavioural challenges. New technologies appeared during the COVID-19 pandemic, but there is a need for a deeper understanding of market, physician, and consumer behaviour to improve the use of diagnostics in patient management. Ensuring sustainable access to antibiotics also requires infection prevention. Vaccines offer the potential to prevent infections from drug-resistant pathogens, but funding for vaccine development has been scarce in this context. The High-Level Meeting of the UN General Assembly in 2024 offers an opportunity to rethink how research and development can be reoriented to serve disease management, prevention, patient access, and antibiotic stewardship.
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Affiliation(s)
- Ramanan Laxminarayan
- One Health Trust, Bengaluru, India; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA.
| | | | | | - Jennifer Cohn
- Global Antibiotic Research and Development Partnership, Geneva, Switzerland
| | | | | | - Steffanie Strathdee
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Nithima Sumpradit
- Food and Drug Administration, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Heiman Wertheim
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboudumc, Netherlands
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Fang P, Gao K, Yang J, Li T, Sun Q, Shan Z, Wang Y. Clinical characteristics and risk factors for neonatal bloodstream infection due to carbapenem-resistant Enterobacteriaceae: A single-centre Chinese retrospective study. J Glob Antimicrob Resist 2024; 37:28-36. [PMID: 38412919 DOI: 10.1016/j.jgar.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/09/2024] [Accepted: 02/10/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES To analyse the clinical characteristics and risk factors for bloodstream infections (BSIs) caused by carbapenem-resistant Enterobacteriaceae (CRE) in neonates. METHODS This single-centre, retrospective study included all patients with BSIs admitted to a neonatal intensive care unit between 1 January 2015 and 30 April 2022. The clinical and microbiological data of patients were collected; predictors of 30-day mortality in patients with CRE BSIs were also identified in this study. RESULTS Among the 224 neonates with Enterobacteriaceae BSIs, 39.29% (88/224) of the patients developed CRE BSIs. The 30-day mortality rate reached up to 21.59% (19/88). The Quick Sequential Organ Failure Assessment score > 2 (odds ratio [OR] and 95% credibility interval [CI]: 3.852 [1.111-13.356], P < 0.05), prior to more than two kinds of antibiotics use (OR and 95% CI: 9.433 [1.562-56.973], P < 0.05), pneumonia (OR and 95% CI: 3.847 [1.133-13.061], P < 0.05), and caesarean section (OR and 95% CI: 2.678 [1.225-5.857], P < 0.05) were independent risk factors associated with CRE BSIs. Moreover, the risk factors for mortality in neonates with CRE BSIs were significantly associated with neonatal Sequential Organ Failure Assessment score > 6 (OR and 95% CI: 16.335 [1.446-184.517], P < 0.05). CONCLUSION Prior to more than two kinds of antibiotics use, Quick Sequential Organ Failure Assessment score > 2, pneumonia and caesarean section were independent risk factors for CRE BSIs. The Neonatal Sequential Organ Failure Assessment score > 6 was a risk factor for mortality associated with CRE BSIs.
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Affiliation(s)
- Panpan Fang
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Kaijie Gao
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Junmei Yang
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China.
| | - Tiewei Li
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Qianqian Sun
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Zhiming Shan
- Zhengzhou Key Laboratory of Children's Infection and Immunity, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
| | - Yingyuan Wang
- Department of Neonatal Intensive Care Unit, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, People's Republic of China
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Okeke IN, de Kraker MEA, Van Boeckel TP, Kumar CK, Schmitt H, Gales AC, Bertagnolio S, Sharland M, Laxminarayan R. The scope of the antimicrobial resistance challenge. Lancet 2024; 403:2426-2438. [PMID: 38797176 DOI: 10.1016/s0140-6736(24)00876-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/03/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024]
Abstract
Each year, an estimated 7·7 million deaths are attributed to bacterial infections, of which 4.95 million are associated with drug-resistant pathogens, and 1·27 million are caused by bacterial pathogens resistant to the antibiotics available. Access to effective antibiotics when indicated prolongs life, reduces disability, reduces health-care expenses, and enables access to other life-saving medical innovations. Antimicrobial resistance undoes these benefits and is a major barrier to attainment of the Sustainable Development Goals, including targets for newborn survival, progress on healthy ageing, and alleviation of poverty. Adverse consequences from antimicrobial resistance are seen across the human life course in both health-care-associated and community-associated infections, as well as in animals and the food chain. The small set of effective antibiotics has narrowed, especially in resource-poor settings, and people who are very young, very old, and severely ill are particularly susceptible to resistant infections. This paper, the first in a Series on the challenge of antimicrobial resistance, considers the global scope of the problem and how it should be measured. Robust and actionable data are needed to drive changes and inform effective interventions to contain resistance. Surveillance must cover all geographical regions, minimise biases towards hospital-derived data, and include non-human niches.
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Affiliation(s)
- Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria.
| | - Marlieke E A de Kraker
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; WHO Collaborating Centre on AMR, Geneva, Switzerland
| | - Thomas P Van Boeckel
- Health Geography and Policy Group, Department of Environmental Systems Science, ETH Zürich, Zürich, Switzerland; One Health Trust, Bengaluru, India
| | | | - Heike Schmitt
- Centre for Zoonoses and Environmental Microbiology, Dutch National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands; Environmental Biotechnology, Faculty of Applied Sciences, Delft University of Technology, Delft, Netherlands
| | - Ana C Gales
- Division of Infectious Diseases, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Silvia Bertagnolio
- Department of Surveillance, Control, and Prevention of Antimicrobial Resistance, WHO, Geneva, Switzerland
| | - Mike Sharland
- Centre for Neonatal and Paediatric Infection, St George's, University London, London, UK
| | - Ramanan Laxminarayan
- One Health Trust, Bengaluru, India; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA.
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Daunt R, Curtin D, O'Mahony D. Optimizing drug therapy for older adults: shifting away from problematic polypharmacy. Expert Opin Pharmacother 2024; 25:1199-1208. [PMID: 38940370 DOI: 10.1080/14656566.2024.2374048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/25/2024] [Indexed: 06/29/2024]
Abstract
INTRODUCTION The accelerated discovery and production of pharmaceutical products has resulted in many positive outcomes. However, this progress has also contributed to problematic polypharmacy, one of the rapidly growing threats to public health in this century. Problematic polypharmacy results in adverse patient outcomes and imposes increased strain and financial burden on healthcare systems. AREAS COVERED A review was conducted on the current body of evidence concerning factors contributing to and consequences of problematic polypharmacy. Recent trials investigating interventions that target polypharmacy and emerging solutions, including incorporation of artificial intelligence, are also examined in this article. EXPERT OPINION To shift away from problematic polypharmacy, a multifaceted interdisciplinary approach is necessary. Any potentially successful strategy must be adapted to suit various healthcare settings and must utilize all available resources, including artificial intelligence.
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Affiliation(s)
- Ruth Daunt
- Department of Medicine (Geriatrics), School of Medicine, University College Cork, Cork, Ireland
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Denis Curtin
- Department of Medicine (Geriatrics), School of Medicine, University College Cork, Cork, Ireland
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
| | - Denis O'Mahony
- Department of Medicine (Geriatrics), School of Medicine, University College Cork, Cork, Ireland
- Department of Geriatric Medicine, Cork University Hospital, Cork, Ireland
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Bamford A, Masini T, Williams P, Sharland M, Gigante V, Dixit D, Sati H, Huttner B, Bin Nisar Y, Cappello B, Were W, Cohn J, Penazzato M. Tackling the threat of antimicrobial resistance in neonates and children: outcomes from the first WHO-convened Paediatric Drug Optimisation exercise for antibiotics. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:456-466. [PMID: 38648808 DOI: 10.1016/s2352-4642(24)00048-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 04/25/2024]
Abstract
Children and neonates are highly vulnerable to the impact of antimicrobial resistance. Substantial barriers are faced in relation to research and development of antibacterial agents for use in neonates, children, and adolescents aged yonger than 19 years, and focusing finite resources on the most appropriate agents for development and paediatric optimisation is urgently needed. In November and December, 2022, following the successes of previous similar disease-focused exercises, WHO convened the first Paediatric Drug Optimisation (PADO) exercise for antibiotics, aiming to provide a shortlist of antibiotics to be prioritised for paediatric research and development, especially for use in regions with the highest burden of disease attributable to serious bacterial infection. A range of antibiotics with either existing license for children or in clinical development in adults but with little paediatric data were considered, and PADO priority and PADO watch lists were formulated. This Review provides the background and overview of the exercise processes and its outcomes as well as a concise review of the literature supporting decision making. Follow-up actions to implement the outcomes from the PADO for antibiotics process are also summarised. This Review highlights the major beneficial influence the collaborative PADO process can have, both for therapeutic drug class and disease-specific themes, in uniting efforts to ensure children have access to essential medicines across the world.
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Affiliation(s)
- Alasdair Bamford
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; University College London Great Ormond Street Institute of Child Health, London, UK.
| | - Tiziana Masini
- Research for Health Department, Science Division, WHO, Geneva, Switzerland
| | - Phoebe Williams
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, NSW, Australia; Department of Infectious Diseases, Sydney Children's Hospital Network, Sydney, NSW, Australia
| | | | | | - Devika Dixit
- Cumming School of Medicine, Department of Pediatrics, Section of Infectious Diseases, University of Calgary, Calgary, AB, Canada
| | - Hatim Sati
- Antimicrobial Resistance Division, WHO, Geneva, Switzerland
| | | | - Yasir Bin Nisar
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | | | - Wilson Were
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland
| | - Jennifer Cohn
- Global Antibiotic Research and Development Partnership, Geneva, Switzerland
| | - Martina Penazzato
- Research for Health Department, Science Division, WHO, Geneva, Switzerland
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Lewnard JA, Charani E, Gleason A, Hsu LY, Khan WA, Karkey A, Chandler CIR, Mashe T, Khan EA, Bulabula ANH, Donado-Godoy P, Laxminarayan R. Burden of bacterial antimicrobial resistance in low-income and middle-income countries avertible by existing interventions: an evidence review and modelling analysis. Lancet 2024; 403:2439-2454. [PMID: 38797180 DOI: 10.1016/s0140-6736(24)00862-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/18/2024] [Accepted: 04/22/2024] [Indexed: 05/29/2024]
Abstract
National action plans enumerate many interventions as potential strategies to reduce the burden of bacterial antimicrobial resistance (AMR). However, knowledge of the benefits achievable by specific approaches is needed to inform policy making, especially in low-income and middle-income countries (LMICs) with substantial AMR burden and low health-care system capacity. In a modelling analysis, we estimated that improving infection prevention and control programmes in LMIC health-care settings could prevent at least 337 000 (95% CI 250 200-465 200) AMR-associated deaths annually. Ensuring universal access to high-quality water, sanitation, and hygiene services would prevent 247 800 (160 000-337 800) AMR-associated deaths and paediatric vaccines 181 500 (153 400-206 800) AMR-associated deaths, from both direct prevention of resistant infections and reductions in antibiotic consumption. These estimates translate to prevention of 7·8% (5·6-11·0) of all AMR-associated mortality in LMICs by infection prevention and control, 5·7% (3·7-8·0) by water, sanitation, and hygiene, and 4·2% (3·4-5·1) by vaccination interventions. Despite the continuing need for research and innovation to overcome limitations of existing approaches, our findings indicate that reducing global AMR burden by 10% by the year 2030 is achievable with existing interventions. Our results should guide investments in public health interventions with the greatest potential to reduce AMR burden.
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Affiliation(s)
- Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA.
| | - Esmita Charani
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Alec Gleason
- One Health Trust, Bengaluru, India; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Wasif Ali Khan
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Abhilasha Karkey
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Clare I R Chandler
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK; Antimicrobial Resistance Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Tapfumanei Mashe
- One Health Office, Ministry of Health and Child Care, Harare, Zimbabwe; Health System Strengthening Unit, WHO, Harare, Zimbabwe
| | - Ejaz Ahmed Khan
- Department of Pediatrics, Shifa Tameer-e-Millat University, Shifa International Hospital, Islamabad, Pakistan
| | - Andre N H Bulabula
- Division of Disease Control and Prevention, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Pilar Donado-Godoy
- AMR Global Health Research Unit, Colombian Integrated Program of Antimicrobial Resistance Surveillance, Corporación Colombiana de Investigación Agropecuaria, Cundinamarca, Colombia
| | - Ramanan Laxminarayan
- One Health Trust, Bengaluru, India; High Meadows Environmental Institute, Princeton University, Princeton, NJ, USA.
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Al Qahtani M, AlFulayyih SF, Al Baridi SS, Alomar SA, Alshammari AN, Albuaijan RJ, Uddin MS. Exploring the Impact of Antibiotics on Fever Recovery Time and Hospital Stays in Children with Viral Infections: Insights from Advanced Data Analysis. Antibiotics (Basel) 2024; 13:518. [PMID: 38927184 PMCID: PMC11200729 DOI: 10.3390/antibiotics13060518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/21/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Antibiotic overuse in pediatric patients with upper respiratory tract infections (UR-TIs) raises concerns about antimicrobial resistance. This study examines the impact of antibiotics on hospital stay duration and fever resolution in pediatric patients diagnosed with viral infections via a multiplex polymerase chain reaction (PCR) respiratory panel. Methods: In the pediatric ward of Imam Abdulrahman Bin Faisal Hospital, a retrospective cohort analysis was conducted on pediatric patients with viral infections confirmed by nasopharyngeal aspirates from October 2016 to December 2021. Cohorts receiving antibiotics versus those not receiving them were balanced using the gradient boosting machine (GBM) technique for propensity score matching. Results: Among 238 patients, human rhinovirus/enterovirus (HRV/EV) was most common (44.5%), followed by respiratory syncytial virus (RSV) (18.1%). Co-infections occurred in 8.4% of cases. Antibiotic administration increased hospital length of stay (LOS) by an average of 2.19 days (p-value: 0.00). Diarrhea reduced LOS by 2.26 days, and higher albumin levels reduced LOS by 0.40 days. Fever and CRP levels had no significant effect on LOS. Time to recovery from fever showed no significant difference between antibiotic-free (Abx0) and antibiotic-received (Abx1) groups (p-value: 0.391), with a hazard ratio of 0.84 (CI: 0.57-1.2). Conclusions: Antibiotics did not expedite recovery but were associated with longer hospital stays in pediatric patients with acute viral respiratory infections. Clinicians should exercise caution in prescribing antibiotics to pediatric patients with confirmed viral infections, especially when non-critical.
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Affiliation(s)
| | | | | | | | | | | | - Mohammed Shahab Uddin
- Department of Pediatric, Ministry of National Guard Health Affairs, Dammam 31412, Saudi Arabia; (M.A.Q.); (S.F.A.); (S.S.A.B.); (S.A.A.); (A.N.A.); (R.J.A.)
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Zhang L, Zhou E, Liu C, Tian X, Xue B, Zhang K, Luo B. Avian influenza and gut microbiome in poultry and humans: A "One Health" perspective. FUNDAMENTAL RESEARCH 2024; 4:455-462. [PMID: 38933214 PMCID: PMC11197557 DOI: 10.1016/j.fmre.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 09/20/2023] [Accepted: 10/10/2023] [Indexed: 06/28/2024] Open
Abstract
A gradual increase in avian influenza outbreaks has been found in recent years. It is highly possible to trigger the next human pandemic due to the characteristics of antigenic drift and antigenic shift in avian influenza virus (AIV). Although great improvements in understanding influenza viruses and the associated diseases have been unraveled, our knowledge of how these viruses impact the gut microbiome of both poultry and humans, as well as the underlying mechanisms, is still improving. The "One Health" approach shows better vitality in monitoring and mitigating the risk of avian influenza, which requires a multi-sectoral effort and highlights the interconnection of human health with environmental sustainability and animal health. Therefore, monitoring the gut microbiome may serve as a sentinel for protecting the common health of the environment, animals, and humans. This review summarizes the interactions between AIV infection and the gut microbiome of poultry and humans and their potential mechanisms. With the presented suggestions, we hope to address the current major challenges in the surveillance and prevention of microbiome-related avian influenza with the "One Health" approach.
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Affiliation(s)
- Ling Zhang
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Erkai Zhou
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Ce Liu
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Xiaoyu Tian
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Baode Xue
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Bin Luo
- Institute of Occupational Health and Environmental Health, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China
- Shanghai Key Laboratory of Meteorology and Health, Shanghai Meteorological Bureau, Shanghai 200030, China
- Shanghai Typhoon Institute, China Meteorological Administration, Shanghai 200030, China
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Oldendorff F, Nordberg V, Giske CG, Navér L. A decade of neonatal sepsis in Stockholm, Sweden: Gram-positive pathogens were four times as common as Gram-negatives. Eur J Clin Microbiol Infect Dis 2024; 43:959-968. [PMID: 38517573 PMCID: PMC11108929 DOI: 10.1007/s10096-024-04809-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/11/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE To assess Gram-positive bacterial (GPB) bloodstream infection (BSI) in neonates, covering incidence, morbidity, mortality, antimicrobial resistance patterns and biomarkers in Region Stockholm, Sweden between 2006 and 2016. METHODS A population-based retrospective epidemiological study including infants with GPB-BSI, admitted to the neonatal units at Karolinska University Hospital (KUH). Data were collected from patient records, the Swedish Neonatal Quality Register, the microbiological laboratory at KUH and the Swedish Public Health Agency. RESULTS We identified 357 infants with GPB-BSI, representing an incidence of 1.47/1000 live births (LB). Group B streptococcus (GBS) was the most common pathogen causing BSI in full-term infants and early-onset sepsis (EOS) (0.20/1000 LB), while coagulase-negative staphylococci (CoNS) were predominant in infants born very preterm and in late-onset sepsis (LOS) (0.79/1000 LB). There were no fatal GBS BSI cases, but 10.2% developed meningitis. The GPB case fatality rate was 9.5% and the sepsis fatality rate 2.8%. In GPB-BSI, 1/10 did not have an elevated C-reactive protein level. Staphylococcus aureus (S. aureus) BSI increased during the study period, but no methicillin or vancomycin resistant strains were found. The antimicrobial resistance (AMR) rate was highest in CoNS isolates. CONCLUSION GPB-BSI was four times more common than Gram-negative BSI in neonates but resulted in lower mortality rate. GBS was the most common pathogen in full-term infants and in EOS. CoNS was the most common pathogen in LOS and infants born very preterm, and the AMR rate was high in these isolates. The increasing trend of S. aureus BSI indicates a need of further investigation.
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Affiliation(s)
- Frida Oldendorff
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden.
| | - Viveka Nordberg
- Department of Neonatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden
| | - Christian G Giske
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet, Stockholm, Sweden
- Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Navér
- Department of Neonatology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science Intervention and Technology (CLINTEC), Division of Pediatrics, Karolinska Institutet, Stockholm, Sweden
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Sharma S, Chauhan A, Ranjan A, Mathkor DM, Haque S, Ramniwas S, Tuli HS, Jindal T, Yadav V. Emerging challenges in antimicrobial resistance: implications for pathogenic microorganisms, novel antibiotics, and their impact on sustainability. Front Microbiol 2024; 15:1403168. [PMID: 38741745 PMCID: PMC11089201 DOI: 10.3389/fmicb.2024.1403168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/15/2024] [Indexed: 05/16/2024] Open
Abstract
Overuse of antibiotics is accelerating the antimicrobial resistance among pathogenic microbes which is a growing public health challenge at the global level. Higher resistance causes severe infections, high complications, longer stays at hospitals and even increased mortality rates. Antimicrobial resistance (AMR) has a significant impact on national economies and their health systems, as it affects the productivity of patients or caregivers due to prolonged hospital stays with high economic costs. The main factor of AMR includes improper and excessive use of antimicrobials; lack of access to clean water, sanitation, and hygiene for humans and animals; poor infection prevention and control measures in hospitals; poor access to medicines and vaccines; lack of awareness and knowledge; and irregularities with legislation. AMR represents a global public health problem, for which epidemiological surveillance systems have been established, aiming to promote collaborations directed at the well-being of human and animal health and the balance of the ecosystem. MDR bacteria such as E. coli, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus spp., Acinetobacter spp., and Klebsiella pneumonia can even cause death. These microorganisms use a variety of antibiotic resistance mechanisms, such as the development of drug-deactivating targets, alterations in antibiotic targets, or a decrease in intracellular antibiotic concentration, to render themselves resistant to numerous antibiotics. In context, the United Nations issued the Sustainable Development Goals (SDGs) in 2015 to serve as a worldwide blueprint for a better, more equal, and more sustainable existence on our planet. The SDGs place antimicrobial resistance (AMR) in the context of global public health and socioeconomic issues; also, the continued growth of AMR may hinder the achievement of numerous SDGs. In this review, we discuss the role of environmental pollution in the rise of AMR, different mechanisms underlying the antibiotic resistance, the threats posed by pathogenic microbes, novel antibiotics, strategies such as One Health to combat AMR, and the impact of resistance on sustainability and sustainable development goals.
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Affiliation(s)
- Shikha Sharma
- Amity Institute of Environmental Sciences, Amity University, Noida, Uttar Pradesh, India
| | - Abhishek Chauhan
- Amity Institute of Environmental Toxicology, Safety and Management, Amity University, Noida, Uttar Pradesh, India
| | - Anuj Ranjan
- Academy of Biology and Biotechnology, Southern Federal University, Rostov-on-Don, Russia
| | - Darin Mansor Mathkor
- Research and Scientific Studies Unit, College of Nursing and Health Sciences, Jazan University, Jazan, Saudi Arabia
| | - Shafiul Haque
- Research and Scientific Studies Unit, College of Nursing and Health Sciences, Jazan University, Jazan, Saudi Arabia
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Seema Ramniwas
- University Centre for Research & Development, University Institute of Pharmaceutical Sciences, Chandigarh University, Mohali, Punjab, India
| | - Hardeep Singh Tuli
- Department of Bio-Sciences and Technology, Maharishi Markandeshwar Engineering College, Maharishi Markandeshwar (Deemed to Be University), Ambala, India
| | - Tanu Jindal
- Amity Institute of Environmental Toxicology, Safety and Management, Amity University, Noida, Uttar Pradesh, India
| | - Vikas Yadav
- Department of Translational Medicine, Clinical Research Centre, Skåne University Hospital, Lund University, Malmö, Sweden
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Jain M, Meshram P, Bang A, Chauhan V, Datta V, Dhanireddy R. Implementation of a quality improvement initiative for standardising essential newborn care in a teaching public hospital in rural central India. BMJ Open Qual 2024; 13:e001869. [PMID: 38626941 PMCID: PMC11029480 DOI: 10.1136/bmjoq-2022-001869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/15/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE Our aim was to refine the essential newborn care practices by employing the multidisciplinary peer team-led quality improvement (QI) projects. DESIGN In 2017, concerning the same, the department focused on early initiation of breast feeding, prevention of hypothermia within an hour of life and rational usage of antibiotics among babies admitted to neonatal intensive care unit (NICU). Baseline data reported the rate of initiation of breast feeding, hypothermia and antibiotic exposure rate as 35%, 78% and 75%, respectively. Root causes were analysed and a series of Plan-Do-Study-Act cycles were conducted to test the changes. The process of change was studied through run charts (whereas control charts were used for study purpose). RESULT After the implementation of the QI projects, the rate of initiation of breast feeding was found to be improved from 35% to 90%, the incidence of hypothermia got reduced from 78% to 10% and the antibiotic exposure rate declined from 75% to 20%. Along with the improvement in indicators related to essential newborn care, down the stream we found a decrease in the percentage of culture-positive sepsis rate in the NICU. CONCLUSION Peer team-led QI initiatives in a resource-limited setting proved beneficial in improving essential newborn care practices.
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Affiliation(s)
- Manish Jain
- Pediatrics, MGIMS, Wardha, Maharashtra, India
| | - Payal Meshram
- Paediatric, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Akash Bang
- Pediatrics, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Varsha Chauhan
- Paediatric, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Vikram Datta
- Neonatology, Kalawati Saran Children's Hospital, New Delhi, India
- Neonatology, Lady Hardinge Medical College, New Delhi, India
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Immunization agenda 2030: A global strategy to leave no one behind. Vaccine 2024; 42 Suppl 1:S5-S14. [PMID: 39004466 DOI: 10.1016/j.vaccine.2022.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/01/2022] [Accepted: 11/17/2022] [Indexed: 07/16/2024]
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Pokharel S, Adhikari B, Johnson T, Cheah PY. Interventions to address antimicrobial resistance: an ethical analysis of key tensions and how they apply in low- income and middle-income countries. BMJ Glob Health 2024; 9:e012874. [PMID: 38569658 PMCID: PMC11002359 DOI: 10.1136/bmjgh-2023-012874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 01/14/2024] [Indexed: 04/05/2024] Open
Abstract
Antimicrobial resistance (AMR) is a global health and one health problem. Efforts to mitigate the problem of AMR are challenging to implement due to unresolved ethical tensions. We present an in-depth ethical analysis of tensions that might hinder efforts to address AMR. First, there is a tension between access and excess in the current population: addressing lack of access requires facilitating use of antimicrobials for some populations, while addressing excessive use for other populations. Second, there is a tension between personal interests and a wider, shared interest in curbing AMR. These personal interests can be viewed from the perspective of individuals seeking care and healthcare providers whose livelihoods depend on using or selling antimicrobials and who profit from the sales and use of antimicrobials. Third, there is a tension between the interests of current populations and the interests of future generations. Last, there is a tension between addressing immediate health threats such as pandemics, and AMR as a 'silent', chronic threat. For each of these tensions, we apply 'descriptive ethics' methods that draw from existing evidence and our experiences living and working in low-income and middle-income countries to highlight how these ethical tensions apply in such settings.
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Affiliation(s)
- Sunil Pokharel
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Bipin Adhikari
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University Phayathai Campus, Bangkok, Thailand
| | - Tess Johnson
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Phaik Yeong Cheah
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University Phayathai Campus, Bangkok, Thailand
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Ruef M, Emonet S, Merglen A, Dewez JE, Obama BM, Catho G, Andrey DO, Kowalski M, Harbarth S, Combescure C, Wagner N, Galetto-Lacour A. Carriage of third-generation cephalosporin-resistant and carbapenem-resistant Enterobacterales among children in sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2024; 70:102508. [PMID: 38500839 PMCID: PMC10945212 DOI: 10.1016/j.eclinm.2024.102508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/09/2024] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Abstract
Background The increasing resistance of Enterobacterales to third-generation cephalosporins and carbapenems in sub-Saharan Africa (SSA) is a major public health concern. We did a systematic review and meta-analysis of studies to estimate the carriage prevalence of Enterobacterales not susceptible to third-generation cephalosporins or carbapenems among paediatric populations in SSA. Methods We performed a systematic literature review and meta-analysis of cross-sectional and cohort studies to estimate the prevalence of childhood (0-18 years old) carriage of extended-spectrum cephalosporin-resistant Enterobacterales (ESCR-E) or carbapenem-resistant Enterobacterales (CRE) in SSA. Medline, EMBASE and the Cochrane Library were searched for studies published from 1 January 2005 to 1 June 2022. Studies with <10 occurrences per bacteria, case reports, and meta-analyses were excluded. Quality and risk of bias were assessed using the Newcastle-Ottawa scale. Meta-analyses of prevalences and odds ratios were calculated using generalised linear mixed-effects models. Heterogeneity was assessed using I2 statistics. The protocol is available on PROSPERO (CRD42021260157). Findings Of 1111 studies examined, 40 met our inclusion criteria, reporting on the carriage prevalence of Enterobacterales in 9408 children. The pooled carriage prevalence of ESCR-E was 32.2% (95% CI: 25.2%-40.2%). Between-study heterogeneity was high (I2 = 96%). The main sources of bias pertained to participant selection and the heterogeneity of the microbiological specimens. Carriage proportions were higher among sick children than healthy ones (35.7% vs 16.9%). The pooled proportion of nosocomial acquisition was 53.8% (95% CI: 32.1%-74.1%) among the 922 children without ESCR-E carriage at hospital admission. The pooled odds ratio of ESCR-E carriage after antibiotic treatment within the previous 3 months was 3.20 (95% CI: 2.10-4.88). The proportion of pooled carbapenem-resistant for Enterobacterales was 3.6% (95% CI: 0.7%-16.4%). Interpretation This study suggests that ESCR-E carriage among children in SSA is frequent. Microbiology capacity and infection control must be scaled-up to reduce the spread of those multidrug-resistant microorganisms. Funding There was no funding source for this study.
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Affiliation(s)
- Micaela Ruef
- Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephane Emonet
- Division of Infectious Diseases, Hospital of Valais, Sion, and Faculty of Medicine, Geneva, Switzerland
| | - Arnaud Merglen
- Division of General Paediatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Juan Emmanuel Dewez
- Medical Department, Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland
| | - Basilice Minka Obama
- Paediatric Infectious Diseases Unit, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Regional Hospital Centre for Ebolowa, Cameroon
| | - Gaud Catho
- Infectious Diseases Division, Central Institute, Hospital of Valais, Switzerland
- Infection Control Division, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Diego O. Andrey
- Division of Infectious Diseases, Department of Medicine and Division of Laboratory Medicine, Department of Diagnostics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Morgane Kowalski
- Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Programme and World Health Organization Collaborating Centre on Infection Prevention and Control and Antimicrobial Resistance, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Christophe Combescure
- Centre for Clinical Research, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Noémie Wagner
- Medical Department, Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland
- Paediatric Infectious Diseases Unit, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Annick Galetto-Lacour
- Division of Paediatric Emergency Medicine, Children’s Hospital, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Xu X, Feng Q, Zhang T, Gao Y, Cheng Q, Zhang W, Wu Q, Xu K, Li Y, Nguyen N, Taft DH, Mills DA, Lemay DG, Zhu W, Mao S, Zhang A, Xu K, Liu J. Infant age inversely correlates with gut carriage of resistance genes, reflecting modifications in microbial carbohydrate metabolism during early life. IMETA 2024; 3:e169. [PMID: 38882494 PMCID: PMC11170968 DOI: 10.1002/imt2.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/23/2023] [Accepted: 12/06/2023] [Indexed: 06/18/2024]
Abstract
The infant gut microbiome is increasingly recognized as a reservoir of antibiotic resistance genes, yet the assembly of gut resistome in infants and its influencing factors remain largely unknown. We characterized resistome in 4132 metagenomes from 963 infants in six countries and 4285 resistance genes were observed. The inherent resistome pattern of healthy infants (N = 272) could be distinguished by two stages: a multicompound resistance phase (Months 0-7) and a tetracycline-mupirocin-β-lactam-dominant phase (Months 8-14). Microbial taxonomy explained 40.7% of the gut resistome of healthy infants, with Escherichia (25.5%) harboring the most resistance genes. In a further analysis with all available infants (N = 963), we found age was the strongest influencer on the resistome and was negatively correlated with the overall resistance during the first 3 years (p < 0.001). Using a random-forest approach, a set of 34 resistance genes could be used to predict age (R 2 = 68.0%). Leveraging microbial host inference analyses, we inferred the age-dependent assembly of infant resistome was a result of shifts in the gut microbiome, primarily driven by changes in taxa that disproportionately harbor resistance genes across taxa (e.g., Escherichia coli more frequently harbored resistance genes than other taxa). We performed metagenomic functional profiling and metagenomic assembled genome analyses whose results indicate that the development of gut resistome was driven by changes in microbial carbohydrate metabolism, with an increasing need for carbohydrate-active enzymes from Bacteroidota and a decreasing need for Pseudomonadota during infancy. Importantly, we observed increased acquired resistance genes over time, which was related to increased horizontal gene transfer in the developing infant gut microbiome. In summary, infant age was negatively correlated with antimicrobial resistance gene levels, reflecting a composition shift in the gut microbiome, likely driven by the changing need for microbial carbohydrate metabolism during early life.
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Affiliation(s)
- Xinming Xu
- Laboratory of Gastrointestinal Microbiology, College of Animal Science & Technology Nanjing Agricultural University Nanjing China
- Jiangsu Key Laboratory of Gastrointestinal Nutrition and Animal Health, National Center for International Research on Animal Gut Nutrition Nanjing Agricultural University Nanjing China
- Department of Nutrition and Food Hygiene, School of Public Health, Institute of Nutrition Fudan University Shanghai China
| | - Qingying Feng
- Laboratory of Gastrointestinal Microbiology, College of Animal Science & Technology Nanjing Agricultural University Nanjing China
- Jiangsu Key Laboratory of Gastrointestinal Nutrition and Animal Health, National Center for International Research on Animal Gut Nutrition Nanjing Agricultural University Nanjing China
- Biological Engineering Division Massachusetts Institute of Technology (MIT) Cambridge Massachusetts USA
| | - Tao Zhang
- Laboratory of Gastrointestinal Microbiology, College of Animal Science & Technology Nanjing Agricultural University Nanjing China
- Jiangsu Key Laboratory of Gastrointestinal Nutrition and Animal Health, National Center for International Research on Animal Gut Nutrition Nanjing Agricultural University Nanjing China
| | - Yunlong Gao
- Laboratory of Gastrointestinal Microbiology, College of Animal Science & Technology Nanjing Agricultural University Nanjing China
- Jiangsu Key Laboratory of Gastrointestinal Nutrition and Animal Health, National Center for International Research on Animal Gut Nutrition Nanjing Agricultural University Nanjing China
| | - Qu Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College Huazhong University of Science and Technology Wuhan China
| | - Wanqiu Zhang
- Laboratory of Gastrointestinal Microbiology, College of Animal Science & Technology Nanjing Agricultural University Nanjing China
- Jiangsu Key Laboratory of Gastrointestinal Nutrition and Animal Health, National Center for International Research on Animal Gut Nutrition Nanjing Agricultural University Nanjing China
| | - Qinglong Wu
- Department of Pathology and Immunology Baylor College of Medicine Houston Texas USA
| | - Ke Xu
- Department of Statistics University of Chicago Chicago Illinois
| | - Yucan Li
- State Key Laboratory of Genetic Engineering, Human Phenome Institute Fudan University Shanghai China
| | - Nhu Nguyen
- Department of Food Science and Technology University of California, Davis Davis California USA
| | - Diana H Taft
- Department of Food Science and Technology University of California, Davis Davis California USA
| | - David A Mills
- Department of Food Science and Technology University of California, Davis Davis California USA
- Department of Viticulture and Enology, Robert Mondavi Institute for Wine and Food Science University of California, Davis Davis California USA
| | - Danielle G Lemay
- USDA ARS Western Human Nutrition Research Center Davis California USA
| | - Weiyun Zhu
- Laboratory of Gastrointestinal Microbiology, College of Animal Science & Technology Nanjing Agricultural University Nanjing China
- Jiangsu Key Laboratory of Gastrointestinal Nutrition and Animal Health, National Center for International Research on Animal Gut Nutrition Nanjing Agricultural University Nanjing China
| | - Shengyong Mao
- Laboratory of Gastrointestinal Microbiology, College of Animal Science & Technology Nanjing Agricultural University Nanjing China
- Jiangsu Key Laboratory of Gastrointestinal Nutrition and Animal Health, National Center for International Research on Animal Gut Nutrition Nanjing Agricultural University Nanjing China
| | - Anyun Zhang
- Animal Disease Prevention and Food Safety Key Laboratory of Sichuan Province, Key Laboratory of Bio-Resource and Eco-Environment of Ministry of Education, College of Life Sciences Sichuan University Chengdu China
| | - Kelin Xu
- Department of Biostatistics, Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health Fudan University Shanghai China
| | - Jinxin Liu
- Laboratory of Gastrointestinal Microbiology, College of Animal Science & Technology Nanjing Agricultural University Nanjing China
- Jiangsu Key Laboratory of Gastrointestinal Nutrition and Animal Health, National Center for International Research on Animal Gut Nutrition Nanjing Agricultural University Nanjing China
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