A comparative analysis of how the media in the United Kingdom and India represented the emergence of NDM-1

Antimicrobial resistance in South East Asia: time to ask the right questions

Antimicrobial resistance (AMR) has emerged as a major public health concern, around which the international leadership has come together to form strategic partnerships and action plans. The main driving force behind the emergence of AMR is selection pressure created due to consumption of antibiotics. Consumption of antibiotics in human as well as animal sectors are driven by a complex interplay of determinants, many of which are typical to the local settings. Several sensitive and essential realities are tied with antibiotic consumption - food security, livelihoods, poverty alleviation, healthcare access and national economies, to name a few. That makes one-size-fits-all policies, framed with the developed country context in mind, inappropriate for developing countries. Many countries in the South East Asian Region have some policy structures in place to deal with AMR, but most of them lack detailed implementation plans or monitoring structures. In this current debates piece, the authors argue that the principles driving the AMR agenda in the South East Asian countries need to be dealt with using locally relevant policy structures. Strategies, which have successfully reduced the burden of AMR in the developed countries, should be evaluated in the developing country contexts instead of ad hoc implementation. The Global Action Plan on AMR encourages member states to develop locally relevant National Action Plans on AMR. This policy position should be leveraged to develop and deploy locally relevant strategies, which are based on a situation analysis of the local systems, and are likely to meet the needs of the individual member states.

Individual care versus broader public health: A qualitative study of hospital doctors' antibiotic decisions

OBJECTIVES

This study aimed to examine how hospital doctors balance competing concerns around antibiotic use and resistance, with a focus on individual care versus broader public health considerations.

METHODS

Sixty-four doctors across two hospitals in Australia participated in semi-structured interviews about their perspectives on antibiotic resistance and prescribing decisions. Results were analysed using the framework approach.

RESULTS

The first theme focused on the significance of antimicrobial resistance (AMR) and the role of hospital doctors. Participants did not perceive resistance to be central to clinical decision-making, and externalised the resistance threat. They perceived themselves as separated from the issue of escalating resistance, viewing the key drivers to be overseas use, use in agriculture, and community prescribing. The second theme was around balancing risks. Immediate clinical risks were described as prioritised over long term population risk. Participants described concern around reputational and legal risks, which were perceived to be associated with under-prescribing of antibiotics. Over-prescribing was described by participants to be easier and without perceived immediate risk to them or to patients.

CONCLUSION

Hospital doctors perceived antimicrobial resistance as externally produced and described clinical concerns taking precedence in individual antibiotic decisions. These dual processes mean that a population health model has limited traction in the hospital context. The externalisation of resistance leads to a sense of futility in changing practice, which combines with the pressures of acute medicine to prioritise immediate patient outcomes. Such dynamics are leading to antibiotic optimisation as a low or absent priority in hospital clinician antibiotic decision-making.

Fungal Root Microbiome from Healthy and Brittle Leaf Diseased Date Palm Trees (Phoenix dactylifera L.) Reveals a Hidden Untapped Arsenal of Antibacterial and Broad Spectrum Antifungal Secondary Metabolites

In this study, we aimed to explore and compare the composition, metabolic diversity and antimicrobial potential of endophytic fungi colonizing internal tissues of healthy and brittle leaf diseased (BLD) date palm trees (Phoenix dactylifera L.) widely cultivated in arid zones of Tunisia. A total of 52 endophytic fungi were isolated from healthy and BLD roots of date palm trees, identified based on internal transcribed spacer-rDNA sequence analysis and shown to represent 13 species belonging to five genera. About 36.8% of isolates were shared between healthy and diseased root fungal microbiomes, whereas 18.4 and 44.7% of isolates were specific to healthy and BLD root fungal microbiomes, respectively. All isolates were able to produce at least two of the screened enzymes including amylase, cellulase, chitinase, pectinase, protease, laccase and lipase. A preliminary screening of the isolates using disk diffusion method for antibacterial activity against four Gram-positive and three Gram-negative bacteria and antifungal activities against three phytopathogenic fungi indicated that healthy and BLD root fungal microbiomes displayed interesting bioactivities against examined bacteria and broad spectrum bioactivity against fungal pathogens. Some of these endophytic fungi (17 isolates) were fermented and their extracts were evaluated for antimicrobial potential against bacterial and fungal isolates. Results revealed that fungal extracts exhibited antibacterial activities and were responsible for approximately half of antifungal activities against living fungi. These results suggest a strong link between fungal bioactivities and their secondary metabolite arsenal. EtOAc extracts of Geotrichum candidum and Thielaviopsis punctulata originating from BLD microbiome gave best results against Micrococcus luteus and Bacillus subtilis with minimum inhibitory concentration (MIC, 0.78 mg/mL) and minimum bactericidal concentration (6.25 mg/mL). G. candidum gave the best result against Rhizoctonia solani with MIC 0.78 mg/mL and minimum fungicidal concentration (MFC, 6.25 mg/mL). In conclusion, using plant microbiomes subjected to biotic stresses offers new endophytes with different bioactivities than those of healthy plants. Therefore, date palm endophytic fungi represent a hidden untapped arsenal of antibacterial and broad spectrum antifungal secondary metabolites and could be considered promising source of bioactive compounds with industrial and pharmaceutical applications.