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Jorgensen SCJ, Brown K, Clarke AE, Schwartz KL, Maxwell C, Daneman N, Kwong JC, MacFadden DR. The Effect of COVID-19 Vaccination on Outpatient Antibiotic Prescribing in Older Adults: A Self-Controlled Risk-Interval Study. Clin Infect Dis 2024:ciae182. [PMID: 38700036 DOI: 10.1093/cid/ciae182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) vaccination has been associated with reduced outpatient antibiotic prescribing among older adults with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed the impact of COVID-19 vaccination on outpatient antibiotic prescribing in the broader population of older adults, regardless of SARS-CoV-2 infection status. METHODS We included adults aged ≥65 years who received their first, second, and/or third COVID-19 vaccine dose from December 2020 to December 2022. We used a self-controlled risk-interval design and included cases who received an antibiotic prescription 2-6 weeks before vaccination (pre-vaccination or control interval) or after vaccination (post-vaccination or risk interval). We used conditional logistic regression to estimate the odds of being prescribed (1) any antibiotic, (2) a typical "respiratory" infection antibiotic, or (3) a typical "urinary tract" infection antibiotic (negative control) in the post-vaccination interval versus the pre-vaccination interval. We accounted for temporal changes in antibiotic prescribing using background monthly antibiotic prescribing counts. RESULTS 469 923 vaccine doses met inclusion criteria. The odds of receiving any antibiotic or a respiratory antibiotic prescription were lower in the post-vaccination versus pre-vaccination interval (aOR, .973; 95% CI, .968-.978; aOR, .961; 95% CI, .953-.968, respectively). There was no association between vaccination and urinary antibiotic prescriptions (aOR, .996; 95% CI, .987-1.006). Periods with high (>10%) versus low (<5%) SARS-CoV-2 test positivity demonstrated greater reductions in antibiotic prescribing (aOR, .875; 95% CI, .845-.905; aOR, .996; 95% CI, .989-1.003, respectively). CONCLUSIONS COVID-19 vaccination was associated with reduced outpatient antibiotic prescribing in older adults, especially during periods of high SARS-CoV-2 circulation.
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Affiliation(s)
- Sarah C J Jorgensen
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Kevin Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Anna E Clarke
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Kevin L Schwartz
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Unity Health Toronto, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Colleen Maxwell
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Nick Daneman
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Derek R MacFadden
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Division of Infectious Diseases, University of Ottawa, Ottawa, Ontario, Canada
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Yao R, Vinsard DG, Sweetser S. 59-Year-Old Woman With Fever and Hematemesis. Mayo Clin Proc 2023; 98:1225-1229. [PMID: 37422737 DOI: 10.1016/j.mayocp.2022.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/27/2022] [Indexed: 07/10/2023]
Affiliation(s)
- Rebecca Yao
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Daniela Guerrero Vinsard
- Fellow in Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Seth Sweetser
- Advisor to residents and Consultant in Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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Akegbe H, Onyeaka H, Michael Mazi I, Alex Olowolafe O, Dolapo Omotosho A, Olatunji Oladunjoye I, Amuda Tajudeen Y, Seun Ofeh A. The need for Africa to develop capacity for vaccinology as a means of curbing antimicrobial resistance. Vaccine X 2023; 14:100320. [PMID: 37293248 PMCID: PMC10244683 DOI: 10.1016/j.jvacx.2023.100320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/08/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
The high prevalence of infectious diseases in Africa, combined with weak healthcare systems, poor antimicrobial stewardship, and an unchecked drug supply chain, is steadily reversing the trend in the fight against infectious diseases in this part of the world, posing severe threats to antimicrobial resistance (AMR). AMR continuously evolves and threatens to undermine antimicrobial efficacy and undo advances against infectious diseases. This brewing pandemic is now recognized as a significant worldwide health danger, implicated in several cases of morbidity, mortality, and increasing healthcare costs. Vaccine technology has been proven to be the principal remedy to this imminent danger since it prevents microbial infections. However, since Africa cannot produce its vaccines, it relies on external sources and, as a result, it is significantly affected by vaccine nationalism, hoarding, and instabilities in global supply chains. This has further adversely impacted the ability of African governments to regulate rollouts, protect their citizens, and ultimately rejoin the global economy. This dependency is a severe challenge to Africa's health resilience, as it is unsustainable. Given the inevitability of potential global pandemics and the alarming incidences of multi-drug resistance infections reported daily, Africa must develop the capability to produce its vaccines. The review utilized a systematic search of academic databases and grey literature, as well as a manual search of relevant reports and articles. In this review, we outline the public health threats and concerns that AMR poses to Africans, and the hurdles and advances achieved in vaccine development over the years. We also highlight possible strategies, particularly collaborative efforts, that will accelerate vaccine production and ease the strain of infectious diseases and antimicrobial resistance in Africa. Key findings indicate that Africa has significant gaps in its vaccine manufacturing and distribution capacity, with only a few countries having the ability to produce vaccines. Additionally, existing vaccine production facilities are often outdated and require significant investment to meet international standards. The review also highlights successful initiatives in Africa, such as the mRNA vaccine hub and the African Vaccine Manufacturing Initiative, which have demonstrated the potential for building local vaccine manufacturing capacity. The study concludes that Africa needs to prioritize investment in vaccine research and development, regulatory capacity, and infrastructure to build a sustainable vaccine manufacturing ecosystem. Overall, this review emphasizes the urgent need for Africa to develop its vaccine manufacturing capacity to improve vaccine access and strengthen its ability to respond to future pandemics. The findings underscore the importance of collaboration between African governments, international organizations, and the private sector to build a resilient vaccine ecosystem in Africa.
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Affiliation(s)
- Hope Akegbe
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Nigeria
| | - Helen Onyeaka
- School of Chemical Engineering, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Ifeanyi Michael Mazi
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Nigeria
| | - Opeyemi Alex Olowolafe
- Department of Microbiology, Faculty of Life Sciences, University of Benin, Benin City, Nigeria
| | | | | | - Yusuf Amuda Tajudeen
- Department of Microbiology, Faculty of Life Sciences, University of Ilorin, Ilorin, Nigeria
| | - Augustine Seun Ofeh
- Department of Microbiology, Faculty of Science, Delta State University, Abraka, Nigeria
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Puzia W, Gawor J, Gromadka R, Skoczyńska A, Sadowy E. Comparative genomic analysis of two ST320 Streptococcus pneumoniae isolates, representing serotypes 19A and 19F. BMC Genom Data 2023; 24:19. [PMID: 37032356 PMCID: PMC10084702 DOI: 10.1186/s12863-023-01118-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Streptococcus pneumoniae (pneumococcus) represents an important human pathogen, responsible for respiratory and invasive infections in the community. The efficacy of polysaccharide conjugate vaccines formulated against pneumococci is reduced by the phenomenon of serotype replacement in population of this pathogen. The aim of the current study was to obtain and compare complete genomic sequences of two pneumococcal isolates, both belonging to ST320 but differing by the serotype. RESULTS Here, we report genomic sequences of two isolates of important human pathogen, S. pneumoniae. Genomic sequencing resulted in complete sequences of chromosomes of both isolates, 2,069,241 bp and 2,103,144 bp in size, and confirmed the presence of cps loci specific for serotypes 19A and 19F. The comparative analysis of these genomes revealed several instances of recombination, which involved not only S. pneumoniae but also presumably other streptococci as donors. CONCLUSIONS We report the complete genomic sequences of two S. pneumoniae isolates of ST320 and serotypes 19A and 19F. The detailed comparative analysis of these genomes revealed the history of several recombination events, clustered in the region including the cps locus.
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Affiliation(s)
- Weronika Puzia
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
- DNA Sequencing and Synthesis Facility, Institute of Biochemistry and Biophysics PAS, Warsaw, Poland
| | - Jan Gawor
- DNA Sequencing and Synthesis Facility, Institute of Biochemistry and Biophysics PAS, Warsaw, Poland
| | - Robert Gromadka
- DNA Sequencing and Synthesis Facility, Institute of Biochemistry and Biophysics PAS, Warsaw, Poland
| | - Anna Skoczyńska
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
- National Reference Centre for Bacterial Meningitis, National Medicines Institute, Warsaw, Poland
| | - Ewa Sadowy
- Department of Molecular Microbiology, National Medicines Institute, Ul. Chelmska 30/34, 00-725, Warsaw, Poland.
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Fernández Chávez AC, García Comas L, Gómez Barroso D, Ramis Prieto R, López Fresneña N, Bishofberguer Valdes C, Aranaz Andrés JM. Spatial and temporal analysis of invasive pneumococcal disease due to erythromycinresistant serotypes. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:92-98. [PMID: 35907773 DOI: 10.1016/j.eimce.2022.07.001] [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: 02/08/2021] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 04/14/2023]
Abstract
OBJECTIVES To study the spatio-temporal distribution of cases of invasive pneumococcal disease (IPD) due to serotypes resistant to erythromycin and its relationship with community consumption of macrolides and childhood vaccination coverage. METHODS We selected IPD cases in adults over 59 years old, residents in the Community of Madrid (MC), notified in the period 2007-2016. The variables studied were obtained from the Vaccination Information Systems and the Pharmaceutical Service. The cut-off point (minimum inhibitory erythromycin concentration > 0.5 mg/L) of the EUCAST classification was used to define erythromycin resistant serotypes. We used JointPoint to estimate the incidence trends by erythromycin resistant serotypes included in the 13-valent vaccine (STPCV13) and not included in it (STnoPCV13). The association of these incidences with the community consumption of macrolides and vaccination coverage was made using Poisson models. Statistical scanning was used for the detection of temporal-spaces clusters of cases. RESULTS 1936 cases were identified, of which 427 erythromycin resistant serotypes were identified. The incidence of all cases due to resistant serotypes was decreasing (AAPC: -5,40%). During the period studied, the incidence of cases due to erythromycin resistant STPCV13 was decreasing with an annual percentage change (APC): -13.8 and was inversely associated with childhood vaccination coverage (IRR 0.641), while that of cases due to erythromycin resistant STnoPCV13 was ascending (APC): 4.5; and was not associated with coverage. 1 cluster was detected by STnoPCV13 and none by STPCV13 after the date of inclusion of the 13-valent in the childhood vaccination calendar. CONCLUSIONS The decrease in IPD due to resistant STPCV13 was associated with an increase in childhood vaccination coverage. The presence of clusters due to STnoPCV13 after the date of inclusion of the 13-valent vaccine in the childhood vaccination calendar indicates serotypes replacement. The increase in cases of resistant STnoPCV13 could be related to the replacement of vaccine serotypes in nasopharyngeal colonization, facilitated by the consumption of macrolides still at high levels in MC.
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Affiliation(s)
| | - Luis García Comas
- Servicio de Epidemiología de la Consejería de Sanidad de la Comunidad de Madrid, Madrid, Spain
| | | | | | - Nieves López Fresneña
- Medicina Preventiva del Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Maugeri A, Barchitta M, Agodi A. Vaccination coverage in Italian children and antimicrobial resistance: an ecological analysis. Antimicrob Resist Infect Control 2022; 11:136. [PMID: 36352471 PMCID: PMC9648027 DOI: 10.1186/s13756-022-01173-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/15/2022] [Indexed: 11/11/2022] Open
Abstract
Background Although a general consensus that vaccines could be a complementary strategy against antimicrobial resistance (AMR), there is still the need for studies investigating the relationship between childhood vaccination coverage and AMR proportions in the overall population. Methods We performed an ecological analysis of available Italian data (vaccination coverages, AMR proportions, number of isolates tested, and antibiotic use) to evaluate the relationships between vaccination coverages in children and AMR proportions in the last 2 decades. Results After adjusting for covariates, we showed that AMR proportions decreased with increasing vaccination coverages, especially for some combinations of vaccines, pathogens, and antimicrobials. Vaccination coverages for pertussis, diphtheria, and tetanus were inversely related to proportions of E. coli resistant to fluoroquinolones and third generation cephalosporins, K. pneumoniae resistant to carbapenems and third generation cephalosporins, and P. aeruginosa resistant to piperacillin and tazobactam. Polio vaccination coverage was inversely related to proportions of E. coli and K. pneumoniae resistant to third generation cephalosporins. Conclusions These results, however, should be interpreted cautiously due to the ecological nature of our analysis. For this reason, further studies designed ad hoc should be encouraged to measure the impact of increasing childhood vaccination coverage on AMR. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01173-0.
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Mohanty S, Johnson KD, Yu KC, Watts JA, Gupta V. A Multicenter Evaluation of Trends in Antimicrobial Resistance among Streptococcus pneumoniae Isolates from Adults in the United States. Open Forum Infect Dis 2022; 9:ofac420. [PMID: 36168549 PMCID: PMC9511122 DOI: 10.1093/ofid/ofac420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022] Open
Abstract
Background Management of pneumococcal disease is complicated by high rates of antimicrobial resistance (AMR). This study assessed AMR trends for Streptococcus pneumoniae isolates from adults with pneumococcal disease. Methods From January 2011 to February 2020, we evaluated 30-day nonduplicate S. pneumoniae isolates from 290 US hospitals (BD Insights Research Database) from adults (≥18 years) in inpatient and outpatient settings. Isolates were required to have ≥1 AMR result for invasive (blood, cerebrospinal fluid/neurologic) or noninvasive (respiratory or ear/nose/throat) pneumococcal disease samples. Determination of AMR was based on facility reports of intermediate or resistant. Descriptive statistics and generalized estimated equations were used to assess variations over time. Results Over the study period, 34 039 S. pneumoniae isolates were analyzed (20 749 [61%] from noninvasive sources and 13 290 [39%] from invasive sources). Almost half (46.6%) of the isolates were resistant to ≥1 drug, and noninvasive isolates had higher rates of AMR than invasive isolates. Total S. pneumoniae isolates had high rates of resistance to macrolides (37.7%), penicillin (22.1%), and tetracyclines (16.1%). Multivariate modeling identified a significant increasing trend in resistance to macrolides (+1.8%/year; P < .001). Significant decreasing trends were observed for penicillin (−1.6%/year; P < .001), extended-spectrum cephalosporins (ESCs; −0.35%/year; P < .001), and ≥3 drugs (−0.5%/year; P < .001). Conclusions Despite decreasing trends for penicillin, ESCs, and resistance to ≥3 drugs, AMR rates are persistently high in S. pneumoniae isolates among US adults. Increasing macrolide resistance suggests that efforts to address AMR in S. pneumoniae may require antimicrobial stewardship efforts and higher-valent pneumococcal conjugate vaccines.
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Affiliation(s)
| | | | - Kalvin C Yu
- Becton, Dickinson & Company , Franklin Lakes, NJ , USA
| | - Janet A Watts
- Becton, Dickinson & Company , Franklin Lakes, NJ , USA
| | - Vikas Gupta
- Becton, Dickinson & Company , Franklin Lakes, NJ , USA
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Gaikwad WK, Jana SK, Dhere RM, Ravenscroft N, Kodam KM. Purification of capsular polysaccharides isolated from S. pneumoniae serotype 2 by hydrogen peroxide and endonuclease. Carbohydr Polym 2022; 294:119783. [DOI: 10.1016/j.carbpol.2022.119783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/02/2022]
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Valente LG, Le ND, Pitton M, Chiffi G, Grandgirard D, Jakob SM, Cameron DR, Resch G, Que YA, Leib SL. Efficacy assessment of a novel endolysin PlyAZ3aT for the treatment of ceftriaxone-resistant pneumococcal meningitis in an infant rat model. PLoS One 2022; 17:e0266928. [PMID: 35472061 PMCID: PMC9041855 DOI: 10.1371/journal.pone.0266928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background Treatment failure in pneumococcal meningitis due to antibiotic resistance is an increasing clinical challenge and alternatives to antibiotics warrant investigation. Phage-derived endolysins efficiently kill gram-positive bacteria including multi-drug resistant strains, making them attractive therapeutic candidates. The current study assessed the therapeutic potential of the novel endolysin PlyAZ3aT in an infant rat model of ceftriaxone-resistant pneumococcal meningitis. Methods Efficacy of PlyAZ3aT was assessed in a randomized, blinded and controlled experimental study in infant Wistar rats. Meningitis was induced by intracisternal infection with 5 x 107 CFU/ml of a ceftriaxone-resistant clinical strain of S. pneumoniae, serotype 19A. Seventeen hours post infection (hpi), animals were randomized into 3 treatment groups and received either (i) placebo (phosphate buffered saline [PBS], n = 8), (ii) 50 mg/kg vancomycin (n = 10) or (iii) 400 mg/kg PlyAZ3aT (n = 8) via intraperitoneal injection. Treatments were repeated after 12 h. Survival at 42 hpi was the primary outcome; bacterial loads in cerebrospinal fluid (CSF) and blood were secondary outcomes. Additionally, pharmacokinetics of PlyAZ3aT in serum and CSF was assessed. Results PlyAZ3aT did not improve survival compared to PBS, while survival for vancomycin treated animals was 70% which is a significant improvement when compared to PBS or PlyAZ3aT (p<0.05 each). PlyAZ3aT was not able to control the infection, reflected by the inability to reduce bacterial loads in the CSF, whereas Vancomycin sterilized the CSF and within 25 h. Pharmacokinetic studies indicated that PlyAZ3aT did not cross the blood brain barrier (BBB). In support, PlyAZ3aT showed a peak concentration of 785 μg/ml in serum 2 h after intraperitoneal injection but could not be detected in CSF. Conclusion In experimental pneumococcal meningitis, PlyAZ3aT failed to cure the infection due to an inability to reach the CSF. Optimization of the galenic formulation e.g. using liposomes might enable crossing of the BBB and improve treatment efficacy.
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Affiliation(s)
- Luca G. Valente
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Ngoc Dung Le
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Melissa Pitton
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Gabriele Chiffi
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Denis Grandgirard
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Stephan M. Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David R. Cameron
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Grégory Resch
- Centre for Research and Innovation in Clinical Pharmaceutical Sciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Yok-Ai Que
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephen L. Leib
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
- * E-mail:
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Attitudes towards vaccination and knowledge about antibiotics: Analysis of Wellcome Monitor survey data. Vaccine 2022; 40:3038-3045. [PMID: 35437191 DOI: 10.1016/j.vaccine.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/14/2022] [Accepted: 04/04/2022] [Indexed: 11/24/2022]
Abstract
Vaccine hesitancy and antimicrobial resistance are biomedically connected public health challenges, but to date minimal research has examined social connections between the UK public's attitudes towards vaccination and attitudes towards antibiotic use. Understanding the extent to which these issues are attitudinally parallel would be valuable for implementing and evaluating public health interventions. Using data from the Wellcome Trust Monitor Wave 4 this study examined social associations between these two areas. An ordinal logistic regression model predicting knowledge level about antibiotics was fitted using 2,654 observations, controlling for known outcome covariates, with perceptions of the risk of side-effects from vaccination and of the efficacy of vaccination as a preventative intervention as independent variables. Compared to the modal response category of 'Fairly low', respondents who rated the risk of serious side-effects from vaccination as 'Very high' (OR = 2.87, 95% CI = 1.71-4.89) or 'Fairly high' (OR = 1.51, 95% CI = 1.21-1.88) were more likely to have provided incorrect responses to questions about the utility of antibiotics for treating different types of infection. Conversely, respondents who felt there was 'No risk at all' (OR = 0.69, 95% CI = 0.50-0.95) were less likely to have provided incorrect responses about the utility of antibiotics. Compared to the modal category of 'Almost always effective', only respondents who felt that vaccines were 'Sometimes effective' (OR = 1.26, 95% CI = 1.05-1.51) or 'Almost never or never effective' (OR = 2.32, CI = 1.32-4.19) were more likely provide incorrect responses regarding antibiotics' utility. Negative perceptions of vaccination and misperceptions about the role of antibiotics for treating infections are associated with one other within the general UK public. Qualitative research is needed to understand the nature of this association and identify areas of public understanding that are not exclusive to specific health interventions but that may be targeted to improve responsiveness to vaccine- and antibiotic-related public health interventions.
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Gutiérrez-Tobar IF, Londoño-Ruiz JP, Mariño-Drews C, Beltrán-Higuera S, Camacho-Moreno G, Leal-Castro AL, Patiño-Niño JA, Álvarez-Olmos MI, Barrero-Barreto R, Espinosa F, Suarez MA, Ramos N, Moreno-Mejia VM, Marín A, Sierra Parada CR, Pescador A, Montañez A. Epidemiological characteristics and serotype distribution of culture-confirmed pediatric pneumococcal pneumonia before and after PCV 10 introduction, a multicenter study in Bogota, Colombia, 2008-2019. Vaccine 2022; 40:2875-2883. [PMID: 35396166 DOI: 10.1016/j.vaccine.2022.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 02/21/2022] [Accepted: 03/10/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pneumococcal conjugate vaccines (PCVs) have decreased pneumonia in children. Colombia introduced mass vaccination with PCV10 in 2012. METHODS Cases of pneumococcal pneumonia from 10 hospitals were included. Two periods were compared: pre-PCV10: 2008-2011 and post-PCV10: 2014-2019. The objective was to compare epidemiological and clinical characteristics before and after PCV10 vaccination. RESULTS A total of 370 cases were included. Serotypes 1 (15, 11.2%) and 14 (33, 24.6%) were the most frequent in the pre-PCV10 period, with only 4 (3%) cases of serotype 19A and 1 case (0.7%) serotype 3. From the pre-PCV10 period to the post-PCV10 period, cases of serotypes 1 (6, 3.1%) and 14 (1, 7.8%) decreased, while cases of serotypes 19A (58, 30.2%), serotype 3 (32, 16.7%) and 6A (7, 3.6%) increased (p < 0.001); complicated pneumonia (CP) increased significantly (13.4% to 31.8%) (p < 0.001); hospitalizations increased from 8 (5.5-15) to 12 (7-22) days (p < 0.001); and the frequency of PICU admission increased from 32.8% to 51.6% (p = 0.001). The use of ampicillin-sulbactam (0.7% to 24%) and ceftriaxone/clindamycin (0.7% to 5.7%) increased in the post-PCV10 period. The duration of empirical antibiotic treatment was 7 (4-11) days in the pre-PCV10 period and increased to 10 (6-17) days (p < 0.001) in the post-PCV10 period. Lethality showed a slight nonsignificant increase (7.5% vs. 9.9%; p = 0.57) in the post-PCV10 period. CONCLUSIONS PCV10 significantly decreased cases of serotypes 1 and 14, with an increase in cases of serotypes 19A, 3 and 6A, which were the predominant serotypes and had greater severity (e.g., admission to the PICU, CP and more resistance, with an increase in the use of broad-spectrum antibiotics and longer hospitalization) and subsequently included in PCV13. Current data support national and regional evidence on the importance of replacing PCV10 with a higher valence that includes 19A, such as PCV13, with the aim of reducing circulation, particularly of this serotype.
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Affiliation(s)
| | - Juan Pablo Londoño-Ruiz
- Red Neumocolombia, Colombia; Clínica Infantil Colsubsidio, Clínica Infantil Santa María del Lago, Colombia; Universidad el Bosque, Colombia
| | | | | | - Germán Camacho-Moreno
- Red Neumocolombia, Colombia; HOMI, Fundación Hospital Pediátrico la Misericordia, Bogotá, Colombia; Hospital Infantil Universitario de San José, Colombia; Universidad Nacional de Colombia.
| | | | | | | | - Rocio Barrero-Barreto
- Red Neumocolombia, Colombia; Hospital Universitario Clínica San Rafael, Colombia; Unidad de Servicios de Salud Santa Clara, Colombia
| | - Fabio Espinosa
- Red Neumocolombia, Colombia; Hospital Infantil Universitario de San José, Colombia
| | | | - Nicolás Ramos
- Red Neumocolombia, Colombia; COBOS Medical Center, Colombia; Universidad el Bosque, Colombia
| | | | - Alejandra Marín
- Red Neumocolombia, Colombia; Clínica Infantil Colsubsidio, Clínica Infantil Santa María del Lago, Colombia
| | | | - Angela Pescador
- Red Neumocolombia, Colombia; Hospital Militar Central, Colombia
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Waddington C, Carey ME, Boinett CJ, Higginson E, Veeraraghavan B, Baker S. Exploiting genomics to mitigate the public health impact of antimicrobial resistance. Genome Med 2022; 14:15. [PMID: 35172877 PMCID: PMC8849018 DOI: 10.1186/s13073-022-01020-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/04/2022] [Indexed: 12/13/2022] Open
Abstract
Antimicrobial resistance (AMR) is a major global public health threat, which has been largely driven by the excessive use of antimicrobials. Control measures are urgently needed to slow the trajectory of AMR but are hampered by an incomplete understanding of the interplay between pathogens, AMR encoding genes, and mobile genetic elements at a microbial level. These factors, combined with the human, animal, and environmental interactions that underlie AMR dissemination at a population level, make for a highly complex landscape. Whole-genome sequencing (WGS) and, more recently, metagenomic analyses have greatly enhanced our understanding of these processes, and these approaches are informing mitigation strategies for how we better understand and control AMR. This review explores how WGS techniques have advanced global, national, and local AMR surveillance, and how this improved understanding is being applied to inform solutions, such as novel diagnostic methods that allow antimicrobial use to be optimised and vaccination strategies for better controlling AMR. We highlight some future opportunities for AMR control informed by genomic sequencing, along with the remaining challenges that must be overcome to fully realise the potential of WGS approaches for international AMR control.
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Affiliation(s)
- Claire Waddington
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK.,Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Megan E Carey
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK.,Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | | | - Ellen Higginson
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK.,Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | - Balaji Veeraraghavan
- Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Stephen Baker
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0AW, UK. .,Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK.
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13
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14
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Ozawa S, Chen HH, Rao GG, Eguale T, Stringer A. Value of pneumococcal vaccination in controlling the development of antimicrobial resistance (AMR): Case study using DREAMR in Ethiopia. Vaccine 2021; 39:6700-6711. [PMID: 34538697 DOI: 10.1016/j.vaccine.2021.04.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 03/11/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Antimicrobial resistance (AMR) poses an imminent threat to global health security. Pneumococcal vaccination reduces disease incidence, prevents antibiotic use, and decreases antibiotic-resistant infections. However, the benefit of vaccination in reducing AMR has been poorly quantified to date. METHODS We developed an agent-based model, DREAMR (Dynamic Representation of the Economics of AMR) to evaluate the economic value of childhood immunization with the pneumococcal conjugate vaccine (PCV) in mitigating the development of AMR. Our model incorporates vaccination coverage, disease incidence, care seeking, and antibiotic use. Accumulation of AMR is simulated based on antibiotic exposure through pharmacokinetics and resulting pharmacodynamics. The model was applied to Ethiopia. RESULTS Introduction of PCV vaccination has helped slow the development of AMR by 14.77% for amoxicillin and 0.59% for ceftriaxone in Ethiopia since 2011. In addition to the benefit of reduction in disease incidence, PCV vaccination has averted approximately 718,100 antibiotic treatment failures and 9,520 AMR-related deaths (27.8% reduction) in Ethiopia between 2011 and 2017, resulting in savings of $32.7 million. Maintaining current PCV immunization coverage will contribute an additional $7.67 million in annual AMR cost savings over five years compared to no vaccination scenario, which could increase to $11.43 million by increasing PCV coverage to 85% by 2022. CONCLUSIONS This study is the first to demonstrate the broader economic value of pneumococcal vaccination in controlling the development of AMR in Africa. Vaccination not only saves lives by preventing illnesses, but also benefits society by reducing antibiotic utilization and treatment failures due to AMR.
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Affiliation(s)
- Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA; Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA.
| | - Hui-Han Chen
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Gauri G Rao
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Tadesse Eguale
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andrew Stringer
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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15
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Myopathy Associated with Treatment of Graves’ Disease. Medicina (B Aires) 2021; 57:medicina57101016. [PMID: 34684053 PMCID: PMC8537232 DOI: 10.3390/medicina57101016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/22/2022] Open
Abstract
Here, we report a case of an increase in serum creatine kinase (CK) concentration in an 11-year-old girl being treated for Graves’ disease with antithyroid drugs (ATDs). The patient complained of myalgia two weeks after methimazole treatment. Triiodothyronine (T3) and free thyroxine (FT4) levels were normal, but the serum CK level was significantly elevated. After switching to propylthiouracil, the serum CK level decreased to normal, and the myalgia was resolved. The development of myopathy during the treatment of hyperthyroidism may be considered as an adverse reaction of MMI. In this report, we present a rare pediatric case, along with a discussion on the possible causes of myopathy that occurred during the treatment of Graves’ disease. A careful follow-up (serum CK levels and thyroid function) and treatment reassessment should always be considered after antithyroid treatment.
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16
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Saha SK, Tabassum N, Saha S. Typhoid Conjugate Vaccine - an urgent tool to combat typhoid, and tackle antimicrobial resistance. J Infect Dis 2021; 224:S788-S791. [PMID: 34528685 PMCID: PMC8687048 DOI: 10.1093/infdis/jiab443] [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] [Indexed: 11/12/2022] Open
Abstract
Typhoid is endemic in many countries in South Asia and sub-Saharan Africa. The high burden of this age-old, preventable disease exacerbates constraints on the health systems of these countries. Currently, most patients are treated effectively in the community or outpatient departments, however, with rising antimicrobial resistance and the dearth of novel antimicrobials in the horizon, we risk losing our primary defense against typhoid. Extensively drug-resistant Salmonella Typhi is spreading, and azithromycin is the last oral drug to continue treating typhoid in the community. With increasing azithromycin resistance, emergence of pan-oral drug resistant Salmonella Typhi is imminent. The high burden of typhoid is also an underlying cause of the unnecessary use of antimicrobials. In addition to implementing water sanitation and hygiene interventions to prevent typhoid, it is imperative to rapidly roll out typhoid conjugate vaccines in endemic countries. This will not only reduce the burden of typhoid, but also aid in interrupting the trend of increasing antimicrobial resistance.
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Affiliation(s)
- Samir K Saha
- Child Health Research Foundation, Dhaka 1207, Bangladesh.,Department of Microbiology, Dhaka Shishu Hospital, Bangladesh Institute of Child Health, Dhaka 1207, Bangladesh
| | | | - Senjuti Saha
- Child Health Research Foundation, Dhaka 1207, Bangladesh
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17
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Fernández Chávez AC, García Comas L, Gómez Barroso D, Ramis Prieto R, López Fresneña N, Bishofberguer Valdes C, Aranaz Andrés JM. Spatial and temporal analysis of invasive pneumococcal disease due to erythromycinresistant serotypes. Enferm Infecc Microbiol Clin 2021; 41:S0213-005X(21)00205-6. [PMID: 34256972 DOI: 10.1016/j.eimc.2021.06.009] [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: 02/08/2021] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To study the spatio-temporal distribution of cases of invasive pneumococcal disease (IPD) due to serotypes resistant to erythromycin and its relationship with community consumption of macrolides and childhood vaccination coverage. METHODS We selected IPD cases in adults over 59 years old, residents in the Community of Madrid (MC), notified in the period 2007-2016. The variables studied were obtained from the Vaccination Information Systems and the Pharmaceutical Service. The cut-off point (minimum inhibitory erythromycin concentration > 0.5 mg/L) of the EUCAST classification was used to define erythromycin resistant serotypes. We used JointPoint to estimate the incidence trends by erythromycin resistant serotypes included in the 13-valent vaccine (STPCV13) and not included in it (STnoPCV13). The association of these incidences with the community consumption of macrolides and vaccination coverage was made using Poisson models. Statistical scanning was used for the detection of temporal-spaces clusters of cases. RESULTS 1936 cases were identified, of which 427 erythromycin resistant serotypes were identified. The incidence of all cases due to resistant serotypes was decreasing (AAPC: -5,40%). During the period studied, the incidence of cases due to erythromycin resistant STPCV13 was decreasing with an annual percentage change (APC): -13.8 and was inversely associated with childhood vaccination coverage (IRR 0.641), while that of cases due to erythromycin resistant STnoPCV13 was ascending (APC): 4.5; and was not associated with coverage. 1 cluster was detected by STnoPCV13 and none by STPCV13 after the date of inclusion of the 13-valent in the childhood vaccination calendar. CONCLUSIONS The decrease in IPD due to resistant STPCV13 was associated with an increase in childhood vaccination coverage. The presence of clusters due to STnoPCV13 after the date of inclusion of the 13-valent vaccine in the childhood vaccination calendar indicates serotypes replacement. The increase in cases of resistant STnoPCV13 could be related to the replacement of vaccine serotypes in nasopharyngeal colonization, facilitated by the consumption of macrolides still at high levels in MC.
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Affiliation(s)
| | - Luis García Comas
- Servicio de Epidemiología de la Consejería de Sanidad de la Comunidad de Madrid, Madrid, España
| | | | | | - Nieves López Fresneña
- Medicina Preventiva del Hospital General Universitario Gregorio Marañón, Madrid, España
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18
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Wang LM, Cravo Oliveira Hashiguchi T, Cecchini M. Impact of vaccination on carriage of and infection by antibiotic-resistant bacteria: a systematic review and meta-analysis. Clin Exp Vaccine Res 2021; 10:81-92. [PMID: 34222121 PMCID: PMC8217572 DOI: 10.7774/cevr.2021.10.2.81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/26/2021] [Indexed: 11/15/2022] Open
Abstract
This systematic review and meta-analysis aims to quantify the impact of vaccination on the incidence and prevalence of nonsusceptible infections and investigates the impact of vaccination programs on serotype replacement. We searched a comprehensive set of databases. Identified studies were assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach and resulting evidence was analyzed using random-effect meta-analyses. Nineteen studies on pneumococcal conjugate vaccines (PCV) met our inclusion criteria. PCV decreases the incidence of nonsusceptible pneumococcal infections (PIs) by 56.91% (95% confidence interval [CI], −50.90% to −62.91%) and the probability of carriage of nonsusceptible pneumococcal bacteria by 28.10% (95% CI, −13.25% to −42.95%). The effect of PCV on PIs becomes higher when only serotypes specifically targeted by the vaccine are taken into account (−80.98%; 95% CI, −70.34% to −91.52%), while it becomes lower when all the PIs, including both susceptible and nonsusceptible PIs, are considered (−48.30%; 95% CI, −31.55% to −65.08%). The effect of PCV is found greater in populations with high prevalence of human immunodeficiency virus and for PCV covering a higher number of serotypes. Findings from this study suggest that vaccination programs may be an effective tool to prevent the spread of PIs and may play a significant role in tackling antimicrobial resistance.
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Affiliation(s)
- Li Min Wang
- Health Division, Organization for Economic Co-operation and Development, Paris, France.,Ecole des Hautes Études en Santé Publique (EHESP), Paris, France
| | | | - Michele Cecchini
- Health Division, Organization for Economic Co-operation and Development, Paris, France
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19
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Cracking the Challenge of Antimicrobial Drug Resistance with CRISPR/Cas9, Nanotechnology and Other Strategies in ESKAPE Pathogens. Microorganisms 2021; 9:microorganisms9050954. [PMID: 33946643 PMCID: PMC8145940 DOI: 10.3390/microorganisms9050954] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 11/23/2022] Open
Abstract
Antimicrobial resistance is mushrooming as a silent pandemic. It is considered among the most common priority areas identified by both national and international agencies. The global development of multidrug-resistant strains now threatens public health care improvement by introducing antibiotics against infectious agents. These strains are the product of both continuous evolution and unchecked antimicrobial usage (AMU). The ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) are the leading cause of nosocomial infections throughout the world. Most of them are now multidrug-resistant, which pose significant challenges in clinical practice. Understanding these bacteria’s resistance mechanisms is crucial for developing novel antimicrobial agents or other alternative tools to fight against these pathogens. A mechanistic understanding of resistance in these pathogens would also help predict underlying or even unknown mechanisms of resistance of other emerging multidrug-resistant pathogens. Research and development to find better antibacterial drugs and research on tools like CRISPER-Cas9, vaccines, and nanoparticles for treatment of infections that can be further explored in the clinical practice health sector have recognized these alternatives as essential and highly effective tools to mitigate antimicrobial resistance. This review summarizes the known antimicrobial resistance mechanisms of ESKAPE pathogens and strategies for overcoming this resistance with an extensive overview of efforts made in this research area.
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20
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Vaccines against antimicrobial resistance: a promising escape route for multidrug resistance. Pharm Pat Anal 2021; 10:83-98. [PMID: 33829866 DOI: 10.4155/ppa-2020-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Antibiotic resistance has become a global health problem requiring urgent intervention. The pace of development and frequency of transmission of antimicrobial resistance have tremendously surpassed the number of antibiotics developed in the past few decades. Emergence and transmission of multidrug-resistant genes, for example, mcr-1 and mcr-5.3, against the last resort of antibiotics has challenged the treatment options. Vaccination is a promising approach with no instance of antimicrobial resistance generation or transmission reported so far. The time required for developing a vaccine, extensive pre- and post-licensure studies and the financial constraints for the R&D has hampered vaccine development over the past few decades. Vaccine can prove to be an effective future strategy for combating antimicrobial resistance.
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21
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Dayie NTKD, Osei MM, Opintan JA, Tetteh-Quarcoo PB, Kotey FCN, Ahenkorah J, Adutwum-Ofosu KK, Egyir B, Donkor ES. Nasopharyngeal Carriage and Antimicrobial Susceptibility Profile of Staphylococcus aureus among Children under Five Years in Accra. Pathogens 2021; 10:136. [PMID: 33572983 PMCID: PMC7912391 DOI: 10.3390/pathogens10020136] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/16/2021] [Accepted: 01/26/2021] [Indexed: 01/31/2023] Open
Abstract
This cross-sectional study investigated the Staphylococcus aureus (S. aureus) and methicillin-resistant S. aureus (MRSA) nasopharyngeal carriage epidemiology in Accra approximately five years post-pneumococcal conjugate vaccines introduction in the country. Archived nasopharyngeal swabs collected from 410 children aged under five years old were bacteriologically cultured. The resultant S. aureus isolates were subjected to antimicrobial susceptibility testing and screening for carriage of the mecA and LukF-PV (pvl) genes, following standard procedures. The data obtained were analyzed with Statistical Products and Services Solutions (SPSS) using descriptive statistics and Chi square tests of associations. The isolated bacteria decreased across coagulase-negative Staphylococci (47.3%, n = 194), S. aureus (23.2%, n = 95), Diphtheroids (5.4%, n = 22), Micrococcus species (3.7%, n = 15), Klebsiella pneumoniae (3.2%, n = 13), Moraxella species and Citrobacter species (1.5% each, n = 6), Escherichia coli, Enterobacter species, and Pseudomonas species (0.9% each, n = 2). The MRSA carriage prevalence was 0.49% (n = 2). Individuals aged 37-48 months recorded the highest proportion of S. aureus carriage (32.6%, 31/95). Resistance of S. aureus to the antibiotics tested were penicillin G (97.9%, n = 93), amoxiclav (20%, n = 19), tetracycline (18.9%, n = 18), erythromycin (5.3%, n = 5), ciprofloxacin (2.1%, n = 2), gentamicin (1.1%, n = 1), cotrimoxazole, clindamycin, linezolid, and teicoplanin (0% each). No inducible clindamycin resistance was observed for the erythromycin-resistant isolates. Three (3.2%) of the isolates were multidrug resistant, of which 66.7% (2/3) were MRSA. The pvl gene was associated with 59.14% (55/93) of the methicillin-sensitive S. aureus (MSSA) isolates, but was not detected among any of the MRSA isolates.
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Affiliation(s)
- Nicholas T. K. D. Dayie
- Department of Medical Microbiology, University of Ghana Medical School, P.O. Box KB 4236 Accra, Ghana; (M.-M.O.); (J.A.O.); (P.B.T.-Q.); (F.C.N.K.); (E.S.D.)
| | - Mary-Magdalene Osei
- Department of Medical Microbiology, University of Ghana Medical School, P.O. Box KB 4236 Accra, Ghana; (M.-M.O.); (J.A.O.); (P.B.T.-Q.); (F.C.N.K.); (E.S.D.)
- FleRhoLife Research Consult, P.O. Box TS 853 Accra, Ghana
| | - Japheth A. Opintan
- Department of Medical Microbiology, University of Ghana Medical School, P.O. Box KB 4236 Accra, Ghana; (M.-M.O.); (J.A.O.); (P.B.T.-Q.); (F.C.N.K.); (E.S.D.)
| | - Patience B. Tetteh-Quarcoo
- Department of Medical Microbiology, University of Ghana Medical School, P.O. Box KB 4236 Accra, Ghana; (M.-M.O.); (J.A.O.); (P.B.T.-Q.); (F.C.N.K.); (E.S.D.)
| | - Fleischer C. N. Kotey
- Department of Medical Microbiology, University of Ghana Medical School, P.O. Box KB 4236 Accra, Ghana; (M.-M.O.); (J.A.O.); (P.B.T.-Q.); (F.C.N.K.); (E.S.D.)
- FleRhoLife Research Consult, P.O. Box TS 853 Accra, Ghana
| | - John Ahenkorah
- Department of Anatomy, University of Ghana Medical School, P.O. Box 4236 Accra, Ghana; (J.A.); (K.K.A.-O.)
| | - Kevin Kofi Adutwum-Ofosu
- Department of Anatomy, University of Ghana Medical School, P.O. Box 4236 Accra, Ghana; (J.A.); (K.K.A.-O.)
| | - Beverly Egyir
- Department of Bacteriology, Noguchi Memorial Institute for Medical Research, University of Ghana, P.O. Box LG 581 Accra, Ghana;
| | - Eric S. Donkor
- Department of Medical Microbiology, University of Ghana Medical School, P.O. Box KB 4236 Accra, Ghana; (M.-M.O.); (J.A.O.); (P.B.T.-Q.); (F.C.N.K.); (E.S.D.)
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22
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Jansen KU, Gruber WC, Simon R, Wassil J, Anderson AS. The impact of human vaccines on bacterial antimicrobial resistance. A review. ENVIRONMENTAL CHEMISTRY LETTERS 2021; 19:4031-4062. [PMID: 34602924 PMCID: PMC8479502 DOI: 10.1007/s10311-021-01274-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/09/2021] [Indexed: 05/07/2023]
Abstract
At present, the dramatic rise in antimicrobial resistance (AMR) among important human bacterial pathogens is reaching a state of global crisis threatening a return to the pre-antibiotic era. AMR, already a significant burden on public health and economies, is anticipated to grow even more severe in the coming decades. Several licensed vaccines, targeting both bacterial (Haemophilus influenzae type b, Streptococcus pneumoniae, Salmonella enterica serovar Typhi) and viral (influenza virus, rotavirus) human pathogens, have already proven their anti-AMR benefits by reducing unwarranted antibiotic consumption and antibiotic-resistant bacterial strains and by promoting herd immunity. A number of new investigational vaccines, with a potential to reduce the spread of multidrug-resistant bacterial pathogens, are also in various stages of clinical development. Nevertheless, vaccines as a tool to combat AMR remain underappreciated and unfortunately underutilized. Global mobilization of public health and industry resources is key to maximizing the use of licensed vaccines, and the development of new prophylactic vaccines could have a profound impact on reducing AMR.
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Affiliation(s)
| | | | - Raphael Simon
- Pfizer Vaccine Research and Development, Pearl River, NY USA
| | - James Wassil
- Pfizer Patient and Health Impact, Collegeville, PA USA
- Present Address: Vaxcyte, 353 Hatch Drive, Foster City, CA 94404 USA
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Abstract
The development of vaccines is one of the greatest medical interventions in the history of global infectious diseases and has contributed to the annual saving of at least 2 to 3 million lives worldwide. However, many diseases are not preventable through currently available vaccines, and the potential of modulating the immune response during vaccination has not been fully exploited. The first golden age of vaccines was based on the germ theory and the use of live, attenuated, inactivated pathogens or toxins. New strategies and formulations (e.g., adjuvants) with an immunomodulatory capacity to enhance the protective qualities and duration of vaccines have been incompletely exploited. These strategies can prevent disease and improve protection against infectious diseases, modulate the course of some noncommunicable diseases, and increase the immune responses of patients at a high risk of infection, such as the elderly or immunocompromised patients. In this minireview, we focus on how metabolic and epigenetic modulators can amplify and enhance the function of immunity in a given vaccine. We propose the term “amplifier” for such additives, and we pose that future vaccines will have three components: antigen, adjuvant, and amplifier.
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24
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Hink RK, Adam HJ, Golden AR, Baxter M, Martin I, Nichol KA, Demczuk W, Mulvey MR, Karlowsky JA, Zhanel GG. Comparison of PCV-10 and PCV-13 vaccine coverage for invasive pneumococcal isolates obtained across Canadian geographic regions, SAVE 2011 to 2017. Diagn Microbiol Infect Dis 2020; 99:115282. [PMID: 33341491 DOI: 10.1016/j.diagmicrobio.2020.115282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 01/08/2023]
Abstract
To assess the coverage of invasive Streptococcus pneumoniae by pneumococcal conjugate vaccines (PCV)-10 and PCV-13 across Canada. In total, 9166 invasive S. pneumoniae isolates were collected as part of the SAVE 2011 to 2017 study. Serotyping was performed by the Quellung reaction and antimicrobial susceptibility testing was performed using CLSI methods. The proportion of both PCV-10 and PCV-13 serotypes decreased significantly (P < 0.0001) from 2011 (26.7% and 48.0%, respectively) to 2017 (11.2% and 26.2%). For central, western, and eastern regions of Canada, PCV-13 provided significantly greater (P < 0.0001) coverage at 33.7% (2060/6110), 23.0% (456/1985), and 36.3% (389/1071), respectively, compared to PCV-10 at 15.4% (939/6110), 10.1% (201/1985), and 15.8% (169/1071) coverage. PCV-13 provided significantly greater coverage (53.3%, 282/529) of multidrug-resistant (MDR) isolates (resistant to ≥3 antimicrobial classes) than PCV-10 (14.6%, 77/529, P < 0.0001). PCV-13 provided significantly greater coverage of invasive S. pneumoniae serotypes, as well as coverage of MDR isolates, than PCV-10.
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Affiliation(s)
- Rachel K Hink
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0J9, Canada
| | - Heather J Adam
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0J9, Canada; Clinical Microbiology, Diagnostic Services, Shared Health, Health Sciences Centre, Winnipeg, Manitoba, R3A 1R9, Canada
| | - Alyssa R Golden
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0J9, Canada
| | - Melanie Baxter
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0J9, Canada
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Kimberly A Nichol
- Clinical Microbiology, Diagnostic Services, Shared Health, Health Sciences Centre, Winnipeg, Manitoba, R3A 1R9, Canada
| | - Walter Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Michael R Mulvey
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0J9, Canada; National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, R3E 3R2, Canada
| | - James A Karlowsky
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0J9, Canada; Clinical Microbiology, Diagnostic Services, Shared Health, Health Sciences Centre, Winnipeg, Manitoba, R3A 1R9, Canada
| | - George G Zhanel
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0J9, Canada.
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25
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Gingras H, Patron K, Leprohon P, Ouellette M. Azithromycin resistance mutations in Streptococcus pneumoniae as revealed by a chemogenomic screen. Microb Genom 2020; 6. [PMID: 33074087 PMCID: PMC7725334 DOI: 10.1099/mgen.0.000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We report on the combination of chemical mutagenesis, azithromycin selection and next-generation sequencing (Mut-Seq) for the identification of small nucleotide variants that decrease the susceptibility of Streptococcus pneumoniae to the macrolide antibiotic azithromycin. Mutations in the 23S ribosomal RNA or in ribosomal proteins can confer resistance to macrolides and these were detected by Mut-Seq. By concentrating on recurrent variants, we could associate mutations in genes implicated in the metabolism of glutamine with decreased azithromycin susceptibility among S. pneumoniae mutants. Glutamine synthetase catalyses the transformation of glutamate and ammonium into glutamine and its chemical inhibition is shown to sensitize S. pneumoniae to antibiotics. A mutation affecting the ribosomal-binding site of a putative ribonuclease J2 is also shown to confer low-level resistance. Mut-Seq has the potential to reveal chromosomal changes enabling high resistance as well as novel events conferring more subtle phenotypes.
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Affiliation(s)
- Hélène Gingras
- Axe des Maladies Infectieuses et Immunitaires du Centre de Recherche du CHU de Québec and Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Kévin Patron
- Axe des Maladies Infectieuses et Immunitaires du Centre de Recherche du CHU de Québec and Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Philippe Leprohon
- Axe des Maladies Infectieuses et Immunitaires du Centre de Recherche du CHU de Québec and Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Marc Ouellette
- Axe des Maladies Infectieuses et Immunitaires du Centre de Recherche du CHU de Québec and Département de Microbiologie, Infectiologie et Immunologie, Faculté de Médecine, Université Laval, Québec, Québec, Canada
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26
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Suaya JA, Mendes RE, Sings HL, Arguedas A, Reinert RR, Jodar L, Isturiz RE, Gessner BD. Streptococcus pneumoniae serotype distribution and antimicrobial nonsusceptibility trends among adults with pneumonia in the United States, 2009‒2017. J Infect 2020; 81:557-566. [DOI: 10.1016/j.jinf.2020.07.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/15/2020] [Accepted: 07/28/2020] [Indexed: 10/23/2022]
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Nadeem SF, Gohar UF, Tahir SF, Mukhtar H, Pornpukdeewattana S, Nukthamna P, Moula Ali AM, Bavisetty SCB, Massa S. Antimicrobial resistance: more than 70 years of war between humans and bacteria. Crit Rev Microbiol 2020; 46:578-599. [PMID: 32954887 DOI: 10.1080/1040841x.2020.1813687] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Development of antibiotic resistance in bacteria is one of the major issues in the present world and one of the greatest threats faced by mankind. Resistance is spread through both vertical gene transfer (parent to offspring) as well as by horizontal gene transfer like transformation, transduction and conjugation. The main mechanisms of resistance are limiting uptake of a drug, modification of a drug target, inactivation of a drug, and active efflux of a drug. The highest quantities of antibiotic concentrations are usually found in areas with strong anthropogenic pressures, for example medical source (e.g., hospitals) effluents, pharmaceutical industries, wastewater influents, soils treated with manure, animal husbandry and aquaculture (where antibiotics are generally used as in-feed preparations). Hence, the strong selective pressure applied by antimicrobial use has forced microorganisms to evolve for survival. The guts of animals and humans, wastewater treatment plants, hospital and community effluents, animal husbandry and aquaculture runoffs have been designated as "hotspots for AMR genes" because the high density of bacteria, phages, and plasmids in these settings allows significant genetic exchange and recombination. Evidence from the literature suggests that the knowledge of antibiotic resistance in the population is still scarce. Tackling antimicrobial resistance requires a wide range of strategies, for example, more research in antibiotic production, the need of educating patients and the general public, as well as developing alternatives to antibiotics (briefly discussed in the conclusions of this article).
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Affiliation(s)
- Syeda Fatima Nadeem
- Institute of Industrial Biotechnology, Government College University, Lahore, Pakistan
| | - Umar Farooq Gohar
- Institute of Industrial Biotechnology, Government College University, Lahore, Pakistan
| | - Syed Fahad Tahir
- Institute of Industrial Biotechnology, Government College University, Lahore, Pakistan
| | - Hamid Mukhtar
- Institute of Industrial Biotechnology, Government College University, Lahore, Pakistan
| | | | - Pikunthong Nukthamna
- Faculty of Food Industry, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand.,College of Research Methodology and Cognitive Science, Burapha University, Chonburi, Thailand
| | - Ali Muhammed Moula Ali
- Faculty of Food Industry, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand
| | | | - Salvatore Massa
- Faculty of Food Industry, King Mongkut's Institute of Technology Ladkrabang, Bangkok, Thailand.,Department of Agricultural, Food and Environmental Sciences, University of Foggia, Foggia, Italy
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Iskandar K, Molinier L, Hallit S, Sartelli M, Catena F, Coccolini F, Craig Hardcastle T, Roques C, Salameh P. Drivers of Antibiotic Resistance Transmissionin Low- and Middle-Income Countriesfrom a "One Health" Perspective-A Review. Antibiotics (Basel) 2020; 9:E372. [PMID: 32630353 PMCID: PMC7400606 DOI: 10.3390/antibiotics9070372] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
Antibiotic resistance is an ecosystem problem threatening the interrelated human-animalenvironmenthealth under the "One Health" framework. Resistant bacteria arising in onegeographical area can spread via cross-reservoir transmission to other areas worldwide either bydirect exposure or through the food chain and the environment. Drivers of antibiotic resistance arecomplex and multi-sectoral particularly in Lower- and Middle-income countries. These includeinappropriate socio-ecological behaviors; poverty; overcrowding; lack of surveillance systems; foodsupply chain safety issues; highly contaminated waste effluents; and loose rules and regulations. Inorder to examine the drivers of antibiotic resistance from a "one health" perspective, a literaturereview was conducted on three databases including PubMed, Medline and Google Scholar. A totalof 485 studies of potential relevance were selected, out of which 182 were included in this review.Results have shown that the aforementioned market failures are the leading cause for the negativeexternality of antibiotic resistance that extends in scope from the individual to the global ecosystem.Incremental and sustainable global actions can make the change, however, the problem willcontinue to prevail if governments do not prioritize the "One health" approach and if individual'saccountability is still denied in a world struggling with profound socio-economic problems.
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Affiliation(s)
- Katia Iskandar
- Department of Mathématiques Informatique et Télécommunications, Université Toulouse III, Paul Sabatier, INSERM, UMR 1027, F-31000 Toulouse, France
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573-14, Lebanon; (S.H.); (P.S.)
- Faculty of Pharmacy, Lebanese University, Beirut 1106, Lebanon
| | - Laurent Molinier
- Department of Medical Information, Centre Hospitalier Universitaire, INSERM, UMR 1027, Université Paul Sabatier Toulouse III, F-31000 Toulouse, France;
| | - Souheil Hallit
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573-14, Lebanon; (S.H.); (P.S.)
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh P.O. Box 446, Lebanon
| | - Massimo Sartelli
- Department of surgery, University of Macerata, 62100 Macerata, Italy;
| | - Fausto Catena
- Department of Emergency Surgery, Parma Maggiore Hospital, 43126 Parma, Italy;
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Cisanello University Hospital, 56100 Pisa, Italy;
| | - Timothy Craig Hardcastle
- Department of Trauma service, Inkosi Albert Luthuli Central Hospital, Durban 4091, South Africa;
- Department of Surgery, Nelson Mandela School of Clinical Medicine, University of KwaZulu-Natal, Congela, Durban 4041, South Africa
| | - Christine Roques
- Departement of Bioprocédés et Systèmes Microbiens, Laboratoire de Génie Chimique, Université Paul Sabatier Toulouse III, UMR 5503, 31330 Toulouse, France;
- Department of Bactériologie-Hygiène, Centre Hospitalier Universitaire, Hôpital Purpan, 31330 Toulouse, France
| | - Pascale Salameh
- INSPECT-LB: Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, Beirut 6573-14, Lebanon; (S.H.); (P.S.)
- Faculty of Pharmacy, Lebanese University, Beirut 1106, Lebanon
- Faculty of Public Health, Lebanese University, Beirut 1103, Lebanon
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29
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Resistance of Gram-Positive Bacteria to Current Antibacterial Agents and Overcoming Approaches. Molecules 2020; 25:molecules25122888. [PMID: 32586045 PMCID: PMC7356343 DOI: 10.3390/molecules25122888] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 12/22/2022] Open
Abstract
The discovery of antibiotics has created a turning point in medical interventions to pathogenic infections, but unfortunately, each discovery was consistently followed by the emergence of resistance. The rise of multidrug-resistant bacteria has generated a great challenge to treat infections caused by bacteria with the available antibiotics. Today, research is active in finding new treatments for multidrug-resistant pathogens. In a step to guide the efforts, the WHO has published a list of the most dangerous bacteria that are resistant to current treatments and requires the development of new antibiotics for combating the resistance. Among the list are various Gram-positive bacteria that are responsible for serious healthcare and community-associated infections. Methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecium, and drug-resistant Streptococcus pneumoniae are of particular concern. The resistance of bacteria is an evolving phenomenon that arises from genetic mutations and/or acquired genomes. Thus, antimicrobial resistance demands continuous efforts to create strategies to combat this problem and optimize the use of antibiotics. This article aims to provide a review of the most critical resistant Gram-positive bacterial pathogens, their mechanisms of resistance, and the new treatments and approaches reported to circumvent this problem.
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30
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Kaufhold S, Yaesoubi R, Pitzer VE. Predicting the Impact of Typhoid Conjugate Vaccines on Antimicrobial Resistance. Clin Infect Dis 2020; 68:S96-S104. [PMID: 30845324 PMCID: PMC6405272 DOI: 10.1093/cid/ciy1108] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Empiric prescribing of antimicrobials in typhoid-endemic settings has increased selective pressure on the development of antimicrobial-resistant Salmonella enterica serovar Typhi. The introduction of typhoid conjugate vaccines (TCVs) in these settings may relieve this selective pressure, thereby reducing resistant infections and improving health outcomes. Methods A deterministic transmission dynamic model was developed to simulate the impact of TCVs on the number and proportion of antimicrobial-resistant typhoid infections and chronic carriers. One-way sensitivity analyses were performed to ascertain particularly impactful model parameters influencing the proportion of antimicrobial-resistant infections and the proportion of cases averted over 10 years. Results The model simulations suggested that increasing vaccination coverage would decrease the total number of antimicrobial-resistant typhoid infections but not affect the proportion of cases that were antimicrobial resistant. In the base-case scenario with 80% vaccination coverage, 35% of all typhoid infections were antimicrobial resistant, and 44% of the total cases were averted over 10 years by vaccination. Vaccination also decreased both the total number and proportion of chronic carriers of antimicrobial-resistant infections. The prevalence of chronic carriers, recovery rates from infection, and relative fitness of resistant strains were identified as crucially important parameters. Conclusions Model predictions for the proportion of antimicrobial resistant infections and number of cases averted depended strongly on the relative fitness of the resistant strain(s), prevalence of chronic carriers, and rates of recovery without treatment. Further elucidation of these parameter values in real-world typhoid-endemic settings will improve model predictions and assist in targeting future vaccination campaigns and treatment strategies.
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Affiliation(s)
- Samantha Kaufhold
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
- Present address: Analysis Group, 31 Menlo Park, CA 94025
| | - Reza Yaesoubi
- Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, Connecticut
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, Connecticut
- Correspondence: V. E. Pitzer, Yale School of Public Health, P.O. Box 208034, New Haven, CT 06520-8034 ()
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Kobayashi M, Bigogo G, Kim L, Mogeni OD, Conklin LM, Odoyo A, Odiembo H, Pimenta F, Ouma D, Harris AM, Odero K, Milucky JL, Ouma A, Aol G, Audi A, Onyango C, Cosmas L, Jagero G, Farrar JL, da Gloria Carvalho M, Whitney CG, Breiman RF, Lessa FC. Impact of 10-Valent Pneumococcal Conjugate Vaccine Introduction on Pneumococcal Carriage and Antibiotic Susceptibility Patterns Among Children Aged <5 Years and Adults With Human Immunodeficiency Virus Infection: Kenya, 2009-2013. Clin Infect Dis 2020; 70:814-826. [PMID: 30959526 PMCID: PMC6942635 DOI: 10.1093/cid/ciz285] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 04/03/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Kenya introduced 10-valent pneumococcal conjugate vaccine (PCV10) among children <1 year in 2011 with catch-up vaccination among children 1-4 years in some areas. We assessed changes in pneumococcal carriage and antibiotic susceptibility patterns in children <5 years and adults. METHODS During 2009-2013, we performed annual cross-sectional pneumococcal carriage surveys in 2 sites: Kibera (children <5 years) and Lwak (children <5 years, adults). Only Lwak had catch-up vaccination. Nasopharyngeal and oropharyngeal (adults only) swabs underwent culture for pneumococci; isolates were serotyped. Antibiotic susceptibility testing was performed on isolates from 2009 and 2013; penicillin nonsusceptible pneumococci (PNSP) was defined as penicillin-intermediate or -resistant. Changes in pneumococcal carriage by age (<1 year, 1-4 years, adults), site, and human immunodeficiency virus (HIV) status (adults only) were calculated using modified Poisson regression, with 2009-2010 as baseline. RESULTS We enrolled 2962 children (2073 in Kibera, 889 in Lwak) and 2590 adults (2028 HIV+, 562 HIV-). In 2013, PCV10-type carriage was 10.3% (Lwak) to 14.6% (Kibera) in children <1 year and 13.8% (Lwak) to 18.7% (Kibera) in children 1-4 years. This represents reductions of 60% and 63% among children <1 year and 52% and 60% among children 1-4 years in Kibera and Lwak, respectively. In adults, PCV10-type carriage decreased from 12.9% to 2.8% (HIV+) and from 11.8% to 0.7% (HIV-). Approximately 80% of isolates were PNSP, both in 2009 and 2013. CONCLUSIONS PCV10-type carriage declined in children <5 years and adults post-PCV10 introduction. However, PCV10-type and PNSP carriage persisted in children regardless of catch-up vaccination.
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Affiliation(s)
- Miwako Kobayashi
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Godfrey Bigogo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Lindsay Kim
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
- US Public Health Service, Rockville, Maryland
| | | | - Laura M Conklin
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Arthur Odoyo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Herine Odiembo
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Fabiana Pimenta
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dominic Ouma
- Centre for Global Health Research, Nairobi, Kenya
| | - Aaron M Harris
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jennifer L Milucky
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alice Ouma
- Centre for Global Health Research, Nairobi, Kenya
| | - George Aol
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Allan Audi
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu
| | - Clayton Onyango
- Global Disease Detection Division, Centers for Disease Control and Prevention, Nairobi
| | - Leonard Cosmas
- Global Disease Detection Division, Centers for Disease Control and Prevention, Nairobi
| | - Geofrey Jagero
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu
- University of Maryland School of Medicine, Center for International Health, Education, and Biosecurity Kenya Programs, Nairobi
| | - Jennifer L Farrar
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Cynthia G Whitney
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert F Breiman
- Centre for Global Health Research, Nairobi, Kenya
- Emory Global Health Institute, Atlanta, Georgia
| | - Fernanda C Lessa
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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Chang B, Akeda H, Nakamura Y, Hamabata H, Ameku K, Toma T, Miyagi M, Ohnishi M. Impact of thirteen-valent pneumococcal conjugate vaccine on nasopharyngeal carriage in healthy children under 24 months in Okinawa, Japan. J Infect Chemother 2020; 26:465-470. [PMID: 31926843 DOI: 10.1016/j.jiac.2019.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/21/2019] [Accepted: 12/05/2019] [Indexed: 11/28/2022]
Abstract
In November 2013, a 13-valent pneumococcal conjugate vaccine (PCV13) for all infants aged younger than 5 years was incorporated into the Japan national immunization program. An annual survey of nasopharyngeal carriage rates was performed on healthy infants aged 2-24 months from Okinawa, Japan to evaluate the effect of PCV13 on pneumococcal colonization. Of 756 evaluable infants, 203 pneumococcal strains were detected in 193 infants. The overall nasopharyngeal carriage rate was 25.5%, which was not different from our previously reported isolation rate before the introduction of PCV13. The main serotypes of the Streptococcus pneumoniae strains are 15A (18.2%), non-typeable (14.8%), and 15B (11.8%). The carriage rates of pneumococcal strains with 7-valent pneumococcal conjugate vaccine serotypes and PCV13 serotypes were 3.0% and 9.9%, respectively. These values were significantly lower than we reported before the introduction of PCV13. However, the carriage rates of non-PCV13 serotypes have increased. Multivariate logistic regression analysis suggested that siblings and day care attendance are risk factors for pneumococcal carriage.
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Affiliation(s)
- Bin Chang
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan.
| | - Hideki Akeda
- The Okinawa Society of Child Health, Okinawa, Japan
| | - Yoshihisa Nakamura
- Nakamura Clinic Pediatric, Dermatology and Internal Medicine, Okinawa, Japan
| | | | | | | | | | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
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Pokharel S, Raut S, Adhikari B. Tackling antimicrobial resistance in low-income and middle-income countries. BMJ Glob Health 2019; 4:e002104. [PMID: 31799007 PMCID: PMC6861125 DOI: 10.1136/bmjgh-2019-002104] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sunil Pokharel
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford, UK
| | - Shristi Raut
- Department of Microbiology, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford, UK
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Buchy P, Ascioglu S, Buisson Y, Datta S, Nissen M, Tambyah PA, Vong S. Impact of vaccines on antimicrobial resistance. Int J Infect Dis 2019; 90:188-196. [PMID: 31622674 DOI: 10.1016/j.ijid.2019.10.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 12/28/2022] Open
Abstract
DRIVERS OF ANTIMICROBIAL RESISTANCE Antibiotic use drives the development and spread of resistant bacterial infections. Antimicrobial resistance (AMR) has become a prolific global issue, due to significant increases in antibiotic use in humans, livestock and agriculture, inappropriate use (under-dosing and over-prescribing), and misuse of antibiotics (for viral infections where they are ineffective). Fewer new antibiotics are being developed. THE PROBLEM OF AMR AMR is now considered a key threat to global health, leading to more mortality and increased healthcare costs threatening future conduct of routine medical procedures. Traditional approaches to address AMR include antibiotic stewardship, better hygiene/infection control, promoting antibiotic research and development, and restricting use for agricultural purposes. VACCINES AS A TOOL TO REDUCE AMR While antibiotic development is declining, vaccine technology is growing. This review shows how vaccines can decrease AMR by preventing bacterial and viral infections, thereby reducing the use/misuse of antibiotics, and by preventing antibiotic-resistant infections. Vaccines are less likely to induce resistance. Some future uses and developments of vaccines are also discussed. CONCLUSIONS Vaccines, along with other approaches, can help reduce AMR by preventing (resistant) infections and reducing antibiotic use. Industry and governments must focus on the development of novel vaccines and drugs against resistant infections to successfully reduce AMR. A graphical abstract is available online.
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Affiliation(s)
| | | | - Yves Buisson
- Académie Nationale de Médecine, 16 rue Bonaparte, 75006 Paris, France.
| | - Sanjoy Datta
- GSK, 23 Rochester Park, Singapore 139234, Singapore.
| | | | | | - Sirenda Vong
- World Health Organization, Regional Office for South-East Asia (WHO SEARO), Metropolitan Hotel, Bangla Sahib Road, Connaught Place, New Delhi 110001, India.
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Kuti JL, Nicolau DP. Critique of prevention of pneumococcal disease in high risk adults: A pharmacist‐based assessment of adult immunization protocols in clinical practice. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Joseph L. Kuti
- Center for Anti‐Infective Research and Development Hartford Hospital Hartford Connecticut
| | - David P. Nicolau
- Center for Anti‐Infective Research and Development Hartford Hospital Hartford Connecticut
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Kaufmann SH. Highly affordable vaccines are critical for our continued efforts to reduce global childhood mortality. Hum Vaccin Immunother 2019; 15:2660-2665. [PMID: 30973039 PMCID: PMC6930051 DOI: 10.1080/21645515.2019.1605817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/22/2019] [Accepted: 04/05/2019] [Indexed: 11/13/2022] Open
Abstract
Infectious diseases remain a major health threat, not only in resource-poor countries but also in pockets of poverty within middle-income and sometimes high-income countries. Whilst strong research and development for novel vaccines are urgently needed, equal care needs to be taken that current vaccines are produced at affordable prices so that universal childhood immunization will be accomplished. The Serum Institute of India (SII) has become the largest producer of affordable vaccines. Provision of SII produced vaccines against measles, rubella and meningitis to 73 GAVI supported countries alone will avert more than 5 million deaths between 2001 and 2020. Similarly, the SII produced measles vaccine, supplied to UNICEF and PAHO, can be attributed to nearly 22 million averted deaths between 1990 and 2016. Data presented provide compelling evidence for the crucial impact of partnerships between affordable vaccine producers and governmental, intergovernmental and nongovernmental organizations on universal vaccination to reduce childhood mortality.
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Affiliation(s)
- Stefan H.E. Kaufmann
- Department of Immunology, Max Planck Institute for Infection Biology, Berlin, Germany
- Hagler Institute for Advanced Study, College of Veterinary Medicine and College of Medicine, Texas A&M University, College Station, USA
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Perniciaro S, Imöhl M, van der Linden M. Invasive Pneumococcal Disease in Refugee Children, Germany. Emerg Infect Dis 2019; 24:1934-1936. [PMID: 30226179 PMCID: PMC6154141 DOI: 10.3201/eid2410.180253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Refugee children in Germany are not routinely given a pneumococcal conjugate vaccine. Cases of invasive pneumococcal disease (IPD) in 21 refugee children were compared with those in 405 Germany-born children for 3 pneumococcal seasons. Refugee children had significantly higher odds of vaccine-type IPD and multidrug-resistant IPD than did Germany-born children.
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Abstract
La vaccination représente une des avancées majeures dans le domaine de la santé. Les premiers vaccins ont été produits sur un concept assez empirique reposant sur la stratégie des « 3 i » : isolement, inactivation, injection. Plus récemment sont apparus les vaccins protéiques. Cependant l’émergence de nouveaux pathogènes, l’inefficacité des stratégies vaccinales actuelles pour protéger contre certaines infections, la nécessité de pouvoir développer rapidement et à bas coût de revient des vaccins ont conduit à développer de nouveaux types de vaccins. C’est dans ce contexte que se sont développés des vaccins basés sur l’utilisation des séquences codantes d’acides nucléiques des antigènes d’intérêt (vecteurs viraux, vaccins ADN, vaccins ARN) visant à améliorer l’efficacité des vaccins actuellement disponibles et à proposer des plateformes génériques potentiellement utilisables contre un grand nombre de pathogènes différents. Outre l’utilisation de ces nouveaux vaccins, les recherches vaccinales en cours bénéficient d’évolutions technologiques visant à délivrer de manière optimale les vaccins, en ciblant par exemple les cellules dendritiques, et de mieux caractériser les antigènes d’intérêt via notamment l’utilisation de la vaccinologie inverse.
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Affiliation(s)
- Jean-Daniel Lelièvre
- Vaccine Research Institute, CHU Henri Mondor, 51 avenue Maréchal de Lattre de Tassigny, 94010 Créteil, France
- Service d’immunologie clinique et maladies infectieuses, CHU Henri Mondor, APHP, 51 avenue Maréchal de Lattre de Tassigny, 94010 Créteil, France
- IMRB, équipe 16, CHU Henri Mondor, 51 avenue Maréchal de Lattre de Tassigny, 94010 Créteil, France
- UPEC, 8, rue du Général Sarrail 94010 Créteil Cedex, France
- Auteur correspondant :
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39
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Sallam M, Abbadi J, Natsheh A, Ababneh NA, Mahafzah A, Özkaya Şahin G. Trends in Antimicrobial Drug Resistance of Streptococcus pneumoniae Isolates at Jordan University Hospital (2000⁻2018). Antibiotics (Basel) 2019; 8:antibiotics8020041. [PMID: 31013803 PMCID: PMC6628336 DOI: 10.3390/antibiotics8020041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/28/2019] [Accepted: 04/10/2019] [Indexed: 01/28/2023] Open
Abstract
Antimicrobial drug resistance (AMR) in pneumococci complicates the treatment of serious pneumococcal infections. Country-specific AMR patterns can help to establish guidelines for empiric therapy. The aim of the current study was to analyze the distribution of AMR among Streptococcus pneumoniae isolates at Jordan University Hospital (JUH) during 2000–2018. Paper-based and electronic clinical data registry records from 2000 to 2018 were retrospectively analyzed to study the AMR among pneumococcal isolates at JUH. Temporal trend analysis was done using two-tailed linear-by-linear test for association. The total number of unique pneumococcal isolates that were identified was 556, of which 544 isolates had antimicrobial susceptibility testing results. The most frequent specimens were eye (n = 117, 21.0%), bloodstream (n = 93, 16.7%) and sputum (n = 81, 14.6%). Invasive infections represented 23.6% of all unique isolates. The overall susceptibility of S. pneumoniae isolates during the study period to different antimicrobials was: 100% to vancomycin, 97.7% to ceftriaxone, 97.1% to cefotaxime, 94.9% to chloramphenicol, 89.7% to penicillin, 83.8% to levofloxacin, 67.7% to clindamycin and 52.1% to erythromycin. The prevalence of multi-drug resistance (MDR) was 8.6% (95% confidence interval: 6.4–11.5%). Trend analysis showed an increase in the prevalence of non-susceptibility to erythromycin, clindamycin and levofloxacin (p < 0.001). MDR prevalence increased from 1.6% in the first quarter to 14.6% in the fourth quarter (p < 0.001). The incidence of invasive infections declined over the study period (p < 0.001). The increase in the prevalence of AMR and MDR among pneumococcal isolates in Jordan demands judicious use of antimicrobials and regular surveillance of resistance.
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Affiliation(s)
- Malik Sallam
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, the University of Jordan, Amman 19328, Jordan.
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 22362, Jordan.
- Department of Translational Medicine, Faculty of Medicine, Lund University, 22362 Malmö, Sweden.
| | - Jumana Abbadi
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, the University of Jordan, Amman 19328, Jordan.
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 22362, Jordan.
| | - Anas Natsheh
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, the University of Jordan, Amman 19328, Jordan.
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 22362, Jordan.
| | - Nidaa A Ababneh
- Cell Therapy Center (CTC), The University of Jordan, Amman, Jordan.
| | - Azmi Mahafzah
- Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, the University of Jordan, Amman 19328, Jordan.
- Department of Clinical Laboratories and Forensic Medicine, Jordan University Hospital, Amman 22362, Jordan.
| | - Gülşen Özkaya Şahin
- Department of Translational Medicine, Faculty of Medicine, Lund University, 22362 Malmö, Sweden.
- Department of Clinical Microbiology, Laboratory Medicine, Skåne University Hospital, 22362 Lund, Sweden.
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Impact of existing vaccines in reducing antibiotic resistance: Primary and secondary effects. Proc Natl Acad Sci U S A 2019; 115:12896-12901. [PMID: 30559195 DOI: 10.1073/pnas.1721095115] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Vaccines impact antibiotic-resistant infections in two ways: through a direct reduction in the organisms and strains carrying resistant genes that are specifically targeted by the vaccine and also via a secondary effect through a reduction in febrile illnesses that often lead to the use of antibiotics. We review here the impact of pneumococcal conjugate vaccines (PCVs) on the prevalence of antibiotic-resistant disease and antibiotic usage as an example of the direct effect of vaccines on antibiotic resistance and the impact of influenza vaccination on antibiotic usage as an example of a secondary effect. A prelicensure study of a PCV in Africa demonstrated 67% fewer penicillin-resistant invasive disease episodes in the PCV group compared with controls. Similar studies in the United States and Europe demonstrated reductions in antibiotic use consistent with the vaccines' impact on the risk of otitis media infections in children. Postlicensure reductions in the circulation of antibiotic-resistant strains targeted by the vaccines have been dramatic, with virtual elimination of these strains in children following vaccine introduction. In terms of a secondary effect, following influenza vaccination reductions of 13-50% have been observed in the use of antibiotics by individuals receiving influenza vaccine compared with controls. With the demonstrated effectiveness of vaccination programs in impacting the risk of antibiotic-resistant infections and the increasing threat to public health that these infections represent, more attention needs to be given to development and utilization of vaccines to address antibiotic resistance.
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El-Rami FE, Zielke RA, Wi T, Sikora AE, Unemo M. Quantitative Proteomics of the 2016 WHO Neisseria gonorrhoeae Reference Strains Surveys Vaccine Candidates and Antimicrobial Resistance Determinants. Mol Cell Proteomics 2019; 18:127-150. [PMID: 30352803 PMCID: PMC6317477 DOI: 10.1074/mcp.ra118.001125] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 10/23/2018] [Indexed: 12/27/2022] Open
Abstract
The sexually transmitted disease gonorrhea (causative agent: Neisseria gonorrhoeae) remains an urgent public health threat globally because of its reproductive health repercussions, high incidence, widespread antimicrobial resistance (AMR), and absence of a vaccine. To mine gonorrhea antigens and enhance our understanding of gonococcal AMR at the proteome level, we performed the first large-scale proteomic profiling of a diverse panel (n = 15) of gonococcal strains, including the 2016 World Health Organization (WHO) reference strains. These strains show all existing AMR profiles - established through phenotypic characterization and reference genome publication - and are intended for quality assurance in laboratory investigations. Herein, these isolates were subjected to subcellular fractionation and labeling with tandem mass tags coupled to mass spectrometry and multi-combinatorial bioinformatics. Our analyses detected 904 and 723 common proteins in cell envelope and cytoplasmic subproteomes, respectively. We identified nine novel gonorrhea vaccine candidates. Expression and conservation of new and previously selected antigens were investigated. In addition, established gonococcal AMR determinants were evaluated for the first time using quantitative proteomics. Six new proteins, WHO_F_00238, WHO_F_00635c, WHO_F_00745, WHO_F_01139, WHO_F_01144c, and WHO_F_01126, were differentially expressed in all strains, suggesting that they represent global proteomic AMR markers, indicate a predisposition toward developing or compensating gonococcal AMR, and/or act as new antimicrobial targets. Finally, phenotypic clustering based on the isolates' defined antibiograms and common differentially expressed proteins yielded seven matching clusters between established and proteome-derived AMR signatures. Together, our investigations provide a reference proteomics data bank for gonococcal vaccine and AMR research endeavors, which enables microbiological, clinical, or epidemiological projects and enhances the utility of the WHO reference strains.
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Affiliation(s)
- Fadi E El-Rami
- From the ‡Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, Oregon
| | - Ryszard A Zielke
- From the ‡Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, Oregon
| | - Teodora Wi
- §Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Aleksandra E Sikora
- From the ‡Department of Pharmaceutical Sciences, College of Pharmacy, Oregon State University, Corvallis, Oregon;; ¶Vaccine and Gene Therapy Institute, Oregon Health and Science University, Beaverton, Oregon;.
| | - Magnus Unemo
- ‖World Health Organization Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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Feldman C, Shaddock E. Epidemiology of lower respiratory tract infections in adults. Expert Rev Respir Med 2018; 13:63-77. [DOI: 10.1080/17476348.2019.1555040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Charles Feldman
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Erica Shaddock
- Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Andrews JR, Baker S, Marks F, Alsan M, Garrett D, Gellin BG, Saha SK, Qamar FN, Yousafzai MT, Bogoch II, Antillon M, Pitzer VE, Kim JH, John J, Gauld J, Mogasale V, Ryan ET, Luby SP, Lo NC. Typhoid conjugate vaccines: a new tool in the fight against antimicrobial resistance. THE LANCET. INFECTIOUS DISEASES 2018; 19:e26-e30. [PMID: 30170987 DOI: 10.1016/s1473-3099(18)30350-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 05/10/2018] [Accepted: 05/17/2018] [Indexed: 10/28/2022]
Abstract
Typhoid fever is an acute systemic infectious disease responsible for an estimated 12-20 million illnesses and over 150 000 deaths annually. In March, 2018, a new recommendation was issued by WHO for the programmatic use of typhoid conjugate vaccines in endemic countries. Health economic analyses of typhoid vaccines have informed funding decisions and national policies regarding vaccine rollout. However, by focusing only on averted typhoid cases and their associated costs, traditional cost-effectiveness analyses might underestimate crucial benefits of typhoid vaccination programmes, because the potential effect of typhoid vaccines on the treatment of patients with non-specific acute febrile illnesses is not considered. For every true case of typhoid fever, three to 25 patients without typhoid disease are treated with antimicrobials unnecessarily, conservatively amounting to more than 50 million prescriptions per year. Antimicrobials for suspected typhoid might therefore be an important selective pressure for the emergence and spread of antimicrobial resistance globally. We propose that large-scale, more aggressive typhoid vaccination programmes-including catch-up campaigns in children up to 15 years of age, and vaccination in lower incidence settings-have the potential to reduce the overuse of antimicrobials and thereby reduce antimicrobial resistance in many bacterial pathogens. Funding bodies and national governments must therefore consider the potential for broad reductions in antimicrobial use and resistance in decisions related to the rollout of typhoid conjugate vaccines.
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Affiliation(s)
- Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Stephen Baker
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Florian Marks
- Department of Medicine, University of Cambridge, Cambridge, UK; Epidemiology Unit, International Vaccine Institute, Seoul, South Korea
| | - Marcella Alsan
- Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| | | | | | - Samir K Saha
- Department of Microbiology, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Farah Naz Qamar
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Isaac I Bogoch
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Marina Antillon
- Center for Health Economics Research and Modeling Infectious Diseases, University of Antwerp, Belgium
| | - Virginia E Pitzer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - Jong-Hoon Kim
- Epidemiology Unit, International Vaccine Institute, Seoul, South Korea
| | - Jacob John
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Vittal Mogasale
- Policy and Economic Research Department, Development and Delivery Unit, International Vaccine Institute, Seoul, South Korea
| | - Edward T Ryan
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nathan C Lo
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Abstract
The problem of antimicrobial resistance (AMR) and the associated morbidity and mortality due to antibiotic resistant bacterial pathogens is not new. However, AMR has been increasing at an alarming rate with appearances of diseases caused by bacteria exhibiting resistance to not just one but multiple classes of antibiotics. The World Health Organization (WHO) supported by governments, health ministries and health agencies has formulated global action plans to combat the rise in AMR, supporting a number of proven initiatives such as antimicrobial stewardship, investments in development of new classes of antibiotics, and educational programs designed to eliminate inappropriate antibiotic use. Vaccines as tools to reduce AMR have historically been under-recognized, yet the positive effect in reducing AMR has been well established. For example Haemophilus influenzae type B (Hib) as well as Streptococcus pneumoniae (pneumococcal) conjugate vaccines have impressive track records in not only preventing life threatening diseases caused by these bacteria, but also reducing antibiotic use and AMR. This paper will describe the drivers of antibiotic use and subsequent development of AMR; it will make the case how existing vaccines are already participating in combatting AMR, describe future prospects for the role of new vaccines in development to reduce AMR, and highlight challenges associated with future vaccine development to combat AMR.
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Affiliation(s)
- Kathrin U Jansen
- a Pfizer Vaccine Research and Development , Pearl River , NY , USA
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45
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Tagliabue A, Rappuoli R. Changing Priorities in Vaccinology: Antibiotic Resistance Moving to the Top. Front Immunol 2018; 9:1068. [PMID: 29910799 PMCID: PMC5992407 DOI: 10.3389/fimmu.2018.01068] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 04/30/2018] [Indexed: 01/08/2023] Open
Abstract
Antimicrobial resistance (AMR) is currently the most alarming issue for human health. AMR already causes 700,000 deaths/year. It is estimated that 10 million deaths due to AMR will occur every year after 2050. This equals the number of people dying of cancer every year in present times. International institutions such as G20, World Bank, World Health Organization (WHO), UN General Assembly, European Union, and the UK and USA governments are calling for new antibiotics. To underline this emergency, a list of antibiotic-resistant "priority pathogens" has been published by WHO. It contains 12 families of bacteria that represent the greatest danger for human health. Resistance to multiple antibiotics is particularly relevant for the Gram-negative bacteria present in the list. The ability of these bacteria to develop mechanisms to resist treatment could be transmitted with genetic material, allowing other bacteria to become drug resistant. Although the search for new antimicrobial drugs remains a top priority, the pipeline for new antibiotics is not promising, and alternative solutions are needed. A possible answer to AMR is vaccination. In fact, while antibiotic resistance emerges rapidly, vaccines can lead to a much longer lasting control of infections. New technologies, such as the high-throughput cloning of human B cells from convalescent or vaccinated people, allow for finding new protective antigens (Ags) that could not be identified with conventional technologies. Antibodies produced by convalescent B cell clones can be screened for their ability to bind, block, and kill bacteria, using novel high-throughput microscopy platforms that rapidly capture digital images, or by conventional technologies such as bactericidal, opsono-phagocytosis and FACS assays. Selected antibodies expressed by recombinant DNA techniques can be used for passive immunization in animal models and tested for protection. Antibodies providing the best protection can be employed to identify new Ags and then used for generating highly specific recombinant Fab fragments. Co-crystallization of Ags bound to Fab fragments will allow us to determine the structure and characteristics of new Ags. This structure-based Ag design will bring to a new generation of vaccines able to target previously elusive infections, thereby offering an effective solution to the problem of AMR.
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Affiliation(s)
- Aldo Tagliabue
- Institute for Genetic and Biomedical Research, CNR, Cagliari, Italy
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46
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Jansen KU, Knirsch C, Anderson AS. The role of vaccines in preventing bacterial antimicrobial resistance. Nat Med 2018; 24:10-19. [DOI: 10.1038/nm.4465] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 12/04/2017] [Indexed: 01/03/2023]
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van der Linden M, Rutschmann J, Maurer P, Hakenbeck R. PBP2a in β-Lactam-Resistant Laboratory Mutants and Clinical Isolates: Disruption Versus Reduced Penicillin Affinity. Microb Drug Resist 2017; 24:718-731. [PMID: 29195053 DOI: 10.1089/mdr.2017.0302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Alterations in PBP2a have been recognized in cefotaxime-resistant laboratory mutants and β-lactam-resistant clinical isolates of Streptococcus pneumoniae. DNA sequencing revealed fundamental differences between these two settings. Internal stop codons in pbp2a occurred in all three laboratory mutants analyzed, caused by a mutation in pbp2a of mutant C604, and tandem duplications within pbp2a resulting in premature stop codons in another two mutants C403 and C406. In contrast, mosaic PBP2a genes were observed in several penicillin-resistant clinical isolates from South Africa, the Czech Republic, Hungary, and in the clone Poland23F-16, with sequence blocks diverging from sensitive strains by over 4%. Most of these pbp2a variants except pbp2a from the South African strain contained sequences related to pbp2a of Streptococcus mitis B6, confirming that this species serves as reservoir for penicillin-resistance determinants.
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Affiliation(s)
- Mark van der Linden
- 1 Department of Medical Microbiology, German National Reference Center for Streptococci , Aachen, Germany
| | | | - Patrick Maurer
- 3 School of Engineering, University of Applied Sciences , Saarbrücken, Germany
| | - Regine Hakenbeck
- 4 Department of Microbiology, University of Kaiserslautern , Kaiserslautern, Germany
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Redistribution of Streptococcus pneumoniae Serotypes After Nationwide 13-valent Pneumococcal Conjugate Vaccine Program in Children in Northern Taiwan. Pediatr Infect Dis J 2017. [PMID: 28650416 DOI: 10.1097/inf.0000000000001664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND After the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) against Streptococcus pneumoniae, public health officials in Taiwan monitored a decline in circulating vaccine serotypes and the emergence of nonvaccine serotypes in children with invasive pneumococcal disease. A gradually expanded PCV13 national immunization program was launched in 2013 in Taiwan. Here, we evaluate the changes in the distribution of pneumococcal serotypes and antimicrobial nonsusceptibility in children during the evolution of vaccination policy. METHODS S. pneumoniae isolates from children with pneumococcal disease were collected and serotyped from 2010 to 2015 in northern Taiwan. PCVs were administered at the recipients' expense between 2010 and 2012, and then PCV13 was partially reimbursed by the government beginning in 2013. The distribution and diversity of serotypes were analyzed along with their antimicrobial susceptibilities. RESULTS Among a total of 498 isolates, the proportion of invasive pneumococcal disease isolates declined (47.1%-10.6%) during the study period, and serotype diversity increased after 2011. Between 2010 and 2012, the dominant serotypes were 19A, 19F, 3, 6B and 14, and serotype 19A rose from 44.1% to 57.5%. Serotypes 19A, 15A, 19F and 15B were more prevalent from 2013 to 2015, and serotype 19A decreased from 42.1% to 4.5%. Serotypes 19F and 15A became the most commonly detected serotypes in 2015. Overall, PCV13 additional serotypes were reduced by 80% (P < 0.0001) but nonvaccine serotypes increased from 8.8% to 51.5% (P < 0.0001). CONCLUSIONS The step-by-step PCV13 national immunization program is effective against pneumococcal disease in Taiwanese children, mainly by reducing PCV13 additional serotypes.
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Michael CA, Franks AE, Labbate M. The antimicrobial resistance crisis: management through gene monitoring. Open Biol 2017; 6:rsob.160236. [PMID: 27831476 PMCID: PMC5133444 DOI: 10.1098/rsob.160236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 10/14/2016] [Indexed: 12/13/2022] Open
Abstract
Antimicrobial resistance (AMR) is an acknowledged crisis for humanity. Its genetic origins and dire potential outcomes are increasingly well understood. However, diagnostic techniques for monitoring the crisis are currently largely limited to enumerating the increasing incidence of resistant pathogens. Being the end-stage of the evolutionary process that produces antimicrobial resistant pathogens, these measurements, while diagnostic, are not prognostic, and so are not optimal in managing this crisis. A better test is required. Here, using insights from an understanding of evolutionary processes ruling the changing abundance of genes under selective pressure, we suggest a predictive framework for the AMR crisis. We then discuss the likely progression of resistance for both existing and prospective antimicrobial therapies. Finally, we suggest that by the environmental monitoring of resistance gene frequency, resistance may be detected and tracked presumptively, and how this tool may be used to guide decision-making in the local and global use of antimicrobials.
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Affiliation(s)
- Carolyn A Michael
- School of Life Sciences, University of Technology Sydney, Sydney 2007, Australia
| | - Ashley E Franks
- Department of Physiology, Anatomy and Microbiology, School of Life Sciences, La Trobe University, Melbourne, Victoria, Australia
| | - Maurizio Labbate
- School of Life Sciences, University of Technology Sydney, Sydney 2007, Australia.,ithree institute, University of Technology Sydney, Sydney 2007, Australia
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50
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Cookson WOCM, Cox MJ, Moffatt MF. New opportunities for managing acute and chronic lung infections. Nat Rev Microbiol 2017; 16:111-120. [PMID: 29062070 DOI: 10.1038/nrmicro.2017.122] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Lung diseases caused by microbial infections affect hundreds of millions of children and adults throughout the world. In Western populations, the treatment of lung infections is a primary driver of antibiotic resistance. Traditional therapeutic strategies have been based on the premise that the healthy lung is sterile and that infections grow in a pristine environment. As a consequence, rapid advances in our understanding of the composition of the microbiota of the skin and bowel have not yet been matched by studies of the respiratory tree. The recognition that the lungs are as populated with microorganisms as other mucosal surfaces provides the opportunity to reconsider the mechanisms and management of lung infections. Molecular analyses of the lung microbiota are revealing profound adverse responses to widespread antibiotic use, urbanization and globalization. This Opinion article proposes how technologies and concepts flowing from the Human Microbiome Project can transform the diagnosis and treatment of common lung diseases.
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Affiliation(s)
- William O C M Cookson
- Asmarley Centre for Genomic Medicine, National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK
| | - Michael J Cox
- Asmarley Centre for Genomic Medicine, National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK
| | - Miriam F Moffatt
- Asmarley Centre for Genomic Medicine, National Heart and Lung Institute, Imperial College London, Dovehouse Street, London SW3 6LY, UK
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