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Cocker D, Birgand G, Zhu N, Rodriguez-Manzano J, Ahmad R, Jambo K, Levin AS, Holmes A. Healthcare as a driver, reservoir and amplifier of antimicrobial resistance: opportunities for interventions. Nat Rev Microbiol 2024:10.1038/s41579-024-01076-4. [PMID: 39048837 DOI: 10.1038/s41579-024-01076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
Antimicrobial resistance (AMR) is a global health challenge that threatens humans, animals and the environment. Evidence is emerging for a role of healthcare infrastructure, environments and patient pathways in promoting and maintaining AMR via direct and indirect mechanisms. Advances in vaccination and monoclonal antibody therapies together with integrated surveillance, rapid diagnostics, targeted antimicrobial therapy and infection control measures offer opportunities to address healthcare-associated AMR risks more effectively. Additionally, innovations in artificial intelligence, data linkage and intelligent systems can be used to better predict and reduce AMR and improve healthcare resilience. In this Review, we examine the mechanisms by which healthcare functions as a driver, reservoir and amplifier of AMR, contextualized within a One Health framework. We also explore the opportunities and innovative solutions that can be used to combat AMR throughout the patient journey. We provide a perspective on the current evidence for the effectiveness of interventions designed to mitigate healthcare-associated AMR and promote healthcare resilience within high-income and resource-limited settings, as well as the challenges associated with their implementation.
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Affiliation(s)
- Derek Cocker
- David Price Evans Infectious Diseases & Global Health Group, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | - Gabriel Birgand
- Centre d'appui pour la Prévention des Infections Associées aux Soins, Nantes, France
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Cibles et medicaments des infections et de l'immunitée, IICiMed, Nantes Universite, Nantes, France
| | - Nina Zhu
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Jesus Rodriguez-Manzano
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Raheelah Ahmad
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Department of Health Services Research & Management, City University of London, London, UK
- Dow University of Health Sciences, Karachi, Pakistan
| | - Kondwani Jambo
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Anna S Levin
- Department of Infectious Disease, School of Medicine & Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Alison Holmes
- David Price Evans Infectious Diseases & Global Health Group, University of Liverpool, Liverpool, UK.
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK.
- Department of Infectious Disease, Imperial College London, London, UK.
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Resci I, Zavatta L, Piva S, Mondo E, Albertazzi S, Nanetti A, Bortolotti L, Cilia G. Predictive statistical models for monitoring antimicrobial resistance spread in the environment using Apis mellifera (L. 1758) colonies. ENVIRONMENTAL RESEARCH 2024; 248:118365. [PMID: 38301758 DOI: 10.1016/j.envres.2024.118365] [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: 11/30/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/03/2024]
Abstract
The rise of antimicrobial resistance (AMR) is one of the most relevant problems for human and animal health. According to One Health Approach, it is important to regulate the use of antimicrobials and monitor the spread of AMR in the environment as well. Apis mellifera (L. 1758) colonies were used as bioindicators thanks to their physical and behavioural characteristics. During their foraging flights, bees can intercept small particles, including atmospheric particulate matter, etc., and also microorganisms. To date, the antimicrobial surveillance network is limited to the sanitary level but lacks into environmental context. This study aimed to evaluate the use of A. mellifera colonies distributed throughout the Emilia-Romagna region (Italy) as indicators of environmental antimicrobial-resistant bacteria. This was performed by creating a statistical predictive model that establishes correlations between environmental characteristics and the likelihood of isolating specific bacterial genera and antimicrobial-resistant strains. A total of 608 strains were isolated and tested for susceptibility to 19 different antimicrobials. Aztreonam-resistant strains were significantly related to environments with sanitary structures, agricultural areas and wetlands, while urban areas present a higher probability of trimethoprim/sulfamethoxazole-resistant strains isolation. Concerning genera, environments with sanitary structures and wetlands are significantly related to the genera Proteus spp., while the Escherichia spp. strains can be probably isolated in industrial environments. The obtained models showed maximum values of Models Accuracy and robustness (R2) of 55 % and 24 %, respectively. The results indicate the efficacy of utilizing A. mellifera colonies as valuable bioindicators for estimating the prevalence of AMR in environmentally disseminated bacteria. This survey can be considered a good basis for the development of further studies focused on monitoring both sanitary and animal pathology, creating a specific network in the environments of interest.
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Affiliation(s)
- Ilaria Resci
- Research Centre for Agriculture and Environment (CREA-AA), Council for Agricultural Research and Agricultural Economics Analysis, Via di Corticella 133, 40128 Bologna, Italy; Department of Veterinary Sciences, University of Bologna, Via Tolara di Sopra, 43, 40064 Ozzano Dell'Emilia (BO), Italy
| | - Laura Zavatta
- Research Centre for Agriculture and Environment (CREA-AA), Council for Agricultural Research and Agricultural Economics Analysis, Via di Corticella 133, 40128 Bologna, Italy; DISTAL-Department of Agricultural and Food Sciences, University of Bologna, 40127 Bologna, Italy
| | - Silvia Piva
- Department of Veterinary Sciences, University of Bologna, Via Tolara di Sopra, 43, 40064 Ozzano Dell'Emilia (BO), Italy
| | - Elisabetta Mondo
- Department of Veterinary Sciences, University of Bologna, Via Tolara di Sopra, 43, 40064 Ozzano Dell'Emilia (BO), Italy
| | - Sergio Albertazzi
- Research Centre for Agriculture and Environment (CREA-AA), Council for Agricultural Research and Agricultural Economics Analysis, Via di Corticella 133, 40128 Bologna, Italy
| | - Antonio Nanetti
- Research Centre for Agriculture and Environment (CREA-AA), Council for Agricultural Research and Agricultural Economics Analysis, Via di Corticella 133, 40128 Bologna, Italy
| | - Laura Bortolotti
- Research Centre for Agriculture and Environment (CREA-AA), Council for Agricultural Research and Agricultural Economics Analysis, Via di Corticella 133, 40128 Bologna, Italy
| | - Giovanni Cilia
- Research Centre for Agriculture and Environment (CREA-AA), Council for Agricultural Research and Agricultural Economics Analysis, Via di Corticella 133, 40128 Bologna, Italy.
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Alsaad R. Control study of Musca domestica (Diptera, Muscidae) in Misan Province. F1000Res 2023; 12:459. [PMID: 38106654 PMCID: PMC10721963 DOI: 10.12688/f1000research.132636.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/19/2023] Open
Abstract
Background Houseflies are the most common type of Diptera, specifically Muscidae, worldwide, representing more than 90% of all species. This family has over 170 genera and 4200 species, but a few are of medical significance. This study aimed to estimate and assessing the measures to control and prevent grow-up inside houses and flying of the housefly ( Musca domestica Linnaeus, 1758) in Misan. Methods The study occurred over 12 months, from December 2020 to December 2021. Using plastic containers, Musca domestica were collected from all potential breeding sites in the study region (inside and around houses). Sticky oil paper and traps were used to collect the insects. The collected insects were transferred to sealed plastic containers and then to the laboratory of the Department of Microbiology.Out of 200 randomly selected houses, 150 (75%) contained insects. Light traps and sticky oil papers were the most effective control measures, with 26.7% and 25.9% of the Musca domestica collected from these methods, respectively. The ratio of male (233) to female (456) Musca was 1:2, with a significant difference between the frequencies (P<0.05). A large population of houseflies was collected during the hot season (501, 72.7%), whereas fewer Musca were collected during the cold months (188, 27.3%), with a strongly significant difference (P<0.05). The percentage of HI was 54.4%, the CI was 21.9%, and the BI was 79.9%. The overall larval densities (LD) were at a medium level. Conclusions Misan has a high density of Musca domestica, with females being more prominent than males. Hot climate, humid sites, and dirty places are responsible for the breeding of houseflies. The overall larval density was medium. Therefore, the risk of transmitting infectious diseases by houseflies is high within the boundaries of Misan province, and effective control parameters should include measures like light traps and sticky oil.
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Affiliation(s)
- Rasha Alsaad
- Microbiology Department, Faculty of Medicine, Misan University, Misan, 62001, Iraq
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4
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Resci I, Cilia G. The use of honey bee (Apis mellifera L.) as biological monitors for pathogenic bacteria and antimicrobial resistance: A systematic review. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 333:122120. [PMID: 37385360 DOI: 10.1016/j.envpol.2023.122120] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/06/2023] [Accepted: 06/26/2023] [Indexed: 07/01/2023]
Abstract
The phenomenon of antimicrobial resistance (AMR) is an increasingly real and relevant health problem. It is essential to verify the spread of this phenomenon in the environment. The European honey bee, Apis mellifera L., is a globally managed pollinator continuously used for biomonitoring thanks to its morphological and behavioural characteristics. During their foraging activities, a large number of honey bees move in the area surrounding the hive within a 1.5 km of radius. Besides, their body covered with hair and bristles are able to intercept pollen and minute particles, such as atmospheric particles, contaminants and microorganisms. For these reasons, A. mellifera L. is widely used as an environmental sentinel, especially for detecting pollutants, pesticides, microorganisms, and AMR. This systematic review aimed to collect and summarize the role of honey bee colonies as a biological monitor of AMR pathogenic bacteria and the environmental spread of antimicrobial resistance genes (ARGs). From honey bees were isolated a wide range of pathogenic and environmental bacteria strains, harbouring AMR and ARGs. However, AMR and ARGs were detected not only in environmental bacteria but also in symbiotic bacteria colonizing the bee gut. This systematic review highlights the employment of potential use of honey bees as AMR sentinel helpful for ecosystem health to implement possible control measures for humans, animals and plants, in the context of the "One-Health" approach.
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Affiliation(s)
- Ilaria Resci
- Research Centre for Agriculture and Environment (CREA-AA), Council for Agricultural Research and Agricultural Economics Analysis, Via di Corticella 133, 40128, Bologna, Italy
| | - Giovanni Cilia
- Research Centre for Agriculture and Environment (CREA-AA), Council for Agricultural Research and Agricultural Economics Analysis, Via di Corticella 133, 40128, Bologna, Italy.
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5
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Brimblecombe P, Jeannottat L, Querner P. Insect Distribution in a Vacant Multi-Level Office Building. INSECTS 2023; 14:578. [PMID: 37504585 PMCID: PMC10380796 DOI: 10.3390/insects14070578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023]
Abstract
The webbing clothes moth (Tineola bisselliella) causes extensive and costly damage to fabrics, furnishings, and museum objects. It is best known from its presence in homes, museums, and historic properties, while infestations in office buildings are not as well understood. Offices typically have more frequent cleaning, fewer quiet habitats, less food availability, and fewer breeding environments for moths, which may explain the lower abundance. Nevertheless, they can be introduced with materials or by employees whose homes have a moth infestation. This study examines the distribution of different insect pests determined from pheromone traps set out in an unoccupied multi-floor office building in Switzerland. Tineola bisselliella dominated the insect catch but was mostly found in the aisles on the lower floors. The larger rooms tended to have a greater insect catch. Carpet beetles (Attagenus smirnovi) and silverfish (Zygentoma) were also found, although in smaller numbers, and often preferred the basement floors. The ghost silverfish (Ctenolepisma calvum) dominated the Zygentoma, even though it has been rare until recently in Switzerland. The study suggests the need for Integrated Pest Management within office buildings. In addition, in unoccupied buildings under renovation, with no obvious sources of food, insect pests still need monitoring.
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Affiliation(s)
- Peter Brimblecombe
- Department of Marine Environment and Engineering, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
- School of Environmental Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - Laure Jeannottat
- Swiss National Library, Hallwylstrasse 15, 3003 Bern, Switzerland
| | - Pascal Querner
- Natural History Museum Vienna, Burgring 7, 1010 Vienna, Austria
- Institute of Zoology, Department of Integrative Biology and Biodiversity Research, University of Natural Resources and Life Sciences Vienna (BOKU), Gregor-Mendel-Straße 33, 1180 Vienna, Austria
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Rawat N, Sabu B, Jamwal R, Devi PP, Yadav K, Raina HS, Rajagopal R. Understanding the role of insects in the acquisition and transmission of antibiotic resistance. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 858:159805. [PMID: 36461578 DOI: 10.1016/j.scitotenv.2022.159805] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/23/2022] [Accepted: 10/25/2022] [Indexed: 06/17/2023]
Abstract
Antibiotic resistance (AR) is a global healthcare threat that requires a comprehensive assessment. Poorly regulated antibiotic stewardship in clinical and non-clinical settings has led to a horizontal dissemination of AR. A variety of often neglected elements facilitate the circulation of AR from antibiotic sinks like concentrated animal feeding operations and healthcare settings to other environments that include healthy human communities. Insects are one of those elements that have received underwhelming attention as vectors of AR, despite their well-known role in transmitting clinically relevant pathogens. We here make an exhaustive attempt to highlight the role of insects as zoonotic reservoirs of AR by discussing the available literature and deriving realistic inferences. We review the AR associated with insects housing various human-relevant environments, namely, animal farm industry, edible-insects enterprise, healthcare institutes, human settlements, agriculture settings and the wild. We also provide evidence-based accounts of the events of the transmission of AR from insects to humans. We evaluate the clinical threats associated with insect-derived AR and propose the adoption of more sophisticated strategies to understand and mitigate future AR concerns facilitated by insects. Future works include a pan-region assessment of insects for AR in the form of AR bacteria (ARB) and AR determinants (ARDs) and the introduction of modern techniques like whole-genome sequencing, metagenomics, and in-silico modelling.
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Affiliation(s)
- Nitish Rawat
- Gut Biology Laboratory, Department of Zoology, University of Delhi, Room No. 117, Delhi 110007, India
| | - Benoy Sabu
- Gut Biology Laboratory, Department of Zoology, University of Delhi, Room No. 117, Delhi 110007, India
| | - Rohit Jamwal
- Gut Biology Laboratory, Department of Zoology, University of Delhi, Room No. 117, Delhi 110007, India
| | - Pukhrambam Pushpa Devi
- Gut Biology Laboratory, Department of Zoology, University of Delhi, Room No. 117, Delhi 110007, India
| | - Karuna Yadav
- Gut Biology Laboratory, Department of Zoology, University of Delhi, Room No. 117, Delhi 110007, India
| | - Harpreet Singh Raina
- Gut Biology Laboratory, Department of Zoology, University of Delhi, Room No. 117, Delhi 110007, India; Department of Zoology, Sri Guru Teg Bahadur Khalsa College, University of Delhi, Delhi 110007, India
| | - Raman Rajagopal
- Gut Biology Laboratory, Department of Zoology, University of Delhi, Room No. 117, Delhi 110007, India.
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Songca SP. Applications of Nanozymology in the Detection and Identification of Viral, Bacterial and Fungal Pathogens. Int J Mol Sci 2022; 23:4638. [PMID: 35563029 PMCID: PMC9100627 DOI: 10.3390/ijms23094638] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/12/2022] [Accepted: 02/21/2022] [Indexed: 02/05/2023] Open
Abstract
Nanozymes are synthetic nanoparticulate materials that mimic the biological activities of enzymes by virtue of their surface chemistry. Enzymes catalyze biological reactions with a very high degree of specificity. Examples include the horseradish peroxidase, lactate, glucose, and cholesterol oxidases. For this reason, many industrial uses of enzymes outside their natural environments have been developed. Similar to enzymes, many industrial applications of nanozymes have been developed and used. Unlike the enzymes, however, nanozymes are cost-effectively prepared, purified, stored, and reproducibly and repeatedly used for long periods of time. The detection and identification of pathogens is among some of the reported applications of nanozymes. Three of the methodologic milestones in the evolution of pathogen detection and identification include the incubation and growth, immunoassays and the polymerase chain reaction (PCR) strategies. Although advances in the history of pathogen detection and identification have given rise to novel methods and devices, these are still short of the response speed, accuracy and cost required for point-of-care use. Debuting recently, nanozymology offers significant improvements in the six methodological indicators that are proposed as being key in this review, including simplicity, sensitivity, speed of response, cost, reliability, and durability of the immunoassays and PCR strategies. This review will focus on the applications of nanozymes in the detection and identification of pathogens in samples obtained from foods, natural, and clinical sources. It will highlight the impact of nanozymes in the enzyme-linked immunosorbent and PCR strategies by discussing the mechanistic improvements and the role of the design and architecture of the nanozyme nanoconjugates. Because of their contribution to world health burden, the three most important pathogens that will be considered include viruses, bacteria and fungi. Although not quite seen as pathogens, the review will also consider the detection of cancer cells and helminth parasites. The review leaves very little doubt that nanozymology has introduced remarkable advances in enzyme-linked immunosorbent assays and PCR strategies for detecting these five classes of pathogens. However, a gap still exists in the application of nanozymes to detect and identify fungal pathogens directly, although indirect strategies in which nanozymes are used have been reported. From a mechanistic point of view, the nanozyme technology transfer to laboratory research methods in PCR and enzyme-linked immunosorbent assay studies, and the point-of-care devices such as electronic biosensors and lateral flow detection strips, that is currently taking place, is most likely to give rise to no small revolution in each of the six methodological indicators for pathogen detection and identification. While the evidence of widespread research reports, clinical trials and point-of-care device patents support this view, the gaps that still exist point to a need for more basic research studies to be conducted on the applications of nanozymology in pathogen detection and identification. The multidisciplinary nature of the research on the application of nanozymes in the detection and identification of pathogens requires chemists and physicists for the design, fabrication, and characterization of nanozymes; microbiologists for the design, testing and analysis of the methodologies, and clinicians or clinical researchers for the evaluation of the methodologies and devices in the clinic. Many reports have also implicated required skills in mathematical modelling, and electronic engineering. While the review will conclude with a synopsis of the impact of nanozymology on the detection and identification of viruses, bacteria, fungi, cancer cells, and helminths, it will also point out opportunities that exist in basic research as well as opportunities for innovation aimed at novel laboratory methodologies and devices. In this regard there is no doubt that there are numerous unexplored research areas in the application of nanozymes for the detection of pathogens. For example, most research on the applications of nanozymes for the detection and identification of fungi is so far limited only to the detection of mycotoxins and other chemical compounds associated with fungal infection. Therefore, there is scope for exploration of the application of nanozymes in the direct detection of fungi in foods, especially in the agricultural production thereof. Many fungal species found in seeds severely compromise their use by inactivating the germination thereof. Fungi also produce mycotoxins that can severely compromise the health of humans if consumed.
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Affiliation(s)
- Sandile Phinda Songca
- School of Chemistry and Physics, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban 4041, South Africa
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Dramowski A, Bekker A, Anugulruengkitt S, Bayani O, Martins Gonçalves F, Naizgi M, Magnino A, Puthanakit T, Salle F, da Silva ARA, Molyneux E, Strysko J, Vieira C, Coffin S. Keeping It Real: Infection Prevention and Control Problems and Solutions in Low- and Middle-income Countries. Pediatr Infect Dis J 2022; 41:S36-S39. [PMID: 35134038 PMCID: PMC8815840 DOI: 10.1097/inf.0000000000003319] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 11/26/2022]
Abstract
Infection prevention challenges are ubiquitous in healthcare, but some are unique to or more prevalent in low-and middle-income country settings. Despite limited resources, innovative and committed paediatric healthcare providers and infection preventionists have found creative solutions to address the very real and pressing risks their patients face every day. We gathered examples of infection prevention and control challenges faced by clinicians in resource-limited healthcare facilities, and the real-world infection prevention and control solutions they implemented, with the goal of learning broader lessons applicable to low-and middle-income countrie.
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Affiliation(s)
- Angela Dramowski
- Division of Paediatric Infectious Diseases and Division of Neonatology and
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Tygerberg Hospital, Cape Town, South Africa
| | - Suvaporn Anugulruengkitt
- Department of Paediatrics and
- Center of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - One Bayani
- Department of Paediatrics and Adolescent Health, Faculty of Medicine, University of Botswana School of Medicine, Gaborone, Botswana
| | | | - Mulugeta Naizgi
- Paediatric & Child Health Department, Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | | | - Thanyawee Puthanakit
- Department of Paediatrics and
- Center of Excellence for Paediatric Infectious Diseases and Vaccines, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | - Elizabeth Molyneux
- Paediatric and Child Health Department, College of Medicine, Blantyre, Malawi
| | | | | | - Susan Coffin
- Paediatric and Child Health Department, College of Medicine, Blantyre, Malawi
- Global Health Center and
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Musa L, Proietti PC, Marenzoni ML, Stefanetti V, Kika TS, Blasi F, Magistrali CF, Toppi V, Ranucci D, Branciari R, Franciosini MP. Susceptibility of Commensal E. coli Isolated from Conventional, Antibiotic-Free, and Organic Meat Chickens on Farms and at Slaughter toward Antimicrobials with Public Health Relevance. Antibiotics (Basel) 2021; 10:1321. [PMID: 34827259 PMCID: PMC8614865 DOI: 10.3390/antibiotics10111321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 11/20/2022] Open
Abstract
The spread of resistant bacteria from livestock to the food industry promoted an increase of alternative poultry production systems, such as organic and antibiotic-free ones, based on the lack of antimicrobial use, except in cases in which welfare is compromised. We aimed to investigate the antibiotic susceptibility of commensal Escherichia coli isolated from organic, antibiotic-free, and conventional broiler farms and slaughterhouses toward several antimicrobials critically important for human health. To assess antimicrobial susceptibility, all E. coli isolates and extended spectrum beta-lactamase (ESBL) E. coli were analysed by the microdilution method. The prevalence of tigecycline, azithromycin and gentamicin E. coli-resistant strains was highest in organic samplings. Conversely, the lowest prevalence of resistant E. coli strains was observed for cefotaxime, ceftazidime and ciprofloxacin in organic systems, representing a significant protective factor compared to conventional systems. All E. coli strains were colistin-susceptible. Contamination of the external environment by drug-resistant bacteria could play a role in the presence of resistant strains detected in organic systems. Of interest is the highest prevalence of cephalosporin resistance of E. coli in conventional samplings, since they are not permitted in poultry. Our results suggest that monitoring of antibiotic resistance of the production chain may be helpful to detect "risks" inherent to different rearing systems.
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Affiliation(s)
- Laura Musa
- Department of Veterinary Medicine, Via S. Costanzo 4, 06126 Perugia, Italy; (L.M.); (M.L.M.); (V.S.); (V.T.); (D.R.); (R.B.); (M.P.F.)
| | - Patrizia Casagrande Proietti
- Department of Veterinary Medicine, Via S. Costanzo 4, 06126 Perugia, Italy; (L.M.); (M.L.M.); (V.S.); (V.T.); (D.R.); (R.B.); (M.P.F.)
| | - Maria Luisa Marenzoni
- Department of Veterinary Medicine, Via S. Costanzo 4, 06126 Perugia, Italy; (L.M.); (M.L.M.); (V.S.); (V.T.); (D.R.); (R.B.); (M.P.F.)
| | - Valentina Stefanetti
- Department of Veterinary Medicine, Via S. Costanzo 4, 06126 Perugia, Italy; (L.M.); (M.L.M.); (V.S.); (V.T.); (D.R.); (R.B.); (M.P.F.)
| | - Tana Shtylla Kika
- Department of Veterinary Public Health, Faculty of Veterinary Medicine, Agricultural University of Tirana, Koder Kamez, 1029 Tirana, Albania;
| | - Francesca Blasi
- Istituto Zooprofilattico Sperimentale dell’Umbria e delle Marche ‘Togo Rosati’, 06124 Perugia, Italy; (F.B.); (C.F.M.)
| | - Chiara Francesca Magistrali
- Istituto Zooprofilattico Sperimentale dell’Umbria e delle Marche ‘Togo Rosati’, 06124 Perugia, Italy; (F.B.); (C.F.M.)
| | - Valeria Toppi
- Department of Veterinary Medicine, Via S. Costanzo 4, 06126 Perugia, Italy; (L.M.); (M.L.M.); (V.S.); (V.T.); (D.R.); (R.B.); (M.P.F.)
| | - David Ranucci
- Department of Veterinary Medicine, Via S. Costanzo 4, 06126 Perugia, Italy; (L.M.); (M.L.M.); (V.S.); (V.T.); (D.R.); (R.B.); (M.P.F.)
| | - Raffaella Branciari
- Department of Veterinary Medicine, Via S. Costanzo 4, 06126 Perugia, Italy; (L.M.); (M.L.M.); (V.S.); (V.T.); (D.R.); (R.B.); (M.P.F.)
| | - Maria Pia Franciosini
- Department of Veterinary Medicine, Via S. Costanzo 4, 06126 Perugia, Italy; (L.M.); (M.L.M.); (V.S.); (V.T.); (D.R.); (R.B.); (M.P.F.)
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Sobur MA, Islam MS, Haque ZF, Orubu ESF, Toniolo A, Choudhury MA, Rahman MT. Higher seasonal temperature enhances the occurrence of methicillin resistance of Staphylococcus aureus in house flies (Musca domestica) under hospital and environmental settings. Folia Microbiol (Praha) 2021; 67:109-119. [PMID: 34569031 DOI: 10.1007/s12223-021-00922-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/17/2021] [Indexed: 11/27/2022]
Abstract
Antimicrobial resistance (AMR) emergence in commensal and pathogenic bacteria is a global health issue. House flies (Musca domestica) are considered as biological and mechanical vectors for pathogens causing nosocomial infections, including methicillin-resistant Staphylococcus aureus (MRSA). However, the prevalence of antimicrobial resistance and the role of temperature on the occurrence of Staphylococcus aureus and MRSA in house flies in a hospital environment have not been studied. A total of 400 house flies were collected in winter and summer from four hospital-associated areas in Mymensingh, Bangladesh. Detection of S. aureus and MRSA in flies was done by culturing, staining, and PCR methods targeting nuc and mec genes (mecA and mecC), respectively. Disc diffusion test was used to detect resistance phenotype against six antimicrobials. Logistic regression models were constructed to assess the effect of temperature on the frequency of antimicrobial resistance, and on the presence of the nuc and mecA genes, and location of samples in and around a hospital environment. By PCR, S. aureus was detected in 208 (52%) samples. High frequencies of resistance (≥ 80% of isolates) to amoxicillin, azithromycin, and oxacillin were observed by disk diffusion test. Increase in temperature had a positive effect on the occurrence of S. aureus and MRSA isolates as well as on their resistance to individual and multiple antimicrobials. Among the study areas, hospital premises had increased odds of having S. aureus. Increased temperature of summer significantly increased the occurrence of MRSA in house flies in and around the hospital environment, which might pose a human and animal health risk.
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Affiliation(s)
- Md Abdus Sobur
- Department of Microbiology and Hygiene, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - Md Saiful Islam
- Department of Microbiology and Hygiene, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - Zobayda Farzana Haque
- Department of Microbiology and Hygiene, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh
| | - Ebiowei Samuel F Orubu
- Institute for Health System Innovation and Policy, Boston University, 180 Riverway, Boston, MA, 02215, USA
| | - Antonio Toniolo
- Global Virus Network, University of Insubria, 21100, Varese, Italy
| | - Md Abu Choudhury
- Menzies Health Institute Queensland, Griffith University, 170 Kessels Road, Nathan, Queensland, 4111, Australia
| | - Md Tanvir Rahman
- Department of Microbiology and Hygiene, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh, 2202, Bangladesh.
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11
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Carramaschi IN, Lopes JCO, Leite JA, Carneiro MT, Barbosa RR, Boas MHV, Rangel K, Chagas TPG, Queiroz MM, Zahner V. Surveillance of antimicrobial resistant bacteria in flies (Diptera) in Rio de Janeiro city. Acta Trop 2021; 220:105962. [PMID: 34029528 DOI: 10.1016/j.actatropica.2021.105962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/11/2022]
Abstract
Antimicrobial-resistant bacteria were isolated from muscoid dipterans collected at five different areas of Rio de Janeiro city, in proximity to hospitals. Extracts obtained by maceration of flies were diluted and used as inocula for different culture media, with or without antibiotic (ceftriaxone 1 mg/L) supplementation. Purified isolates were submitted to antimicrobial susceptibility testing (AST). Bacterial identification was performed by MALDI TOF Microflex LT (Bruker Daltonics). A total of 197 bacterial strains were obtained from 117 dipterous muscoids. Forty-two flies (35.9%) carried bacteria resistant to at least one antimicrobial, while 7 insects (5.9%) carried multidrug-resistant bacteria (MDR), which were all members of the family Enterobacteriaceae. Among 10 MDR bacteria (5%), 5 strains (2,5%) were positive by PCR for one or more of the following antibiotic resistance genes: aac(6')-Ib, blaTEM-1, blaCTX-M-15, blaKPC-2 and blaNDM-1. Analysis of variance (ANOVA) and cluster analysis compared the number of resistant isolates per collection point and showed that a single location was statistically different from the others with regard to resistance. Although there are still no criteria to determine the environmental contamination by resistant bacteria the fact that they have been isolated from flies is an indication of a disseminated contamination. As such, these insects may be useful in monitoring programs of antibiotic resistance in non-hospital environments, where they could function as sentinels.
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Affiliation(s)
- Isabel Nogueira Carramaschi
- Laboratório de Entomologia Médica e Forense, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Manguinhos, Cep, Rio de Janeiro 21040-360, Brazil
| | - Jonathan Christian O Lopes
- Laboratório de Entomologia Médica e Forense, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Manguinhos, Cep, Rio de Janeiro 21040-360, Brazil
| | - Jéssica Albuquerque Leite
- Laboratório de Entomologia Médica e Forense, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Manguinhos, Cep, Rio de Janeiro 21040-360, Brazil
| | - Marcos Tavares Carneiro
- Laboratório de Microbiologia do Departamento de Saneamento e Saúde Ambiental, Escola Nacional de Saúde Pública Sérgio Arouca, R. Leopoldo Bulhões, 1480 - Manguinhos, Rio de Janeiro 21041-210, Brazil
| | - Rodrigo Rocha Barbosa
- Laboratório de Entomologia Médica e Forense, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Manguinhos, Cep, Rio de Janeiro 21040-360, Brazil; Centro Universitário de Volta Redonda. Av. Paulo Erlei Alves Abrantes, 1325 - Três Poços, Volta Redonda - RJ 27240-560, Brazil
| | - Maria Helena Villas Boas
- Laboratório de Saneantes, Instituto Nacional de Controle de Qualidade em Saúde, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Cep, Rio de Janeiro 21040-360, Brazil
| | - Karyne Rangel
- Laboratório de Bioquímica de Proteínas e Peptídeos, Centro de Desenvolvimento Tecnológico em Saúde Fiocruz, Avenida Brasil, 4365, Manguinhos, Cep, Rio de Janeiro 21040-360, Brazil
| | - Thiago Pavoni Gomes Chagas
- Departamento de Patologia, Faculdade de Medicina, Universidade Federal Fluminense. Rua Marquês de Paraná, 303, Centro, Cep, Niterói 24220-000, Brazil
| | - Margareth Mc Queiroz
- Laboratório de Entomologia Médica e Forense, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Manguinhos, Cep, Rio de Janeiro 21040-360, Brazil
| | - Viviane Zahner
- Laboratório de Entomologia Médica e Forense, Instituto Oswaldo Cruz, Fiocruz, Avenida Brasil, 4365, Manguinhos, Cep, Rio de Janeiro 21040-360, Brazil.
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12
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BAĞRIAÇIK N, SAMANCI TEKİN Ç. Knowledge Level About Insects and Mites of Health School Students. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.722203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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13
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The Changing Face of the Family Enterobacteriaceae (Order: " Enterobacterales"): New Members, Taxonomic Issues, Geographic Expansion, and New Diseases and Disease Syndromes. Clin Microbiol Rev 2021; 34:34/2/e00174-20. [PMID: 33627443 DOI: 10.1128/cmr.00174-20] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The family Enterobacteriaceae has undergone significant morphogenetic changes in its more than 85-year history, particularly during the past 2 decades (2000 to 2020). The development and introduction of new and novel molecular methods coupled with innovative laboratory techniques have led to many advances. We now know that the global range of enterobacteria is much more expansive than previously recognized, as they play important roles in the environment in vegetative processes and through widespread environmental distribution through insect vectors. In humans, many new species have been described, some associated with specific disease processes. Some established species are now observed in new infectious disease settings and syndromes. The results of molecular taxonomic and phylogenetics studies suggest that the current family Enterobacteriaceae should possibly be divided into seven or more separate families. The logarithmic explosion in the number of enterobacterial species described brings into question the relevancy, need, and mechanisms to potentially identify these taxa. This review covers the progression, transformation, and morphogenesis of the family from the seminal Centers for Disease Control and Prevention publication (J. J. Farmer III, B. R. Davis, F. W. Hickman-Brenner, A. McWhorter, et al., J Clin Microbiol 21:46-76, 1985, https://doi.org/10.1128/JCM.21.1.46-76.1985) to the present.
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14
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Gwenzi W, Chaukura N, Muisa-Zikali N, Teta C, Musvuugwa T, Rzymski P, Abia ALK. Insects, Rodents, and Pets as Reservoirs, Vectors, and Sentinels of Antimicrobial Resistance. Antibiotics (Basel) 2021; 10:antibiotics10010068. [PMID: 33445633 PMCID: PMC7826649 DOI: 10.3390/antibiotics10010068] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/07/2021] [Accepted: 01/08/2021] [Indexed: 12/22/2022] Open
Abstract
This paper reviews the occurrence of antimicrobial resistance (AMR) in insects, rodents, and pets. Insects (e.g., houseflies, cockroaches), rodents (rats, mice), and pets (dogs, cats) act as reservoirs of AMR for first-line and last-resort antimicrobial agents. AMR proliferates in insects, rodents, and pets, and their skin and gut systems. Subsequently, insects, rodents, and pets act as vectors that disseminate AMR to humans via direct contact, human food contamination, and horizontal gene transfer. Thus, insects, rodents, and pets might act as sentinels or bioindicators of AMR. Human health risks are discussed, including those unique to low-income countries. Current evidence on human health risks is largely inferential and based on qualitative data, but comprehensive statistics based on quantitative microbial risk assessment (QMRA) are still lacking. Hence, tracing human health risks of AMR to insects, rodents, and pets, remains a challenge. To safeguard human health, mitigation measures are proposed, based on the one-health approach. Future research should include human health risk analysis using QMRA, and the application of in-silico techniques, genomics, network analysis, and ’big data’ analytical tools to understand the role of household insects, rodents, and pets in the persistence, circulation, and health risks of AMR.
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Affiliation(s)
- Willis Gwenzi
- Biosystems and Environmental Engineering Research Group, Department of Agricultural and Biosystems Engineering, University of Zimbabwe, Mount. Pleasant, Harare P.O. Box MP167, Zimbabwe
- Correspondence: or (W.G.); or (A.L.K.A.)
| | - Nhamo Chaukura
- Department of Physical and Earth Sciences, Sol Plaatje University, Kimberley 8300, South Africa;
| | - Norah Muisa-Zikali
- Department of Environmental Sciences and Technology, School of Agricultural Sciences and Technology, Chinhoyi University of Technology, Private Bag, Chinhoyi 7724, Zimbabwe; or
| | - Charles Teta
- Future Water Institute, Faculty of Engineering & Built Environment, University of Cape Town, Cape Town 7700, South Africa;
| | - Tendai Musvuugwa
- Department of Biological and Agricultural Sciences, Sol Plaatje University, Kimberley 8300, South Africa;
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
- Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), 60-806 Poznań, Poland
| | - Akebe Luther King Abia
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban 4000, South Africa
- Correspondence: or (W.G.); or (A.L.K.A.)
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15
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Punyadi P, Thongngen P, Kiddee A, Assawatheptawee K, Tansawai U, Bunchu N, Niumsup PR. Prevalence of blaCTX-M and Emergence of blaCTX-M-5-Carrying Escherichia coli in Chrysomya megacephala (Diptera: Calliphoridae), Northern Thailand. Microb Drug Resist 2020; 27:698-705. [PMID: 33085574 DOI: 10.1089/mdr.2020.0249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
This study was undertaken to assess the prevalence of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (ESBL-EC) among blow fly (Chrysomya megacephala) populations in Northern Thailand. Of 600 blow flies collected from rural (n = 400) and urban (n = 200) areas, 334 blow flies carried ESBL-EC (55.7%). Prevalence of ESBL-EC in blow flies captured from rural areas was significantly higher than that from urban region (72.5% vs. 22.0%, p < 0.001). Susceptibility tests revealed that 68.6% of ESBL-EC possessed multidrug-resistant phenotypes. Coresistance to gentamicin (85%) was common, while resistance to ciprofloxacin was relatively low (18.0%). Of the 334 isolates, 253 isolates (75.7%) harbored blaCTX-M, in which blaCTX-M group 1 was predominant (56.5%), followed by blaCTX-M group 9 (39.1%). Interestingly, a single isolate was found to carry blaCTX-M-5, which resided on the IncA/C conjugative plasmid. This is the first report of blaCTX-M-5 from Thailand and its first identification in blow fly. Pulsed field gel electrophoresis (PFGE) demonstrated high genetic diversity among ESBL-EC isolates. Nevertheless, identical and closely related PFGE profiles were detected among isolates within the same regions and the regions which are several kilometers apart, suggesting that clonal transmission has occurred. Moreover, epidemiologically related isolates were observed between ESBL-EC from blow flies and human intestinal tract. This study provides evidences that blow flies, C. megacephala, are important reservoirs for ESBL-EC and could potentially act as vectors for the spread of ESBL-EC in a Thai community.
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Affiliation(s)
- Phirapat Punyadi
- Department of Microbiology and Parasitology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
| | - Phetrada Thongngen
- Department of Microbiology and Parasitology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
| | - Anong Kiddee
- Department of Microbiology and Parasitology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
| | - Kanit Assawatheptawee
- Department of Microbiology and Parasitology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
| | - Uttapoln Tansawai
- Department of Microbiology and Parasitology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
| | - Nophawan Bunchu
- Department of Microbiology and Parasitology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
| | - Pannika R Niumsup
- Department of Microbiology and Parasitology, Faculty of Medical Science, Naresuan University, Phitsanulok, Thailand
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16
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Dibaj R, Shojaei H, Narimani T. Identification and molecular characterization of mycobacteria isolated from animal sources in a developing country. Acta Trop 2020; 204:105297. [PMID: 31837313 DOI: 10.1016/j.actatropica.2019.105297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/07/2019] [Accepted: 12/10/2019] [Indexed: 01/15/2023]
Abstract
The essential role of animals in the transmission of infectious diseases has long been recognized. Apart from zoonosis due to Mycobacterium bovis in domestic cattle, acquired mycobacterial zoonosis from animals are vastly under-reported worldwide. This is partly the result of not recognizing that animals can be the source of zoonotic nontuberculous mycobacteria (NTM) infection. The present study intended to be a contribution to the knowledge of somewhat neglected role of animals in harboring, maintenance and dissemination of NTM in the environment. A total of 326 samples from 250 animals were collected and analyzed for the presence of mycobacteria using standard protocols. The preliminary identification and Runyon's classification of isolates were performed by conventional tests. The PCR amplification of a 228 bp fragment of 65-kDa heat shock protein (hsp) gene was applied for the genus identification and the partial sequence analysis of 16S rRNA was applied for the species identification. In total 32 isolates including 26 rapidly growing and 6 slowly growing mycobacteria were recovered from 250 animal samples (12.8%). The isolates recovered from 21 (65.60%) fish, 8 (25%) insects and 3 (9.4%) house cats, dogs and mice. M. fortuitum was the most frequent Mycobacterium spp (13 isolates; 40.6% of all isolates), followed by M. abscessus-chelonae-M. saopaulense group, (5 isolates; 15.6% of all isolates), M. iranicum (3 isolates; 9.4% of all isolates),and M. marinum, M. terrae complex and M. chlorophenolicum (2 isolates each; 18.8% of all isolates), and the single isolates of M. mucogenicum, M. neoaurum, M. conceptionense, M. virginiense, and M. gordonae (5 isolates; 15.6% of all isolates). The current study indicates that a variety of animals can be a permanent or transient source of mycobacterial agents. This ensures the life cycle of the bacteria and the chance of their survival in the environment, which may pose a potential threat to human health.
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17
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Heiden SE, Kurz MSE, Bohnert J, Bayingana C, Ndoli JM, Sendegeya A, Gahutu JB, Eger E, Mockenhaupt FP, Schaufler K. Flies from a tertiary hospital in Rwanda carry multidrug-resistant Gram-negative pathogens including extended-spectrum beta-lactamase-producing E. coli sequence type 131. Antimicrob Resist Infect Control 2020; 9:34. [PMID: 32066506 PMCID: PMC7026959 DOI: 10.1186/s13756-020-0696-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/07/2020] [Indexed: 11/24/2022] Open
Abstract
Multidrug-resistant gram-negative (MRGN) bacteria are a serious threat to global health. We used genomics to study MRGN obtained from houseflies in a tertiary Rwandan hospital. Our analysis revealed a high abundance of different MRGN including E. coli pathogenic lineage ST131 suggesting the important role of flies in disseminating highly virulent pathogens in clinical settings and beyond.
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Affiliation(s)
- Stefan E Heiden
- Pharmaceutical Microbiology, Institute of Pharmacy, University of Greifswald, Friedrich-Ludwig-Jahn-Str. 17, 17489, Greifswald, Germany
| | | | | | | | - Jules M Ndoli
- University of Rwanda, Kigali, Rwanda.,University Teaching Hospital of Butare, Butare, Rwanda
| | - Augustin Sendegeya
- University of Rwanda, Kigali, Rwanda.,University Teaching Hospital of Butare, Butare, Rwanda
| | - Jean Bosco Gahutu
- University of Rwanda, Kigali, Rwanda.,University Teaching Hospital of Butare, Butare, Rwanda
| | - Elias Eger
- Pharmaceutical Microbiology, Institute of Pharmacy, University of Greifswald, Friedrich-Ludwig-Jahn-Str. 17, 17489, Greifswald, Germany
| | | | - Katharina Schaufler
- Pharmaceutical Microbiology, Institute of Pharmacy, University of Greifswald, Friedrich-Ludwig-Jahn-Str. 17, 17489, Greifswald, Germany.
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18
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Coates ARM, Hu Y, Holt J, Yeh P. Antibiotic combination therapy against resistant bacterial infections: synergy, rejuvenation and resistance reduction. Expert Rev Anti Infect Ther 2020; 18:5-15. [DOI: 10.1080/14787210.2020.1705155] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Anthony R. M. Coates
- Institute of Infection and Immunity, St George’s, University of London, London, UK
| | - Yanmin Hu
- Institute of Infection and Immunity, St George’s, University of London, London, UK
| | - James Holt
- Division of Infection and Immunity, University College London, London, UK
| | - Pamela Yeh
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, CA, USA
- Santa Fe Institute, Santa Fe, NM, USA
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