The antimicrobial resistance crisis: causes, consequences, and management

Public Health Insurance and Healthcare Utilisation Decisions of Young Adults

This paper investigates the impact of a dependent coverage age-eligibility rule on young adults' health and healthcare utilisation under Indonesia's National Health Insurance (NHI) program. Employing a regression discontinuity design, analysis of the NHI administrative data documents a significant 14.6 to 20.9 percentage points drop in coverage among young adults at age 21, the age cut-off imposed by the rule. Using a large nationally representative household survey, this paper shows that the loss of insurance coverage does not change young adults' health status but markedly decreases the utilisation of outpatient care among those who are ill. Specifically, there is an abrupt 5.3 to 8.4 percentage points reduction in the probability of young adults having any outpatient visit in the past month, primarily driven by lower utilisation of primary care services. The study also finds an increased likelihood of self-treatment and the use of traditional healers, indicating a substitution effect. Further analysis shows a larger impact on those who are poor, less educated, and live in regions with higher healthcare costs.

Gemini surfactant stabilized zein nanoparticles: Preparation, characterization, interaction mechanism, and antibacterial activity

To enhance the physicochemical properties of zein nanoparticles, zein complexes with two Gemini surfactants (12-3-12 and 12-4-12) were prepared using the anti-solvent method and investigated the physicochemical properties, formation mechanism and antibacterial activity. Results indicated that the optimal mass ratio between zein and Gemini surfactants was at 1:1, and the incorporation of Gemini surfactants significantly improved the surface properties of zein, reducing its surface hydrophobicity and surface tension, thereby enhancing its dispersion in aqueous media. Fluorescence spectroscopy and molecular docking experiments further elucidated the interaction mechanisms between zein and Gemini surfactant, revealing a spontaneous binding process, mainly driven by hydrophobic and hydrogen interaction, and a strong binding affinity of 12-4-12 with zein. Additionally, the zein/Gemini surfactant complexes exhibited significant antibacterial activity against Staphylococcus aureus, with the zein/12-4-12 complex showing particularly prominent inhibitory effects. Therefore, this research not only provides a theoretical foundation for the construction of Gemini surfactant stabilized zein nanoparticles but also points the way for the subsequent embedding of bacteriostatic agents to achieve synergistic antibacterial effects.

Physicochemical characterization and nanochemical analysis of ciprofloxacin hydrophobic ion Pairs for enhanced encapsulation in PLGA nanoparticle

This study investigates the physicochemical transformation of ciprofloxacin (CIP) through hydrophobic ion pairing with five counter ions-sodium oleate, sodium laurate, sodium caprate, disodium pamoate, and sodium deoxycholate-to enhance compatibility with hydrophobic Poly (lactic-co-glycolic acid) (PLGA) nanoparticles. Complexation efficiencies (CE) reached up to 92.26 %, with ciprofloxacin pamoate (CIP-PAM) achieving over 90 % CE at a 1:0.5 M ratio. Differential scanning calorimetry (DSC) and X-ray diffraction (XRD) analyses showed reduced crystallinity across all complexes, with CIP-PAM exhibiting an amorphous form. Optical photothermal infrared spectroscopy (O-PTIR) confirmed uniform complexation within particles, while CIP-PAM displayed a broad peak and weak intensity in the 900-1300 cm-1 region, supporting its amorphous nature. Log P values demonstrated increased hydrophobicity for all complexes, with ciprofloxacin oleate (CIP-OLE) showing a 93-fold increase (p < 0.001). In vitro dissociation patterns varied: CIP-OLE maintained steady release in DW (49.7 %) and PBS (32.3 %) over 48 h, whereas CIP-PAM exhibited strong stability in DW (25.2 %) and a contrasting 68.1 % release in PBS, highlighting solvent-dependent dissociation behaviors. PLGA nanoparticles prepared via S/O/W achieved particle sizes under 200 nm, with CIP-PAM showing the highest encapsulation efficiency (63.02 % vs 17.21 % (CIP)). These findings underscore the importance of counter ion selection to optimize CIP compatibility with hydrophobic carriers, providing a basis for improved drug loading of hydrophilic antibiotics.

Fecal carriage of carbapenemase and AmpC-β-lactamase producers among extended spectrum β-Lactamase-producing E. coli and Klebsiella spp. isolates in patients attending hospitals

BACKGROUND

Extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE), particularly Escherichia coli and Klebsiella pneumoniae, have been consistently associated with treatment failure, high mortality and morbidity. The emergence of carbapenem resistance among ESBL-PE strains exacerbates the antimicrobial resistance. However, data are very limited in developing countries as Burkina Faso. This study aimed to determine the prevalence of carbapenemase and AmpC-β-lactamase production among ESBL-producing E. coli (ESBL-Ec) and Klebsiella spp. (ESBL-K) isolated from patients' stool in Burkina Faso.

MATERIALS AND METHODS

From January 2020 to June 2022, we isolated 277 ESBL-PE from patients' stool in five hospitals in Burkina Faso. The strains were isolated on ESBL-selective chromogenic media and identified using API20E. The isolates were tested against 15 antimicrobial agents using the disc-diffusion method on Mueller-Hinton (MH) agar. ESBL production was confirmed by double disc synergy method. Carbapenemase and AmpC-β-lactamase production and phenotypic co-resistance were determined.

RESULTS

Among the 277 ESBL-PE strains isolated, 203 were E. coli, and 74 were Klebsiella spp. Of these bacteria, 2.9% were carbapenemase producers and 6.5% were AmpC-β-lactamase producers. The carbapenemase producers were detected at tertiary and secondary hospitals, mainly in hospitalized patients and females, whereas AmpC-β-lactamase producers were detected at all levels of healthcare, predominantly in non-hospitalized patients, male, and under 15 years of age. The co-resistance rates were as high as 82% for fluoroquinolones, 91% for aminoglycosides, and 94% for sulfonamides. Fosfomycin resistance was 2.5% for ESBL-Ec and 50% for ESBL-K.

CONCLUSION

This study showed that ESBL-PEs co-produce carbapenemase and/or AmpC-β-lactamase. High co-resistances were reported for commonly used antibiotic agents. Therefore, screening for carbapenem-resistant Enterobacterales (CRE) carriage is necessary to limit its spread within hospitals.

Unveiling the nanoworld of antimicrobial resistance: integrating nature and nanotechnology

A significant global health crisis is predicted to emerge due to antimicrobial resistance by 2050, with an estimated 10 million deaths annually. Increasing antibiotic resistance necessitates continuous therapeutic innovation as conventional antibiotic treatments become increasingly ineffective. The naturally occurring antibacterial, antifungal, and antiviral compounds offer a viable alternative to synthetic antibiotics. This review presents bacterial resistance mechanisms, nanocarriers for drug delivery, and plant-based compounds for nanoformulations, particularly nanoantibiotics (nAbts). Green synthesis of nanoparticles has emerged as a revolutionary approach, as it enhances the effectiveness, specificity, and transport of encapsulated antimicrobials. In addition to minimizing systemic side effects, these nanocarriers can maximize therapeutic impact by delivering the antimicrobials directly to the infection site. Furthermore, combining two or more antibiotics within these nanoparticles often exhibits synergistic effects, enhancing the effectiveness against drug-resistant bacteria. Antimicrobial agents are routinely obtained from secondary metabolites of plants, including essential oils, phenols, polyphenols, alkaloids, and others. Integrating plant-based antibacterial agents and conventional antibiotics, assisted by suitable nanocarriers for codelivery, is a potential solution for addressing bacterial resistance. In addition to increasing their effectiveness and boosting the immune system, this synergistic approach provides a safer and more effective method of tackling future bacterial infections.

Antibiotic use and antimicrobial resistance: Knowledge, Attitude and Practices survey of medical students to evaluate undergraduate training curriculum

Introduction. A better understanding of knowledge, attitude and practices of undergraduate medical students towards antimicrobial resistance (AMR) is necessary to identify gaps in the current training curriculum. Methods. A 20-point Likert scale-based questionnaire divided into three parts, knowledge, attitude and practices, relating to antibiotic use and resistance was devised. Students attending each year of the undergraduate medical programme were approached to participate in the study over a 1-week period. Knowledge, Attitude and Practices scores of each year were compared through logistic ordinal regression and the Kruskal-Wallis (KW) test. Results. Two hundred and eight students participated in the study. Overall, knowledge of about intended use of antibiotics, fixed drug combinations and awareness about AMR was good (average score of 73.75%). Steady improvement in knowledge scores was observed from the first year (-0.441) to the final year (0.00). The medical students had favourable attitude towards rational antimicrobial use (Likert score ≥4), including the need to spread awareness about AMR amongst students and the public and following doctor's prescriptions. Self-medication was reported by 28.4% of students and hoarding of leftover doses by 49.1%. Attitude score had a direct correlation with the knowledge score on the KW test (χ 2=29.6, P≤0.5) but had no significant correlation with antimicrobial practices (χ 2=3.9, P≥0.5). The gaps identified in students' practices included self-medication, skipping of dosing and hoarding of leftover medication. Conclusion. As improvement in knowledge did not correlate with better personal behaviours regarding antibiotics, the current curriculum needs to include AMR as a focus area to ensure good antibiotic prescribing practices in future practitioners.

Human and Veterinary Medicine Collaboration: Synergistic Approach to Address Antimicrobial Resistance Through the Lens of Planetary Health

Antimicrobial resistance (AMR) represents a critical threat to human, animal, and environmental health, challenging global efforts to maintain sustainable ecosystems and public health systems. In this review, the complex, cross-disciplinary issues of AMR are explored within the framework of planetary health, emphasizing the interconnectedness of human and veterinary medicine with broader environmental and social systems. Specifically, it addresses the social, economic, environmental, and health dimensions of AMR under the planetary health framework. The social aspects consider how public awareness, education, and healthcare practices shape antimicrobial use (AMU) and resistance patterns. The economic impact evaluates the cost burdens of AMR, including healthcare costs, loss of productivity, and the implications for the livestock and food production industries. The environmental dimension highlights the role of pharmaceutical waste, agricultural runoff, and industrial pollution in contributing to the spread of antimicrobials and resistant pathogens in ecosystems. To illustrate these challenges, a comprehensive literature review using the PubMed and Web of Science databases was conducted, identifying 91 relevant articles on planetary health and AMR. In this review, the knowledge from these studies and additional references is integrated to provide a holistic overview of the AMR crisis. By applying the four pillars of planetary health-social, economic, environmental, and health knowledge-in this manuscript, the necessity is underscored of collaborative strategies across human and veterinary medicine to combat AMR. Ultimately, this synergistic approach aims to shape the policies and practices that safeguard public health, protect ecosystems, and promote a sustainable future by implementing antimicrobial stewardship programs and encouraging prudent AMU.

Synergistic Antibacterial Effect of ZnO Nanoparticles and Antibiotics against Multidrug-resistant Biofilm Bacteria

BACKGROUND

The misuse of antibiotics leads to a global increase in antibiotic resistance. Therefore, it is imperative to search for alternative compounds to conventional antibiotics. ZnO nanoparticles (Zn NP) are one of these alternatives because they are an effective option to overcome biofilm bacterial cells and a novel way to overcome multidrug resistance in bacteria. The current research study aims to characterize the efficacy of ZnO nanoparticles alone and in combination with other antibacterial drugs against bacterial biofilms.

METHODS

ZnO NPs were prepared by co-precipitation method, and their anti-biofilm and antibacterial activities alone or combined with four types of broad-spectrum antibacterial (Norfloxacin, Colistin, Doxycycline, and Ampicillin) were evaluated against E. coli and S. aureus bacterial strains. Finally, the cytotoxicity and the hemolytic activity were evaluated.

RESULTS

ZnO NPs were prepared, and results showed that their size was around 10 nm with a spherical shape and a zeta potential of -21.9. In addition, ZnO NPs were found to have a strong antibacterial effect against Gram-positive and Gram-negative microorganisms, with a minimum inhibitory concentration (MIC) of 62.5 and 125 μg/mL, respectively. Additionally, they could eradicate biofilmforming microorganisms at a concentration of 125 μg/m. ZnO NPs were found to be non-toxic to erythrocyte cells. Still, some toxicity was observed for Vero cells at effective concentration ranges needed to inhibit bacterial growth and eradicate biofilm-forming organisms. When combined with different antibacterial, ZnO NP demonstrated synergistic and additive effects with colistin, and the MIC and MBEC of the combination decreased significantly to 0.976 μg/mL against planktonic and biofilm strains of MDR Gram-positive bacteria, resulting in significantly reduced toxicity.

CONCLUSION

The findings of this study encourage the development of alternative therapies with high efficacy and low toxicity. ZnO nanoparticles have demonstrated promising results in overcoming multi-drug resistant bacteria and biofilms, and their combination with colistin has shown a significant reduction in toxicity. Further studies are needed to investigate the potential of ZnO nanoparticles as a viable alternative to conventional antibiotics.

Urinary Catheter Utility in Laparoscopic Appendectomy: Risk Benefit Analysis of Post-Operative Urinary Tract Complications

Background: Catheter-associated urinary tract infections (CAUTIs) account for 1 million nosocomial infections annually and 75% of all hospital-acquired UTIs. A risk factor for CAUTI is prolonged urinary catheterization (UC); therefore, transitory UC during laparoscopic appendectomy (LA), a common practice justified to avoid iatrogenic bladder injury, is believed to be safe. However, data on the incidence of post-operative UC-related complications, including CAUTI, following LA or their avoidance are limited. Hypothesis: Patients who underwent UC for LA developed more post-operative UTIs than patients without UC (noUC), without effect on the incidence of bladder injury. Patients and Methods: Retrospective analysis of patients ≥21 years who underwent LA (2016-2023) at an academic hospital. The primary outcome was post-operative UTI in UC versus noUC patients, defined as symptoms or urinalysis findings compatible with UTI within 21 days from LA. Secondary outcomes included bladder injury, catheter-related complications, time until UTI diagnosis, and antibiotic exposure. Statistics: Mann-Whitney U and Fisher exact tests; p < 0.05. Results: Among 981 LA, there were 678 UC and 303 noUC. A majority was male (56%) and young [38 years, inter-quartile range (IQR) 28-50]. Duration of catheterization was 102 min (IQR 85-123), whereas duration of the procedure was 58 min (IQR 44-80). There were more catheter-related complications in the UC versus noUC group (10 [1.5%] vs. 0; p = 0.04). The incidence of UTI was 0.5%, with five cases (0.7%) after UC and zero for noUC (p = 0.34). UTIs were detected at 11 post-operative days (IQR 6-17) and treated with antibiotic agents for 5 days (IQR 5-13). Four UC patients had urinary retention (two required re-catheterization and discharge with an indwelling catheter). One UC urinary "retainer" developed a post-operative UTI and required hospital re-admission. There was no urinary retention in the noUC group. There were no bladder injuries. Conclusions: The incidence of UTI was low following LA; bladder injuries were non-existent. UC-related complications were greater among UC patients, but there was neither urinary retention and post-operative catheterization nor bladder injury in the noUC group; we suggest the omission of UC for LA.

2-D transition metal trichalcophosphogenide FePS3 against multi-drug resistant microbial infections

Antimicrobial resistance (AMR) is a significant concern to society as it threatens the effectiveness of antibiotics and leads to increased morbidity and mortality rates. Innovative approaches are urgently required to address this challenge. Among promising solutions, two dimensional (2-D) nanomaterials with layered crystal structures have emerged as potent antimicrobial agents owing to their unique physicochemical properties. This antimicrobial activity is largely attributed to their high surface area, which allows for efficient interaction with microbial cell membranes, leading to physical disruption or oxidative stress through the generation of reactive oxygen species (ROS). The latter mechanism is particularly noteworthy as it involves the degradation of these nanomaterials under specific conditions, releasing ROS that can effectively kill bacteria and other pathogens without harming human cells. This study explores the antimicrobial properties of a novel biodegradable nanomaterial based on 2-D transition metal trichalcogenides, FePS3, as a potential solution to drug-resistant microbes. Our findings indicate that FePS3 is an exceptionally effective antimicrobial agent with over 99.9% elimination of various bacterial strains. Crucially, it exhibits no cytotoxic effects on mammalian cells, underscoring the potential for safe biomedical application. The primary mechanism driving the antimicrobial efficacy of FePS3 is the release of ROS during biodegradation. ROS has a crucial role in neutralizing bacterial cells, conferring significant antipathogenic properties to this compound. The unique combination of high antimicrobial activity, biocompatibility, and biodegradability makes FePS3 a promising candidate for developing new antimicrobial strategies. This research contributes to the increasing body of evidence supporting the use of 2-D nanomaterials in addressing the global challenge of AMR, offering a potential pathway for the development of advanced, effective, and safe antimicrobial agents.

Metabolic interplay between Proteus mirabilis and Enterococcus faecalis facilitates polymicrobial biofilm formation and invasive disease

Biofilms play an important role in the development and pathogenesis of catheter-associated urinary tract infection (CAUTI). Proteus mirabilis and Enterococcus faecalis are common CAUTI pathogens that persistently co-colonize the catheterized urinary tract and form biofilms with increased biomass and antibiotic resistance. In this study, we uncover the metabolic interplay that drives biofilm enhancement and examine the contribution to CAUTI severity. Through compositional and proteomic biofilm analyses, we determined that the increase in biofilm biomass stems from an increase in the protein fraction of the polymicrobial biofilm. We further observed an enrichment in proteins associated with ornithine and arginine metabolism in polymicrobial biofilms compared with single-species biofilms. We show that arginine/ornithine antiport by E. faecalis promotes arginine biosynthesis and metabolism in P. mirabilis, ultimately driving the increase in polymicrobial biofilm protein content without affecting viability of either species. We further show that disrupting E. faecalis ornithine antiport alters the metabolic profile of polymicrobial biofilms and prevents enhancement, and this defect was complemented by supplementation with exogenous ornithine. In a murine model of CAUTI, ornithine antiport did not contribute to E. faecalis colonization but was required for the increased incidence of urinary stone formation and bacteremia that occurs during polymicrobial CAUTI with P. mirabilis. Thus, disrupting metabolic interplay between common co-colonizing species may represent a viable strategy for reducing risk of bacteremia.IMPORTANCEChronic infections often involve the formation of antibiotic-resistant biofilm communities that include multiple different microbes, which pose a challenge for effective treatment. In the catheterized urinary tract, potential pathogens persistently co-colonize for long periods of time and the interactions between them can lead to more severe disease outcomes. In this study, we identified the metabolite L-ornithine as a key mediator of disease-enhancing interactions between two common and challenging pathogens, Enterococcus faecalis and Proteus mirabilis. Disrupting ornithine-mediated interactions may therefore represent a strategy to prevent polymicrobial biofilm formation and decrease risk of severe disease.

Evaluation of Antibiotic Resistance Mechanisms in Gram-Positive Bacteria

The prevalence of resistance in Gram-positive bacterial infections is rapidly rising, presenting a pressing global challenge for both healthcare systems and economies. The WHO categorizes these bacteria into critical, high, and medium priority groups based on the urgency for developing new antibiotics. While the first priority pathogen list was issued in 2017, the 2024 list remains largely unchanged. Despite six years having passed, the progress that has been made in developing novel treatment approaches remains insufficient, allowing antimicrobial resistance to persist and worsen on a global scale. Various strategies have been implemented to address this growing threat by targeting specific resistance mechanisms. This review evaluates antimicrobial resistance (AMR) in Gram-positive bacteria, highlighting its critical impact on global health due to the rise of multidrug-resistant pathogens. It focuses on the unique cell wall structure of Gram-positive bacteria, which influences their identification and susceptibility to antibiotics. The review explores the mechanisms of AMR, including enzymatic inactivation, modification of drug targets, limiting drug uptake, and increased drug efflux. It also examines the resistance strategies employed by high-priority Gram-positive pathogens such as Staphylococcus aureus, Streptococcus pneumoniae, and Enterococcus faecium, as identified in the WHO's 2024 priority list.

Assessing Illinois companion animal veterinarians' antimicrobial prescription practices and the factors that influence their decisions when treating bacterial infections in dogs and cats

AIMS

Judicious antimicrobial use in companion animal practice is critical for maintaining the effectiveness of antimicrobial agents against bacterial infections and reducing the selection of antimicrobial-resistant bacteria. This study aimed to provide insights into companion animal veterinarians' antimicrobial treatment recommendations for common bacterial infections in dogs and cats and describe the factors influencing their prescription choices.

METHODS AND RESULTS

An online survey using QualtricsXM® software was administered between September and November 2022 to companion animal veterinarians who were Illinois State Veterinary Medical Association members. Descriptive and text analyses were conducted to assess the participants' responses. A total of 78 surveys were included in the analysis. Skin infections were ranked as the most common bacterial infections for which veterinarians prescribed antimicrobial agents, followed by ear, urinary tract, respiratory, and enteric infections. The severity of clinical symptoms and the results of bacterial culture and susceptibility tests were the most influential factors for veterinarians when making antimicrobial prescription choices. Veterinarians were aware of the current antimicrobial prescription guideline recommendations when prescribing antimicrobials empirically to nine hypothetical scenarios of bacterial infections. According to the results of the text analysis that assessed veterinarians' responses to an open-ended question, regarding their challenges when prescribing antimicrobial agents, the pairwise correlation of word frequencies within each response showed the highest correlations between the words 'owner' and 'compliance', 'administration' and 'route', 'cost' and 'culture', and 'patients' and 'acceptance'.

CONCLUSIONS

The study results can support animal health stakeholders in the development of antimicrobial stewardship programmes to promote appropriate antimicrobial use and limit the emergence of antimicrobial resistance.

Exploring advanced genomic and immunoinformatics techniques for identifying drug and vaccine targets against SARS-CoV-2

The coronavirus that causes serious acute respiratory syndrome. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still a major problem in public health and biomedicine. Even if there is no cure for it, the infection is still progressing naturally, and the only time that optimal treatment choices, such as doxycycline, work is at the beginning of the infection. Our project is structured into two critical parts: the first focuses on the identification of potential drug targets, and the second on vaccine design, both aimed at exploring new ways to treat the disease. Initially, cytoplasmic proteins identified through subtractive analysis underwent comprehensive evaluation for potential drug targeting, focusing on metabolic pathways, homology prediction, drugability assessment, essentiality, and protein-protein interactions. Subsequently, surface proteins underwent rigorous assessment for allergenicity, antigenicity, physiochemical attributes, conserved regions, protein interactions, and identification of B and T cell epitopes. Molecular docking and immunological simulation analyses were then employed to develop and characterize a multi-epitope vaccine, integrating findings from the aforementioned evaluations. Findings from the study point to six proteins as potential critical therapeutic targets for SARS-CoV-2, each of which is involved in a distinct metabolic process. The reverse vaccinology analysis suggested that the following proteins could be used as vaccine candidates: sp|P05106, sp|O00187, sp|Q9NYK1, sp|P05556, sp|P09958, and sp|Q9HC29. Four multi-epitope vaccine named as SARS-COV-2-, C1, C2, C3, and C4 was designed by utilizing different adjuvants and eighteen B cell overlapped epitopes which were predicted from top ranked protiens. Based on immune simulation study, the vaccine exhibited adequate immune-reactivity and favorable encounters with toll-type receptors (TLR4, TLR8, HLA, etc ACE), Among them the SARS-COV-2-C2 showed best binding affinity of which all receptors. Findings from this study could be a game-changer in the quest to develop a vaccine and medication that effectively combat SARS-CoV-2. It is necessary to do additional experimental analyses, nevertheless.

Burkholderia cepacia complex in cystic fibrosis: critical gaps in diagnosis and therapy

Burkholderia cepacia complex (Bcc) is a bacterial group with 'natural' multi-antimicrobial resistance. This complex has generated epidemic outbreaks across the world. In people with cystic fibrosis (CF), Bcc can cause severe lung infections that lead to accelerated lung damage, which can be complicated by necrotizing pneumonia accompanied by high fevers, leucocytosis, and bacteraemia, which commonly causes fatal outcomes. Specifically, infection by Burkholderia cenocepacia is considered an exclusion criterion for lung transplantation. The species of Bcc exhibit both genetic and phenotypic hypervariability that complicate their accurate microbiological identification. Automated methods such as MALDI-TOF can err in the determination of species. Their slow growth even in selective agars and the absence of international consensuses on the optimal conditions for their isolation make early diagnosis a difficult challenge to overcome. The absence of correlations between antibiograms and clinical results has resulted in the absence of standardized cut-off values of antimicrobial susceptibility, a fact that brings a latent risk since incorrect antibiotic therapy can induce the selection of more aggressive variants that worsen the clinical picture of the host, added to the absence of a clear therapeutic guide for the eradication of pulmonary infections by Bcc in patients with CF, resulting in frequently ineffective treatments. There is an urgent need to standardize methods and diagnostic tools that would allow an early and accurate diagnosis, as well as to perform clinical studies of the effectiveness of available antibiotics to eradicate Bcc infections, which would allow us to establish standardized therapeutic schemes for Bcc-infected patients.

Optimizing Antibiotic Use: Addressing Resistance Through Effective Strategies and Health Policies

Background: Antimicrobial resistance (AMR) has emerged as a significant challenge to public health, posing a considerable threat to effective disease management on a global scale. The increasing incidence of infections caused by resistant bacteria has led to heightened morbidity and mortality rates, particularly among vulnerable populations. Main text: This review analyzes current strategies and health policies adopted in the European Union (EU) and Italy to manage AMR, presenting an in-depth examination of approaches for containment and mitigation. Factors such as excessive prescriptions, self-medication, and the misuse of antibiotics in livestock contribute to the selection and spread of resistant strains. Furthermore, this review provides a detailed overview of resistance mechanisms, including enzymatic inactivation, reduced permeability, efflux pump activity, and target site protection, with specific examples provided. The review underscores the urgent need to develop new antibiotics and implement diagnostic testing to ensure targeted prescriptions and effectively combat resistant infections. Current estimates indicate that AMR-related infections cause over 60,000 deaths annually in Europe and the United States, with projections suggesting a potential rise to 10 million deaths per year by 2050 if current trends are not reversed. The review also examines existing public health policies in Europe and Italy, focusing on national and regional strategies to combat AMR. These include promoting responsible antibiotic use, improving surveillance systems, and encouraging research and development of new therapeutic options. Conclusions: Finally, the review presents short- and long-term perspectives from the authors, suggesting actionable steps for policymakers and healthcare providers. Ultimately, a coordinated and multidisciplinary approach involving healthcare professionals, policymakers, and the public is essential to mitigate the impact of AMR and ensure the effectiveness of antibiotics for future generations.

Antibiotic prescribing for acute uncomplicated cystitis among community pharmacists in Thailand

OBJECTIVES

This study aimed to evaluate the knowledge of community pharmacists toward acute uncomplicated cystitis regarding diagnosis, referral, and conformity to guidelines of the chosen antibiotic and to identify the associated factors with the pharmacist's knowledge.

METHODS

This was a descriptive cross-sectional survey using a questionnaire. Data was collected from 349 community pharmacies in upper southern Thailand between December 2021 and February 2022. Univariate logistic regression analysis was used to assess factors associated with an inappropriate diagnosis of acute uncomplicated cystitis. The variables with P-value < 0.2 were included in the multivariate model. The statistically significant level was set as P-value < 0.05.

KEY FINDINGS

Three hundred and forty-nine pharmacists from 349 community pharmacies were included. Approximately 65% and 69% of the participants had the knowledge to identify which patients should be considered for cystitis and which patients should be considered for acute uncomplicated cystitis. Ninety eight percentage of pharmacists could select the appropriate antibiotic for uncomplicated cystitis patients. The most prescribed antibiotics were ciprofloxacin (44.7%), norfloxacin (40.7%), and ofloxacin (10.3%). Inappropriate diagnosis was significantly related to age (P = 0.016) and role in the community pharmacy (P = 0.033).

CONCLUSION

The majority of participants had misconceptions about the differential diagnosis between complicated and uncomplicated cystitis. These were related to the community pharmacists' advanced age. Continuous pharmacy education should be established to advocate rational antibiotic use, especially in a country where community pharmacists are legally allowed to dispense antimicrobials without a prescription.

Antimicrobial Resistance of Escherichia coli for Uncomplicated Cystitis: Korean Antimicrobial Resistance Monitoring System

Objectives: Uncomplicated cystitis is a leading form of bacterial UTI; the most common causative bacterium worldwide is Escherichia coli. This internet-based, prospective, multicenter, and national observational study aimed to report the antimicrobial resistance of E. coli in patients with uncomplicated cystitis through the use of the Korean Antimicrobial Resistance Monitoring System (KARMS) in 2023. Results: Data for a total of 654 patients were retrieved from the KARMS database. The mean (standard deviation) patient age was 55.9 (18.3) years. The numbers of postmenopausal women and patients with recurrent cystitis were 381 (59.4%) and 78 (11.9%), respectively. Regarding antimicrobial susceptibility, 96.8% were susceptible to fosfomycin, 98.9% to nitrofurantoin, 50.9% to ciprofloxacin, and 82.4% to cefotaxime. Extended-spectrum beta-lactamase positivity was 14.4% (89/616), and was significantly higher in tertiary hospitals (24.6%, p < 0.001) and recurrent cystitis (27.6%, p < 0.001). Fluoroquinolone resistance was significantly higher in tertiary hospitals (57.8%, p < 0.001), postmenopausal women (54.2%, p < 0.001), and recurrent cystitis (70.3%, p < 0.001). In addition, postmenopausal status (95% confidence interval [CI]: 1.44-3.17, odds ratio [OR] 2.13, p < 0.001), recurrent cystitis (95% CI: 1.40-4.66, OR 2.56, p = 0.002) and tertiary hospitals (95% CI: 1.00-2.93, OR 1.71, p = 0.049) were associated with significantly increased fluoroquinolone resistance. Methods: Any female patient diagnosed with clinical uncomplicated cystitis and microbiologically proven E. coli infection in 2023 was eligible for this study. Patient data were obtained from the web-based KARMS database. The antimicrobial susceptibility of E. coli was analyzed according to clinical factors, including hospital region, hospital type, menopause status, and recurrence status. Conclusions: The antimicrobial resistance of E. coli in patients with uncomplicated cystitis in the Republic of Korea has reached a serious level, especially in fluoroquinolone resistance. Therefore, major efforts should be made to reduce antimicrobial resistance.

In-Vitro Antimicrobial Activities of Grape Seed, Green Tea, and Rosemary Phenolic Extracts Against Liver Abscess Causing Bacterial Pathogens in Cattle

Liver abscesses, which occur in finishing cattle, are of significant economic concern to the feedlot industry. The causative agents include both Fusobacterium necrophorum subspecies (F. necrophorum and F. funduliforme), Trueperella pyogenes (T. pyogenes), and Salmonella enterica serotype Lubbock (S. Lubbock). Tylosin, a macrolide antibiotic, is supplemented in the feed to reduce liver abscesses. However, due to the concern with emergence of antimicrobial resistance, the antimicrobial activities of the plant-based phenolic compounds could be an antibiotic alternative to control liver abscesses. We investigated the inhibitory activities of phenolic compounds extracted from grape seed, green tea, and rosemary on liver-abscess-causing bacterial pathogens. Total phenolic content was determined spectrophotometrically. Anaerobic Brain-Heart Infusion broth (for Fusobacterium) and Muller-Hinton broth (for S. enterica and T. pyogenes) with phenolic extracts at 0, 0.1, 1, and 2 mg/mL were prepared. Growth was measured at 0, 12, 24 and 48 h by determining bacterial concentrations. A micro-broth dilution method was used to quantify the inhibition. Grape seed and green tea phenolics inhibited growth of both Fusobacterium subspecies, T. pyogenes and S. enterica. Green tea at 1 mg/mL concentration was more effective in inhibiting the growth of Fusobacterium when compared to grape seed and rosemary. Green tea at 2 mg/mL was more effective than at 1 mg/mL against Salmonella. The inhibitory effect was dose-dependent, which was consistent across all strains within the same bacterial species. The phenolic extracts were inhibitory against T. pyogenes with minimum inhibitory concentration ranging from 6.25 to 12.5 µg/mL. Among the phenolic extracts tested, green tea showed the most potent activity, suggesting its strong potential as a natural alternative to conventional antibiotics. Plant-based phenolic compounds supplemented in the feed may have the potential to control liver abscesses.

Polyvinyl alcohol-chitosan based oleanolic acid nanofibers against bacterial infection: In vitro studies and in vivo evaluation by optical and laser Doppler imaging modalities

The present work focuses on the fabrication of polyvinyl alcohol-chitosan-loaded oleanolic acid-nanofibers (PVA-CS-OLA-NFs) for bacterial infection. The prepared PVA-CS-OLA-NFs were characterized for contact angle, SEM, AFM, XRD, FTIR, and TGA. The solid-state characterization and in vitro performance evaluation of nanofibers reveal consistent interconnection and diameters ranging from 102 ± 9.5 to 386 ± 11.6 nm. The nanofibers have a flat surface topography and exhibit efficient drug entrapment. Moreover, the in vitro release profile of PVA-CS-OLA-NFs was found to be 51.82 ± 1.49 % at 24 h. Furthermore, the hemocompatibility study showed that the developed PVA-CS-OLA-NFs are non-hemolytic to human blood. The PVA-CS-OLA-NFs demonstrate remarkable antibacterial capabilities, as evidenced by their MBC and MIC values, which range from 128 and 32 μg/mL, against the strains of S. aureus. The in-vivo fluorescence optical imaging showed the sustained PVA-CS-OLA-NFs release at the wound site infected with S. aureus for a longer duration of time. Moreover, the PVA-CS-OLA-NFs showed superior wound healing performance against S. aureus infected wounds compared to the marketed formulation. Further, the laser Doppler imaging system improved oxygen saturation, blood supply, and wound healing by providing real-time blood flow and oxygen saturation information.

A comprehensive review of marine sponge metabolites, with emphasis on Neopetrosia sp

The secondary metabolites that marine sponges create are essential to the advancement of contemporary medicine and are often employed in clinical settings. Over the past five years, microbes associated with sponges have yielded the identification of 140 novel chemicals. Statistics show that most are derived from actinomycetes (bacteria) and ascomycotes (fungi). The aim of this study was to investigate the biological activity of metabolites from marine sponges. Chlocarbazomycins A-D, which are a group of novel chlorinated carbazole alkaloids isolated from the sponge Neopetrosia fennelliae KUFA 0811, exhibit antimicrobial, cytotoxic, and enzyme inhibitory activities. Recently, marine sponges of the genus Neopetrosia have attracted attention due to the unique chemical composition of the compounds they produce, including alkaloids of potential importance in drug discovery. Fridamycin H and fridamycin I are two novel type II polyketides synthesized by sponge-associated bacteria exhibit antitrypanosomal activity. Fintiamin, composed of amino acids and terpenoid moieties, shows affinity for the cannabinoid receptor CB 1. It was found that out of 27 species of Neopetrosia sponges, the chemical composition of only 9 species has been studied. These species mainly produce bioactive substances such as alkaloids, quinones, sterols, and terpenoids. The presence of motuporamines is a marker of the species Neopetrosia exigua. Terpenoids are specific markers of Neopetrosia vanilla species. Although recently discovered, secondary metabolites from marine sponges have been shown to have diverse biological activities, antimicrobial, antiviral, antibacterial, antimicrobial, antioxidant, antimalarial, and anticancer properties, providing many lead compounds for drug development. The data presented in this review on known and future natural products derived from sponges will further clarify the role and importance of microbes in marine sponges and trace the prospects of their applications, especially in medicine, cosmeceuticals, environmental protection, and manufacturing industries.

Food Webs and Feedbacks: The Untold Ecological Relevance of Antimicrobial Resistance as Seen in Harmful Algal Blooms

Antimicrobial resistance (AMR) has long been framed as an epidemiological and public health concern. Its impacts on the environment are unclear. Yet, the basis for AMR is altered cell physiology. Just as this affects how microbes interact with antimicrobials, it can also affect how they interact with their own species, other species, and their non-living environment. Moreover, if the microbes are globally notorious for causing landscape-level environmental issues, then these effects could alter biodiversity and ecosystem function on a grand scale. To investigate these possibilities, we compiled peer-reviewed literature from the past 20 years regarding AMR in toxic freshwater cyanobacterial harmful algal blooms (HABs). We examined it for evidence of AMR affecting HAB frequency, severity, or persistence. Although no study within our scope was explicitly designed to address the question, multiple studies reported AMR-associated changes in HAB-forming cyanobacteria (and co-occurring microbes) that pertained directly to HAB timing, toxicity, and phase, as well as to the dynamics of HAB-afflicted aquatic food webs. These findings highlight the potential for AMR to have far-reaching environmental impacts (including the loss of biodiversity and ecosystem function) and bring into focus the importance of confronting complex interrelated issues such as AMR and HABs in concert, with interdisciplinary tools and perspectives.

In vitro and in vivo assessment of the competence of a novel lytic phage vB_EcoS_UTEC10 targeting multidrug resistant Escherichia coli with a robust biofilm eradication activity

Escherichia coli (E. coli) is a leading cause of human infections worldwide and is considered a major cause of nosocomial infections, sepsis, meningitis and diarrhea. Lately, there has been an alarming increase in the incidence of antimicrobial resistance among clinical E. coli isolates. In the current study, a novel bacteriophage (phage) vB_EcoS_UTEC10 was isolated and characterized. The isolated phage showed high stability over wide temperature and pH ranges beside its promising bacteriolytic activity against multidrug resistant (MDR) E. coli isolates. In addition, vB_EcoS_UTEC10 showed a marked antibiofilm capability against mature E. coli biofilms. Genomic investigation revealed that vB_EcoS_UTEC10 has a double stranded DNA genome that consists of 44,772 bp comprising a total of 73 open reading frames (ORFs), out of which 35 ORFs were annotated as structural or functional proteins, and none were related to antimicrobial resistance or lysogeny. In vivo investigations revealed a promising bacteriolytic activity of vB_EcoS_UTEC10 against MDR E. coli which was further supported by a significant reduction in bacterial load in specimens collected from the phage-treated mice. Histopathology examination demonstrated minimal signs of inflammation and necrosis in the tissues of phage-treated mice compared to the degenerative tissue damage observed in untreated mice. In summary, the present findings suggest that vB_EcoS_UTEC10 has a remarkable ability to eradicate MDR E. coli infections and biofilms. These findings could be further invested for the development of targeted phage therapies that offer a viable alternative to traditional antibiotics against resistant E. coli.

Screening of Novel Drug Targets and Drug Design for Bordetella pertussis: A Subtractive Proteomics Approach

Bordetella pertussis causes whooping cough in humans that spreads directly from individual to individual mainly by aerosolized respiratory droplets. Nowadays, it gained the attention of scientific community because it has already been reemerged as one of the major public health threats despite widespread vaccination efforts. Moreover, the growing antibiotic resistance has made it difficult to combat this pathogen with currently available antibiotics. Consequently, screening drug targets and discovering drugs against unique proteins of the pathogen could be a promising alternative. With this view, 3,359 proteins of B. pertussis were screened in silico to identify non-duplicate proteins crucial for survival of the bacteria, non-homologous to humans, involved in unique metabolic pathways of the pathogen, and conserved among various bacterial strains. Among these, Chemotaxis protein Mota, Chromosomal replication initiator protein DnaA, Short-chain fatty acids transporter, [protein-PII] uridylyltransferase, Type III secretion protein V, Potassium-transporting ATPase potassium-binding subunit, N-acetylmuramoyl-L-alanine amidase, and RNA polymerase sigma-54 factor fulfilled these criteria. These proteins were further analyzed for qualitative characteristics such as virulence properties and associations with antibiotic resistance, etc. In addition, plant metabolites were screened against these unique proteins utilizing molecular docking to discover putative drugs against them. Four metabolites exhibited superior binding affinity and favorable ADME (Adsorption, distribution, metabolism, and excretion) properties which can further be tested in vivo.

Pharmacology of spinal interventions: review of agents used in spine pain procedures

Spine procedures are commonly performed to diagnose and treat various spinal conditions, ranging from degenerative disc disease to vertebral fractures. These procedures often involve the use of pharmaceutical agents to enhance the efficacy of the intervention and improve patient outcomes. This review provides an overview of the pharmaceuticals commonly utilized in spine procedures, including corticosteroids, anesthetics, antibiotics, radiographic contrast, neurolytic agents, and materials used in kyphoplasty and vertebroplasty. This review summarizes the utilization of these pharmaceutical agents in spine procedures in an effort to optimize patient outcomes. Understanding the pharmacological properties and appropriate uses of these pharmaceuticals is essential for interventionalist and healthcare providers involved in the care of patients undergoing spinal interventions.

The Central Role of the Global Emerging Infections Surveillance Program in Supporting Force Health Protection

The Global Emerging Infections Surveillance (GEIS) program is the only Department of Defense (DoD) organization that coordinates global surveillance for emerging infectious diseases that affect US military forces operating in the United States or foreign locations. Since 1997, the GEIS program has focused on surveilling pathogens likely to affect military operations and the health of service members. The foundation of the GEIS program is the long-standing, mutually beneficial relationships between the DoD overseas laboratories and their host-country partners and militaries. Through centralized programmatic support, the GEIS program provides the infrastructure needed for a rapid and scalable response to emerging threats. The GEIS program continues to enhance and evolve its initiatives to provide timely, reliable information to decision-makers in the DoD. The GEIS program has been and will continue to be a vital source of actionable biosurveillance information during infectious disease events of global public health concern.

Engineered Bacteriophage-Polymer Nanoassemblies for Treatment of Wound Biofilm Infections

The antibacterial efficacy and specificity of lytic bacteriophages (phages) make them promising therapeutics for treatment of multidrug-resistant bacterial infections. Restricted penetration of phages through the protective matrix of biofilms, however, may limit their efficacy against biofilm infections. Here, engineered polymers were used to generate noncovalent phage-polymer nanoassemblies (PPNs) that penetrate bacterial biofilms and kill resident bacteria. Phage K, active against multiple strains of Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), was assembled with cationic poly(oxanorbornene) polymers into PPNs. The PPNs retained phage infectivity, while demonstrating enhanced biofilm penetration and killing relative to free phages. PPNs achieved 3-log10 bacterial reduction (∼99.9%) against MRSA biofilms in vitro. PPNs were then incorporated into Poloxamer 407 (P407) hydrogels and applied onto in vivo wound biofilms, demonstrating controlled and sustained release. Hydrogel-incorporated PPNs were effective in a murine MRSA wound biofilm model, showing a 1.5-log10 reduction in bacterial load compared to a 0.5 log reduction with phage K in P407 hydrogel. Overall, this work showcases the therapeutic potential of phage K engineered with cationic polymers for treating wound biofilm infections.

Treatment of Acute Sore Throat in Malaysia: A Consensus of Multidisciplinary Recommendations Using Modified Delphi Methodology

Introduction

Using antibiotics in the treatment of acute sore throats has been linked with antimicrobial resistance (AMR) and needs to be addressed. The consensus sought to improve diagnostic accuracy, decrease unwarranted antibiotic prescriptions and enhance patient outcomes.

Methods

A multidisciplinary panel of nine experts reviewed published literature and discussed current practices in managing sore throat. Ten evidence-based statements on sore throat and AMR, diagnostic accuracy and antibiotic prescribing, and symptomatic therapy were developed. A modified Delphi exercise was then carried out. A consensus was reached if at least 70% of the group agreed with the statement.

Results

All 10 statements for managing acute sore throat achieved consensus. The major concern of AMR caused by improper antibiotic prescribing, particularly in cases of viral sore throat, was recognized. This underscores the need for improved diagnostic tools, such as the McIsaac score, to reduce needless antibiotic prescriptions. To improve patient satisfaction, effective pain management using non-antibiotic alternatives such as paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), and flurbiprofen throat lozenges was recommended. Pain and inflammation can be adequately managed with low-dose NSAIDs. The potential benefits of topical NSAIDs were acknowledged for their milder safety profile than oral formulations.

Conclusion

A consensus was achieved on the use of a clinical diagnostic tool, prudent use of antibiotics, and symptomatic therapy in acute sore throat management. The McIsaac score and point-of-care testing (POCT) for the presence of group A beta-hemolytic Streptococcus (GABHS) can aid in the decision-making process for antibiotic use, reducing needless prescriptions. The mainstay of therapy is symptomatic treatment, which includes the use of NSAIDs.

Understanding of probiotic origin antimicrobial peptides: a sustainable approach ensuring food safety

The practice of preserving and adding value to food dates back to over 10,000 BCE, when unintentional microbial-driven chemical reactions imparted flavor and extended the shelf life of fermented foods. The process evolved, and with the urbanization of society, significant shifts in dietary habits emerged, accompanied by sporadic food poisoning incidents. The repercussions of the COVID-19 pandemic have intensified the search for antibiotic alternatives owing to the rise in antibiotic-resistant pathogens, emphasizing the exploration of probiotic-origin antimicrobial peptides to alleviate human microbiome collateral damage. Often termed 'molecular knives', these peptides outstand as potent antimicrobials due to their compatibility with innate microflora, amenability to bioengineering, target specificity, versatility and rapidity in molecular level mode of action. This review centres on bacteriocins sourced from lactic acid bacteria found in ethnic fermented foods, accentuating their desirable attributes, technological applications as nanobiotics and potential future applications in the modern context of ensuring food safety.

UNAM-HIMFG Bacterial Lysate Activates the Immune Response and Inhibits Colonization of Bladder of Balb/c Mice Infected with the Uropathogenic CFT073 Escherichia coli Strain

Urinary tract infections (UTIs) represent a clinical and epidemiological problem of worldwide impact that affects the economy and the emotional state of the patient. Control of the condition is complicated due to multidrug resistance of pathogens associated with the disease. Considering the difficulty in carrying out effective treatment with antimicrobials, it is necessary to propose alternatives that improve the clinical status of the patients. With this purpose, in a previous study, the safety and immunostimulant capacity of a polyvalent lysate designated UNAM-HIMFG prepared with different bacteria isolated during a prospective study of chronic urinary tract infection (CUTI) was evaluated. In this work, using an animal model, results are presented on the immunostimulant and protective activity of the polyvalent UNAM-HIMFG lysate to define its potential use in the control and treatment of CUTI. Female Balb/c mice were infected through the urethra with Escherichia coli CFT073 (UPEC O6:K2:H1) strain; urine samples were collected before the infection and every week for up to 60 days. Once the animals were colonized, sublingual doses of UNAM-HIMFG lysate were administrated. The colonization of the bladder and kidneys was evaluated by culture, and their alterations were assessed using histopathological analysis. On the other hand, the immunostimulant activity of the compound was analyzed by qPCR of spleen mRNA. Uninfected animals receiving UNAM-HIMFG lysate and infected animals administered with the physiological saline solution were used as controls. During this study, the clinical status and evolution of the animals were evaluated. At ninety-six hours after infection, the presence of CFT073 was identified in the urine of infected animals, and then, sublingual administration of UNAM-HIMFG lysate was started every week for 60 days. The urine culture of mice treated with UNAM-HIMFG lysate showed the presence of bacteria for three weeks post-treatment; in contrast, in the untreated animals, positive cultures were observed until the 60th day of this study. The histological analysis of bladder samples from untreated animals showed the presence of chronic inflammation and bacteria in the submucosa, while tissues from mice treated with UNAM-HIMFG lysate did not show alterations. The same analysis of kidney samples of the two groups (treated and untreated) did not present alterations. Immunostimulant activity assays of UNAM-HIMFG lysate showed overexpression of TNF-α and IL-10. Results suggest that the lysate activates the expression of cytokines that inhibit the growth of inoculated bacteria and control the inflammation responsible for tissue damage. In conclusion, UNAM-HIMFG lysate is effective for the treatment and control of CUTIs without the use of antimicrobials.

Knowledge, attitude, and practices of pharmacy students in 7 Middle Eastern countries concerning antibiotic resistance: A cross-sectional study

Addressing antimicrobial resistance (AMR) stands as a major global health challenge threatening humanity. Resolving this issue can be initiated through emphasizing the significance of AMR education among students in health colleges during their undergraduate studies. Hence, the aim of this study is to assess the pharmacy students' knowledge, attitudes, and practices regarding antibiotic resistance in 7 Middle Eastern countries. A cross-sectional study was conducted among undergraduate pharmacy students at universities in Egypt, Jordan, Saudi Arabia, Lebanon, the United Arab Emirates, Qatar, and Kuwait between March 2021 and January 2022. The first section of the questionnaire gathered demographic information. The knowledge section comprised 7 questions. Subsequently, the questionnaire explored participants' attitudes (6 items) and practices (2 items) concerning antibiotic resistance. Mann-Whitney and Kruskal-Wallis tests were used to compare the median knowledge score between different demographic groups. Logistic regression was used to estimate odds ratios, with 95% confidence intervals (CIs) for being more knowledgeable about antibiotic resistance. A 2-sided P < .05 was considered statistically significant. A total of 4265 pharmacy students were involved in this study (Egypt (2249), Jordan (n = 704), Saudi Arabia (n = 531), Lebanon (n = 401), United Araba Emirates (n = 130), Qatar (n = 129), and Kuwait (n = 121)). The median knowledge score for the participating pharmacy students was 5.00 (IQR = 4.00-6.00) out of 7, equals to 71.4% with 4th, and 5th year students and bachelor of pharmacy program students have higher odds of being more knowledgeable about antibiotics resistance compared to other students (P < .05). The majority of the students agreed that antibiotic resistance is increasing, they should be more concerned regarding antibiotic consumption and that government should create more awareness of antibiotic resistance, and that they should have enough knowledge to prevent antibiotic resistance. Around 3 quarters of the students (73.0%) confirmed that they take antibiotic only after getting prescription from their physician and almost half (51.7%) reported that they take antibiotic to manage their fever. The study concluded good educational programs in Middle East pharmacy schools with the need for targeted educational interventions promoting responsible antibiotic stewardship practices among future pharmacists.

Cost-Effectiveness of Test-and-Treat Strategies to Reduce the Antibiotic Prescription Rate for Acute Febrile Illness in Primary Healthcare Clinics in Africa

BACKGROUND

Inappropriate antibiotic use increases selective pressure, contributing to antimicrobial resistance. Point-of-care rapid diagnostic tests (RDTs) would be instrumental to better target antibiotic prescriptions, but widespread implementation of diagnostics for improved management of febrile illnesses is limited.

OBJECTIVE

Our study aims to contribute to evidence-based guidance to inform policymakers on investment decisions regarding interventions that foster more appropriate antibiotic prescriptions, as well as to address the evidence gap on the potential clinical and economic impact of RDTs on antibiotic prescription.

METHODS

A country-based cost-effectiveness model was developed for Burkina Faso, Ghana and Uganda. The decision tree model simulated seven test strategies for patients with febrile illness to assess the effect of different RDT combinations on antibiotic prescription rate (APR), costs and clinical outcomes. The incremental cost-effectiveness ratio (ICER) was expressed as the incremental cost per percentage point (ppt) reduction in APR.

RESULTS

For Burkina Faso and Uganda, testing all patients with a malaria RDT was dominant compared to standard-of-care (SoC) (which included malaria testing). Expanding the test panel with a C-reactive protein (CRP) test resulted in an ICER of $ 0.03 and $ 0.08 per ppt reduction in APR for Burkina Faso and Uganda, respectively. For Ghana, the pairwise comparison with SoC-including malaria and complete blood count testing-indicates that both testing with malaria RDT only and malaria RDT + CRP are dominant.

CONCLUSION

The use of RDTs for patients with febrile illness could effectively reduce APR at minimal additional costs, provided diagnostic algorithms are adhered to. Complementing SoC with CRP testing may increase clinicians' confidence in prescribing decisions and is a favourable strategy.

Development of an effective meropenem/KPC-2 inhibitor combination to combat infections caused by carbapenem-resistant Klebsiella pneumoniae

The global public health threat of antibiotic resistance continues to escalate, and necessitates the implementation of urgent measures to expand the arsenal of antimicrobial drugs. This study identified a benzoxaborane compound, namely 5-chloro-1,3-dihydro-1-hydroxy-2,1-benzoxaborole (AN2178), which can inhibit the catalytic activity of the Klebsiella pneumoniae carbapenemase (KPC-2) enzyme effectively. The efficacy of AN2718 as an inhibitor for the KPC-2 enzyme was verified through various assays, including enzyme activity assays and isothermal titration calorimetry. Results of multiple biochemical assays, minimum inhibitory concentration assays and time-killing assays also showed that binding of AN2718 to KPC-2 enabled restoration of the bactericidal effect of meropenem. The survival rate of mice infected with carbapenem-resistant, high-virulence strains increased significantly upon treatment with AN2718. Most importantly, the meropenem and AN2718 combination was effective on KPC-2 mutations such as KPC-33, which evolved clinically and exhibited resistance to ceftazidime-avibactam after clinical use for a couple of years. Comprehensive safety tests both in vitro and in vivo, such as cytotoxicity, haemolytic activity and cytochrome P450 inhibition assays, demonstrated that AN2718 was safe for clinical use. These promising data indicate that AN2718 has high potential for approval for the treatment of drug resistant-bacterial infections, including those caused by ceftazidime-avibactam-resistant strains. AN2718 can be regarded as a valuable addition to the current antimicrobial armamentarium, and a promising tool to combat antimicrobial resistance.

Trends in the Prevalence of Antimicrobial Resistance in Escherichia coli Isolated from Outpatient Urine Cultures in French Amazonia

Antimicrobial resistance (AMR) in the community is increasing worldwide. We aimed to assess AMR trends in Escherichia coli from the community urine isolates in French Amazonia. We conducted a retrospective study from January 2016 to December 2022 in the Cayenne General Hospital microbiology laboratory (French Guiana). It included all urine samples positive for E. coli collected from adult outpatients. During the study period, 3,443 urinalyses positive for E. coli were studied. In 46% of cases, patients were women. In 64.4% of cases, E. coli were β-lactamase producers. The most frequently diagnosed resistance mechanisms were penicillinase production and sparing third-generation cephalosporins. Isolated E. coli were extended-spectrum β-lactamase (ESBL) producers in 6.1% of cases. Overall, E. coli was susceptible to amoxicillin in 35.9% [95% CI: 34.3-37.5], to amoxicillin/clavulanic acid in 62.2% [95% CI: 60.6-63.9], to cefotaxime in 94% [95% CI: 93.1-94.7], to gentamicin in 92.1% [95% CI: 89.1-92.6], to ofloxacin in 76.8% [95% CI: 75.3-78.2], to trimethoprim/sulfamethoxazole (SXT) in 58.8% [95% CI: 57.1-60.5], to fosfomycin in 99.1% [95% CI: 98.6-99.4], and to nitrofurantoin in 99% of cases [95% CI: 98.6-99.3]. We have observed a gradual decline in the susceptibility profile of E. coli for amoxicillin/clavulanic acid (P <0.001), piperacillin/tazobactam (P = 0.003), and temocillin (P = 0.006). However, susceptibility to ciprofloxacin was increasing (P = 0.001). In contrast, the susceptibility trends for amoxicillin, third-generation cephalosporins, gentamicin, SXT, nitrofurantoin, and fosfomycin remained stable over the 28 quarters of the study. In conclusion, isolated E. coli from outpatient urinalyses showed increased resistance profiles involving penicillinase and ESBL production. Close monitoring and strategies to decrease antibiotic consumption in the community are needed.

Effective Immobilization of Novel Antimicrobial Peptides via Conjugation onto Activated Silicon Catheter Surfaces

Antibiotic-resistant microorganisms have become a serious threat to public health, resulting in hospital infections, the majority of which are caused by commonly used urinary tract catheters. Strategies for preventing bacterial adhesion to the catheters' surfaces have been potentially shown as effective methods, such as coating thesurface with antimicrobial biomolecules. Here, novel antimicrobial peptides (AMPs) were designed as potential biomolecules to prevent antibiotic-resistant bacteria from binding to catheter surfaces. Thiolated AMPs were synthesized using solid-phase peptide synthesis (SPPS), and prep-HPLC was used to obtain AMPs with purity greater than 90%. On the other side, the silicone catheter surface was activated by UV/ozone treatment, followed by functionalization with allyl moieties for conjugation to the free thiol group of cystein in AMPs using thiol-ene click chemistry. Peptide-immobilized surfaces were found to become more resistant to bacterial adhesion while remaining biocompatible with mammalian cells. The presence and site of conjugation of peptide molecules were investigated by immobilizing them to catheter surfaces from both ends (C-Pep and Pep-C). It was clearly demonstrated that AMPs conjugated to the surface via theirN terminus have a higher antimicrobial activity. This strategy stands out for its effective conjugation of AMPs to silicone-based implant surfaces for the elimination of bacterial infections.

Electrically polarized nanoscale surfaces generate reactive oxygenated and chlorinated species for deactivation of microorganisms

Because of the decreasing supply of new antibiotics, recent outbreaks of infectious diseases, and the emergence of antibiotic-resistant microorganisms, it is imperative to develop new effective strategies for deactivating a broad spectrum of microorganisms and viruses. We have implemented electrically polarized nanoscale metallic (ENM) coatings that deactivate a wide range of microorganisms including Gram-negative and Gram-positive bacteria with greater than 6-log reduction in less than 10 minutes of treatment. The electrically polarized devices were also effective in deactivating lentivirus and Candida albicans. The key to the high deactivation effectiveness of ENM devices is electrochemical production of micromolar cuprous ions, which mediated reduction of oxygen to hydrogen peroxide. Formation of highly damaging species, hydroxyl radicals and hypochlorous acid, from hydrogen peroxide contributed to antimicrobial properties of the ENM devices. The electric polarization of nanoscale coatings represents an unconventional tool for deactivating a broad spectrum of microorganisms through in situ production of reactive oxygenated and chlorinated species.

Antibiotic resistance and nanotechnology: A narrative review

The rise of antibiotic resistance poses a significant threat to public health worldwide, leading researchers to explore novel solutions to combat this growing problem. Nanotechnology, which involves manipulating materials at the nanoscale, has emerged as a promising avenue for developing novel strategies to combat antibiotic resistance. This cutting-edge technology has gained momentum in the medical field by offering a new approach to combating infectious diseases. Nanomaterial-based therapies hold significant potential in treating difficult bacterial infections by circumventing established drug resistance mechanisms. Moreover, their small size and unique physical properties enable them to effectively target biofilms, which are commonly linked to resistance development. By leveraging these advantages, nanomaterials present a viable solution to enhance the effectiveness of existing antibiotics or even create entirely new antibacterial mechanisms. This review article explores the current landscape of antibiotic resistance and underscores the pivotal role that nanotechnology plays in augmenting the efficacy of traditional antibiotics. Furthermore, it addresses the challenges and opportunities within the realm of nanotechnology for combating antibiotic resistance, while also outlining future research directions in this critical area. Overall, this comprehensive review articulates the potential of nanotechnology in addressing the urgent public health concern of antibiotic resistance, highlighting its transformative capabilities in healthcare.

Phage therapy combats pan drug-resistant Acinetobacter baumannii infection safely and efficiently

Phage therapy offers a promising approach to combat the growing threat of antimicrobial resistance. Yet, key questions remain regarding dosage, administration routes, combination therapy, and the causes of therapeutic failure. In this study, we focused on a novel lytic phage, ФAb4B, which specifically targeted the Acinetobacter baumannii strains with KL160 capsular polysaccharide, including the pan-drug resistant A. baumannii YQ4. ФAb4B exhibited the ability to effectively inhibit biofilm formation and eradicate mature biofilms independently of dosage. Additionally, it demonstrated a wide spectrum of antibiotic-phage synergy and did not show any cytotoxic or haemolytic effects. Continuous phage injections, both intraperitoneally and intravenously over 7 d, showed no acute toxicity in vivo. Importantly, phage therapy significantly improved neutrophil counts, outperforming ciprofloxacin. However, excessive phage injections suppressed neutrophil levels. The combinatorial treatment of phage-ciprofloxacin rescued 91% of the mice, a superior outcome compared to phage alone (67%). The efficacy of the combinatorial treatment was independent of phage dosage. Notably, prophylactic administration of the combinatorial regimen provided no protection, but even when combined with a delayed therapeutic regimen, it saved all the mice. Bacterial resistance to the phage was not a contributing factor to treatment failure. Our preclinical study systematically describes the lytic phage's effectiveness in both in vitro and in vivo settings, filling in crucial details about phage treatment against bacteriemia caused by A. baumannii, which will provide a robust foundation for the future of phage therapy.

From Data to Decisions: Leveraging Artificial Intelligence and Machine Learning in Combating Antimicrobial Resistance - a Comprehensive Review

The emergence of drug-resistant bacteria poses a significant challenge to modern medicine. In response, Artificial Intelligence (AI) and Machine Learning (ML) algorithms have emerged as powerful tools for combating antimicrobial resistance (AMR). This review aims to explore the role of AI/ML in AMR management, with a focus on identifying pathogens, understanding resistance patterns, predicting treatment outcomes, and discovering new antibiotic agents. Recent advancements in AI/ML have enabled the efficient analysis of large datasets, facilitating the reliable prediction of AMR trends and treatment responses with minimal human intervention. ML algorithms can analyze genomic data to identify genetic markers associated with antibiotic resistance, enabling the development of targeted treatment strategies. Additionally, AI/ML techniques show promise in optimizing drug administration and developing alternatives to traditional antibiotics. By analyzing patient data and clinical outcomes, these technologies can assist healthcare providers in diagnosing infections, evaluating their severity, and selecting appropriate antimicrobial therapies. While integration of AI/ML in clinical settings is still in its infancy, advancements in data quality and algorithm development suggest that widespread clinical adoption is forthcoming. In conclusion, AI/ML holds significant promise for improving AMR management and treatment outcome.

Complex Hospital-Based Electronic Prescribing-Based Intervention to Support Antimicrobial Stewardship: Qualitative Study

BACKGROUND

Antimicrobial resistance (AMR) represents a growing concern for public health.

OBJECTIVE

We sought to explore the challenges associated with development and implementation of a complex intervention designed to improve AMS in hospitals.

METHODS

We conducted a qualitative evaluation of a complex AMS intervention with educational, behavioral, and technological components in 5 wards of an English hospital. At 2 weeks and 7 weeks after initiating the intervention, we interviewed 25 users of the intervention, including senior and junior prescribers, a senior nurse, a pharmacist, and a microbiologist. Topics discussed included perceived impacts of different elements of the intervention and facilitators and barriers to effective use. Interviews were supplemented by 2 observations of ward rounds to gain insights into AMS practices. Data were audio-recorded, transcribed, and inductively and deductively analyzed thematically using NVivo12.

RESULTS

Tracing the adoption and impact of the various components of the intervention was difficult, as it had been introduced into a setting with competing pressures. These particularly affected behavioral and educational components (eg, training, awareness-building activities), which were often delivered ad hoc. We found that the participatory intervention design had addressed typical use cases but had not catered for edge cases that only became visible when the intervention was delivered in real-world settings (eg, variations in prescribing workflows across different specialties and conditions).

CONCLUSIONS

Effective user-focused design of complex interventions to promote AMS can support acceptance and use. However, not all requirements and potential barriers to use can be fully anticipated or tested in advance of full implementation in real-world settings.

Point prevalence survey of antibiotics use among hospitalised neonates and children in Saudi Arabia: findings and implications

Background

Neonates and children are more susceptible to a variety of infections, leading to frequent antibiotic prescriptions. However, the inappropriate use of antibiotics leads to antibiotic resistance and higher mortality rates. Therefore, this study aimed to determine the prevalence of antibiotic use, and current antibiotic prescribing practices among neonates and children admitted in the selected hospitals of Saudi Arabia.

Methods

A cross-sectional study was conducted from September to November 2023 to assess the prevalence of antibiotic use, and the current antibiotic prescribing practices across six hospitals of Saudi Arabia.

Results

The study included 499 children and neonates, with 94.6% receiving antibiotic prescriptions. The most frequently prescribed antibiotic class was third-generation cephalosporin (31.5%), with ceftriaxone being the most commonly prescribed antibiotic (15%). The majority of patients were prescribed one antibiotic (81.4%), and the intravenous route (96.4%) was the primary route for administration. The majority of patients were prescribed antibiotics empirically (69.7%), and community-acquired infections (64.2%) were the most common type of infection for antibiotic prescription. Similarly, sepsis (39.2%) was the most common indication for antibiotics, and the majority of prescribed antibiotics (61.7%) belonged to the 'Watch' category as per WHO AWaRe classification.

Conclusion

Our study revealed excessive antibiotic consumption in neonates and children, therefore quality improvement programmes including antimicrobial stewardship programmes are urgently needed to address ongoing issues.

Metal Nanoparticle-Based Biosensors for the Early Diagnosis of Infectious Diseases Caused by ESKAPE Pathogens in the Fight against the Antimicrobial-Resistance Crisis

The species included in the ESKAPE group (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and the genus Enterobacter) have a high capacity to develop antimicrobial resistance (AMR), a health problem that is already among the leading causes of death and could kill 10 million people a year by 2050. The generation of new potentially therapeutic molecules has been insufficient to combat the AMR "crisis", and the World Health Organization (WHO) has stated that it will seek to promote the development of rapid diagnostic strategies. The physicochemical properties of metallic nanoparticles (MNPs) have made it possible to design biosensors capable of identifying low concentrations of ESKAPE bacteria in the short term; other systems identify antimicrobial susceptibility, and some have been designed with dual activity in situ (bacterial detection and antimicrobial activity), which suggests that, in the near future, multifunctional biosensors could exist based on MNPs capable of quickly identifying bacterial pathogens in clinical niches might become commercially available. This review focuses on the use of MNP-based systems for the rapid and accurate identification of clinically important bacterial pathogens, exhibiting the necessity for exhaustive research to achieve these objectives. This review focuses on the use of metal nanoparticle-based systems for the rapid and accurate identification of clinically important bacterial pathogens.

Secondary metabolite profile of Streptomyces spp. changes when grown with the sub-lethal concentration of silver nanoparticles: possible implication in novel compound discovery

The decline of new antibiotics and the emergence of multidrug resistance in pathogens necessitates a revisit of strategies used for lead compound discovery. This study proposes to induce the production of bioactive compounds with sub-lethal concentrations of silver nanoparticles (Ag-NPs). A total of Forty-two Actinobacteria isolates from four Saudi soil samples were grown with and without sub-lethal concentration of Ag-NPs (50 µg ml-1). The spent broth grown with Ag-NPs, or without Ag-NPs were screened for antimicrobial activity against four bacteria. Interestingly, out of 42 strains, broths of three strains grown with sub-lethal concentration of Ag-NPs exhibit antimicrobial activity against Staphylococcus aureus and Micrococcus luteus. Among these, two strains S4-4 and S4-21 identified as Streptomyces labedae and Streptomyces tirandamycinicus based on 16S rRNA gene sequence were selected for detailed study. The change in the secondary metabolites profile in the presence of Ag-NPs was evaluated using GC-MS and LC-MS analyses. Butanol extracts of spent broth grown with Ag-NPs exhibit strong antimicrobial activity against M. luteus and S. aureus. While the extracts of the controls with the same concentration of Ag-NPs do not show any activity. GC-analysis revealed a clear change in the secondary metabolite profile when grown with Ag-NPs. Similarly, the LC-MS patterns also differ significantly. Results of this study, strongly suggest that sub-lethal concentrations of Ag-NPs influence the production of secondary metabolites by Streptomyces. Besides, LC-MS results identified possible secondary metabolites, associated with oxidative stress and antimicrobial activities. This strategy can be used to possibly induce cryptic biosynthetic gene clusters for the discovery of new lead compounds.

The resistome of the food chain: A One Health perspective

Antimicrobial resistance (AMR) represents a significant global health problem which challenges Sustainable Development Goal 3 of the United Nations, with growing concerns about the possibility of AMR transmission through the food chain. The indiscriminate use of antimicrobials for the treatment of food production animals and for agricultural crop improvement, in addition to the direct discharge of livestock farm residues to sewage and the use of animal manure in agriculture, are among the factors that can facilitate the selection and transmission of AMR throughout the food chain. The study of food microbiomes has been boosted by the advent of next-generation sequencing techniques, which have enabled gaining in-depth understanding of the diversity of antimicrobial resistance genes present in food and associated environments (the so-called resistome). The aim of this review is to provide an accurate and comprehensive overview of the knowledge currently available on the resistome of the most frequently consumed foods worldwide, from a One Health perspective. To this end, the different metagenomic studies which have been conducted to characterize the resistome of foods are compiled and critically discussed.

Infection on Frail Patients in the Intensive Care Unit: Insights From the PalMuSIC Study

BACKGROUND

Along with population aging, frailty is also increasingly common in the intensive care unit (ICU). However, the impact of frailty on the infection incidence, the risk of multidrug-resistant (MDR) microorganisms, and the potential benefits of broad-spectrum antibiotics are still poorly studied.

METHODS

This is a multicentric, prospective, observational study collecting data for 15 consecutive days of all consecutive adult patients admitted in each participating ICU. Exclusion criteria included admission for less than 24 hours or failure to obtain informed consent. The Clinical Frailty Score (CFS) was calculated both by the doctor and by the nurse in charge, and the patient's next of kin. Patients were considered frail if the mean of the three measured scores was ≥5. This is a post hoc analysis of the PALliative MUlticenter Study in Intensive Care (PalMuSIC) study. The Hospital de Vila Franca de Xira Ethics Committee approved the study (approval number: 63).

RESULTS

A total of 335 patients from 23 Portuguese ICUs were included. Frailty was diagnosed in 20.9%. More than 60% of the patients had a diagnosis of infection during their ICU stay, either present on admission or hospital-acquired. This included 25 (35.7%) frail and 75 (28.3%) non-frail (p=0.23) patients diagnosed with infection. In 34 patients, MDR microorganisms were isolated, which were more common in frail patients (odds ratio (OR): 2.65, 95% confidence interval (CI): 1.3-5.6, p=0.018). Carbapenems were started in 37 (18.1%) patients, but after adjusting for frailty and severity, no clear mortality benefit of this strategy was noted (odds ratio for ICU mortality: 1.61, 95% confidence interval: 0.49-5.31, p=0.43; odds ratio for hospital mortality: 1.61, 95% confidence interval: 0.61-4.21, p=0.33).

CONCLUSION

Frail patients had similar rates of infection to non-frail patients but were more prone to have MDR microorganisms as causative pathogens. The use of empirical therapy with large-spectrum antibiotics should be based on microbiological risk factors and not simply on the host characteristics.

Resistome in a changing environment: Hotspots and vectors of spreading with a focus on the Russian-Ukrainian War

This work aims to shed light on the key factors contributing to the development of environmental resistance and the urgent need to address the growing problem of antibiotic resistance (AR) under the Russian-Ukrainian conflict. The article provides an overview of the main mechanisms involved in AR development and dissemination globally and the challenges posed by the ongoing war in Ukraine. The work outlines various international initiatives to reduce AR, including the concept of "One Health" and the strategies established, which are the key to reducing the effects on public health. Addressing AR globally and in conflict areas requires a comprehensive approach. This involves implementing monitoring of the microorganism's resistance levels to antibiotics, controlling the use of antimicrobial drugs, increasing public awareness of the AR, introducing educational programs to prevent the improper use of antibiotics, and adopting environmentally safe methods for the disposal of waste from medical, food, and other industries that produce or use antibiotics. Such initiatives are essential for promoting the responsible use of antibiotics, preventing the spread of AR infections, and preserving the effectiveness of existing antimicrobial drugs.

Dual pH- and ATP-Responsive Antibacterial Nanospray: On-Demand Release of Antibacterial Factors, Imaging Monitoring, and Accelerated Healing of Bacteria-Infected Wounds under NIR Activation

The prevalence of pathogenic bacterial infections with high morbidity and mortality poses a widespread challenge to the healthcare system. Therefore, it is imperative to develop nanoformulations capable of adaptively releasing antimicrobial factors and demonstrating multimodal synergistic antimicrobial activity. Herein, an NIR-activated multifunctional synergistic antimicrobial nanospray MXene/ZIF-90@ICG was prepared by incorporating ZIF-90@ICG nanoparticles onto MXene-NH2 nanosheets. MXene/ZIF-90@ICG can on-demand release the antimicrobial factors MXenes, ICG, and Zn2+ in response to variations in pH and ATP levels within the bacterial infection microenvironment. Under NIR radiation, the combination of MXenes, Zn2+, and ICG generated a significant amount of ROS and elevated heat, thereby enhancing the antimicrobial efficacy of PDT and PTT. Meanwhile, NIR excitation could accelerate the further release of ICG and Zn2+, realizing the multimodal synergistic antibacterial effect of PDT/PTT/Zn2+. Notably, introducing MXenes improved the dispersion of the synthesized antimicrobial nanoparticles in aqueous solution, rendering MXene/ZIF-90@ICG a candidate for application as a nanospray. Importantly, MXene/ZIF-90@ICG demonstrated antimicrobial activity and accelerated wound healing in the constructed in vivo subcutaneous Staphylococcus aureus infection model with NIR activation, maintaining a favorable biosafety level. Therefore, MXene/ZIF-90@ICG holds promise as an innovative nanospray for adaptive multimodal synergistic and efficient antibacterial applications with NIR activation.

Limitations of current techniques in clinical antimicrobial resistance diagnosis: examples and future prospects

Antimicrobial resistance is a global threat to public health. Without proactive intervention, common infections may become untreatable, restricting the types of clinical intervention that can be undertaken and reversing improvements in mortality rates. Effective antimicrobial stewardship represents one approach to restrict the spread of antimicrobial resistance but relies on rapid and accurate diagnostics that minimise the unnecessary use of antibiotics. This is increasingly a key unmet clinical need. In this paper, we describe existing techniques for the detection of antimicrobial resistance, while examining their drawbacks and limitations. We also discuss emerging diagnostic technologies in the field, and the need for standardisation to allow for swifter and more widespread clinical adoption.

A review of microbes mediated biosynthesis of silver nanoparticles and their enhanced antimicrobial activities

In recent decades, biosynthesis of metal and (or) metal oxide nanoparticles using microbes is accepted as one of the most sustainable, cost-effective, robust, and green processes as it does not encompass the usage of largely hazardous chemicals. Accordingly, numerous simple, inexpensive, and environmentally friendly approaches for the biosynthesis of silver nanoparticles (AgNPs) were reported using microbes avoiding conventional (chemical) methods. This comprehensive review detailed an advance made in recent years in the microbes-mediated biosynthesis of AgNPs and evaluation of their antimicrobial activities covering the literature from 2015-till date. It also aimed at elaborating the possible effect of the different phytochemicals, their concentrations, extraction temperature, extraction solvent, pH, reaction time, reaction temperature, and concentration of precursor on the shape, size, and stability of the synthesized AgNPs. In addition, while trying to understand the antimicrobial activities against targeted pathogenic microbes the probable mechanism of the interaction of produced AgNPs with the cell wall of targeted microbes that led to the cell's reputed and death have also been detailed. Lastly, this review detailed the shape and size-dependent antimicrobial activities of the microbes-mediated AgNPs and their enhanced antimicrobial activities by synergetic interaction with known commercially available antibiotic drugs.