Effects of laboratory capabilities on combating antimicrobial resistance, 2013-2016: A static model panel data analysis.

Antimicrobial resistance (AMR) poses significant challenges to health and treatment options in both human and veterinary medicine. Animal AMR monitoring in the US evaluates carcasses, retail meat, live animals, and diagnostic laboratory submissions; however, there is a lack of consistent on-farm monitoring of use and resistance. In 2020, 153 pig farms in the Midwestern United States enrolled in an antimicrobial purchase and resistance monitoring program. Intestinal samples or fecal swabs were collected biannually for 3 years from pigs and their dunging areas; antibiotic purchase data were tracked. Salmonella enterica and Escherichia coli were isolated and underwent antibiotic susceptibility testing using either a commercial bovine/ porcine (BOPO 7F) panel (for pig samples) or the National Antimicrobial Resistance Monitoring System (NARMS) Gram-negative panel (for dunging area samples). Minimum inhibitory concentrations (MICs) of antibiotics were used to evaluate the susceptibility of pig sample isolates, while NARMS breakpoints were used to assess resistance in isolates from dunging areas. Tetracyclines were the most purchased, and penicillins were the most used antibiotic class across farm types. For pig samples, more isolates exhibited MIC values at the high end of the tested range among E. coli and Salmonella isolates from wean-to-market (WTM) sites compared to breed-to-wean (BTW) sites for almost all antibiotic classes. In addition, E. coli isolates from sick pigs had higher MIC values compared to isolates from substandard but otherwise healthy pigs. Among the dunging area isolates, both bacteria had higher rates of resistance in the WTM sites compared to the BTW sites across multiple antibiotics. Individual ages of pigs were a likely confounder and were not controlled for, as these data were not reliably collected. A greater frequency of monitoring, along with controlling for age, recent treatments, and disease events at the individual level, would improve farm-level insights from on-farm AMR monitoring. Currently, the interpretation of phenotypic AMR data for resistance monitoring in swine medicine is limited by the lack of established veterinary breakpoints for enteric organisms. The available NARMS breakpoints are designed for humans, can be used for public health monitoring, and are likely to be applicable primarily to gastrointestinal infections involving the same bacteria in farm animals.

Antimicrobial resistance is part of a perfect storm of health crises

Clinical practice guidelines and recommended practices to control use of antibiotics have been published, but the effect of these practices on antimicrobial resistance (AMR) rates in hospitals is unknown. The objective of this study was to examine relationships between antimicrobial use control strategies and AMR rates in a national sample of US hospitals. Cross-sectional, stratified study of a nationally representative sample of US hospitals. A survey instrument was sent to the person responsible for infection control at a sample of 670 US hospitals. The outcome was current prevalences of 4 epidemiologically important, drug-resistant pathogens, considered concurrently: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, ceftazidime-resistant Klebsiella species, and quinolone (ciprofloxacin)-resistant Escherichia coli. Five independent variables regarding hospital practices were selected from the survey: the extent to which hospitals (1) implement practices recommended in clinical practice guidelines and ensure best practices for antimicrobial use, (2) disseminate information on clinical practice guidelines for antimicrobial use, (3) use antimicrobial-related information technology, (4) use decision support tools, and (5) communicate to prescribers about antimicrobial use. Control variables included the hospitals' number of beds, teaching status, Veterans Affairs status, geographic region, and number of long-term care beds; and the presence of an intensive care unit, a burn unit, or transplant services. A generalized estimating equation modeled all resistance rates simultaneously to identify overall predictors of AMR levels at the facility. Completed survey instruments were returned by 448 hospitals (67%). Four antimicrobial control measures were associated with higher prevalence of AMR. Implementation of recommended practices for antimicrobial use (P < .01) and optimization of the duration of empirical antibiotic prophylaxis (P < .01) were associated with a lower prevalence of AMR. Use of restrictive formularies (P = .05) and dissemination of clinical practice guideline information (P < .01) were associated with higher prevalence of AMR. Number of beds and Veterans Affairs status were also associated with higher AMR rates overall. Implementation of guideline-recommended practices to control antimicrobial use and optimize the duration of empirical therapy appears to help control AMR rates in US hospitals. A longitudinal study would confirm the results of this cross-sectional study. These results highlight the need for systems interventions and reengineering to ensure more-consistent application of guideline-recommended measures for antimicrobial use.

INTRODUCTION: Antimicrobial resistance is one of the topical issues that is part of the “One Health” concept with implications for animal health, human health, and even environmental “health”. At the European Commission (EC) level, legislation has been issued for the monitoring of antimicrobial resistance and these rules are applicable by each Member State (MS). For the proper implementation of the above legislation, audits are carried out in Member States that have developed programs on antimicrobial resistance that go beyond the EC's requests.OBJECTIVES: The aim of the study was the analysis of existing data reports, legislation and recommendations on antimicrobial resistance through which surveillance and monitoring is carried out in the European Union (EU). METHODS: The audit reports issued between 2015 and 2017 by the Food Veterinary Office (FVO), as well as the articles and studies issued by the EC through the antimicrobial resistance institutes were analysed.RESULTS: The FVO conducted audits to “evaluate the monitoring and reporting of antimicrobial resistance in zoonotic and commensal bacteria in certain food-producing animal populations and food” in 12 MS, and audits to “gather information on the prudent use of antimicrobials in animals” in 8 MS. These are countries that have very well implemented the EC's requests and included the “One Health” perspective in antimicrobial resistance programs. Some Member States have risk management strategies for reducing antimicrobial resistance for more than 20 years. They have carried out research projects on antimicrobial resistance. There is an action plan on antimicrobial resistance at the EC level, but their implementation and understanding up to the level of all actors involved in this issue varies from MS to MS. Antimicrobial resistance in the animal population is a topical issue, notoriety among the actors involved, as well as an interdisciplinary problem with indirect results. The same principle of antimicrobial resistance in animals is applicable to humans and the environment as such, this problem can be embedded in the concept of “One Health”. The overall objective of the MS is to generate knowledge and tools to “combat” antimicrobial resistance in animals, humans and even the environment.CONCLUSION: As a conclusion, in order to improve and optimize antimicrobial resistance programs, a “good practice guide” can be achieved by MS with extensive experience in this area, to be used by MS with a more precarious application and over time to harmonize antimicrobial resistance programs within the EU.

Metagenomic sequencing has proven to be a powerful tool in the monitoring of antimicrobial resistance (AMR). Here, we provide a comparative analysis of the resistome from pigs, poultry, veal calves, turkey, and rainbow trout, for a total of 538 herds across nine European countries. We calculated the effects of per-farm management practices and antimicrobial usage (AMU) on the resistome in pigs, broilers, and veal calves. We also provide an in-depth study of the associations between bacterial diversity, resistome diversity, and AMR abundances as well as co-occurrence analysis of bacterial taxa and antimicrobial resistance genes (ARGs) and the universality of the latter. The resistomes of veal calves and pigs clustered together, as did those of avian origin, while the rainbow trout resistome was different. Moreover, we identified clear core resistomes for each specific food-producing animal species. We identified positive associations between bacterial alpha diversity and both resistome alpha diversity and abundance. Network analyses revealed very few taxa-ARG associations in pigs but a large number for the avian species. Using updated reference databases and optimized bioinformatics, previously reported significant associations between AMU, biosecurity, and AMR in pig and poultry farms were validated. AMU is an important driver for AMR; however, our integrated analyses suggest that factors contributing to increased bacterial diversity might also be associated with higher AMR load. We also found that dispersal limitations of ARGs are shaping livestock resistomes, and future efforts to fight AMR should continue to emphasize biosecurity measures.IMPORTANCEUnderstanding the occurrence, diversity, and drivers for antimicrobial resistance (AMR) is important to focus future control efforts. So far, almost all attempts to limit AMR in livestock have addressed antimicrobial consumption. We here performed an integrated analysis of the resistomes of five important farmed animal populations across Europe finding that the resistome and AMR levels are also shaped by factors related to bacterial diversity, as well as dispersal limitations. Thus, future studies and interventions aimed at reducing AMR should not only address antimicrobial usage but also consider other epidemiological and ecological factors.

Artificial intelligence (AI) is a branch of science and engineering that focuses on the computational understanding of intelligent behavior. Many human professions, including clinical diagnosis and prognosis, are greatly useful from AI. Antimicrobial resistance (AMR) is among the most critical challenges facing Pakistan and the rest of the world. The rising incidence of AMR has become a significant issue, and authorities must take measures to combat the overuse and incorrect use of antibiotics in order to combat rising resistance rates. The widespread use of antibiotics in clinical practice has not only resulted in drug resistance but has also increased the threat of super-resistant bacteria emergence. As AMR rises, clinicians find it more difficult to treat many bacterial infections in a timely manner, and therapy becomes prohibitively costly for patients. To combat the rise in AMR rates, it is critical to implement an institutional antibiotic stewardship program that monitors correct antibiotic use, controls antibiotics, and generates antibiograms. Furthermore, these types of tools may aid in the treatment of patients in the event of a medical emergency in which a physician is unable to wait for bacterial culture results. AI’s applications in healthcare might be unlimited, reducing the time it takes to discover new antimicrobial drugs, improving diagnostic and treatment accuracy, and lowering expenses at the same time. The majority of suggested AI solutions for AMR are meant to supplement rather than replace a doctor’s prescription or opinion, but rather to serve as a valuable tool for making their work easier. When it comes to infectious diseases, AI has the potential to be a game-changer in the battle against antibiotic resistance. Finally, when selecting antibiotic therapy for infections, data from local antibiotic stewardship programs are critical to ensuring that these bacteria are treated quickly and effectively. Furthermore, organizations such as the World Health Organization (WHO) have underlined the necessity of selecting the appropriate antibiotic and treating for the shortest time feasible to minimize the spread of resistant and invasive resistant bacterial strains.

The objective of the study was to analyze antibiotic consumption and determine bacterial resistance rates as an indicator of the rational utilization of this drug group at the urology department in the Health Centre “Studenica” Kraljevo. Over a two-year period, the average antibiotic consumption was 104.55 DDD/100BD. Of the total financial assets used for medical treatment, the antibiotic group JO1 had a share of 49.52% in 2011 and 47.53% in 2012. Antibacterial drugs from a group of β-lactamic antibiotics were consumed most commonly, at 54.02% (2011) and 43.44% (2012). First-generation cephalosporins, quinolones and aminoglycosides were the most frequently used drug groups, while cephalexin was the antibiotic with the highest individual consumption. E. coli was the most frequently isolated bacterium in 2011, while in 2012, Klebsiella pneumoniae was the most frequently isolated bacterium. The total bacterial resistance both in 2011 and 2012 was above 50%. Gram-negative bacteria showed a higher resistance rate (2011, 59.3%; 2012, 58.9%) than Gram-positive bacteria (2011, 44.4%; 2012, 40.6%). Klebsiella pneumoniae was the bacterium with the highest resistance (75.3%) in 2011, while in 2012, there was a resistance increase in Pseudomonas aeruginosa (71.4%), especially to carbapenems. A correlation was determined between the consumption of individual antibiotics and bacterial strain resistance in 2011 (r=0.433, p=0.044) and in 2012 (r=0.478, p=0.024). The high resistance rate shown in the bacterial strains, which was correlated with antibiotic consumption, as well as the great financial assets used for this group of drugs suggest the necessity for the rationalization of their utilization. Empirical therapy with Gram-negative bacteria should be based on carbapenems utilization, except with Pseudomonas aeruginosa, where piperacillin/tazobactam should be used.

This study aims to quantify antimicrobial consumption (AMC) and antimicrobial resistance (AMR) in tertiary care hospitals in Pakistan. This observational study was conducted at two tertiary care hospitals of Pakistan over a 1-year period. The AMC and resistance patterns of Escherichia coli isolates collected from hospitals were observed and analysed using the pearson correlation coefficient. AMC in hospitals varied between 0.00186 and 0.72 (Mean=0.12 ±0.191) Defined Daily Dose (DDDs)/1000 patient-days. Fluoroquinolones were the most consumed antimicrobial followed by penicillins, cephalosporins, carbapenems, and aminoglycosides. Antimicrobial-resistant rates in hospitals varied between 92.2% and 34.6%. The highest resistance rate was observed for moxifloxacin, followed by ampicillin, cefotaxime, amoxicillin, ceftriaxone, ciprofloxacin, amoxiclav, and amikacin. Statistically significant association was found between AMC and resistance rate for ampicillin (r=0.78, P=0.032), cefotaxime (r=0.87, P=0.012), ceftriaxone (r=0.67, P=0.042), and ciprofloxacin (r=0.63, P=0.031). Additionally, there was a significant association between fluoroquinolone consumption and the resistance rate of third generation cephalosporins (r=0.61, P=0.032), and significance was also found when all antimicrobials were combined into 1 analysis (r=0.721, P=0.032). This data documented a significant association between AMC and resistant rates for multiple antimicrobial agents.

Overcoming resistance.

EDITORIAL article Front. Cell. Infect. Microbiol., 07 February 2023Sec. Clinical Microbiology Volume 13 - 2023 | https://doi.org/10.3389/fcimb.2023.1140567

Early and efficient management of bloodstream infections (BSIs) reduces the risk of complications and death. Therefore, it is crucial to identify antimicrobials with good activity against bacteria isolated from BSIs. This study aimed to determine the bacterial pathogens involved in BSIs, pooled antimicrobial resistance (AMR) rate, AMR phenotype rates, and the evolution of AMR over the years in West Africa. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA 2020) were used, and the protocol for this review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database with the registration identification number (CRD420251064773). Keywords were used to conduct a systematic literature review of electronic databases such as Google Scholar, African Journals Online, PubMed, ResearchGate, Embase, and Scopus. Data analyses were conducted using Stata/MP 17.0, and a random-effects model was used to estimate pooled estimates. Twenty-three research articles, including samples collected between 2003 and 2022, were selected for this study. The prevalence of BSIs was 13.1% (95% CI: 12.8-13.3) (6,864 blood culture-positive out of the 52,566 patients screened for BSIs). A total of 4,992 bacteria were isolated, including 3,219 Gram-negative bacteria (GNB) and 1,773 Gram-positive bacteria (GPB). The pooled AMR rates of 20 antimicrobials were obtained, and the highest were for ampicillin [73% (95% CI: 66, 80)] and trimethoprim-sulfamethoxazole [72% (95% CI: 63, 80)]. The lowest pooled AMR rates were observed for the carbapenems [10% (95% CI: 1, 25)] and clindamycin [15% (95% CI: 6, 27)]. GNB were more resistant to ampicillin (P = 0.003) and amoxicillin-clavulanate (P = 0.002) than GPB, and the pooled prevalence of multidrug-resistant bacteria (MDR) was 53% (95% CI: 30, 75). There were significant upward trends for ciprofloxacin (P = 0.007), carbapenems (P = 0.010), ofloxacin (P = 0.013), and third-generation cephalosporins (3GCs) (P = 0.032) when comparing the pooled AMR rates of 2004-2013 to those of 2014-2022. Carbapenems and clindamycin showed relatively low resistance rates, but high study heterogeneity and limited data warrant caution in their empiric use. Overall, the findings highlight the need to prioritize local antibiograms and strengthen antimicrobial stewardship to address rising AMR in West Africa. Not applicable.

Asymptomatic carriers of antibiotic-resistant Salmonella constitute a significant yet frequently overlooked public health threat. This study aimed to characterize antimicrobial resistance (AMR) patterns in Salmonella isolated from asymptomatic workers in Yulin, China, over a 12-year period (2013-2024) and to identify the potential influence of natural and socioeconomic factors. Antimicrobial susceptibility testing was performed against 11 antimicrobial agents. We analyzed temporal trends in AMR rates using the Mann-Kendall test and assessed associations between AMR rates and natural or socioeconomic variables using Spearman's rank correlation, Principal Component Regression (PCR), and Least Absolute Shrinkage and Selection Operator (LASSO) regression. An Autoregressive Integrated Moving Average (ARIMA) model was employed to forecast future resistance trends. Resistance to tetracycline (TET) was most prevalent (mean rate: 66.2%). The overall multidrug resistance (MDR) rate was 41.9%, exhibiting a significant increasing trend (P<0.05). Most alarmingly, the tigecycline (TGC) resistance rate surged from 0% to 24.4% by 2024. PCR model analysis revealed that a composite "Socioeconomic and Healthcare Development Index" served as the primary predictor of this increase, explaining 54.9% of the variance in TGC resistance rates. The ARIMA model forecasted a continued upward trajectory for TGC resistance through 2025-2026. Our findings demonstrate a significant rise in MDR Salmonella among asymptomatic workers in Yulin, establishing them as important reservoirs of antibiotic-resistant Salmonella. The emergence and rapid escalation of TGC resistance is strongly associated with regional socioeconomic and healthcare development. These results underscore the urgent need for integrated surveillance within the One Health framework to effectively address AMR transmission.

Antimicrobial resistance is a major public health issue caused by antibiotic overuse and misuse. Antimicrobial stewardship (AMS) has been increasingly endorsed worldwide, but its effect has been studied scarcely in urologic settings. A before-after study was performed from 2018 through 2020 to evaluate changes in antimicrobial prescription, resistance rates and clinical safety upon implementation of an AMS audit and feedback program in the Urology Department of a large German academic medical center. The primary endpoints were safety clinical outcomes: the rate of infection-related readmissions and of infectious complications after transrectal prostate biopsies. Resistance rates and antimicrobial consumption rates were the secondary endpoints. The AMS team reviewed 196 cases (12% of all admitted in the department). The overall antibiotic use dropped by 18.7%. Quinolone prescriptions sank by 78.8% (p = 0.02) and 69.8% (p > 0.05) for ciprofloxacin and levofloxacin, respectively. The resistance rate of E. coli isolates declined against ceftriaxone (−9%), ceftazidime (−12%) and quinolones (−25%) in the AMS period. No significant increase in infection-related readmissions or infectious complications after prostate biopsies was observed (p = 0.42). Due to the potential to reduce antibiotic use and resistance rates with no surge of infection-related complications, AMS programs should be widely implemented in urologic departments.

Antimicrobial resistance in Cambodia: a review

Little is known about the antimicrobial resistance (AMR) status of uropathogens in Western Africa. We performed a retrospective evaluation of urine cultures collected from the rural Margret Marquart Catholic Hospital, Kpando, Ghana during the time period from October 2019-December 2021. Urine samples from 348 patients (median age 40 years, 52.6% male) were examined. Of these, 125 (35.9%) showed either fungal or bacterial growth, including Escherichia coli in 48 (38.4%), Candida species (spp.) in 29 (23.2%), Klebsiella spp. in 27 (21.6%), Proteus spp. in 12 (9.6%), Citrobacter spp. in 10 (8.0%), Salmonella spp. in 4 (3.2%), Staphylococcus spp. in 3 (2.4%), and Pseudomonas spp. in 2 (1.6%) cases. Two bacterial spp. were detected in 7 samples (5.6%). Antibiotic susceptibility testing showed resistance to a mean 8.6 out of 11 tested antibiotics per patient. Significant predictors (p &lt; 0.05) of bacterial growth were age (OR 1.03), female sex (OR 3.84), and the number of pus cells (OR 1.05) and epithelial cells (OR 1.07) in urine microscopy. We observed an alarmingly high AMR rate among the uropathogens detected, even to reserve antibiotics. A similar resistance profile can be expected in West African patients living in high-income countries. These observations warrant the implementation of restrictive antibiotic protocols, together with the expansion of urine culture testing capacities, improvement of documentation and reporting of AMR rates, and continued research and development of new antibiotic therapies in order to stem the progression of AMR in this West African region.