scholarly journals Organization of antibiotic stewardship in Europe: the way to go

2021 ◽  
Vol 171 (S1) ◽  
pp. 4-8
Author(s):  
Winfried V. Kern
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Good Practice ◽  
Inappropriate Prescribing ◽  
Antibiotic Consumption ◽  
Surveillance Systems ◽  
Educational Activities ◽  
Essential Components ◽  
The Way

SummaryIt is more than two decades ago that a European Union conference on “The Microbial Threat” hosted by the Danish Government in Copenhagen in September 1998 issued recommendations to encourage good practice in the use of antimicrobial agents and reduce inappropriate prescribing. Essential components of those recommendations were antimicrobial teams in hospitals and the use of feedback to prescribers as well as educational activities. Two decades later, important surveillance systems on both antimicrobial resistance as well as on antibiotic consumption are functioning at the European level and in most European countries; European Committee on Antimicrobial Susceptibility Testing (EUCAST) has thoroughly re-evaluated, standardized and harmonized antibiotic susceptibility testing and breakpoints; there have been educational activities in many countries; and stewardship teams are now included in many guidelines and policy papers and recommendations. Yet, antimicrobial resistance problems in Europe have shifted from methicillin-resistant Staphylococus aureus (MRSA) to vancomycin-resistent Enterococcus faecium (VRE) and to multidrug-resistant gramnegative bacteria, while antibiotic consumption volumes, trends and patterns across countries do not show major and highly significant improvements. The way to go further is to recognize that better prescribing comes at a cost and requires investment in expert personnel, practice guideline drafting, and implementation aids, and, secondly, the setting of clear goals and quantitative targets for prescribing quality.

Combating Antimicrobial Resistance in Foodborne Microorganisms

2016 ◽  
Vol 79 (2) ◽  
pp. 321-336 ◽  
Author(s):  
EDWARD P. C. LAI ◽  
ZAFAR IQBAL ◽  
TYLER J. AVIS
Keyword(s):  
Public Health ◽  
Escherichia Coli ◽  
Food Safety ◽  
Antimicrobial Resistance ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Health Hazard ◽  
Important Public Health ◽  
Killing Action ◽  
Campylobacter Spp

ABSTRACT This review addresses an important public health hazard affecting food safety. Antimicrobial agents are used in foods to reduce or eliminate microorganisms that cause disease. Many traditional organic compounds, novel synthetic organic agents, natural products, peptides, and proteins have been extensively studied for their effectiveness as antimicrobial agents against foodborne Campylobacter spp., Escherichia coli, Listeria spp. and Salmonella. However, antimicrobial resistance can develop in microorganisms, enhancing their ability to withstand the inhibiting or killing action of antimicrobial agents. Knowledge gaps still exist with regard to the actual chemical and microbiological mechanisms that must be identified to facilitate the search for new antimicrobial agents. Technical implementation of antimicrobial active packing films and coatings against target microorganisms must also be improved for extended product shelf life. Recent advances in antimicrobial susceptibility testing can provide researchers with new momentum to pursue their quest for a resistance panacea.

scholarly journals Leapfrogging laboratories: the promise and pitfalls of high-tech solutions for antimicrobial resistance surveillance in low-income settings

2020 ◽  
Vol 5 (12) ◽  
pp. e003622
Author(s):  
Iruka N Okeke ◽  
Nicholas Feasey ◽  
Julian Parkhill ◽  
Paul Turner ◽  
Direk Limmathurotsakul ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Low Income ◽  
Susceptibility Testing ◽  
Point Of Care ◽  
Nucleic Acid Amplification ◽  
High Tech ◽  
Surveillance Systems ◽  
Data Handling ◽  
Data Formats ◽  
Nucleic Acid Amplification Technology

The scope and trajectory of today’s escalating antimicrobial resistance (AMR) crisis is inadequately captured by existing surveillance systems, particularly those of lower income settings. AMR surveillance systems typically collate data from routine culture and susceptibility testing performed in diagnostic bacteriology laboratories to support healthcare. Limited access to high quality culture and susceptibility testing results in the dearth of AMR surveillance data, typical of many parts of the world where the infectious disease burden and antimicrobial need are high. Culture and susceptibility testing by traditional techniques is also slow, which limits its value in infection management. Here, we outline hurdles to effective resistance surveillance in many low-income settings and encourage an open attitude towards new and evolving technologies that, if adopted, could close resistance surveillance gaps. Emerging advancements in point-of-care testing, laboratory detection of resistance through or without culture, and in data handling, have the potential to generate resistance data from previously unrepresented locales while simultaneously supporting healthcare. Among them are microfluidic, nucleic acid amplification technology and next-generation sequencing approaches. Other low tech or as yet unidentified innovations could also rapidly accelerate AMR surveillance. Parallel advances in data handling further promise to significantly improve AMR surveillance, and new frameworks that can capture, collate and use alternate data formats may need to be developed. We outline the promise and limitations of such technologies, their potential to leapfrog surveillance over currently available, conventional technologies in use today and early steps that health systems could take towards preparing to adopt them.

scholarly journals Antimicrobial resistance surveillance of Salmonella isolates from the First People’s Hospital of Yunnan Province, China

2015 ◽  
Vol 9 (04) ◽  
pp. 333-337 ◽  
Author(s):  
Jiang Yaxian ◽  
Zuo Hui ◽  
Niu Hua ◽  
Mao Xiaoqin ◽  
Li Fengliang ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Yunnan Province ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Common Disease ◽  
First Line ◽  
Salmonella Spp ◽  
Resistant Phenotype ◽  
Resistance Rates

Introduction: Typhoid fever is a common disease in Yunnan province; however, the resistant phenotype and epidemic characteristics of Salmonella in this area are still unclear. In this study, a 15-year surveillance of antimicrobial susceptibility of Salmonella is reported. Methodology: From January 1999 to December 2013, Salmonella isolates were recovered from patients in the First People's Hospital of Yunnan Province. Antimicrobial susceptibility was detected and data were analyzed using WHONET5.6. Results: A total of 845 Salmonella isolates were recovered between 1999 and 2013. The most frequently isolated Salmonella serovar was S. Paratyphi A (93%), and 75.1% (635/845) of the isolates were from the young and middle-aged population. The resistance rates of Salmonella spp. to ciprofloxacin, ampicillin, and ceftriaxone increased dramatically during the 15 years. Carbapenems retained the highest and most stable activity against isolates. The resistance rates of all Salmonella isolates to chloramphenicol and sulfamethoxazole were 0.4% (3/845) and 1.8% (15/845), respectively. Conclusions: As Salmonella isolates have been observed to be resistant to first-line antibiotics, antimicrobial agents should be used rationally and prescriptions should be based on case-by-case susceptibility testing.

scholarly journals Identification, Genotyping and Antimicrobial Susceptibility Testing of Brucella spp. Isolated from Livestock in Egypt

2019 ◽  
Vol 7 (12) ◽  
pp. 603 ◽  
Author(s):  
Aman Ullah Khan ◽  
Waleed S. Shell ◽  
Falk Melzer ◽  
Ashraf E. Sayour ◽  
Eman Shawkat Ramadan ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Molecular Mechanisms ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Brucella Melitensis ◽  
Rpob Gene ◽  
Antimicrobial Susceptibility Testing ◽  
Animal Populations ◽  
Microbiological Methods

Brucellosis is a highly contagious zoonosis worldwide with economic and public health impacts. The aim of the present study was to identify Brucella (B.) spp. isolated from animal populations located in different districts of Egypt and to determine their antimicrobial resistance. In total, 34-suspected Brucella isolates were recovered from lymph nodes, milk, and fetal abomasal contents of infected cattle, buffaloes, sheep, and goats from nine districts in Egypt. The isolates were identified by microbiological methods and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Differentiation and genotyping were confirmed using multiplex PCR for B. abortus, Brucella melitensis, Brucella ovis, and Brucella suis (AMOS) and Bruce-ladder PCR. Antimicrobial susceptibility testing against clinically used antimicrobial agents (chloramphenicol, ciprofloxacin, erythromycin, gentamicin, imipenem, rifampicin, streptomycin, and tetracycline) was performed using E-Test. The antimicrobial resistance-associated genes and mutations in Brucella isolates were confirmed using molecular tools. In total, 29 Brucella isolates (eight B. abortus biovar 1 and 21 B. melitensis biovar 3) were identified and typed. The resistance of B. melitensis to ciprofloxacin, erythromycin, imipenem, rifampicin, and streptomycin were 76.2%, 19.0%, 76.2%, 66.7%, and 4.8%, respectively. Whereas, 25.0%, 87.5%, 25.0%, and 37.5% of B. abortus were resistant to ciprofloxacin, erythromycin, imipenem, and rifampicin, respectively. Mutations in the rpoB gene associated with rifampicin resistance were identified in all phenotypically resistant isolates. Mutations in gyrA and gyrB genes associated with ciprofloxacin resistance were identified in four phenotypically resistant isolates of B. melitensis. This is the first study highlighting the antimicrobial resistance in Brucella isolated from different animal species in Egypt. Mutations detected in genes associated with antimicrobial resistance unravel the molecular mechanisms of resistance in Brucella isolates from Egypt. The mutations in the rpoB gene in phenotypically resistant B. abortus isolates in this study were reported for the first time in Egypt.

scholarly journals Etiological Trends and Patterns of Antimicrobial Resistance in Respiratory Infections

2018 ◽  
Vol 12 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Salma M. Al-Zain Ahmed ◽  
Sara S. Abdelrahman ◽  
Doua M. Saad ◽  
Isra S. Osman ◽  
Modasir G. Osman ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Respiratory Infection ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Respiratory Infections ◽  
Resistance Rate ◽  
High Rate ◽  
Culture Positive ◽  
Global Health Problem ◽  
Respiratory Specimens

Background:Respiratory infections are one of the commonest causes of morbidity and mortality related to infectious diseases worldwide. The emergence of antimicrobial resistance is a major global health problem which is well established in developing countries. Good clinical suspicion and correct laboratory identification of respiratory infection causing organisms followed by the appropriate management are needed to compact both community-acquired and nosocomial infection respiratory infections.Objectives:A retrospective study was carried out to elucidate the etiology of respiratory infections in Sudan, as well as to guide the physician to the best antimicrobial alternatives used in the treatment of respiratory infection.Method:Respiratory isolates that have been morphologically identified and biologically characterized were subjected to antibiotic susceptibility testing.Results:A total of 1481 respiratory specimens were examined, recovering 377 organisms from 350 culture positive samples [225(59.7%) sputum, 94(24.9%) broncho-alveolar lavage (BAL), 58(15.4%) Pleural fluid], the commonest organisms wereKlebsiella ssp. (25.20%) andmycobacterium tuberculosis(25.20%), followed byStaphylococcus aureus(19.89%) andPseudomonas aeruginosa(8.49%). High rate of resistance of bacterial isolates was observed to Co-trimoxazole (BA), Ampicillin sulbactam (AS), Cefotaxime (CF) and Tetracycline (TE), being 80%, 72.3%, 68.8% and 66.9% respectively; on the other hand, very low resistance rate was found to Amikacin (AK) and Levofloxacin (LE), being 4.6% and 8.5%, respectively.Conclusion:Guided prescription of antimicrobial agents must be implemented and controlled to limit further spread of antimicrobial resistance.

Antimicrobial resistance in swine production

2008 ◽  
Vol 9 (2) ◽  
pp. 135-148 ◽  
Author(s):  
Frank M. Aarestrup ◽  
C. Oliver Duran ◽  
David G. S. Burch
Keyword(s):  
Antimicrobial Resistance ◽  
Human Health ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Acquired Resistance ◽  
Swine Production ◽  
Susceptibility Data ◽  
Development Of Resistance ◽  
The World ◽  
Different Parts

AbstractLarge amounts of antimicrobial agents are still being used in modern swine production in many countries around the world. This facilitates the emergence and development of antimicrobial resistance. Bacteria causing infections in swine have in several cases acquired resistance to a number of the agents most commonly used for treatment, making it difficult to predict the efficacy of different antimicrobial agents without prior susceptibility testing. This review gives an overview of recent susceptibility data from different parts of the world and discusses the importance of the development of resistance not only in the treatment of infections in swine but also taking into account the human health implications of antimicrobial resistance.

scholarly journals Clonal types and antimicrobial resistance profiles of methicillin-resistant Staphylococcus aureus isolates from hospitals in south Brazil

2008 ◽  
Vol 50 (3) ◽  
pp. 135-137 ◽  
Author(s):  
Leandro Reus Rodrigues Perez ◽  
Pedro Alves D'azevedo
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Agents ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Susceptibility Testing ◽  
Sccmec Type ◽  
Diffusion Method ◽  
Porto Alegre ◽  
Disk Diffusion Method ◽  
And Control ◽  
Sccmec Types

In the present study were evaluated the DNA macrorestriction profile and SCCmec types for nine multi-resistant MRSA selected. Also antimicrobial susceptibility testing by disk diffusion method was evaluated for 68 MRSA isolates against 12 antimicrobial agents. The isolates were recovered from blood culture collected from hospitalized patients in three hospitals of Porto Alegre, Brazil. PFGE and PCR for mecA and SCCmec I, II, III, IV types genes were done on selected nine isolates with susceptibility only to vancomycin, teicoplanin and linezolid. Two clone profiles, with five subtypes, were demonstrated among multi-resistant MRSA analyzed. Eight isolates showed harbor SCCmec type III and one isolate was not typeable. The knowledge of SCCmec type, clone and antimicrobial profiles among S. aureus is essential mainly to prevention and control of dissemination of the antimicrobial resistance.

The Path of More Resistance: A Comparison of NHSN and CLSI Criteria in Developing Cumulative Antimicrobial Susceptibility Test Reports and Institutional Antibiograms

2021 ◽  
Author(s):  
Alexander Winnett ◽  
Vinay Srinivasan ◽  
Matthew Davis ◽  
Tara Vijayan ◽  
Daniel Z. Uslan ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Clinical Laboratory ◽  
Empiric Therapy ◽  
Annual Data ◽  
Antimicrobial Susceptibility Test ◽  
Susceptibility Data ◽  
National Healthcare Safety Network

Background In the absence of antimicrobial susceptibility data, the institutional antibiogram is a valuable tool to guide clinicians in the empiric treatment of infections. However, there is a misunderstanding on how best to prepare cumulative antimicrobial susceptibility testing reports (CASTRs) to guide empiric therapy (e.g., routine antibiogram) versus monitoring antimicrobial resistance, with the former following guidance from the Clinical Laboratory Standards Institute (CLSI), and the latter from Center for Disease Control and Preventions National Healthcare Safety Network (NHSN). These criteria vary markedly in their exclusion or inclusion of isolates cultured repeatedly from the same patient. Methods We compared rates of non-susceptibility (NS)using annual data from a large teaching healthcare system subset to isolates eligible by either NHSN criteria or CLSI criteria. Results For a panel of the three most prevalent gram-negative pathogens in combination with clinically relevant antimicrobial agents (or priority pathogen-agent combinations, PPACs), we found that the inclusion of duplicate isolates by NHSN criteria yielded higher NS rates than when CLSI criteria (for which duplicate isolates are not included) were applied. Conclusions Patients with duplicate isolates may not be representative of antimicrobial resistance within a population. For this reason, users of CASTR data should carefully consider that the criteria used to generate these reports can impact resulting NS rates, and therefore maintain the distinction between CASTRs created for different purposes.

Antimicrobial susceptibility, serotypes and genotypes ofPasteurella multocidaisolates associated with swine pneumonia in Taiwan

2017 ◽  
Vol 181 (12) ◽  
pp. 323-323 ◽  
Author(s):  
Jih-Ching Yeh ◽  
Dan-Yuan Lo ◽  
Shao-Kuang Chang ◽  
Chi-Chung Chou ◽  
Hung-Chih Kuo
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Susceptibility ◽  
Pasteurella Multocida ◽  
Antimicrobial Agents ◽  
Susceptibility Testing ◽  
Antimicrobial Susceptibility Testing ◽  
Atrophic Rhinitis ◽  
Significant Difference ◽  
Progressive Atrophic Rhinitis ◽  
Resistance Rates

Pasteurella multocida(PM) can cause progressive atrophic rhinitis and suppurative bronchopneumonia in pigs. The present study performed antimicrobial susceptibility testing and serotype and genotype identification on the 62 PM strains isolated from the lungs of diseased pigs with respiratory symptoms. Antimicrobial susceptibility testing examined 13 antimicrobial agents (amoxicillin, cefazolin, doxycycline, flumequine, enrofloxacin, florfenicol, kanamycin, lincomycin, Linco-Spectin (lincomycin and spectinomycin), erythromycin, tylosin, tilmicosin and tiamulin). Antimicrobial resistance ratios were over 40% in all of the antimicrobial agents except for cefazolin. The highest levels of resistance (100%) were found for kanamycin, erythromycin and tylosin. The majority of isolated strains was serotype D:L6 (n=35) followed by A:L3 (n=17). Comparison of the antimicrobial resistance levels between the two serotypes showed that the antimicrobial resistance rates were higher in D:L6 than in A:L3 for all the tested antimicrobials except for tylosin and tilmicosin. For PM witherm(B),erm(T) orerm(42), the results showed no significant difference compared with non-resistance gene strains in phenotype. Pulsed-field gel electrophoresis genotyping usingApaI restriction digestion of the genomic DNA demonstrated that there were 17 distinct clusters with a similarity of 85% or more, and the genotyping result was similar to that of serotyping. The results of the present study demonstrated that the PM isolated from diseased pigs in Taiwan was resistant to multiple antimicrobials, and the distribution of antimicrobial resistance was associated with pulsotype and serotype.

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