1012. Characterization of Antibiotic Superutilizers in the Inpatient Setting

Abstract Background Inappropriate use of antibiotics is a major public health concern that contributes to increased antibiotic resistance, adverse effects, and healthcare costs. Little is known about the highest utilizers, or superutilizers, who may be appropriate targets for antibiotic stewardship efforts. The purpose of this study was to characterize superutilizers at an academic hospital. Methods All adult patients who were admitted to the Hospital of the University of Pennsylvania and received at least one day of antibiotics between July 1, 2017 and June 30, 2018 were identified. All inpatient administrations for systemic antibacterial agents were identified. Antibiotics given in procedural areas and the emergency department were excluded, as were any antifungals and antivirals. Usage was reported as days of therapy (DOT). We compared the demographics and DOT among the superutilizers (defined as the top 1% of patients) to different groupings of the rest of the population. Results Overall, 13,559 patients (and 183,082 DOT) were included in the analysis, including 136 superutilizers. The superutilizers received 15% of the total antibacterial DOT and a median of 56 DOT during the 12-month period. (table) Conclusion Inpatient antibiotic use is unevenly distributed across the population. Higher meropenem and sulfamethoxazole/trimethoprim DOT suggest that treatment of multidrug-resistant organisms and opportunistic infection prophylaxis are more common in the superutilizer group. Additional study is needed to determine whether antimicrobial stewardship efforts could impact antibiotic use in the superutilizer population. Disclosures All authors: No reported disclosures.

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A survey of the usage (frequency and pattern) of antibiotics at the University of Maiduguri Veterinary Teaching Hospital, Maiduguri, Borno State, Nigeria

Veterinary World ◽

10.14202/vetworld.2021.2941-2946 ◽

2021 ◽

pp. 2941-2946

Author(s):

Nubwa Daniel ◽

Kefas David Malgwi ◽

Bukar Umaru ◽

Isaac John Omeh ◽

Ladi Sanya

Keyword(s):

Public Health ◽

Teaching Hospital ◽

Negative Impact ◽

Parent Compound ◽

Antibiotic Use ◽

Multidrug Resistant ◽

Chemotherapeutic Agents ◽

Large Animal ◽

Veterinary Antibiotics ◽

The University

Background and Aim: Veterinary antibiotics are widely used to treat bacterial diseases in various species of animals. However, despite the importance of these chemotherapeutic agents, their indiscriminate or extensive use can pose dangers to the animals or humans that consume edible tissues from animals contaminated with antibiotic residues. Therefore, concerns regarding their appropriate and judicious use in animals are of public health significance. This is because of the tendencies of developing resistance to targeted microbes and the ability of the parent compound or its metabolites to persist as residues in the animal tissues. This study aimed to determine the frequency and pattern of antibiotic usage and ascertain the level of awareness of clinicians on the judicious use of antibiotics at the University of Maiduguri Veterinary Teaching Hospital, Maiduguri, Borno State, Nigeria. Materials and Methods: Data related to the administration of antibiotics in all species of animals presented for treatment from January 2009 to December 2018 were obtained from the hospital archives, with permission from the office of the hospital directorate. The diseases, hospital units, antibiotics used, and years were parameters that were recorded for each case. Furthermore, 47 questionnaires were administered to clinicians who render services to the hospital. Results: A total of 63.9% of all cases brought to the hospital within the 10 years under study were infectious, and as such, were treated with antibiotics. The highest recorded use of antibiotics was observed in the poultry unit (38.4%), followed by the large animal unit (24.1%), with the lowest used recorded in the ambulatory unit (9.3%). Furthermore, regarding the antibiotics used, oxytetracycline had the highest occurrence (55%), followed by penicillin-streptomycin combination (12.2%), with the lowest being metronidazole (0.30%). The highest number of cases treated with antibiotics was recorded in 2018 (22.5%), and the lowest was recorded in 2014 (1.3%). Regarding the questionnaire administered to the clinicians, 78.7% of the respondents preferred oxytetracycline as their drug of choice, whereas only 2.1%, 4.3%, 2.1%, and 4.3% preferred amoxicillin, penicillin, streptomycin, and penicillin-streptomycin, respectively. Moreover, 65.9% of the respondents used a particular antibiotic because of its availability at the hospital, 8.5% because of cost, and 27.7% because of clinician preference. Furthermore, 74.5% of the clinicians offered palliative intervention while awaiting laboratory reports, whereas 8.5% treated the animals without requesting laboratory analyses. Conclusion: In this study, oxytetracycline was found to be the most used antibiotic for treating infectious diseases at the hospital because of its availability. The observed pattern appeared in the following order of frequency: Oxytetracycline, penicillin-streptomycin combination, neomycin, erythromycin, amoxicillin, tylosin, streptomycin, and gentamicin with metronidazole being the least frequent. There might also be antibiotic resistance, which requires a change to another antibiotic because of the lack of response to the initial antibiotic. Non-judicious antibiotic use can also have a negative impact on public health because of the development of multidrug-resistant "superbugs" and the problem of drug residue.

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Isolation and Characterization of Two Klebsiella pneumoniae Phages Encoding Divergent Depolymerases

International Journal of Molecular Sciences ◽

10.3390/ijms21093160 ◽

2020 ◽

Vol 21 (9) ◽

pp. 3160 ◽

Cited By ~ 1

Author(s):

Pilar Domingo-Calap ◽

Beatriz Beamud ◽

Lucas Mora-Quilis ◽

Fernando González-Candelas ◽

Rafael Sanjuán

Keyword(s):

Klebsiella Pneumoniae ◽

Multidrug Resistant ◽

Health Concern ◽

Resistant Bacteria ◽

Isolation And Characterization ◽

The Family ◽

Important Challenge ◽

Tail Spike ◽

Reference Strains

The emergence of multidrug-resistant bacteria is a major global health concern. The search for new therapies has brought bacteriophages into the spotlight, and new phages are being described as possible therapeutic agents. Among the bacteria that are most extensively resistant to current antibiotics is Klebsiella pneumoniae, whose hypervariable extracellular capsule makes treatment particularly difficult. Here, we describe two new K. pneumoniae phages, πVLC5 and πVLC6, isolated from environmental samples. These phages belong to the genus Drulisvirus within the family Podoviridae. Both phages encode a similar tail spike protein with putative depolymerase activity, which is shared among other related phages and probably determines their ability to specifically infect K. pneumoniae capsular types K22 and K37. In addition, we found that phage πVLC6 also infects capsular type K13 and is capable of striping the capsules of K. pneumoniae KL2 and KL3, although the phage was not infectious in these two strains. Genome sequence analysis suggested that the extended tropism of phage πVLC6 is conferred by a second, divergent depolymerase. Phage πVLC5 encodes yet another putative depolymerase, but we found no activity of this phage against capsular types other than K22 and K37, after testing a panel of 77 reference strains. Overall, our results confirm that most phages productively infected one or few Klebsiella capsular types. This constitutes an important challenge for clinical applications.

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Carelign: A Novel Handoff System for Medical and Surgical Consultants

Journal of Academic Ophthalmology ◽

10.1055/s-0040-1712173 ◽

2020 ◽

Vol 12 (01) ◽

pp. e63-e66

Author(s):

Brian Michael Shafer ◽

Thomasine Gorry ◽

Paul Tapino ◽

Subha Airan-Javia

Keyword(s):

Medical Center ◽

University Of Pennsylvania ◽

Inpatient Setting ◽

Patient Centered ◽

System A ◽

Item Questionnaire ◽

Department Of Ophthalmology ◽

Significant Difference ◽

The University ◽

Work Management

Abstract Background Patient handoffs are ubiquitous in hospital settings. Historically, formal handoffs of patient information have been conducted in the inpatient setting mainly by primary teams, as opposed to medical and surgical consultants. Carelign is a software developed by the University of Pennsylvania Health System to function as an interdisciplinary, patient-centered handoff. While mainly utilized by primary teams for work management and transitions, it has been enhanced to include specialty consultant handoff functionality. Objective The aim of this study is to determine whether using Carelign for consultant handoffs improves clinical handoffs in comparison to the prior handoff system (a custom-built handoff report within the electronic health record) used by the Department of Ophthalmology at Penn Presbyterian Medical Center. Methods A 7-item questionnaire assessing the effectiveness, efficiency, accessibility, reliability, communication, and security of the handoff using a 1 to 5 scale was distributed to residents prior to and 6 months subsequent to the implementation of Carelign. Results Users reported a statistically significant increase in Health Insurance Portability and Accountability Act (HIPPA)-compliance (44 vs. 100%, p < 0.0001) and ability to communicate with primary teams (38 vs. 70%, p = 0.019) after implementation of Carelign. There was a trend toward significance with ease of accessing information after switching to Carelign (67 vs. 85%, p = 0.185). There was no statistically significant difference in effectiveness, efficiency, accessibility from home, or reliability of information on handoff after converting to the new system. Conclusion Carelign is perceived to be an effective tool that can be used by consulting providers to ensure HIPPA-compliance and the ability to communicate with primary teams without sacrificing effectiveness, efficiency, accessibility, or reliability.

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1034. Automating Assessments of Vancomycin Appropriateness

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.898 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S364-S364

Author(s):

Haley K Holmer ◽

Caitlin M McCracken ◽

Gregory B Tallman ◽

Sara J Gore ◽

Timothy Shan ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Empiric Therapy ◽

Automated Classification ◽

Electronic Health Record Data ◽

Inappropriate Use ◽

Days Of Therapy ◽

Hospital Patients ◽

Icd 10 ◽

Procedure Codes

Abstract Background Assessing appropriateness of hospital antibiotic use is typically a labor-intensive task for antimicrobial stewardship teams and relies heavily on clinician judgement rather than a systematic process. Vancomycin is a frequently used agent that is a common stewardship target. We developed an algorithm to automatically classify the appropriateness of vancomycin days of therapy (DOTs) based upon electronic health record data. Methods We constructed a retrospective cohort of Oregon Health and Science University (OHSU) Hospital and Doernbecher Children’s Hospital patients admitted August 1, 2017 to July 31, 2018 receiving vancomycin. Data were collected on demographic, encounter, pharmacy, microbiology, and surgery data. An electronic algorithm was applied to classify vancomycin DOTs as appropriate, inappropriate, or indeterminate. Inappropriate use was defined as any case in which there was an opportunity for de-escalation as identified using microbiology data, ICD-10 codes, and procedure codes. Results We included 4,231 encounters; 493 (12%) were pediatric patients. Our algorithm automatically classified 59%, 3%, and 38% of encounters as having either appropriate, inappropriate, or indeterminate DOTs, respectively. Forty-four percent of all encounters received no more than a 24-hour course of vancomycin and were considered appropriate empiric therapy; half of these were attributed to surgical prophylaxis. Nine percent of all encounters had vancomycin administered within 3 days of a blood, sputum or tissue culture in which either a methicillin-resistant Staphylococcus species or an ampicillin-resistant, vancomycin-susceptible Enterococcus species was isolated and were classified as appropriate. Six percent of all encounters had cultures in which only Gram-negatives, fungi, or yeast were isolated and were therefore considered appropriate in the empiric period (≤48 hours) but inappropriate thereafter. Conclusion Automated assessments of antibiotic appropriateness could facilitate more informed antimicrobial stewardship initiatives and serve as a valuable stewardship metric. Characterization of indeterminate vancomycin use may inform increased automated classification. Further effort is needed to validate these assessments. Disclosures All authors: No reported disclosures.

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Characterization of Mutations Associated with Streptomycin Resistance in Multidrug-Resistant Mycobacterium tuberculosis in Zambia

Antibiotics ◽

10.3390/antibiotics10101169 ◽

2021 ◽

Vol 10 (10) ◽

pp. 1169

Author(s):

Precious Bwalya ◽

Tomoyuki Yamaguchi ◽

Eddie Samuneti Solo ◽

Joseph Yamweka Chizimu ◽

Grace Mbulo ◽

...

Keyword(s):

Multidrug Resistant ◽

Streptomycin Resistance ◽

University Teaching ◽

Reference Laboratory ◽

Tb Treatment ◽

Resistant Tuberculosis ◽

Multidrug Resistant Tuberculosis ◽

Mdr Tb ◽

The University

Streptomycin (STR) is recommended for the management of multidrug-resistant tuberculosis (MDR-TB). Streptomycin resistance-conferring mutation types and frequency are shown to be influenced by genotypes of circulating strains in a population. This study aimed to characterize the mutations in MDR-TB isolates and examine their relationship with the genotypes in Zambia. A total of 138 MDR-TB isolates stored at the University Teaching Hospital Tuberculosis Reference Laboratory in Zambia were analyzed using spoligotyping and sequencing of STR resistance-associated genes. Streptomycin resistance was observed in 65.9% (91/138) of MDR-TB isolates. Mutations in rpsL, rrs, and gidB accounted for 33%, 12.1%, and 49.5%, respectively. Amino acid substitution K43R in rpsL was strongly associated with the CAS1_Kili genotype (p < 0.0001). The combination of three genes could predict 91.2% of STR resistance. Clustering of isolates based on resistance-conferring mutations and spoligotyping was observed. The clustering of isolates suggests that the increase in STR-resistant MDR-TB in Zambia is largely due to the spread of resistant strains from inadequate treatment. Therefore, rapid detection of STR resistance genetically is recommended before its use in MDR-TB treatment in Zambia.

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1305. Application of Standard Antibiotic Use Criteria to Evaluate Inpatient Antibiotic Use

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1138 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S399-S399

Author(s):

Maureen Campion ◽

Emily Dionne ◽

Elizabeth Radigan ◽

Gail Scully ◽

Moamen Al Zoubi ◽

...

Keyword(s):

Antimicrobial Agents ◽

Average Length ◽

Medical Center ◽

Pharmacy Practice ◽

Antibiotic Use ◽

Antifungal Prophylaxis ◽

Prescribing Practices ◽

Icu Patients ◽

Inappropriate Use ◽

Days Of Therapy

Abstract Background It is estimated that 30–50% of antimicrobial agents prescribed inpatient are not optimal. Historically, antimicrobial evaluation has been based primarily upon expert opinion of ID trained individuals. Spivak and colleagues proposed standard terminology and definitions to assess antimicrobial prescribing practices. At UMass Memorial Medical Center we utilized Spivak’s criteria to measure antimicrobial use within point prevalence studies (PPS) and assessed the ability of Spivak’s criteria to provide consistent results between different evaluators. Methods A PPS was conducted in September 2017 (SEPT) by infectious disease (ID) attendings and ID trained pharmacists. A follow-up PPS was completed in November 2017 (NOV) by a pharmacy practice resident (PGY-1) and first year ID fellow. Patients were included if they were prescribed antibiotics at the time of review, greater than 18 years of age, and admitted to an inpatient unit. Patients only receiving antiretroviral therapy or antifungal prophylaxis were excluded from the study. Antibiotics, indications, days of therapy, and appropriateness or reason for inappropriateness, as defined by Spivak’s criteria, were collected. Results Four hundred five patients in SEPT and 475 patients in NOV were reviewed. Baseline characteristics between SEPT and NOV, including sex, age, average length of hospital stay (LOS) at time of review were similar between groups, (SEPT vs. NOV: male sex: 53.2% vs. 51.1%; age: 60.4 vs. 61.7; LOS:8.55 vs. 8.36 days). Number of antibiotics per patient was different between PPS (SEPT 1.69 vs. NOV 1.28). For non-intensive care unit (ICU) patients, 64.9% of use was considered appropriate in SEPT vs. 69.3% in NOV. The top reasons for inappropriate use in non-ICU patients in both PPS were no indication and excess length of therapy. Within the ICU, 89.4% of use was considered appropriate in SEPT, with 75% of use considered appropriate in NOV. The top reason for inappropriate use in ICU patients in both PPS was overly broad therapy. Conclusion Application of standard antibiotic evaluation criteria can assist healthcare professionals with different levels of ID training to assess antibiotic use in non-ICU patients. Further evaluation should be considered for critically ill patients. Disclosures All authors: No reported disclosures.

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82. Post-Prescription Review with Threat of Infectious Disease Consultation and Sustained Reduction in Meropenem Use Over Four Years

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.127 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S58-S58

Author(s):

Nandita S Mani ◽

Kristine F Lan ◽

Rupali Jain ◽

H Nina Kim ◽

John B Lynch ◽

...

Keyword(s):

Infectious Disease ◽

Medical Center ◽

Interrupted Time Series ◽

Antibiotic Use ◽

Percentage Change ◽

Post Intervention ◽

Sustained Reduction ◽

Days Of Therapy ◽

The University ◽

The Impact

Abstract Background Following a meropenem shortage, we implemented a post-prescription review with feedback (PPRF) in November 2015 with mandatory infectious disease (ID) consultation for all meropenem and imipenem courses > 72 hours. Providers were made aware of the policy via an electronic alert at the time of ordering. Methods A retrospective study was conducted at the University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC) to evaluate the impact of the policy on antimicrobial consumption and clinical outcomes pre- and post-intervention during a 6-year period. Antimicrobial use was tracked using days of therapy (DOT) per 1,000 patient-days, and data were analyzed by an interrupted time series. Results There were 4,066 and 2,552 patients in the pre- and post-intervention periods, respectively. Meropenem and imipenem use remained steady until the intervention, when a marked reduction in DOT/1,000 patient-days occurred at both hospitals (UWMC: percentage change -72.1%, (95% CI -76.6, -66.9), P < 0.001; HMC: percentage change -43.6%, (95% CI -59.9, -20.7), P = 0.001). Notably, although the intervention did not address antibiotic use until 72 hours after initiation, there was a significant decline in meropenem and imipenem initiation (“first starts”) in the post-intervention period, with a 64.9% reduction (95% CI 58.7, 70.2; P < 0.001) at UWMC and 44.7% reduction (95% CI 28.1, 57.4; P < 0.001) at HMC. Meropenem and Imipenem DOT (January 2013 – November 2019) Conclusion Mandatory ID consultation and PPRF for meropenem and imipenem beyond 72 hours resulted in a significant and sustained reduction in the use of these antibiotics and notably impacted their up-front usage. Disclosures All Authors: No reported disclosures

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The lone S41 family C-terminal processing protease in Staphylococcus aureus is localized to the cell wall and contributes to virulence

Microbiology ◽

10.1099/mic.0.079798-0 ◽

2014 ◽

Vol 160 (8) ◽

pp. 1737-1748 ◽

Cited By ~ 16

Author(s):

Ronan K. Carroll ◽

Frances E. Rivera ◽

Courtney K. Cavaco ◽

Grant M. Johnson ◽

David Martin ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Cell Wall ◽

Critical Role ◽

Multidrug Resistant ◽

Health Concern ◽

Host Immune System ◽

Increased Sensitivity ◽

Processing Protease

Staphylococcus aureus is a versatile pathogen of humans and a continued public health concern due to the rise and spread of multidrug-resistant strains. As part of an ongoing investigation into the pathogenic mechanisms of this organism we previously demonstrated that an intracellular N-terminal processing protease is required for S. aureus virulence. Following on from this, here we examine the role of CtpA, the lone C-terminal processing protease of S. aureus. CtpA, a member of the S41 family, is a serine protease whose homologues in Gram-negative bacteria have been implicated in a range of biological functions, including pathogenesis. We demonstrate that S. aureus CtpA is localized to the bacterial cell wall and expression of the ctpA gene is maximal upon exposure to conditions encountered during infection. Disruption of the ctpA gene leads to decreased heat tolerance and increased sensitivity when exposed to components of the host immune system. Finally we demonstrate that the ctpA − mutant strain is attenuated for virulence in a murine model of infection. Our results represent the first characterization of a C-terminal processing protease in a pathogenic Gram-positive bacterium and show that it plays a critical role during infection.

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Unintended Consequences of MRSA Infection: Empiric Non-MRSA Antibiotic Use and Resultant Clostridioides difficile Infection

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1078 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s421-s422

Author(s):

Anastasiia S. Weiland ◽

Julia Y. Lu ◽

Caleb S. Chen ◽

Thomas Tjoa ◽

Raveena D. Singh ◽

...

Keyword(s):

Antibiotic Therapy ◽

Controlled Trial ◽

Antibiotic Use ◽

Medication Administration ◽

Multidrug Resistant ◽

Unintended Consequences ◽

Empiric Antibiotic Therapy ◽

Clostridioides Difficile ◽

Days Of Therapy ◽

Mrsa Infection

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for the largest number of invasive infections due to a multidrug-resistant pathogen. Approximately 10% of hospitalized carriers will experience invasive MRSA disease in the year following discharge incurring antibiotic therapy beyond focused treatment of MRSA. Objective: We aimed to quantify the extent of non-MRSA empiric antibiotics incurred by MRSA infections and further assess the risk of Clostridioides difficile Infection (CDI) as a result of treatment of MRSA infection. Methods: The CLEAR Trial was a postdischarge randomized controlled trial of 2,121 MRSA carriers comparing MRSA education alone to education plus repeated decolonization that demonstrated a 30% reduction in MRSA infection and a 17% reduction in all-cause infection attributable to decolonization in the year following hospital discharge (Huang SS, NEJM 2019). We included all hospitalization outcomes due to MRSA infection in the CLEAR Trial with detailed medication administration records to quantify unintended consequences of MRSA infection related to empiric non-MRSA antibiotic use and resultant CDI. Full-text medical records were reviewed with a standardized abstraction form to collect inpatient administered antibiotics and hospital-associated CDI. Results: In total,154 hospitalizations due to MRSA infection with a mean length-of-stay of 10.6 days were identified. During 25 hospitalizations (16.2%), patients received only anti-MRSA antibiotics. During the remaining 129 (83.8%) hospitalizations, patients received a mean of 1.6 distinct non-MRSA antibiotics totaling a mean of 6.6 days of therapy (DOT). Empiric non-MRSA therapy was given for 3.2 DOT before MRSA culture results became available and was continued for an additional 3.4 DOT afterward. Among all 849 non-MRSA DOT, the most common were due to piperacillin-tazobactam (293 DOT, 34.5%), levofloxacin (105 DOT, 12.4%), and metronidazole (93 DOT, 11.0%). Across all 154 hospitalizations, a mean of 5.5 non-MRSA DOT was calculated per MRSA hospitalization, with 6 CDI cases (3.9%) as a direct sequelae of empiric non-MRSA antibiotics provided for MRSA infection. Conclusions: Hospitalization for MRSA infection results in extensive non-MRSA empiric antibiotic therapy both before and after MRSA culture results are known. This antibiotic use is associated with a 3.9% risk of CDI that exceeds the national risk of acquiring CDI (3.2 per 1,000 admissions) by 12-fold during any hospital stay (Barrett ML, AHRQ 2018). The CLEAR Trial findings that postdischarge decolonization reduces MRSA infection and hospitalization by 30% suggests that decolonization may also reduce non-MRSA antibiotic use and CDI in this population.Funding: NoneDisclosures: None

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Genomic Characterization of Antimicrobial Resistance in Food Chain and Livestock-Associated Salmonella Species

Animals ◽

10.3390/ani11030872 ◽

2021 ◽

Vol 11 (3) ◽

pp. 872

Author(s):

Thobeka P. Mthembu ◽

Oliver T. Zishiri ◽

Mohamed E. El Zowalaty

Keyword(s):

Public Health ◽

Antimicrobial Resistance ◽

Food Chain ◽

Bacterial Infections ◽

Antibiotic Use ◽

Health Concern ◽

Salmonella Spp ◽

Food Animal ◽

Genomic Characterization

The rising trend of antimicrobial resistance (AMR) by foodborne bacteria is a public health concern as these pathogens are easily transmitted to humans through the food chain. Non-typhoid Salmonella spp. is one of the leading foodborne pathogens which infect humans worldwide and is associated with food and livestock. Due to the lack of discovery of new antibiotics and the pressure exerted by antimicrobial resistance in the pharmaceutical industry, this review aimed to address the issue of antibiotic use in livestock which leads to AMR in Salmonella. Much attention was given to resistance to carbapenems and colistin which are the last-line antibiotics used in cases of multi drug resistant bacterial infections. In the present review, we highlighted data published on antimicrobial resistant Salmonella species and serovars associated with livestock and food chain animals. The importance of genomic characterization of carbapenem and colistin resistant Salmonella in determining the relationship between human clinical isolates and food animal isolates was also discussed in this review. Plasmids, transposons, and insertion sequence elements mediate dissemination of not only AMR genes but also genes for resistance to heavy metals and disinfectants, thus limiting the therapeutic options for treatment and control of Salmonella. Genes for resistance to colistin (mcr-1 to mcr-9) and carbapenem (blaVIM-1, blaDNM-1, and blaNDM-5) have been detected from poultry, pig, and human Salmonella isolates, indicating food animal-associated AMR which is a threat to human public health. Genotyping, plasmid characterization, and phylogenetic analysis is important in understanding the epidemiology of livestock-related Salmonella so that measures of preventing foodborne threats to humans can be improved.

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