scholarly journals Antimicrobial drug resistant non-typhoidal Salmonella enterica in commercial poultry value chain in Chitwan, Nepal

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Amy Nelson ◽  
Sulochana Manandhar ◽  
Juliana Ruzante ◽  
Arrogya Gywali ◽  
Bimala Dhakal ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Environmental Samples ◽  
Poultry Meat ◽  
Basic Knowledge ◽  
Health Concern ◽  
Poultry Farms ◽  
Commercial Poultry ◽  
Food Animals ◽  
Poultry Farmers ◽  
Culture Positive

Abstract Background Antimicrobial resistance (AMR) among bacterial pathogens is a fast-growing public health concern. AMR in non-typhoidal Salmonella serovars (NTS) among food animals is of special concern as this may transmit resistant pathogens to humans during handling or consumption of animal products. In Nepal, the possibility of AMR Salmonella serovars among food animals is an important area of research, particularly in light of the rapidly growing poultry industry, lack of surveillance and proper biosecurity measures; and paucity of relevant data. This study was conducted with the aim to estimate the burden of NTS and associated antimicrobial resistance in the environments of commercial poultry farms and the poultry carcasses in slaughter house. This study also intends to find some basic knowledge of the poultry farmers and their practice relating to the use of antimicrobials, vaccination and biosecurity measures. Methods Taking one health approach, a cross-sectional study was carried out in Chitwan district of Nepal between May and October 2017. Various environmental samples viz. farm litter, feed, water, poultry faeces, vehicle swabs, farm swabs from 12 broiler poultry farms and various sections of poultry carcasses from 21 slaughter houses were aseptically collected. These were microbiologically assessed for the presence of NTS serovars and their phenotypic and genotypic indicators of antimicrobial resistance. The poultry farmers were also briefly interviewed regarding their basic biosecurity related knowledge and practices before collecting the environmental samples. Results Overall, of total environmental samples collected, 50% (31/62) tested positive for NTS serovars with environmental swabs (70%, 8/12) being the most culture positive sample types. Similarly, of 159 tissue samples collected from 24 carcasses, 79% (126/159) were culture positive for NTS serovars. Nearly 97% (153/157) of isolates showed antimicrobial resistance to tetracycline, while 11% (17/157) to ciprofloxacin and 5% (8/157) of isolates were resistant against azithromycin. All 157 isolates were sensitive to meropenem. In terms of AMR genes, tetA (83%, 131/157), QrnS (40%,64/157), mefA (8%, 13/157) and VIM-1 (0.6%, 1/157) were detected in the isolates that corresponded to the AMR to tetracycline, ciprofloxacin, azithromycin and meropenem respectively. In farmers interview, only 42% (5/12) of farmers mentioned of using basic biosecurity measures such as applying lime powder around the farm; 84% (10/12) of farmers reported vaccinating their birds with some vaccine and 75% (9/12) of farmers used various antimicrobials prophylactically such as neomycin (33%, 4/12), colistin (33%, 4/12), furaltadone (33%, 4/12), doxycycline (25%, 3/12), sulfatrimethoprim (25%, 3/12) and tylosin (16%, 2/12). Conclusions This study revealed gross contamination of farm environment and subsequent poultry meat samples with NTS serovars that were resistant to several clinically important antimicrobials. Further, inadequacy of even basic biosecurity measures and frequent prophylactic use of antimicrobials in the commercial poultry farms was observed. This reinforces an urgent need to raise awareness and implement proper biosecurity approaches from farms to slaughter houses in order to reduce the burden of NTS contamination of surrounding environment and poultry products. Further, high prevalence AMR among NTS isolates also underscores the need to strengthen the policies to prevent the rampant use of clinically used human antimicrobials in poultry sector.

scholarly journals Antimicrobial drug resistant non-typhoidal Salmonella enterica in commercial poultry value chain in Chitwan, Nepal

2020 ◽  
Author(s):  
Amy Nelson ◽  
Sulochana Manandhar ◽  
Juliana Ruzante ◽  
Arrogya Gyawali ◽  
Bimala Dhakal ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Environmental Samples ◽  
Poultry Meat ◽  
Basic Knowledge ◽  
Health Concern ◽  
Poultry Farms ◽  
Commercial Poultry ◽  
Food Animals ◽  
Poultry Farmers ◽  
Culture Positive

Abstract Background Antimicrobial resistance (AMR) among bacterial pathogens is a fast-growing public health concern. AMR in non-typhoidal Salmonella serovars (NTS) among food animals is of special concern as this may transmit resistant pathogens to humans during handling or consumption of animal products. In Nepal, the possibility of AMR Salmonella serovars among food animals is an important area of research, particularly in light of the rapidly growing poultry industry, lack of surveillance and proper biosecurity measures; and paucity of relevant data. This study was conducted with the aim to estimate the burden of NTS and associated antimicrobial resistance in the environments of commercial poultry farms and the poultry carcasses in slaughter house. This study also intends to find some basic knowledge of the poultry farmers and their practice relating to the use of antimicrobials, vaccination and biosecurity measures.. Methods Taking one health approach, a cross-sectional study was carried out in Chitwan district of Nepal between May and October 2017. Various environmental samples viz. farm litter, feed, water, poultry faeces, vehicle swabs, farm swabs from 12 broiler poultry farms and various sections of poultry carcasses from 21 slaughter houses were aseptically collected. These were microbiologically assessed for the presence of NTS serovars and their phenotypic and genotypic indicators of antimicrobial resistance. The poultry farmers were also briefly interviewed regarding basic their basic biosecurity related knowledge and practices before collecting the environmental samples.Results Overall, of total environmental samples collected, 50% (31/62) tested positive for NTS serovars with environmental swabs (70%, 8/12) being the most culture positive sample types. Similarly, of 159 tissue samples collected from 24 carcasses, 79% (126/159) were culture positive for NTS serovars. Nearly 97% (153/157) of isolates showed antimicrobial resistance to tetracycline, while 11% (17/157) to ciprofloxacin and 5% (8/157) of isolates were resistant against azithromycin. All 157 isolates were sensitive to meropenem. In terms of AMR genes, tetA (83%, 131/157), QrnS (40%,64/157), mefA (8%, 13/157) and VIM-1 (0.6%, 1/157) were detected in the isolates that corresponded to the AMR to tetracycline, ciprofloxacin, azithromycin and meropenem respectively. In farmers interview, only 42% (5/12) of farmers mentioned of using basic biosecurity measures such as applying lime powder around the farm; 84% (10/12) of farmers reported vaccinating their birds with some vaccine and 75% (9/12) of farmers used various antimicrobials prophylactically such as neomycin (33%, 4/12), colistin (33%, 4/12), furaltadone (33%, 4/12), doxycycline (25%, 3/12), sulfatrimethoprim (25%, 3/12) and tylosin (16%, 2/12).Conclusions This study revealed gross contamination of farm environment and subsequent poultry meat samples with NTS serovars that were resistant to several clinically important antimicrobials. Further, inadequacy of even basic biosecurity measures and frequent prophylactic use of antimicrobials in the commercial poultry farms was observed. This reinforces an urgent need to raise awareness and implement proper biosecurity approaches from farms slaughter houses in order to reduce the burden of NTS contamination of surrounding environment and poultry products. Further, high prevalence AMR among NTS isolates also underscores the need to strengthen the policies to prevent the rampant use of clinically used human antimicrobials in poultry sector.

scholarly journals High level of contamination of antimicrobial drug resistant non-typhoidal Salmonella enterica in commercial poultry and its surroundings in Chitwan, Nepal

2020 ◽  
Author(s):  
Amy Nelson ◽  
Sulochana Manandhar ◽  
Juliana Ruzante ◽  
Arrogya Gyawali ◽  
Bimala Dhakal ◽  
...  
Keyword(s):  
Salmonella Enterica ◽  
Environmental Samples ◽  
Positive Sample ◽  
Poultry Meat ◽  
Health Concern ◽  
Feed Water ◽  
Cross Sectional ◽  
Tissue Samples ◽  
Food Animals ◽  
Culture Positive

Abstract BackgroundAntimicrobial resistance (AMR) among bacterial pathogens is a fast-growing public health concern. AMR in non-typhoidal Salmonella species among food animals is of special concern as this may transmit resistant pathogens to humans during handling or consumption of animal products. In Nepal, the possibility of AMR Salmonella species among food animals is an important area of research, particularly in light of the rapidly growing poultry industry, lack of surveillance, and paucity of studies that have been conducted. MethodsTaking one health approach, a cross-sectional study was carried out in Chitwan district of Nepal between May and October 2017. Various environmental samples viz. farm litter, feed, water, poultry feces, vehicle swabs, farm swabs from 12 broiler poultry farms and various sections of poultry carcasses from 21 slaughter houses were aseptically collected. These were microbiologically assessed for the presence of non-typhoidal Salmonella and their phenotypic and genotypic indicators of antimicrobial resistance. ResultsOverall, Of 62 environmental samples collected, 31(50%) tested positive for Salmonella enterica serovars with environmental swabs (70%, 8/12) being the most culture positive sample types. Similarly, of 159 tissue samples collected from 24 carcasses, 79% (126/159) were culture positive for Salmonella enterica. Nearly 97% (153/157), 11% (17/157), 5% (8/157) and none of isolates showed resistance to tetracycline, ciprofloxacin, azithromycin and meropenem respectively. Some 83% (131/157), 40% (64/157), 8% (13/157) and 0.6% (1/157) of isolates tested positive for tetA, QrnS, mefA and VIM-1 AMR genes corresponding to the above antimicrobials respectively.ConclusionsThis study revealed gross contamination of farms and subsequent poultry meat samples with Salmonella enterica serovars that were resistant to several clinically applicable antimicrobials. This reinforces an urgent need to implement proper biosecurity approaches from farms to slaughter houses and strengthen policies to cease the rampant use of clinically important antimicrobials in poultry.

scholarly journals 623. Antimicrobial Resistance in Non-Typhoidal Salmonella from Retail Poultry Meat by Antibiotic Usage-related Production Claims—Pennsylvania, 2008–2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S289-S289
Author(s):  
Xin Yin ◽  
Nkuchia M M’ikanatha ◽  
Lisa Dettinger ◽  
Melinda Johnston ◽  
William Eckroth ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antibiotic Usage ◽  
Poultry Meat ◽  
Health Concern ◽  
Whole Genome Sequencing Data ◽  
Sequencing Data ◽  
Antimicrobial Drugs ◽  
Salmonella Infections ◽  
Drug Classes ◽  
Meat Samples

Abstract Background Antimicrobial-resistant (AMR) nontyphoidal Salmonella infections are a public health concern. Injudicious use of antimicrobials fuels emergence of resistance. The National Antimicrobial Resistance Monitoring System (NARMS) tracks AMR in Salmonella from humans, animals and foods. There is limited evidence regarding antimicrobial use in food animals and AMR bacteria in retail meat. Methods We reviewed antimicrobial susceptibility and whole-genome sequencing data from 320 Salmonella isolated from poultry meat in Pennsylvania as part of NARMS activities. Salmonella strains were isolated from 3,481 samples purchased from randomly selected retail outlets during 2008–2017. Antibiotic usage claims on meat packages were used to compare AMR Salmonella from conventional and antibiotic-free/organic (Abx-free) samples. Genetic mechanisms for AMR were investigated in a subset of isolates. Results The prevalence of Salmonella in conventional poultry meat 10.2% (280/2,733) was significantly higher than the prevalence in poultry meat labeled as Abx-free (5.3%, 40/748; P < 0.0001). Salmonella from conventional poultry meat was more likely to be resistant to 3 or more drugs (55.0%, 154/280) compared with poultry meat labeled as Abx-free (27.5%, 11/40; P = 0.0011). Salmonella from conventional poultry exhibited significantly higher resistance to 4 drug classes including β-lactams (P = 0.006) (figure). One hundred isolates from conventional poultry meat and 8 isolates from antibiotic-free/organic samples harbored a gene conferring resistance to the β-lactam class; 24.3% (68/280) of isolates from conventional and 7.5% (3/40) of isolates from Abx-free samples (P = 0.0145) contained the extended-spectrum β-lactamase (ESBL) gene blaCMY-2. Conclusion Meat samples from conventionally-raised poultry were more likely to be contaminated with AMR Salmonella strains and have genes that reduce the effectiveness of antimicrobial drugs recommended for treatment of severe infections. Contamination of poultry with AMR Salmonella strains is concerning as is the presence of genes that decrease the power of critical antibiotics such as β-lactams. These findings highlight the importance of judicious use of antibiotics in food-producing animals. Disclosures All authors: No reported disclosures.

Prevalence, Risk Factors, and Antimicrobial Resistance Profiles of Salmonella from Commercial Broiler Farms in Two Important Poultry-Producing Regions of Colombia

2012 ◽  
Vol 75 (5) ◽  
pp. 874-883 ◽  
Author(s):  
P. DONADO-GODOY ◽  
I. GARDNER ◽  
B. A. BYRNE ◽  
M. LEON ◽  
E. PEREZ-GUTIERREZ ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Resistance ◽  
Nalidixic Acid ◽  
Health Concern ◽  
Resistance Pattern ◽  
Resistant Bacteria ◽  
Poultry Production ◽  
Poultry Farms ◽  
Paratyphi B ◽  
Salmonella Heidelberg

Salmonella is one of the most common foodborne pathogens associated with diarrheal disease in humans. Food animals, especially poultry, are important direct and indirect sources of human salmonellosis, and antimicrobial resistance is an emerging problem of public health concern. The use of antimicrobials benefits producers but contributes to the emergence of antimicrobial resistant bacteria. As a step toward implementing the Colombian Integrated Program for Antimicrobial Resistance Surveillance, this study was conducted to establish the prevalence, distribution of serovars, antimicrobial resistance profiles, and risk factors for Salmonella on poultry farms in the two largest states of poultry production in Colombia. Salmonella was isolated from 41% of farms and 65% of the 315 chicken houses sampled. Salmonella Paratyphi B variant Java was the most prevalent serovar (76%), followed by Salmonella Heidelberg (23%). All Salmonella isolates were resistant to 2 to 15 of the antimicrobial drugs tested in this study. For Salmonella Paratyphi B variant Java, 34 drug resistance patterns were present. The predominant resistance pattern was ciprofloxacin, nitrofurantoin, tetracycline, trimethoprim-sulfamethoxazole, ceftiofur, streptomycin, enrofloxacin, and nalidixic acid; this pattern was detected in 15% of isolates. The resistance pattern of tetracycline, ceftiofur, and nalidixic acid was found in over 40% of the isolates of Salmonella Heidelberg. Of the biosecurity practices considered, two factors were significantly associated with reduction in Salmonella: cleaning of fixed equipment and composting of dead birds on the farm. Findings from the present study provide scientific evidence to inform implementation of official policies that support new biosecurity legislation in an effort to decrease the prevalence of Salmonella on Colombian poultry farms.

scholarly journals Carcass Salmonella and Its Drug Resistance

2019 ◽  
pp. 1-21
Author(s):  
Gizachew Muluneh Amera ◽  
Amit Kumar Singh
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Pathogenic Bacteria ◽  
Antimicrobial Agents ◽  
Public Health Problem ◽  
Multidrug Resistant ◽  
Health Concern ◽  
Personal Hygiene ◽  
Wide Range ◽  
Food Animals

Salmonella are the major pathogenic bacteria in humans as well as in animals. Salmonella species are leading causes of acute gastroenteritis in several countries and salmonellosis remains an important public health problem worldwide, particularly in the developing countries. Isolation of Salmonella from a wide range of sources suggests that Salmonella is widespread in food animals and meat products and underlines the necessity for a joint and coordinated surveillance and monitoring programs for salmonellosis and other major food borne zoonotic diseases. Food animals harbor a wide range of Salmonella and so act as sources of contamination, which is of paramount epidemiological importance in non-typhoid human salmonellosis. Salmonellosis is more aggravated by the ever increasing rate of antimicrobial resistance strains in food animals. The high prevalence and dissemination of multidrug resistant (MDR) Salmonella have become a growing public health concern. Multidrug resistant (MDR) strains of Salmonella are now encountered frequently and the rates of multidrug resistance have increased considerably in recent years. Food animal consumption is a potential cause for antimicrobial resistant Salmonella illnesses besides, the common factors such as overcrowding, poverty, inadequate sanitary conditions, and poor personal hygiene. Practicing good sanitary measures, extensive education programs for proper hygiene and improvement of managements are solutions to eliminate the high bacteriological load as well as prevalence of Salmonella in cattle carcass. Furthermore, restricting the use of antimicrobial agents in food animals, designation of multidrug-resistant Salmonella as an adulterant in ground beef, improving the mechanisms for product trace-back investigations and wise and discriminate use of antimicrobials should be practiced to combat the ever increasing situation of antimicrobial resistance. So, this review used for updating information on their prevalence and resistance patterns is very important to suggest the acceptance of the carcass in relation to the standards and for proper selection and use of antimicrobial agents in a setting.

scholarly journals Diversity of Antimicrobial Resistance Phenotypes in Salmonella Isolated from Commercial Poultry Farms

2017 ◽  
Vol 4 ◽  
Author(s):  
Karen A. Liljebjelke ◽  
Charles L. Hofacre ◽  
David G. White ◽  
Sherry Ayers ◽  
Margie D. Lee ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Poultry Farms ◽  
Commercial Poultry

Biosecurity practices in commercial poultry farms located in ElFashir Locality- Sudan

2021 ◽  
Vol 1 (1) ◽  
pp. 033-043
Author(s):  
Sami Ahmed Mohammed Arabi ◽  
Mohammed Ahmed Eltayeb Gumaa
Keyword(s):  
Traffic Control ◽  
Feed Consumption ◽  
Poultry Production ◽  
Control Measurement ◽  
Poultry Farms ◽  
Commercial Poultry ◽  
Poultry Farmers ◽  
Biosecurity Practices ◽  
Cleaning And Disinfection ◽  
Risk Limits

This study was conducted to assess the biosecurity practices in commercial poultry farms in the locality of ElFashir, North Darfur State Sudan. Thirty two farms biosecurity tests were used, biosecurity practices were evaluated in poultry farms using the checklist and organized questionnaires administered to commercial poultry farmers. Simple descriptive statistics were used (frequencies and percentages) to summarize and display the results. The results showed that 62.5% of the farms used the floor brooding system of the birds; 59.4% open barns; The domestic stock in access to the farm site 68.8%; Pets or wildlife birds have access to inside of barns or feed storage 71.9%; yearly water quality is not checked by a reputable laboratory 96.9%; employees have routine contact with other poultry species 84.4%; regular cleaning and disinfection of feeders and drinkers washing is done mainly by soap in addition to water. 43.8%; employees and their families with other people on poultry housing site 100%; poultry production, feed consumption, and mortality records are kept, but not reviewed daily 18.8%; there is untrimmed vegetation and debris within barn(s) 81.2%; vehicle flow designated way traffic onto premises and off premises 100% and perimeter fencing and gate present but not always locked or guarded or fence not completed 56.25%. The study concluded that there is a severe weakness in the application of biosecurity practices in its three branches isolation, cleaning disinfecting and traffic control. The adopted hygiene and traffic control measurement were all within the high and medium biosecurity risk limits whereas mismanagement resembled 60.4% the highest risk of biosecurity practices among the studies in commercial poultry farms of ElFashir Locality. Therefore, it is strongly recommended for local authorities to intervene with qualified teams of poultry professional and experts to train poultry farmers, managers and attendees on importance of implementing sound biosecurity practices.

scholarly journals High Prevalence of Vancomycin Non-Susceptible and Multi-Drug Resistant Enterococci in Farmed Animals and Fresh Retail Meats in Bangladesh

2021 ◽  
Author(s):  
Mohammed A. Samad ◽  
Md Shahjalal Sagor ◽  
Muhammad Sazzad Hossain ◽  
Md Rezaul Karim ◽  
Mohammad Asheak Mahmud ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Health Concern ◽  
Specific Pcr ◽  
Retail Meats ◽  
High Prevalence ◽  
Retail Meat ◽  
Food Animals ◽  
Meat Samples ◽  
Line Drug ◽  
Isolated Species

Abstract The emergence of antimicrobial resistant Enterococcus spp., a leading cause of untreatable nosocomial infection, in food animals and dissemination to humans is a public health concern. The study was conducted to determine the prevalence and antimicrobial resistance, and virulence characteristics of Enterococcus faecalis and Enterococcus faecium in food animals and meats in Bangladesh. Enterococcus spp., were confirmed using sodA gene specific PCR, and antimicrobial resistance and virulence properties were characterized by PCR. Enterococcus spp. were recovered from 57% of the collected samples (n=201/352). Farm samples yielded significantly higher (p≤0.05) prevalence (62%) compared to retail meat samples (41%) and E. faecalis (52%) was most frequently isolated species. High proportions of isolates exhibited resistance to tetracycline (74%), erythromycin (65%) and ciprofloxacin (34%). Fifty-one isolates were vancomycin non-susceptible enterococci (VNSE), of which forty-seven were MDR and 20 were linezolid resistant, a last line drug for VNSE. Virulence factors such as gelatinase (gelE), aggregation factor (asa1) and sex pheromone (cpd) were detected along with vancomycin resistance gene (vanA, vanB and vanC2/C3) in VNSE isolates. The high prevalence of MDR enterococci in food animals and retail meats may lead to infection in consumers with concomitant reduced therapeutic options available for treatment.

scholarly journals Evaluation of Antibiotic Sensitivity Against Bacterial Diseases Prevalent in Commercial Poultry Farm in Western Part of Bangladesh

2021 ◽  
Vol 3 (2) ◽  
pp. 69-76
Author(s):  
Aurangazeb Kabir ◽  
Most. Sabina Yasmin ◽  
Md. Golam Sarwar ◽  
Md. Obaidullah Al Masum ◽  
Soshe Ahmed ◽  
...  
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Antibiotic Sensitivity ◽  
Cross Sectional Study ◽  
Poultry Production ◽  
Microbial Infection ◽  
Cross Sectional ◽  
Attitudes And Practices ◽  
Poultry Farms ◽  
Commercial Poultry

A surge in the emergence and spread of antimicrobial resistance (AMR) has become a major concern. The indiscriminate use of antibiotics in poultry farming, increased consumption of poultry products containing antimicrobial residues is likely to hasten the development of multidrug resistance in pathogens, as well as in commensal organisms. To substantiate our knowledge on the status of AMR to the Neomycin, Gentamicin, Levofloxacin, Ciprofloxacin, Doxycycline, Sulfonamide, Amoxicillin and Cephalexin, commonly being used in poultry farms in Rajshahi city (Western Part) of Bangladesh a cross sectional study was carried out using conventional Kirby-Bauer disc diffusion technique. We tried to identify sensitivity of the stated antibiotics against bacterial samples obtained from 30 liver samples of live birds out of which 24 were layer and 6 were broiler from 10 commercial poultry farms. In our study, we observed that Cephalexin, Neomycin, Gentamicin and Levofloxacin retain superior antimicrobial potency at the rate of 33.33%, 23.33%, 20%, and 23.33% respectively. Moreover, Levofloxacin started to show quite (70%) to moderate (6.67%) sensitivity and Neomycin (76.67%), Gentamicin (80%) Cephalexin (33.33%) show only quite sensitivity indicating exacerbation of existing antimicrobial resistance through gradually losing their affectivity against microbial infections. On the other hand, during our observation Ciprofloxacin (33.33%), Amoxicillin (20%), Doxycycline (6.67%) and Sulfonamides (3.33%) were found having no sensitivity at all, however, these drugs still being considered as drug of choice for commercial flocks to treat microbial infection. Farmers ‘knowledge, attitudes, and practices regarding the use of antibiotics have to be fully compliant in line with manufacturers’ recommendations to reduce risk to public health. This study was, therefore, conducted to collect baseline data on the regularly used antibiotics in poultry production and to provide a greater understanding of the potential impact of antimicrobial resistance on public health.

European Surveillance of Antimicrobial Consumption: the ESAC programme

2004 ◽  
Vol 8 (32) ◽  
Author(s):  
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Health Concern ◽  
Antimicrobial Consumption ◽  
Public Health Concern ◽  
Major Public Health Concern

Resistance to antimicrobials has become a major public health concern, and it has been shown that there is a relationship, albeit complex, between antimicrobial resistance and consumption

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