Antimicrobial resistance in Italy: preliminary results from the AR-ISS project

Antimicrobial resistance represents a critical problem in human medicine today, from both clinical and economic points of view. In 1999, the Council of the European Union included antibiotic resistance among the public health priorities in the Community, and a resolution entitled 'A strategy against the microbial threat' was issued (1). According to this document, the establishment or strengthening of a surveillance system for the collection of reliable and comparable data on a national and international scale is one of the main interventions needed to control and prevent antibiotic resistance. Surveillance systems should also integrate data about the use and prescription of antibiotics (2).

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Decreasing and stabilising trends of antimicrobial consumption and resistance in Escherichia coli and Klebsiella pneumoniae in segmented regression analysis, European Union/European Economic Area, 2001 to 2018

Eurosurveillance ◽

10.2807/1560-7917.es.2019.24.46.1900656 ◽

2019 ◽

Vol 24 (46) ◽

Cited By ~ 3

Author(s):

Germán Peñalva ◽

Liselotte Diaz Högberg ◽

Klaus Weist ◽

Vera Vlahović-Palčevski ◽

Ole Heuer ◽

...

Keyword(s):

European Union ◽

Antimicrobial Resistance ◽

European Economic Area ◽

Segmented Regression ◽

The European Union ◽

Antimicrobial Consumption ◽

Surveillance Network ◽

The Public ◽

Early Indication ◽

Health Agenda

Investments to reduce the spread of antimicrobial resistance (AMR) in the European Union have been made, including efforts to strengthen prudent antimicrobial use. Using segmented regression, we report decreasing and stabilising trends in data reported to the European Surveillance of Antimicrobial Consumption Network and stabilising trends in data reported to the European Antimicrobial Resistance Surveillance Network. Our results could be an early indication of the effect of prioritising AMR on the public health agenda.

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Hospital use of antibiotics as the main driver of infections with antibiotic-resistant bacteria – a reanalysis of recent data from the European Union

10.1101/553537 ◽

2019 ◽

Cited By ~ 3

Author(s):

Matthias M. Fischer ◽

Matthias Bild

Keyword(s):

European Union ◽

Antibiotic Resistance ◽

Antimicrobial Resistance ◽

Antibiotic Use ◽

Resistant Bacteria ◽

Individual Member ◽

The European Union ◽

Hospital Sector ◽

Main Driver ◽

Resistance Rates

AbstractAntimicrobial resistance in bacteria causes significant morbidity worldwide. The development and acquisition of resistance to antibiotics is believed to primarily develop under the selective pressure of widespread antibiotic use in humans, however antimicrobial usage in livestock has been proposed as additional, if not principal, driver of antibiotic resistance. In this work, we correlate recent data from the European Union on antibiotic resistance rates with data on antibiotic usage in the primary care and hospital sector and data on veterinary antimicrobial consumption across the individual member states. We quantify the strength of these different potential drivers of antimicrobial resistance in order to compare their biological importance. We found that the correlation between antibiotic use in the hospital sector and antibiotic resistance rates is significantly higher than the correlation between resistance rates and any of the other two predictors. This suggests increased antibiotic use in hospitals as the main driver of the development of antibiotic resistances and necessitates further research on and a re-evaluation of the risks associated with antibiotic use in human and veterinary medicine.

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Antimicrobial Resistance is a Global Problem

International Journal of Antibiotics and Probiotics ◽

10.31405/ijap.4-5.18.01 ◽

2018 ◽

Vol 2 (4) ◽

pp. 6-19

Author(s):

A.G. Salmanov ◽

V.V. Trokhymchuk ◽

O.M. Verner ◽

O.O. Lugach

Keyword(s):

Public Health ◽

Health Care ◽

Antibiotic Resistance ◽

Antimicrobial Resistance ◽

Animal Health ◽

Antibiotic Use ◽

Modern Medicine ◽

Full Spectrum ◽

The Public ◽

Treatment Action

Infectious agents resistance to antimicrobials remains a challenging open problem of health care around the world. As a result, treatment-induced infections pose a serious threat to public health in general. This problem has become so important that the overwhelming majority of countries consider it a threat to the national security. Resistance to antimicrobials threatens to offset the very fundamentals of modern medicine and the sustainability of the public health system effective global response to a permanent infectious diseases threat. Today, antimicrobial resistance issues can be tackled provided that one implements an effective One Health approach (the principle of human and animal health interrelation), assuming that there is a coordination between different sectors and subjects, including experts in medicine, veterinary medicine, agriculture, ecology, and well-informed consumers. To ensure effectiveness of treatment, action is urgently needed to counteract the further development and spread of antibiotic resistance, which is driven by antibiotic use in all sectors. Since this resistance has no ecological, sectoral or geographical borders, its appearance in one sector affects resistance in other sectors. National authorities, veterinarians, physicians, patients and farmers all have key roles in preserving the power of antibiotics. The prevention and containment of antibiotic resistance therefore requires addressing all risk factors for the development and spread of antibiotic resistance across the full spectrum of conditions, sectors, settings (from health care to use in food-animal production) and countries. This article explores the options for prevention and containment of antibiotic resistance in the food-chain through national coordination, including the regulation and reduction of antibiotic use in food animals, training and capacity building, surveillance of resistance trends and antibiotic usage, promotion of knowledge and research, and advocacy and communication to raise awareness of the issues. The article suggests possible ways for adopting a holistic, intersectoral, multifaceted approach to this growing problem.

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Antimicrobial Resistance in Pathogens Isolated from Blood Cultures: A Two-Year Multicenter Hospital Surveillance Study in Italy

Antibiotics ◽

10.3390/antibiotics10010010 ◽

2020 ◽

Vol 10 (1) ◽

pp. 10

Author(s):

Francesca Licata ◽

Angela Quirino ◽

Davide Pepe ◽

Giovanni Matera ◽

Aida Bianco ◽

...

Keyword(s):

Escherichia Coli ◽

Staphylococcus Aureus ◽

Antimicrobial Resistance ◽

Bloodstream Infections ◽

Electronic Record ◽

Coagulase Negative Staphylococcus ◽

Surveillance Systems ◽

Gram Negative ◽

Medicine Today ◽

High Level

Background: Antimicrobial resistance (AMR) is one of the most concerning issues in medicine today. The objectives of this study were to investigate the AMR distribution of the blood-borne pathogens isolated over a two-year period in an Italian region. Methods: A retrospective electronic record review of laboratory-confirmed bloodstream infections (BSIs) was done, and data from three major diagnostic laboratories were used. Twelve invasive clinically important bacteria species were included in the sample. Results: During the study period, 1228 positive BSIs were collected. The most common pathogens were Coagulase-negative Staphylococcus (CoNS) (29.7%), Staphylococcus aureus (19.1%) and Escherichia coli (15.9%). With regard to the AMR pattern, 31.7% of CoNS and 28.1% of Staphylococcus aureus were oxacillin-resistant, and almost half of the Enterococci showed resistance to high-level gentamicin. Among Gram-negative species, 11.7% of Escherichia coli and 39.5% of Klebsiella pneumoniae were carbapenem-resistant. Among the non-fermentative Gram-negative bacteria, the most frequently combined AMR pattern was aminoglycosides and fluoroquinolones (48.4% in A. baumannii and 14.6% in P. aeruginosa). Conclusion: The results display an alarming prevalence of AMR among hospital isolated pathogens, consistently higher than the European average. Information from surveillance systems to better characterize the trend in the incidence of AMR at local and national levels is needed.

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Reporting epidemiology of antibiotic resistance

Microbiologia Medica ◽

10.4081/mm.2015.5308 ◽

2015 ◽

Vol 30 (2) ◽

Author(s):

Simone Ambretti ◽

Carlo Gagliotti ◽

Francesco Luzzaro ◽

Paolo Malacarne ◽

Angelo Pan ◽

...

Keyword(s):

Antibiotic Resistance ◽

Antimicrobial Resistance ◽

Temporal Trends ◽

Surveillance Data ◽

Surveillance Systems ◽

Treatment Protocols ◽

The Us ◽

Resistance Data ◽

Single Set ◽

Critical Aspects

The aim of antimicrobial resistance surveillance is to monitor temporal trends and provide clinicians with data to define empirical treatment protocols. The surveillance methods adopted in different settings can be significantly different and, therefore, no reference can be made to a single set of standards. This paper outlines the main features of analysis and reporting of antimicrobial resistance data according to the guidelines issued by the US Clinical and Laboratory Standards Institute, and the surveillance systems adopted in Europe. In this article the strengths and weaknesses of the various types of analyses will be discussed highlighting the critical aspects to be taken into account in surveillance data reporting.

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Study of Antimicrobial Resistance in Recreational Water Bodies

International Journal of Chemical and Environmental Sciences ◽

10.15864/268963821834540173 ◽

2021 ◽

Vol 3 (1) ◽

pp. 7-10

Author(s):

Udita Roy ◽

Soumi GuhaPolley

Keyword(s):

Antibiotic Resistance ◽

Antimicrobial Resistance ◽

Water Samples ◽

Anthropogenic Activities ◽

Multidrug Resistant ◽

Water Bodies ◽

Recreational Water ◽

Antibiotic Resistant ◽

The Public ◽

A Site

Thc development and proliferation of antibiotic resistance in pathogen, commensal and environmcntal microorganisms is a major heallh conccrn. The natural environment may act as a site of propagation and maintenance of antibiotic resistance and greatly depends on various human activities. The anthropogenic activities leading to rise and dissemination of antibiotic resistance should be studied extensively. Recreational water bodies can act both as the recipient and reservoir of antimicrobial resistance (AMR) and thus serve as a potent site of horizntal transfer of antibiotic resistant genes and dissemination of the same to environmental microbes. In the current study, water samples of recreational water bodies were investigated as possible sources of antibiotic resistant bacterial population. Water samples from RabindraSarobar of Kolkata was surveyed and antibiotic resistance patern of gram negative fecal coliforrnswere mainly evaluated. Many of them were found to be Multidrug resistant(MDR) which is of great concem to the public health.

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Recent Review on Subclass B1 Metallo-β-lactamases Inhibitors: Sword for Antimicrobial Resistance

Current Drug Targets ◽

10.2174/1389450120666181217101812 ◽

2019 ◽

Vol 20 (7) ◽

pp. 756-762 ◽

Cited By ~ 2

Author(s):

Aditi Kaushik ◽

Manish Kaushik ◽

Viney Lather ◽

J.S. Dua

Keyword(s):

Antibiotic Resistance ◽

Multidrug Resistance ◽

Antimicrobial Resistance ◽

Global Health ◽

Human Health ◽

Microbial Pathogens ◽

Present Review ◽

Drug Molecules ◽

Global Threat ◽

Powerful Strategy

An emerging crisis of antibiotic resistance for microbial pathogens is alarming all the nations, posing a global threat to human health. The production of the metallo-β-lactamase enzyme is the most powerful strategy of bacteria to produce resistance. An efficient way to combat this global health threat is the development of broad/non-specific type of metallo-β-lactamase inhibitors, which can inhibit the different isoforms of the enzyme. Till date, there are no clinically active drugs against metallo- β-lactamase. The lack of efficient drug molecules against MBLs carrying bacteria requires continuous research efforts to overcome the problem of multidrug-resistance bacteria. The present review will discuss the clinically potent molecules against different variants of B1 metallo-β-lactamase.

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Antimicrobial Resistance and Presence of Class 1 Integrons Among Different Serotypes of Salmonella spp. Recovered From Children with Diarrhea in Tehran, Iran

Infectious Disorders - Drug Targets ◽

10.2174/1871526519666190130171020 ◽

2020 ◽

Vol 20 (2) ◽

pp. 160-166

Author(s):

Seyedeh Hanieh Eshaghi Zadeh ◽

Hossein Fahimi ◽

Fatemeh Fardsanei ◽

Mohammad Mehdi Soltan Dallal

Keyword(s):

Antibiotic Resistance ◽

Antimicrobial Resistance ◽

Multidrug Resistant ◽

Salmonella Spp ◽

Class 1 Integron ◽

Class 1 Integrons ◽

Food Borne ◽

Class 1 ◽

Resistance Patterns ◽

C 30

Background: Salmonellosis is a major food-borne disease worldwide. The increasing prevalence of antimicrobial resistance among food-borne pathogens such as Salmonella spp. is concerning. Objective: The main objective of this study is to identify class 1 integron genes and to determine antibiotic resistance patterns among Salmonella isolates from children with diarrhea. Methods: A total of 30 Salmonella isolates were recovered from children with diarrhea. The isolates were characterized for antimicrobial susceptibility and screened for the presence of class 1 integron genes (i.e. intI1, sulI1, and qacEΔ1). Results: The most prevalent serotype was Enteritidis 36.7%, followed by Paratyphi C (30%), and Typhimurium (16.7%). The highest rates of antibiotic resistance were obtained for nalidixic acid (53.3%), followed by streptomycin (40%), and tetracycline (36.7%). Regarding class 1 integrons, 36.7%, 26.7%, and 33.3% of the isolates carried intI1, SulI, and qacEΔ1, respectively, most of which (81.8%) were multidrug-resistant (MDR). Statistical analysis revealed that the presence of class 1 integron was significantly associated with resistance to streptomycin and tetracycline (p = 0.042). However, there was no association between class 1 integron and other antibiotics used in this study (p > 0.05). Conclusion: The high frequency of integron class 1 gene in MDR Salmonella strains indicates that these mobile genetic elements are versatile among different Salmonella serotypes, and associated with reduced susceptibility to many antimicrobials.

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The Role of Aquatic Ecosystems (River Tua, Portugal) as Reservoirs of Multidrug-Resistant Aeromonas spp.

Water ◽

10.3390/w13050698 ◽

2021 ◽

Vol 13 (5) ◽

pp. 698

Author(s):

Sónia Gomes ◽

Conceição Fernandes ◽

Sandra Monteiro ◽

Edna Cabecinha ◽

Amílcar Teixeira ◽

...

Keyword(s):

Antibiotic Resistance ◽

Antimicrobial Resistance ◽

Nalidixic Acid ◽

Water Samples ◽

Aquatic Ecosystems ◽

Anthropogenic Activities ◽

Aquatic Organisms ◽

Resistant Bacteria ◽

Anthropogenic Pressures ◽

Resistance Rates

The inappropriate use of antibiotics, one of the causes of the high incidence of antimicrobial-resistant bacteria isolated from aquatic ecosystems, represents a risk for aquatic organisms and the welfare of humans. This study aimed to determine the antimicrobial resistance rates among riverine Aeromonas spp., taken as representative of the autochthonous microbiota, to evaluate the level of antibacterial resistance in the Tua River (Douro basin). The prevalence and degree of antibiotic resistance was examined using motile aeromonads as a potential indicator of antimicrobial susceptibility for the aquatic environment. Water samples were collected from the middle sector of the river, which is most impacted area by several anthropogenic pressures. Water samples were plated on an Aeromonas-selective agar, with and without antibiotics. The activity of 19 antibiotics was studied against 30 isolates of Aeromonas spp. using the standard agar dilution susceptibility test. Antibiotic resistance rates were fosfomycin (FOS) 83.33%, nalidixic acid (NA) 60%, cefotaxime (CTX) 40%, gentamicin (CN) 26.67%, tobramycin (TOB) 26.67%, cotrimoxazole (SXT) 26.67%, chloramphenicol (C) 16.67%, and tetracycline (TE) 13.33%. Some of the nalidixic acid-resistant strains were susceptible to fluoroquinolones. Multiple resistance was also observed (83.33%). The environmental ubiquity, the natural susceptibility to antimicrobials and the zoonotic potential of Aeromonas spp. make them optimal candidates for studying antimicrobial resistance (AMR) in aquatic ecosystems. Aquatic environments may provide an ideal setting for the acquisition and dissemination of antibiotic resistance because anthropogenic activities frequently impact them. The potential risk of multi- and pan-resistant bacteria transmission between animals and humans should be considered in a “One Health—One World” concept.

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Antimicrobials and Food-Related Stresses as Selective Factors for Antibiotic Resistance along the Farm to Fork Continuum

Antibiotics ◽

10.3390/antibiotics10060671 ◽

2021 ◽

Vol 10 (6) ◽

pp. 671

Author(s):

Federica Giacometti ◽

Hesamaddin Shirzad-Aski ◽

Susana Ferreira

Keyword(s):

Antibiotic Resistance ◽

Food Safety ◽

Antimicrobial Resistance ◽

Food Processing ◽

Resistance Mechanisms ◽

Human Environment ◽

Real Risk ◽

Cross Adaptation ◽

Novel Approaches

Antimicrobial resistance (AMR) is a global problem and there has been growing concern associated with its widespread along the animal–human–environment interface. The farm-to-fork continuum was highlighted as a possible reservoir of AMR, and a hotspot for the emergence and spread of AMR. However, the extent of the role of non-antibiotic antimicrobials and other food-related stresses as selective factors is still in need of clarification. This review addresses the use of non-antibiotic stressors, such as antimicrobials, food-processing treatments, or even novel approaches to ensure food safety, as potential drivers for resistance to clinically relevant antibiotics. The co-selection and cross-adaptation events are covered, which may induce a decreased susceptibility of foodborne bacteria to antibiotics. Although the available studies address the complexity involved in these phenomena, further studies are needed to help better understand the real risk of using food-chain-related stressors, and possibly to allow the establishment of early warnings of potential resistance mechanisms.

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