Reducing the Risk of Transmission of Critical Antimicrobial Resistance Determinants From Contaminated Pork Products to Humans in South-East Asia

Antimicrobial resistance (AMR) is a critical challenge worldwide as it impacts public health, especially via contamination in the food chain and in healthcare-associated infections. In relation to farming, the systems used, waste management on farms, and the production line process are all determinants reflecting the risk of AMR emergence and rate of contamination of foodstuffs. This review focuses on South East Asia (SEA), which contains diverse regions covering 11 countries, each having different levels of development, customs, laws, and regulations. Routinely, here as elsewhere antimicrobials are still used for three indications: therapy, prevention, and growth promotion, and these are the fundamental drivers of AMR development and persistence. The accuracy of detection of antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARG) depends on the laboratory standards applicable in the various institutes and countries, and this affects the consistency of regional data. Enterobacteriaceae such as Escherichia coli and Klebsiella pneumoniae are the standard proxy species used for indicating AMR-associated nosocomial infections and healthcare-associated infections. Pig feces and wastewater have been suspected as one of the hotspots for spread and circulation of ARB and ARG. As part of AMR surveillance in a One Health approach, clonal typing is used to identify bacterial clonal transmission from the production process to consumers and patients – although to date there have been few published definitive studies about this in SEA. Various alternatives to antibiotics are available to reduce antibiotic use on farms. Certain of these alternatives together with improved disease prevention methods are essential tools to reduce antimicrobial usage in swine farms and to support global policy. This review highlights evidence for potential transfer of resistant bacteria from food animals to humans, and awareness and understanding of AMR through a description of the occurrence of AMR in pig farm food chains under SEA management systems. The latter includes a description of standard pig farming practices, detection of AMR and clonal analysis of bacteria, and AMR in the food chain and associated environments. Finally, the possibility of using alternatives to antibiotics and improving policies for future strategies in combating AMR in a SEA context are outlined.

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Antimicrobial Resistance and Food Animals: Influence of Livestock Environment on the Emergence and Dissemination of Antimicrobial Resistance

Antibiotics ◽

10.3390/antibiotics9020052 ◽

2020 ◽

Vol 9 (2) ◽

pp. 52 ◽

Cited By ~ 4

Author(s):

Nikola Vidovic ◽

Sinisa Vidovic

Keyword(s):

Antimicrobial Resistance ◽

Western Europe ◽

Growth Promotion ◽

Antibiotic Use ◽

Modern Trend ◽

Resistant Bacteria ◽

Growth Promoter ◽

Antibiotic Resistant ◽

Food Animals ◽

Control And Management

The emergence and dissemination of antimicrobial resistance among human, animal and zoonotic pathogens pose an enormous threat to human health worldwide. The use of antibiotics in human and veterinary medicine, and especially the use of large quantities of antibiotics in livestock for the purpose of growth promotion of food animals is believed to be contributing to the modern trend of the emergence and spread of bacteria with antibiotic resistant traits. To better control the emergence and spread of antimicrobial resistance several countries from Western Europe implemented a ban for antibiotic use in livestock, specifically the use of antibiotics for growth promotion of food animals. This review article summarizes the recent knowledge of molecular acquisition of antimicrobial resistance and the effects of implementation of antibiotic growth promoter bans on the spread of antimicrobial resistant bacteria in animals and humans. In this article, we also discuss the main zoonotic transmission routes of antimicrobial resistance and novel approaches designed to prevent or slow down the emergence and spread of antimicrobial resistance worldwide. Finally, we provide future perspectives associated with the control and management of the emergence and spread of antimicrobial resistant bacteria.

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«One Health» approach: transfer of antimicrobial resistance from animals to humans

International Journal of Antibiotics and Probiotics ◽

10.31405/ijap.2-1.18.06 ◽

2018 ◽

Vol 2 (1) ◽

pp. 64-83

Author(s):

A.G. Salmanov ◽

I.Ya. Kotsyumbas ◽

V.V. Stybel ◽

V.P. Muzyka ◽

O.M. Brezvyn ◽

...

Keyword(s):

Antibiotic Resistance ◽

Antimicrobial Resistance ◽

Resistance Genes ◽

Genetic Interaction ◽

Growth Promotion ◽

Scientific Evidence ◽

Ecological Impact ◽

Antibiotic Use ◽

Resistant Bacteria ◽

Food Animals

Antimicrobials are valuable therapeutics whose efficacy is seriously compromised by the emergence and spread of antimicrobial resistance. The current science provides overwhelming evidence that antibiotic use is a powerful selector of resistance that can appear not only at the point of origin but also nearly everywhere else. The latter phenomenon occurs because of the enormous ramifications of horizontal gene transfer. A mounting body of evidence shows that antimicrobial use in animals, including the nontherapeutic use of antimicrobials, leads to the propagation and shedding of substantial amounts of antimicrobial-resistant bacteria — both as pathogens, which can directly and indirectly infect humans, and as commensals, which may carry transferable resistance determinants across species borders and reach humans through multiple routes of transfer. These pathways include not only food but also water and sludge and manure applications to food crop soils. Continued nontherapeutic use of antimicrobials in food animals will increase the pool of resistance genes, as well as their density, as bacteria migrate into the environment at large. The lack of species barriers for gene transmission argues that the focus of research efforts should be directed toward the genetic infrastructure and that it is now imperative to take an ecological approach toward addressing the impacts of NTA use on human disease. The study of animal-to-human transmission of antibiotic resistance therefore requires a greater understanding of the genetic interaction and spread that occur in the larger arena of commensal and environmental bacteria. The provision of antibiotics to food animals encompasses a wide variety of nontherapeutic purposes that include growth promotion. The concern over resistance emergence and spread to people by nontherapeutic use of antimicrobials has led to conflicted practices and opinions. Considerable evidence supported the removal of nontherapeutic antimicrobials in Europe and North America, based on the «precautionary principle». Still, concrete scientific evidence of the favorable versus unfavorable consequences of nontherapeutic antimicrobials is not clear to all stakeholders. Substantial data show elevated antibiotic resistance in bacteria associated with animals fed nontherapeutic antimicrobials and their food products. This resistance spreads to other animals and humans-directly by contact and indirectly via the food chain, water, air, and manured and sludge-fertilized soils. Modern genetic techniques are making advances in deciphering the ecological impact of nontherapeutic antimicrobials, but modeling efforts are thwarted by deficits in key knowledge of microbial and antibiotic loads at each stage of the transmission chain. Still, the substantial and expanding volume of evidence reporting animal-to-human spread of resistant bacteria, including that arising from use of nontherapeutic antimicrobials, supports eliminating antibiotics use in order to reduce the growing environmental load of resistance genes.

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Antibiogram of Pseudomonas species: an important tool to combat antibiotic resistance for patient safety in Gombe, Nigeria

African Journal of Clinical and Experimental Microbiology ◽

10.4314/ajcem.v22i2.21 ◽

2021 ◽

Vol 22 (2) ◽

pp. 279-283

Author(s):

M.M. Manga ◽

M. Ibrahim ◽

E.W. Isaac ◽

M.D. Hassan ◽

G. Muhammad ◽

...

Keyword(s):

Patient Safety ◽

Antimicrobial Resistance ◽

Antibiotic Susceptibility ◽

Diffusion Method ◽

Resistant Bacteria ◽

Healthcare Associated Infections ◽

Bacterial Isolates ◽

Antibiotic Susceptibility Test ◽

Pseudomonas Species ◽

Healthcare Associated

Background: Pseudomonas species are responsible for different healthcare-associated infections and are inherently resistant to many commonly used antibiotics. Hospital antibiograms are either absent or not regularly available in most healthcare facilities in Nigeria. The objective of this study is to present the antibiogram of Pseudomonas isolates in Federal Teaching Hospital Gombe (FTHG) in order to guide antibiotic prescription for better patient safety in the hospital.Methodology: The is a hospital-based cross-sectional study. A total of 4309 bacterial isolates were recovered from aerobic cultures of routine clinical specimens including urine, sputum, blood, swabs, aspirates, biopsies, seminal fluids and cerebrospinal fluids at the Medical Microbiology laboratory of the hospital between January and December 2019. Pseudomonas species were identified by colony morphology, Gram-reaction and conventional biochemical tests. Antibiotic susceptibility testing was performed on each Pseudomonas isolate using the modified Kirby-Bauer disk diffusion method on Mueller-Hinton agar and results interpreted according to the guideline of the Clinical and Laboratory Standards Institute (CLSI). Data were analysed using the Statistical Package for Social Sciences (SPSSTM) software version 23.0.Results: Of the total 4309 bacterial isolates, 436 (10.1%) Pseudomonas species were identified, with majority (49.8%) from urine specimens. Antibiotic susceptibility test results revealed average susceptibility rates of 73.8%, 70.1%, 66.2%, 59.5%, and 34.3% to ciprofloxacin, gentamicin, levofloxacin ceftazidime, and carbenicillin respectively. These rates fluctuate only slightly for each of the antibiotic during the 12 months period of survey.Conclusion: Pseudomonas species were most sensitive to ciprofloxacin and gentamicin among the first line antibiotics in FTHG in 2019. Regular updates and presentation of hospital antibiogram especially for intrinsically resistant bacteria such as Pseudomonas involved in healthcare associated infections, is an important tool in combating antimicrobial resistance and ensuring patient safety. Keywords: antibiogram, Pseudomonas, antimicrobial resistance, antimicrobial stewardship, patient safety

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Healthcare-associated infections in paediatric and neonatal intensive care units: epidemiology, risk factors and impact of antimicrobial resistance

10.26226/morressier.56d6be7dd462b80296c959b6 ◽

2016 ◽

Author(s):

Laura Folgori

Keyword(s):

Risk Factors ◽

Intensive Care ◽

Antimicrobial Resistance ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Neonatal Intensive Care Units ◽

Healthcare Associated Infections ◽

Healthcare Associated

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Tetracycline-Resistant Bacteria Selected from Water and Zebrafish after Antibiotic Exposure

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063218 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3218

Author(s):

Ana Rita Almeida ◽

Marta Tacão ◽

Joana Soares ◽

Inês Domingues ◽

Isabel Henriques

Keyword(s):

Statistical Significance ◽

Recovery Period ◽

Antibiotic Resistance Genes ◽

Antibiotic Use ◽

Resistant Bacteria ◽

Antibiotic Resistant ◽

Potential Impact ◽

Susceptibility Profiles ◽

Selection Of ◽

Significant Mortality

The emergence of antibiotic-resistant pathogens due to worldwide antibiotic use is raising concern in several settings, including aquaculture. In this work, the selection of antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) was evaluated after exposure of zebrafish to oxytetracycline (OTC) for two months, followed by a recovery period. The selection of ARB in water and fish was determined using selective media. The abundance of tetA genes was estimated through qPCR. Higher prevalence of ARB was measured in all samples exposed to the antibiotic when compared to control samples, although statistical significance was only achieved five days after exposure. Isolates recovered from samples exposed to the antibiotic were affiliated with Pseudomonas and Stenotrophomonas. Various antibiotic susceptibility profiles were detected and 37% of the isolates displayed multidrug resistance (MDR). The selection of the tetA gene was confirmed by qPCR at the highest OTC concentration tested. Two MDR isolates, tested using zebrafish embryos, caused significant mortality, indicating a potential impact on fish health and survival. Overall, our work highlights the potential impact of antibiotic contamination in the selection of potential pathogenic ARB and ARGS.

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A case of neck abscess caused by rare hypervirulent Klebsiella pneumoniae, capsular type K20 and sequence type 420

Annals of Clinical Microbiology and Antimicrobials ◽

10.1186/s12941-021-00453-8 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

John Alexander McHardy ◽

Vathshalan Selvaganeshapillai ◽

Priya Khanna ◽

Ashley Michael Whittington ◽

Jane Turton ◽

...

Keyword(s):

Public Health ◽

Case Report ◽

Antimicrobial Resistance ◽

Klebsiella Pneumoniae ◽

East Asia ◽

South East Asia ◽

Neck Abscess ◽

Global Challenge ◽

Life Threatening ◽

The Uk

Abstract Background This case report describes a neck abscess caused by a strain of Hypervirulent Klebsiella pneumoniae in a middle aged man with diabetes without a history of travel to East and South East Asia. This case report is of notable significance as Hypervirulent Klebsiella pneumoniae neck abscesses are rarely seen in the UK and are very infrequently documented in individuals who have not first travelled to the high prevalence areas of East and South East Asia. Case presentation This case report describes a 53 year old diabetic man who contracted a Hypervirulent Klebsiella pneumoniae neck abscess which led to the development of sepsis. Klebsiella pneumoniae was cultured from blood cultures and fluid aspirated from the abscess grew the pathogen with same antimicrobial susceptibility. Hypervirulence was demonstrated after the samples were analysed, at the Antimicrobial Resistance and Healthcare Associated Infections Reference Unit Public Health England Colindale, and found to contain the K20 (rmp)A and rmpA2 virulence genes. Discussion Hypervirulent Klebsiella pneumoniae is a Gram-negative, encapsulated, non-motile bacillus notable for its ability to metastatically spread and cause potentially life threatening infections in otherwise healthy adults, but especially in those with diabetes. Genes responsible for the production of hyperviscous mucoid polysaccharide capsules and siderophores, such as those isolated in this case, enable the bacteria to more efficiently evade the hosts immune system and disseminate and invade surrounding and distant tissues. Data from Public Health England shows Hypervirulent Klebsiella pneumoniae are rare in the UK. A review of current literature also showed Hypervirulent Klebsiella pneumoniae almost exclusively occur in those who have traveled to East and South East Asia. Conclusions This case reported a rare Hypervirulent Klebsiella pneumoniae neck abscess outside of, and without travel to, East and South East Asia. This raises concerns about future, potentially life threatening, Hypervirulent Klebsiella pneumoniae infections becoming more widespread without the need for endemic travel. This concern is further exacerbated by the growing global challenge of antimicrobial resistance.

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