Anthropogenic Activities and the Problem of Antibiotic Resistance in Latin America: A Water Issue

Antibiotics revolutionized modern medicine and have been an excellent tool to fight infections. However, their overuse and misuse in different human activities such as health care, food production and agriculture has resulted in a global antimicrobial resistance crisis. Some regions such as Latin America present a more complex scenario because of the lack of resources, systematic studies and legislation to control the use of antimicrobials, thus increasing the spread of antibiotic resistance. This review aims to summarize the state of environmental antibiotic resistance in Latin America, focusing on water resources. Three databases were searched to identify publications on antimicrobial resistance and anthropogenic activities in relation to natural and artificial water ecosystems. We found that antibiotic resistant bacteria, mainly against beta lactam antibiotics, have been reported in several Latin American countries, and that resistant bacteria as well as resistant genes can be isolated from a wide variety of aquatic environments, including drinking, surface, irrigation, sea and wastewater. It is urgent to establish policies and regulations for antibiotic use to prevent the increase of multi-drug resistant microorganisms in the environment.

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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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Testudines as Sentinels for Monitoring the Dissemination of Antibiotic Resistance in Marine Environments: An Integrative Review

Antibiotics ◽

10.3390/antibiotics10070775 ◽

2021 ◽

Vol 10 (7) ◽

pp. 775

Author(s):

Kezia Drane ◽

Roger Huerlimann ◽

Michelle Power ◽

Anna Whelan ◽

Ellen Ariel ◽

...

Keyword(s):

Antibiotic Resistance ◽

Anthropogenic Activities ◽

Sea Turtles ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Marine Environments ◽

Beta Lactam ◽

Antibiotic Resistant ◽

Sensitivity Tests ◽

Standard Culture

Dissemination of antibiotic resistance (AR) in marine environments is a global concern with a propensity to affect public health and many ecosystems worldwide. We evaluated the use of sea turtles as sentinel species for monitoring AR in marine environments. In this field, antibiotic-resistant bacteria have been commonly identified by using standard culture and sensitivity tests, leading to an overrepresentation of specific, culturable bacterial classes in the available literature. AR was detected against all major antibiotic classes, but the highest cumulative global frequency of resistance in all represented geographical sites was against the beta-lactam class by a two-fold difference compared to all other antibiotics. Wastewater facilities and turtle rehabilitation centres were associated with higher incidences of multidrug-resistant bacteria (MDRB) accounting for an average of 58% and 49% of resistant isolates, respectively. Furthermore, a relatively similar prevalence of MDRB was seen in all studied locations. These data suggest that anthropogenically driven selection pressures for the development of AR in sea turtles and marine environments are relatively similar worldwide. There is a need, however, to establish direct demonstrable associations between AR in sea turtles in their respective marine environments with wastewater facilities and other anthropogenic activities worldwide.

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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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The Knowledge on antibiotics and antimicrobial resistance among Polish medical students

European Journal of Public Health ◽

10.1093/eurpub/ckz186.517 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

T Sobierajski ◽

M Wanke-Rytt ◽

B Mazińska ◽

K Karpierz ◽

W Hryniewicz

Keyword(s):

Antibiotic Resistance ◽

Medical Students ◽

Antimicrobial Resistance ◽

Viral Infections ◽

Treatment Options ◽

Antibiotic Use ◽

Resistant Bacteria ◽

Antibiotic Prescribing ◽

Medical University ◽

Future Education

Abstract Background Antimicrobial resistance (AMR) is one of the biggest threats to public health worldwide, compromising ability to treat infections. Medical students as a future doctors will have an important role to play in preventing the spread of antibiotic resistance. The aim of this study was to analyse the knowledge and attitudes of Polish medical students towards antibiotics and AMR. Methods A questionnaire containing 24 questions, on medical students’ knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance was developed. The survey was conducted in May-June 2018 among medical students of Medical University of Warsaw at various years of their studies. Results The study group consisted of 291 students (70% women, 30% men). Forty six of the students had used antibiotics within the previous 12 months. The prevailing reasons for taking an antibiotic were: pharyngitis (25%), bronchitis (12,8%), sore throat (12%), cough (8.3%), pneumonia (7.9%), urinary tract infection (7.6%), cold (6.6%). Ninety-two percent of the respondents considered AMR to be a significant problem, and 7.9% stated it will become in the future. Four percent of respondents believed that antibiotics are effective in treating common cold. The majority of students (83.5%) expressed the opinion that doctors often prescribe an antibiotic without need. Most respondents think that too frequent prescription and low awareness of the consequences of their overuse have an impact on the rise and spread of antibiotic resistant bacteria. The vast majority of respondents (80%) declared that university studies enabled the gaining of a wider knowledge about the use of antibiotics. The vast majority of respondents (92.4%) indicated a willingness to extend their knowledge on antibiotic use. Conclusions Medical students are aware that AMR is a growing problem resulting in diminishing treatment options. The results of the study should be taken into future education programs. Key messages Medical students have a good understanding of the health risk of AMR but consider antibiotics for viral infections. More training on rationale antibiotic use included in the curriculum is warranted.

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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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Public Health Literacy, Knowledge, and Awareness Regarding Antibiotic Use and Antimicrobial Resistance during the COVID-19 Pandemic: A Cross-Sectional Study

Antibiotics ◽

10.3390/antibiotics10091107 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1107

Author(s):

Suhaib M. Muflih ◽

Sayer Al-Azzam ◽

Reema A. Karasneh ◽

Barbara R. Conway ◽

Mamoon A. Aldeyab

Keyword(s):

Antibiotic Resistance ◽

Health Literacy ◽

Antimicrobial Resistance ◽

Online Survey ◽

Public Awareness ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Modern Medicine ◽

Sectional Study ◽

Cross Sectional

Multi-drug-resistant (MDR) organisms pose a global threat to modern medicine, which has grown as a result of irrational antibiotic use and misuse. This study aimed to assess general public knowledge in Jordan and awareness of antibiotics and antibiotic resistance during the COVID-19 pandemic. A cross-sectional study was carried out utilizing the WHO multicountry public awareness survey. The study population was composed mainly of social media users, and a total of 1213 participants completed the online survey. According to the findings, more than half of the participants were well versed in antibiotic use and resistance. Those with adequate health literacy were found to better understand antibiotics (OR = 1.37, p = 0.017) and antibiotic resistance (OR = 1.46, p = 0.003). The vast majority (88.5%) recognized at least one antibiotic resistance term; however, 53.2% believed that antibiotic resistance is a problem in other nations. The participants in this study reported using antibiotics incorrectly, believing that they were treating sore throats, colds, and flu. The participants were well aware of antibiotic resistance solutions and their consequences on health. Age, education, health literacy, and antibiotic knowledge were found to be substantially (p < 0.05) associated with greater awareness of antibiotic resistance. The findings highlight the need for antimicrobial resistance education campaigns, health literacy, and antibiotic stewardship initiatives.

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Implications of Antibiotic Use during the COVID-19 Pandemic: The Example of Associated Antimicrobial Resistance in Latin America

Antibiotics ◽

10.3390/antibiotics10030328 ◽

2021 ◽

Vol 10 (3) ◽

pp. 328

Author(s):

Carlos Álvarez-Moreno ◽

Sandra Valderrama-Beltrán ◽

Alfonso J. Rodriguez-Morales

Keyword(s):

Latin America ◽

Antimicrobial Resistance ◽

Antibiotic Use ◽

Infection Management

Antimicrobials are essential for infection management [...]

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Population genomics and antimicrobial resistance dynamics of Escherichia coli in wastewater and river environments

Communications Biology ◽

10.1038/s42003-021-01949-x ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Jose F. Delgado-Blas ◽

Cristina M. Ovejero ◽

Sophia David ◽

Natalia Montero ◽

William Calero-Caceres ◽

...

Keyword(s):

Escherichia Coli ◽

Antimicrobial Resistance ◽

Population Genomics ◽

Population Diversity ◽

Genomic Diversity ◽

Resistant Bacteria ◽

Aquatic Environments ◽

E Coli ◽

Water Ecosystems ◽

Sequence Types

AbstractAquatic environments are key niches for the emergence, evolution and dissemination of antimicrobial resistance. However, the population diversity and the genetic elements that drive the dynamics of resistant bacteria in different aquatic environments are still largely unknown. The aim of this study was to understand the population genomics and evolutionary events of Escherichia coli resistant to clinically important antibiotics including aminoglycosides, in anthropogenic and natural water ecosystems. Here we show that less different E. coli sequence types (STs) are identified in wastewater than in rivers, albeit more resistant to antibiotics, and with significantly more plasmids/cell (6.36 vs 3.72). However, the genomic diversity within E. coli STs in both aquatic environments is similar. Wastewater environments favor the selection of conserved chromosomal structures associated with diverse flexible plasmids, unraveling promiscuous interplasmidic resistance genes flux. On the contrary, the key driver for river E. coli adaptation is a mutable chromosome along with few plasmid types shared between diverse STs harboring a limited resistance gene content.

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Diagnostic Tests Can Stem the Threat of Antimicrobial Resistance: Infectious Disease Professionals Can Help

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1527 ◽

2020 ◽

Author(s):

Dana Trevas ◽

Angela M Caliendo ◽

Kimberly Hanson ◽

Jaclyn Levy ◽

Christine C Ginocchio

Keyword(s):

Infectious Disease ◽

Antimicrobial Resistance ◽

Diagnostic Tests ◽

Healthcare Providers ◽

Federal Funding ◽

Antibiotic Use ◽

Advisory Council ◽

Resistant Bacteria ◽

Research Development ◽

Antibiotic Resistant

Abstract Uptake of existing diagnostics to identify infections more accurately could minimize unnecessary antibiotic use and decrease the growing threat of antibiotic resistance. The Infectious Diseases Society of America (IDSA) and the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (PACCARB) agree that, to improve uptake of existing diagnostics, healthcare providers, health systems, and payors all need better clinical and economic outcomes data to support use of diagnostic tests over empiric use of antibiotics, providers need better tools and education about diagnostic tests, and diagnostics developers need federal funding in the absence of a viable diagnostics market. Recommendations from PACCARB and the IDSA are amplified. Incentives for—and challenges to—diagnostics research, development, and uptake are summarized. Advocacy opportunities are given for infectious disease professionals to join the fight against antimicrobial resistance.

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