Antimicrobial drug resistance

There are concerns that selection pressure from antibiotics in the environment may accelerate the evolution and dissemination of antibiotic-resistant pathogens. Nevertheless, there is currently no regulatory system that takes such risks into account. In part, this is due to limited knowledge of environmental concentrations that might exert selection for resistant bacteria. To experimentally determine minimal selective concentrations in complex microbial ecosystems for all antibiotics would involve considerable effort. In this work, our aim was to estimate upper boundaries for selective concentrations for all common antibiotics, based on the assumption that selective concentrations a priori need to be lower than those completely inhibiting growth. Data on Minimal Inhibitory Concentrations (MICs) were obtained for 111 antibiotics from the public EUCAST database. The 1% lowest observed MICs were identified, and to compensate for limited species coverage, predicted lowest MICs adjusted for the number of tested species were extrapolated through modeling. Predicted No Effect Concentrations (PNECs) for resistance selection were then assessed using an assessment factor of 10 to account for differences between MICs and minimal selective concentrations. The resulting PNECs ranged from 8 ng/L to 64 μg/L. Further- more, the link between taxonomic similarity between species and lowest MIC was weak. This work provides estimated upper boundaries for selective concentrations (lowest MICs) and PNECs for resistance selection for all common antibiotics. In most cases, PNECs for selection of resistance were below available PNECs for ecotoxicological effects. The generated PNECs can guide implementation of compound-specific emission limits that take into account risks for resistance promotion.

Concern has been rising with the respect to the capability of clinically important bacteria to acquire resistance against antibiotics and disinfectants. This investigation was undertaken to provide information on the sensitivity of methicillin-resistant Staphylococcus aureus (MRSA) to some disinfectants. The isolated PCR genotyped MRSA strains were collected from milk and its surrounding animal milking environment of 4 dairy cattle farms. Five commonly used disinfectants (quaternary ammonium compounds, iodine (Povidone-iodine), Sodium hypochlorite (Chlorine), ethyl alcohol and Chloroxylenol (Dettol) were evaluated at different contact times (5, 10, 15 minutes) and variable concentrations using suspension test for measuring their minimal inhibitory concentrations (MICs) against each isolate. The obtained results of MICs of the five tested disinfectants indicated high sensitivity of MRSA to both QACs and iodine, with MICs of 0.25% within 5 minutes(QACs), and 1.37% within 5 minutes (Iodine) at three tested concentrations and exposure times. Nonetheless, these strains exhibited a significant resistance to both ethyl alcohol and chlorine at different concentrations and contact times. Meanwhile, Dettol inhibited MRSA growth at dilutions (5% & 2.5%) within (5, 15, 20 minutes), however, 1.25% at 5 and 15 minutes was unable to potentiate the antibacterial activities of Dettol against strains tested. The findings of the present study reinforce the importance of disinfection as an integral part of the control policies of MRSA prevention and eradication in dairy farms.

Shared decision-making and person centred care (PCC/SDM) are increasingly embraced framework conceptions on how to organise health care's interaction with patients. Although underlying ethical motivation may vary, PCC/SDM holds ideals of a greater adaption of health care to individual circumstances, and of recognising patients as collaborators in clinical decision-making. The PCC/SDM notion has migrated quickly across many areas where it is less clear how it applies, due to patients being in non-standard conditions with regard to personal capacities or care context, and detected to offer a number of peculiar ethical and practical challenges. But the migration has also reached areas with even less similarity to the original PCC/SDM landscape of somatic hospital care. In this presentation, we describe – based on comissioned and work in a Swedish context and ongoing research studies – three examples of this expansion and survey these for extra ethical complications: forensic care, social services and public health (outside of health care institutions). Each area offers peculiar extra ethical challenges for PCC/SDM, as they depart extensively from standard assumptions by, in various ways, embracing goals not built on the standard individualist assumptions of health care ethics. It is possible to implement adapted forms of PCC/SDM to these areas, but these cannot be assumed to serve ideals of emancipating, empowering or recognising individuals as persons. Rather, they have to be viewed though a lens of public goods aimed for in the respective areas. Clients and patients are entitled to be made aware of this fact, but regardless of this, the mentioned perspective-shift will pose particular challenges for health professionals. At the same time, PCC/SDM strategies may also open up for approaches to resolving these tensions and meet typical challenges that would otherwise have remained out of reach.

Introduction Nosocomial infections are induced in hospitalized patients. These patients do not have these infections at the time of reference, but are infected at the time of hospitalization (1). Nosocomial infections are caused two days after hospitalization or discharge from the hospital (2). Despite the efforts and measures to control nosocomial infections, economic costs and mortality, are high (3). Nosocomial infections are the sixth cause of death in the United States with 9900 fatalities per annum approximately (4). Klebsiella pneumoniae is the most important cause of nosocomial infections among gram-negative bacteria (5). K. pneumoniae is an opportunistic pathogen in hospitals, which causes the most common nosocomial infections, such as urinary tract, pneumonia, septicemia, wound, and bloodstream (5). K. pneumoniae is gram-negative, rod-shaped, aerobic and facultative anaerobic, nonmotile, nitrate positive, with mucoid colonies, and large polysaccharide capsule (6). Four spe...

The number of nosocomial infections related to
implants and medical devices increase alarmingly worldwide.
New strategies based on the design of antimicrobial coatings
are required to prevent such infections. Polyelectrolyte
“multilayer” films constitute a powerful tool for nanoscale
surface functionalization which allows addressing this issue. By
investigating films built up with poly(arginine) (PAR) of
various chain lengths (10, 30, 100, and 200 residues) and
hyaluronic acid (HA), we demonstrate that exclusively films
constructed with poly(arginine) composed of 30 residues
(PAR30) acquire a strong antimicrobial activity against Gram-
positive and Gram-negative pathogenic bacteria associated
with infections of medical devices. This chain-size effect is extremely striking and is the first example reported where the length of
the polyelectrolytes played a key-role in the functionality of the films. Moreover, this unexpected functionality of nanolayered
polypeptide/polysaccharide PAR30/HA films occurs without adding any specific antimicrobial agent, such as antibiotics or
antimicrobial peptides. PAR30/HA film inhibits bacteria through a contact-killing mechanism due to the presence of mobile
PAR30 chains. These chains are assumed to diffuse toward the interface, where they interact with the bacteria with the consequence of killing them. This new coating with unique properties based on the association of a homopolypeptide of 30 residues with a polysaccharide constitutes a simple system to prevent implant-related infections with a reasonable production cost.

Polymyxins act by binding to lipid A moiety of the bacterial lipopolysaccharide and subsequently disintegrating the bacterial membranes. The most important mechanism of resistance includes modifications of the bacterial outer membrane structure, including lipopolysaccharide. Lipopolysaccharide modification is mostly mediated by PmrA/PmrB and PhoP/PhoQ two-component regulatory systems. These mechanisms exist with some differences in many gram-negative bacterial species. Resistance to polymyxins is generally less than 10%. In specific regions, such as the Mediterranean basin, Korea and Singapore, they tend to be higher. Heteroresistance to polymyxins is associated with exposure to polymyxins and especially suboptimal therapeutic dosage. Polymyxin combination regimens, tigecycline and fosfomycin may be useful options for the treatment of polymyxin-resistant gram-negative infections.

WHONET is a free software developed by the WHO Collaborating Centre for Surveillance of Antimicrobial Resistance for laboratory-based surveillance of infectious diseases and antimicrobial resistance.

The principal goals of the software are:  to enhance local use of laboratory data; and to promote national and international collaboration through the exchange of data.

WHONET can be used by individual laboratories or as part of a national and international surveillance network. At present, the software, available in 17 languages, is used in over 80 countries around the world managing data from over 1000 clinical, public health, veterinary, and food laboratories.

WHONET analytical tools facilitate:

    the understanding of the local epidemiology of microbial populations;
    the selection of antimicrobial agents;
    the identification of hospital and community outbreaks; and
    the recognition of quality assurance problems in laboratory testing.

Note: At present, WHONET can handle results from the testing of bacteria, fungi, and parasites. WHONET does not yet have virological tests incorporated, but this is a priority area of programming in the upcoming year.


Available: http://www.amrtracker.com/public/whonet/guideline
Detail: http://whonet.org/

The use of antimicrobial agents has become a routine practice for the treatment of paediatric illnesses. The uncontrolled use of antibiotics has caused a rise in antimicrobial resistance. This study aimed to assess the antibiotic prescribing patterns in paediatric patients at Levy Mwanawasa University Teaching Hospital in Lusaka, Zambia. This was a cross-sectional study conducted between April 2019 to July 2019. The study population included both in-patients and outpatients aged between one month and eighteen years whose medical files were reviewed. A sample size of 357 medical files was conveniently sampled. Statistical Package for Social Sciences version 21.0 was used for data analysis. A chi-square test was used to assess the association between categorical variables. A p<0.05 was considered to be statistically significant at 95% confidence level. The majority of the medical files 230 (64.4%) were for paediatrics in the age group of 1 month to 5 years. Antibiotic prescribing was found to be 78.7%. The study revealed that 119 (33.3%) of patients required antibiotics and were on antibiotic treatment while 46 (12.9%) did not require antibiotics but were on antibiotic treatment. The most common diseases 147 (41.2%) were those affecting the respiratory system. The most commonly prescribed antibiotics were penicillins 154 (54.8%), followed by cephalosporins 88 (31.3%). The association between age, white blood cell count status, and system of illness with antibiotic use were statistically significant (χ 2 =15.083, p=0.001; χ 2 = 6.571, p=0.037 and χ 2 =27.717, p<0.0001). The study also found that the frequency of antibiotic use was high among paediatric patients as per the World Health Organization's prescribing indicators. The most commonly prescribed antibiotics to paediatric patients were penicillins.

The antimicrobial activity of different solvent extracts (hydro alcoholic extracts of methanol) of different parts of Lagenaria siceraria (Molina) Standl was evaluated for its antimicrobial potential.  The in vitro antimicrobial activity was evaluated by agar well diffusion method. Extraction was done by individual cold percolation method. The antimicrobial activity was tested against five Gram positive bacteria, five Gram negative bacteria and four fungi.  The MIC and MBC was also determined, including five antibiotics. All the parts possessed antimicrobial activity but to a different level.  The extracts showed better antifungal activity than antibacterial activity and Gram negative bacteria were more susceptible than Gram positive bacteria. The peel showed lowest MIC and MBC values indicating the therapeutic value of agro waste material.

This study was performed to asses and establishes the prevalence of Polypharmacy in geriatric population in the Medicine ward of Rajah Muthaiya Medical College and Hospital, Annamalai University, during one year from January 2013 to January 2014. Demographic analyses of this prospective study revealed that out of 520 patients, 342 (65.76%) were males and 178 (34.23%) were females. All the collected prescriptions were scrutinized for Polypharmacy and were categorized as minor Polypharmacy -concurrent use of ≤ 5 drugs; and major Polypharmacy -concurrent use of > 5 drugs. Out of 502 Prescriptions 61(11.73%) prescriptions were minor Polypharmacy and 457(88.26%) prescriptions were major Polypharmacy. The maximum patients were in the age group of 60-64 (38.84%) range lead to a significant increase in the number of medications. The most common diseases associated systems were Cardiovascular system 147 (28.26 %) patients, and followed by Respiratory system 103(19.80%). Our results show that there is a higher prevalence of Polypharmacy among the males than females. The length of hospital stay of geriatric patients is increase in major Polypharmacy compare with minor Polypharmacy. The prevalence of cardiovascular drugs and respiratory drugs were often involved in Polypharmacy among geriatric patients. Polypharmacy is very common among geriatric patient and health care professional’s interventions to improve the optimal use of medication in geriatric could lead to reduction in the drug related problems associated with Polypharmacy.

Turkey is a home country for a good number of fermented beverages derived from milk, cereals, fruits and vegetables, and several studies have reported the probiotic potentiality of these beverages. Probiotics, otherwise known as beneficial microorganisms possess the ability to exert antimicrobial effects, which is one of the most important selection criteria for their use in commercial products. In the current study, the antimicrobial activities of potential probiotic bacteria isolated from five fermented traditional Turkish beverages (boza, kefir, ayran, shalgam juice and hardaliye) were evaluated. The bacterial isolates were morphologically characterized and genotypically identified by 16S rRNA gene sequence analysis. The antimicrobial effects of the isolates against selected human pathogens were assessed using spot-on-the-lawn and agar well diffusion assays. Eighteen of the twenty-two strains displayed varying degrees of antagonism against the tested pathogens. Amongst the isolat...

Background: Rational use of drugs in veterinary medicine has numerous benefits, such as increasing efficacy, decreasing the potential adverse effects, reducing risk of drug residue and combating development of microorgan-ism's drug resistance. Methods: A retrospective study with the aim of evaluating the current rational use of veterinary drugs was conducted at college of veterinary medicine and agriculture veterinary teaching hospital and Ada district veterinary clinic, central Ethiopia. One thousand eight hundred and nineteen animal patients' encounters were randomly selected for the study from prescription papers and prescription registration books retrospectively. Results: The average number of drugs prescribed per encounter was 1.23 with maximum of five. The percentage of encounters in which antimicrobials and anthelmintics was prescribed were 54.4 % (1216/2235) and 38.9 % (869/2235), respectively. The percentages of drugs prescribed by generic name and from essential veterinary drug list were 90.1 % (2014/2235) and 99.7 % (2229/2235), respectively. The most commonly prescribed antimicrobials and anthelmintics were oxytetracycline 1016 (45.5 %), penicillin and streptomycin combination 168 (7.5 %), sulfa drugs 23 (1.0 %), and albendazole 732 (32.8 %) and ivermectin 137 (6.1 %). Among the 1819 animal-patient encounters, only 57 % (n = 1037) of the prescriptions were written adequately, 43 % (n = 782) incorrectly prescribed and 1179 cases of the adequately specified prescription were tentatively diagnosed. For 656 (53.9 %) and 233 (26.8 %) inadequately specified cases antimicrobials and anthelmintics were prescribed, respectively. Antibiotics were prescribed irrationally for cases which were tentatively diagnosed as parasitic 21.6 % (n = 262) and viral to prevent secondary bacterial complications 6.0 % (n = 73). Among all patients that were admitted to veterinary clinics, 96.6 % (1757) were treated empirically without getting correct laboratory-supported diagnosis. Chi Square test for trend analysis showed a statistically significant association between irrational drug usage and year (p = 0.000). Conclusions: The findings had shown problems in generic prescribing, incorrect diagnosis, and non-availability of standard veterinary treatment guideline and drug formulary in the study area. Therefore, veterinary drugs, specially, antimicrobial agents should be judiciously used; and a wide scale study to safeguard the public from drug residual effects and antimicrobial resistance development is recommended.

Resumo: As plantas medicinais constituem uma alternativa no tratamento primário da saúde, através de seus
compostos bioativos vegetais e óleos essenciais que apresentam potencial multifuncional contra microrganismos
patogênicos. O uso conjugado com drogas sintéticas pode resultar em interações indesejáveisprejudiciais ao
organismo, através de mudanças no mecanismo de ação, que além de promover reações adversas às respostas
farmacológicas esperadas, tem como principal consequência a multirresistência dos microorganismos. Este
trabalho teve como objetivo verificar na literatura científica relatos sobre os principais produtos naturais mais
comumente utilizados que possuem atividade antimicrobiana, que podem ser aplicados na substituição de
fármacos sintéticos, frente à patógenos de interesse humano. Realizou-se um levantamento bibliográfico em
diversas bases de dados, na busca de testes clínicos, in vitro e in vivo e relatos de casos que demonstrassem a
ação antimicrobiana de produtos naturais. Relacionada às doenças infecciosas de fator preocupante a saúde
pública, as espécies patogênicas mais citadas na literatura foram a E. coli, P. aeruginosa, S. aureus e C. albicans.
Das espécies de plantas frequentes no consumo da população, foram selecionadas seis (Matricaria
chamomomilla, Ocimum gratissimum, Punica granatum L., Rosmarinus officinalis, Syzygium aromaticum e
Uncaria tumentosa) das mais utilizadas, além da Própolis, ambas apresentaram atividade antimicrobiana positiva,
com ação inibitória similar ou superior aos antibióticos. Nesta perspectiva, estudos detalhados sobre o
mecanismo de ação dos produtos naturais sob o organismo humano, visam avanços na prevenção e tratamento de
diversas doenças. Palavras-chave: Antibióticos. Fitoterapia. Interação medicamentosa.
Abstract: Medicinal plants are an alternative in the primary health treatment, through its bioactive plant
compounds and essential oils that have multifunctional potential against pathogenic microorganisms. The
combined use of natural and synthetic drugs can result in undesirable interactions that are detrimental to the
organism, through changes in the mechanism of action, which in addition to promoting adverse reactions to the
expected pharmacological responses, has as main consequence the multiresistance of microorganisms. This work
aimed to verify in the scientific literature reports on the main natural products most commonly used that have
antimicrobial activity, which can be applied in the substitution of synthetic drugs, against pathogens of human
interest. A bibliographic survey was carried out in several databases, searching for clinical, in vitro and in vivo
tests and case reports that demonstrated the antimicrobial action of natural products. Related to infectious
diseases of concern to public health, the pathogenic species most cited in the literature were E. coli, P.
aeruginosa, S. aureus and C. albicans. Of the plant species that were common to the population, six (Matricaria
chamomomilla, Ocimum gratissimum, Punica granatum L., Rosmarinus officinalis, Syzygium aromaticum and
Uncaria tumentosa) were selected from the most used, besides Propolis, both showed positive antimicrobial
activity similar to or higher than antibiotics. In this perspective, detailed studies on the mechanism of action of
natural products under the human body, aim at advances in the prevention and treatment of various diseases.
Keywords: Antibiotics. Phytotherapy. Drug interaction.

Antibiotics  provide  the  main  basis  for  the  therapy  of microbial  (bacterial  and
fungal)  infections.  Since  the  discovery  of  these  antibiotics  and  their  uses  as
chemotherapeutic  agents  there  was  a  belief  in  the  medical  fraternity  that  this
would  lead  to  the  eventual  eradication  of  infectious  diseases.  There  is  a
continuous  and  urgent  need  to  discover  new  antimicrobial  compounds  with
diverse  chemical  structures  and  novel  mechanisms  of  action  because  there  has
been  an  alarming  increase  in  the  incidence  of  new  and  re-emerging  infectious
diseases. Another big concern is the development of resistance to the antibiotics
in  current  clinical  use.  In  recent  years,  drug  resistance  to  human  pathogenic
bacteria  has  been  commonly  reported  from  all  over  the  world.  In  the  present
scenario  of  emergence  of  multiple  drug  resistance  to  human  pathogenic
organisms, this has necessitated a search for new antimicrobial substances from
other  sources  including  plants.  Higher  plants  produce  hundreds  to  thousands  of
diverse  chemical  compounds  with  different  biological  activities.  The
antimicrobial compounds produced by plants are active against plant and human
pathogenic microorganisms. It is expected that plant extracts showing target sites
other than those used by antibiotics will be active against drug-resistant microbial
pathogens.

Tomato (solanum lycopersicum), is one of the most important vegetable crop of the solanaceae family, grown all over the world for food and other economic purposes. The microbial spoilage of canned tomato of varying product brands was investigated in this study. It was observed that the total aerobic and anaerobic counts were less than 10 3 cells which were within acceptable limit. Two of the canned product had no microbial count, while the others had counts varying from 2 x 10 1 to 5 x 10 1 for aerobic count of freshly opened tomato, and 1 x 10 1 to 2 x 10 1 for anaerobic count. However, aerobic count of spoilt canned tomato product ranged from 4.2 x 10 4 to 9.1 x 10 4 across all six products investigated. Anaerobic count of spoilt canned tomato ranged from 2.5 x 10 4 to 6.8 x 10 4. Isolated organisms obtained from spoilt canned tomato samples revealed the presence of Bacillus ploymyxa, Aspergillus niger, and Penicillium sp. These organisms were implicated in the spoilage of canned tomato products sold in Benin City. When these products are consumed immediately after opening, they are safe because the microbial load on fresh product is within acceptable regulatory standard.

Antibiotic resistance is a global public health problem that affects everyone. This study
aimed to explore the knowledge, attitude, and practices on antibiotic resistance among pharmacists at
the University Teaching Hospitals in Lusaka, Zambia.
This descriptive cross-sectional study was done among 46 randomly selected hospital pharmacists
from November 2018 to February 2019. Data was analysed using Statistical Packaging for Social
Sciences version 20. Statistical associations were done using Chi-square, Wilcoxon-Mann Whitney
and McNemar-Bowker test. Statistical significance was conducted at 95% confidence level with a
p<0.05 to indicate statistical significance.
The majority of participants 24/46 (52%) were males while 22/46 (48%) were females (p=0.883).
Majority of the participants were in the age group of 26-30 years old (p=0.010), the minimum age was
23 and maximum age was 47 years, mean age was 32.11 years, a standard deviation of 6.533,
p=0.263. The majority of participants 28/46 (61%) were married (p=0.185), the majority of
participants 24/46 (52%) had worked for a period of 1-5 years (p<0.001). All participants 46/46
(100%) were pharmacists (p<0.001) and were all Christians (p<0.001). Majority of the participants
had adequate knowledge, positive attitude and good practices towards antibiotic resistance based on
their responses to the questionnaire. Statistical tests showed no association between knowledge and
attitude (p=0.693), knowledge and practices (p=0.409), and between attitude and practices (p=0.226).
The majority of pharmacists at the University Teaching Hospital in Lusaka have good knowledge,
positive attitude and good practices towards antibiotic resistance. Additionally, there was no
association between knowledge and attitude (p=0.693), knowledge and practices (p=0.409), and
attitude and practices (p=0.226).
Keywords: Antibiotic resistance; Knowledge; Attitude; Practices; Pharmacists

Biofilms are communities of aggregated bacterial cells embedded in a self-produced extracellular polymeric matrix. Biofilms are recalcitrant to antibiotic treatment and immune defenses and are implicated in many chronic bacterial and fungal infections. In this review, we provide an overview of the contribution of biofilms to persistent infections resistant to antibiotic treatment, the impact of multispecies biofilms on drug resistance and tolerance, and recent advances in the development of antibiofilm agents. Understanding the mechanisms of antibiotic resistance and tolerance in biofilms is essential for developing new preventive and therapeutic strategies and curbing drug resistance.

This Open Access volume provides in-depth analysis of the wide range of ethical issues associated with drug-resistant infectious diseases. Antimicrobial resistance (AMR) is widely recognized to be one of the greatest threats to global public health in coming decades; and it has thus become a major topic of discussion among leading bioethicists and scholars from related disciplines including economics, epidemiology, law, and political theory. Topics covered in this volume include responsible use of antimicrobials; control of multi-resistant hospital-acquired infections; privacy and data collection; antibiotic use in childhood and at the end of life; agricultural and veterinary sources of resistance; resistant HIV, tuberculosis, and malaria; mandatory treatment; and trade-offs between current and future generations. As the first book focused on ethical issues associated with drug resistance, it makes a timely contribution to debates regarding practice and policy that are of crucial importance to global public health in the 21st century.

A  new  and  novel  approach  for  the  green  synthesis  of  silver
nanoparticles  is  the  need  of  the  hour.  Use  of  plant  parts  for  the
synthesis of silver nanoparticles is ecofriendly, economic and cost
effective. In the present paper, silver nanoparticles were synthesized
using  aqueous  stem  extract  of Cassia  roxburghii DC  as  a  reducing
agent.  The  biosynthesized  AgNPs  were  characterized  by  various
spectral analysis like UV–Vis, FTIR, XRD, TEM and Zeta potential
measurement. UV–vis spectra showed maxima absorption peak at
432  nm.  XRD  and  TEM  analysis  revealed  AgNPs  to  be  facecentered, cubic structures spherical in shape with an average particle
size of 32-35 nm.
The synergistic antibacterial activity was evaluated against two Gram
positive,  two  Gram  negative  bacteria  and  four  fungi  with  fifteen
commercial antibiotics alone and antibiotics plus synthesized AgNPs.
Antioxidant  activity  of  AgNPs  was  evaluated  by  ABTS  and  FRAP
assay.  The  AgNPs  showed  synergistic  antibacterial  activity  even
better than some antibiotics and also good  antioxidant activity. The
results suggest that Cassia roxburghii stem could be exploited for the
fabrication  of  AgNPs  with  potential  therapeutic  application  in
nanomedicine especially against multi drug resistant microorganisms
which  are  cost  effective  and  ecofriendly  and  simple.  They  can  be
definitely used in cosmetics, medical and pharmaceutical applications

All stakeholders within the livestock industry face a considerable challenge in achieving a balance between economic viability, environmental responsibility and social acceptability; and thus maintaining sustainable food production. This is exacerbated by information about farming practices and management systems that accentuate consumer concerns and lead to confusion as to the roles of productivity, efficiency and animal health in modern agriculture. The suggestions that intensive farms or large-scale herds have negative effects on cattle health; that we can assess cattle welfare by applying anthropomorphic philosophies; and that extensive systems are inherently beneficial to the environment, appear to be intuitively correct. Yet these suppositions are not as simple as they are often presented in mass media articles aimed at the consumer and lead to a multitude of other questions. Although it is tempting to try and overcome these issues by providing factual information, we cannot overcome negative publicity simply by supplying data and statistics. As an industry, we need to combine improved communication mechanisms with a better understanding of how consumer food-buying decisions are made to ensure future social acceptability and sustainability.

Infections caused by Candida species have been increasing in the last decades and can result in local or systemic infections, with high morbidity and mortality. After Candida albicans, Candida glabrata is one of the most prevalent pathogenic fungi in humans. In addition to the high antifungal drugs resistance and inability to form hyphae or secret hydrolases, C. glabrata retain many virulence factors that contribute to its extreme aggressiveness and result in a low therapeutic response and serious recurrent candidiasis, particularly biofilm formation ability. For their extraordinary organization, especially regarding the complex structure of the matrix, biofilms are very resistant to antifungal treatments. Thus, new approaches to the treatment of C. glabrata's biofilms are emerging. In this article, the knowledge available on C. glabrata's resistance will be highlighted, with a special focus on biofilms, as well as new therapeutic alternatives to control them.

En el capítulo 10 “Metabolismo y formación de biopelícula en Staphylococcus aureus”, de Liliana Muñoz Molina, Cristian Alexander Castillo Sánchez, Laura Camila Viuche Malaver, Angie Carolina Sierra Vargas, Cristian Alejandro Ricaurte Pérez, Jeannette Navarrete Ospina y Gladys Pinilla Bermúdez, el Staphylococcus aureus es un microorganismo patógeno y comensal, causante de infecciones de piel, del tracto urinario, de las vías gastrointestinales, endocarditis, septicemia, contaminación de heridas quirúrgicas y de dispositivos médicos permanentes. Presenta una resistencia parcial o total al efecto de algunos antibióticos, fenómeno que implica una participación activa de todos los factores de virulencia de la bacteria para su efectiva colonización e infección; causa aumento en la tasa de mortalidad y morbilidad, así como en los costos, por incremento en las estancias hospitalarias, situación que se ha convertido en una amenaza para la salud pública.

The lack of new antibiotic classes calls for a cautious use of existing agents. Yet, every 10 min, almost two tons of antibiotics are used around the world, all too often without any prescription or control. The use, overuse and misuse of antibiotics select for resistance in numerous species of bacteria which then renders antimicrobial treatment ineffective. Almost all countries face increased antimicrobial resistance (AMR), not only in humans but also in livestock and along the food chain. The spread of AMR is fueled by growing human and animal populations, uncontrolled contamination of fresh water supplies, and increases in international travel, migration and trade. In this context of global concern, 68 international experts attending the fifth edition of the World HAI Resistance Forum in June 2015 shared their successes and failures in the global fight against AMR. They underlined the need for a " One Health " approach requiring research, surveillance, and interventions across human, veterinary, agricultural and environmental sectors. This strategy involves concerted actions on several fronts. Improved education and increased public awareness are a well-understood priority. Surveillance systems monitoring infections need to be expanded to include antimicrobial use, as well as the emergence and spread of AMR within clinical and environmental samples. Adherence to practices to prevent and control the spread of infections is mandatory to reduce the requirement of antimicrobials in general care and agriculture. Antibiotics need to be banned as growth promoters for farm animals in countries where it has not yet been done. Antimicrobial stewardship programmes in animal husbandry have proved to be efficient for minimising AMR, without compromising productivity. Regarding the use of antibiotics in humans, new tools to provide highly specific diagnoses of pathogens can decrease diagnostic uncertainty and improve clinical management. Finally, infection prevention and control measures – some of them as simple as hand hygiene – are essential and should be extended beyond healthcare settings. Aside from regulatory actions, all people can assist in AMR reduction by limiting antibiotic use for minor illnesses. Together, we can all work to reduce the burden of AMR.

International and local surveillance networks as well as numerous reports in the biomedical literature provide evidence that the prevalence of antibiotic resistant Gram-negative bacteria is escalating in many European countries. Furthermore, isolates characterised as multidrug-resistant (i.e. resistant to three or more classes of antimicrobials), extensively drug resistant (i.e. resistant to all but one or two classes) or pandrug-resistant (i.e. resistant to all available classes) are increasingly frequently isolated in hospitalised patients causing infections for which no adequate therapeutic options exist. Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae are specifically addressed in this review as the most problematic and often extensively or pandrug-resistant pathogens. According to the available multicentre surveillance studies, the proportion of imipenem resistant A. baumannii strains is reported to be as high as 85% in bloodstream isolates from intensive care unit patients in Greece and 48% in clinical isolates from hospitalised patients in Spain and Turkey. Among 33 European countries participating in the European
Antimicrobial Resistance Surveillance System (EARSS) in 2007,
six countries reported carbapenem resistance rates of more than 25% among P. aeruginosa isolates, the highest rate reported from Greece (51%). According to EARSS, Greece has also the highest resistance rates among K. pneumoniae; 46% to carbapenems, 58% to quinolones and 63% to third generation cephalosporins. This review describes the magnitude of antimicrobial resistance in Gram-negative bacteria in Europe highlighting where the efforts of the scientific communities, the academia, the industry and the government should focus in order to confront this threat.

Medical professionals' and policymakers' fear of antimicrobial resistance (AMR) has largely been directed toward antibiotic use in medicine and animal agriculture. In Thailand, however, the use of antibiotics in citrus orchards has raised some concern over their 'appropriateness' and there have been calls for reduction-if not complete cessation-of their usage. We explore the emergence of antibiotic use for citrus greening disease (CGD) as part of shifting assemblages of plants, pests, pathogens, and people, as well as of varying climates, technologies, and farming practices. We suggest that rather than being a threat coming from outside orchards, CGD pathogenicity repeatedly emerges from within, and in Thailand appears to have increased alongside, the intensification of agricultural practices. We document how, when antibiotics emerged in the mid-20th century, their 'pharmaceutical efficacy' was insufficient to trigger their widespread adoption. Rather, the pharmaceuticalisation of orchards continues to be entangled with the expansion and intensification of mandarin agriculture, and also with the affordability of antibiotics, dissemination of relevant knowledge, and availability of equipment for their injection. Current proposals to reduce antibiotic use risk not taking sufficiently seriously the importance of their role in sustaining intensive orchard practices-and profits.

The fact that foods can provide additional medicinal health benefits beyond basic energy requirements and nutritional needs for survival, has been proven through rigorous scientific researches over the years. Although Turkey is historically believed to be the ancient origin of a
decent number of fermented probiotic foods and beverages, there is still little awareness amongst the overall populace regarding the usefulness of these medicinal products also known as functional foods. Hence, the current review article discusses probiotics as a top notch variety of functional foods and encapsulates their history as well as some proven beneficial effects of some known probiotic microorganisms on human health. More importantly, greater emphasis is placed on elucidating scientific data on seven fermented traditional probiotic beverages of
Turkish origin namely boza, kefir, ayran, shalgam, hardaliye, koumiss and gilaburu juice. The paper concisely describes their main characteristics, probiotic microbiota composition, production techniques as well as nutritional properties and some potential health benefits derivable from their consumption.

The emergence and spread of carbapenem-resistant Gram-negative bacteria is a worldwide emerging public health threat responsible for large number of nosocomail infections. Metallo-β-lactamases including IMP, VIM, and NDM as well as carbapenem hydrolyzing class D β-lactamase (OXA-48 like) are the predominant types that confer resistance to Carbapenem group of antibiotics. The aim of this study was to identify the carbapenemase encoding genes among Gram negative bacteria isolates. 42 isolates were identified depending on routine morphological tests followed by species identification using the VITEK 2 system. The 16S rDNA gene sequence was used for confirmation of the detection of Enterobacteriaceae and Pseudomonas aeruginosa. Antimicrobial susceptibility testing was performed using VITEK 2 system. For phenotypic detection of carbapenemase activity, modified carbapenem inactivation method (mCIM) was performed. The carbapenemases encoding genes (bla iMP , bla sPM , bla VIM , bla NDM , bla KPC , bla BIC , bla OXA , bla AiM , bla siM , bla GiM , bla DIM) were amplified by PCR and the amplified products were sequenced. Forty two Gram-negative bacteria isolates including 25 of P. aeruginosa (59.5%) and 17 of Enterobacteriaceae family (40.4%) were identified. According to PCR-based method results, carbapenemase gene bla OXA-48 was detected in 31(73.8%) of isolates, bla VIM in 23 (54.7%) and bla NDM in 2(4.76%) of isolates. Twelve (28.5%) of isolates harbored a combination of bla OXA-48 and bla VIM , (2.4%) coexistence bla OXA-48 and bla NDM gene and (2.4%) of isolates harbored a bla OXA-48, bla VIM and bla NDM genes. No other carbapenemase genes were identified. Based on the present study, it was concluded that the high prevalence was in bla OXA-48 gene, followed by bla VIM gene among carbapenemase-producing Gram-negative bacteria isolates.

Introduction: The emergence of carbapenemase-resistant Enterobacteriaceae (CRE) is an imminent threat to public health obligating, the development of novel β-lactam/β-lactamase inhibitors to combat its relentless spread, an example of which is ceftazidime-avibactam (CAZ-AVI). Since its introduction in 2015, worldwide data continues to pour in describing different mechanisms of treatment failure, primarily mediated by members of metallo-β-lactamase (MBL), Klebsiella pneumoniae carbapenemase (KPC), and oxacillinase (OXA) enzymes. Case Report: We report a case of a previously healthy 22-year-old male who was admitted to the critical care burn unit as a case of third-degree chemical burn injury involving 80% of his body surface area. His tissue cultures grew Klebsiella pneumoniae which was resistant to CAZ-AVI. Further analysis of resistance patterns by Xpert ® Carba-R detected the presence of both NDM (New Delhi metallo-β-lactamase) and OXA-48 mutation genes. Conclusion: OXA-48-mediated carbapenemase resistance is a regional threat in the Middle East and it is increasingly expanding in terms of its epidemiology and activity against novel antimicrobials. This activity is primarily mediated by mutant doubling and plasmid adaptation and can be horizontally acquired by coexistence with other resistant genes. We are reporting the first OXA-48-mediated CAZ-AVI resistance in the western region of Saudi Arabia which raises the concern about CRE spread in the country. Necessitating wiser use of available genotypic testing coupled with strict adherence of infection control protocols and antimicrobial stewardship programs.

ABSTRACT

Objectives: This study aimed to assess the awareness, knowledge, and practice of the residents in Greater Lagro, Quezon City, on antimicrobials and the development of antimicrobial resistance.
Methodology:  A questionnaire-based survey was conducted on 340 residents in Greater Lagro, Quezon City, Philippines, whereby their awareness, knowledge, and practices regarding antimicrobial use and the development of antimicrobial resistance was assessed by using a five point Likert scale, whose responses ranged from “strongly agree” to “strongly disagree”, ”no knowledge” to “very knowledgeable” and “always” to “never”. A self-made validated survey instrument was used. (Awareness: α=0.84; Knowledge: α=1.02; Practices-self-medication: α =0.83; Practices- Doctor’s prescription: α =0.682). Simple descriptive statistics was then applied which include percentage, mean, and standard deviation.
Findings: The study showed that the respondents had little awareness regarding antimicrobials and antimicrobial resistance. They were partly knowledgeable that the inappropriate use of antibiotics could lead to ineffective treatment as well as antimicrobial resistance. Furthermore, the respondents were uncertain that they could get trustworthy information about antimicrobials from doctors and pharmacists, and were also uncertain if expensive antimicrobials are more expensive than the cheaper ones. Alarmingly, poor practices on the use of antimicrobials were also observed. Malpractices such as non-compliance to complete antibiotic therapy for seven days, not discarding the leftover antibiotics, and giving away leftover antibiotic drugs were noted. These practices could contribute to antimicrobial resistance.
Conclusion: The misuse of antimicrobials and the development of antimicrobial resistance are fundamental public health problems, and necessary plans and actions to combat these should be taken into action immediately.

Background: The issue of antibiotic resistance has become a global public health concern, with an extensive clinical
and economic burden. The study aimed to assess the knowledge, attitude, and practices of antibiotic resistance among
undergraduate medical students at the University of Zambia.
Methods: This cross-sectional study was conducted at the University of Zambia Ridgeway Campus. A structured
questionnaire was administered to 260 randomly selected undergraduate medical students. Data were analyzed using
Statistical Package for Social Sciences (SPSS) version 22.0. Associations between dependent and independent
variables were done using a Chi-square test. The statistical significance was done at 95% confidence level (p<0.05).
Ethical approval was done by the University of Zambia Health Sciences Research Ethics Committee.
Results: The study found that 227 of 260 (87.3%) of the medical students had good knowledge on antibiotic use and
resistance. The majority of the medical students 252 of 260 (96.9%) had positive attitudes and 195 of 260 (75%) had
good practices towards antibiotic resistance. There was a significant difference between the year of study and the
level of knowledge (χ2=16.333, p=0.003). There was no significant difference between the year of study and the
attitude of the participants (χ2=4.061, p=0.398). A significant difference was found between the year of study and the
practices of the respondents (χ2=10.926, p=0.027).
Conclusions: The medical students had good knowledge, a positive attitude, and good practices towards antibiotic
resistance. Final year students had higher levels of knowledge and attitude but lower levels of practice compared to
other years of study.
Keywords: Antibiotic resistance, Attitude, Knowledge, Medical students, Practices, Zambia

Objective: The present study aimed to the isolation and
characterization of phytochemicals from tissue cultures of Arnebia
hispidissima. The isolated compounds were evaluated for their
antioxidant and antimicrobial activities.
Materials and Methods: Six derivatives of alkannin and shikonin
were isolated and characterized by using various physical and
spectroscopic techniques from callus tissue of A. hispidissima. The
callus tissue was generated by using Murashige and Skoog culture
medium. The isolated compounds were assayed for DPPH-radical,
reducing power, superoxide anion and metal chelating scavenging
and antimicrobial activities by adopting well established methods.
Results: The observed results revealed that deoxyshikonin showed
maximum inhibition (290.20±0.440%) to DPPH-radical scavenging
assay and shikonin demonstrated higher reducing ability
(498.32±0.431%). Similarly, the propionylalkannin and
acetylshikonin possessed moderate to maximum superoxide
(345.45±0.632%) and metal chelating abilities (264.76±0,531%).
Moreover, effective antimicrobial activity was also demonstrated by
all the isolated derivatives of alkannin and shikonin.
Conclusion: The results of present study suggested that the isolated
compounds demonstrated modern antioxidant and high antimicrobial
activities. Therefore, further investigations need to be carried out to
isolate new phytochemicals from tissues cultures and screening for
other different biological and pharmacological activities.

In this paper, we provide a state-of-the-art overview of the ethical challenges that arise in the context of antimicrobial resistance (AMR), which includes an introduction to the contributions to the symposium in this issue. We begin by discussing why AMR is a distinct ethical issue, and should not be viewed purely as a technical or medical problem. In the second section, we expand on some of these arguments and argue that AMR presents us with a broad range of ethical problems that must be addressed as part of a successful policy response to emerging drug resistance. In the third section, we discuss how some of these ethical challenges should be addressed, and we argue that this requires contributions from citizens, ethicists, policy makers, practitioners and industry. We conclude with an overview of steps that should be taken in moving forward and addressing the ethical problems of AMR.