antimicrobial resistance

抗菌素耐药性
  • 文章类型: Journal Article
    Adoption of a rational management in dairy farms would improve the milk quality and farmers\' income. In the current study, we aimed to describe bovine mastitis in 32 dairy herds, identify the main cow- and herd-associated risk factors, and analyze both epidemiological along with molecular characteristics of Staphylococcus aureus infecting udders. Based on Californian Mastitis Test and clinical examination, the prevalence of mastitis in cows was 52.25% (116/222), of which 6.3% was clinical mastitis and 45.94% was subclinical mastitis. Overall, 218 (24.54%) quarters suffered from mastitis, whose 29.81% (65/218) infected with S. aureus. Mastitis was lowest in mid-lactation with OR = 0.371 with 95% confidence interval (CI) of 0.141-0.976, and in cows separated from their calves (OR = 0.164, 95% CI 0.056-0.477) than suckler cows. Similar results were obtained from S. aureus related mastitis. To assess the genetic lineages of S. aureus isolates, we determined clonal complexes (CC) using DNA microarray hybridization profiles and performed spa typing. The strains were assigned to nine clonal complexes, and 19 spa types; with CC97 (44.77%), and CC22 (40.29%) were the most predominant lineages and t223 (40.29%), t7136 (10.44%), t359 (8.95%) and t267 (5.97%) were the most common spa types. A total of 88.05% (n = 59) isolates were resistant to at least one tested antibiotic while only 4.47% were multi-drug resistant strains. Higher rates of resistance were observed for penicillin (86.5%) and tetracycline (14.9%) respectively. Our results show the need for adoption of feasible mastitis program with special emphasis on sub-clinical mastitis and associated risk factors.
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  • 文章类型: Journal Article
    UNASSIGNED: Reducing antimicrobial resistance (AMR) is a priority for public health. Inappropriate patient demand is an important driver of unnecessary antibiotic use. To develop an effective intervention to reduce inappropriate demand for antibiotics in upper respiratory tract infections (URTIs), it is important to identify patient perceptions that influence demand for, and appropriate use of antibiotics.
    UNASSIGNED: To identify and describe the beliefs about antibiotics necessity and concerns that patients with URTIs have, in Riyadh, Saudi Arabia.
    UNASSIGNED: An exploratory qualitative approach was used. One-to-one, face-to-face or telephone semi-structured interviews were conducted with participants recruited using purposive sampling (based on age and gender) from primary healthcare centre in Riyadh, Saudi Arabia were conducted. Only adult patients who currently experience URTIs symptoms and agreed to participate were recruited. Recruitment for interviews continued until data saturation point was reached. The interview guide explored patients\' necessity beliefs and concerns about antibiotics, AMR perceptions, and expectations from URTIs consultation. Interview transcripts were coded using QSR NVivo 12 using framework analysis informed by the Necessity-Concerns Framework to identify key motivations driving antibiotic requests and consultations.
    UNASSIGNED: the study interviewed 32 participants (44% were male, average age was 36.84). Results identified that the patients often relate their personal need for antibiotics when encountering an URTIs symptoms to the type, severity and duration of symptoms. Patients also linked antibiotics with quicker recovery, generally expressing few concerns about antibiotics mainly because of its short duration of use. However, some conveyed their concern about frequent administration of antibiotics and effect on the body\'s immune system function, which may make them more prone to infections in the future. Participants varied widely in their awareness of AMR; this was associated with many misconceptions, such as confusing AMR with antibiotics efficacy and tolerance. Interestingly, the interplay between necessity beliefs and concerns was observed to influence the decision to start and stop antibiotic, potentially impacting inappropriate antibiotic demand and unnecessary use.
    UNASSIGNED: This study highlighted important beliefs and misconceptions about antibiotics and AMR in Saudi population which can be targeted in future interventions to reduce inappropriate demand for antibiotics and optimise appropriate usage.
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  • 文章类型: Journal Article
    Antimicrobial resistance remains a significant global and One Health threat, owing to the diminishing effectiveness of antibiotics against rapidly evolving multidrug-resistant bacteria, and the limited innovative research towards the development of new antibiotic therapeutics. In this article, we present the whole-genome sequence data of Proteus mirabilis-MN029 obtained from highly accurate long-read PacBioⓇ HiFi technology. The antibacterial activities of the selected African native plant species were also evaluated using the disk diffusion method. Acquired antibiotic resistance genes and chromosomal mutations corresponding to antibiotics of clinical importance were identified from genomic data. Using ethlyl acetate as solvent, Pterocarpus angolensis leaf extracts showed the most promising antibacterial effects against Proteus mirabilis-MN029. These datasets will be useful for future experimental research aimed at designing new antibacterial drugs from plant extracts that are effective alone or in combination with existing antibiotics to overcome multidrug-resistance mechanisms.
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  • 文章类型: Journal Article
    The gut microbial metalloenzymes play an important role in maintaining the balance between gut microbial ecosystem, human physiologically processes and immune system. The metals coordinated into active site contribute in various detoxification and defense strategies to avoid unfavourable environment and ensure bacterial survival in human gut. Metallo-β-lactamase is a potent degrader of antibiotics present in periplasmic space of both commensals and pathogenic bacteria. The resistance to anti-microbial agents developed in this enzyme is one of the global threats for human health. The organophosphorus eliminator, organophosphorus hydrolases have evolved over a course of time to hydrolyze toxic organophosphorus compounds and decrease its effect on human health. Further, the redox stress responders namely superoxide dismutase and catalase are key metalloenzymes in reducing both endogenous and exogenous oxidative stress. They hold a great importance for pathogens as they contribute in pathogenesis in human gut along with reduction of oxidative stress. The in-silico study on these enzymes reveals the importance of point mutation for the evolution of these enzymes in order to enhance their enzyme activity and stability. Various mutation studies were conducted to investigate the catalytic activity of these enzymes. By using the \"directed evolution\" method, the enzymes involved in detoxification and defense system can be engineered to produce new variants with enhance catalytic features, which may be used to predict the severity due to multi-drug resistance and degradation pattern of organophosphorus compounds in human gut.
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  • 文章类型: Journal Article
    本文有助于越来越多的关于如何减轻药品污染的讨论,这是对人类的威胁,动物,和环境健康以及抗生素耐药性的潜在驱动因素。它将药品的市场批准确定为塑造生产者行为的最有力方法之一,并强调应用该工具会引发道德问题,因为它可能会影响患者获得药物。该文件确定了七种不同的政策选择,这些政策选择在批准过程中逐步将环境考虑因素放在首位,确定受此类政策影响的伦理相关利益,并在这些利益之间进行明确的紧张关系和必要的权衡。虽然认为当前的欧洲法规对环境考虑的重视不够,该文件强调了对最强有力的政策选择的担忧,理由是这些很可能危及患者获得有效药物。
    This paper contributes to the growing discussion about how to mitigate pharmaceutical pollution, which is a threat to human, animal, and environmental health as well as a potential driver of antimicrobial resistance. It identifies market approval of pharmaceuticals as one of the most powerful ways to shape producer behavior and highlights that applying this tool raises ethical issues given that it might impact patients\' access to medicines. The paper identifies seven different policy options that progressively give environmental considerations increased priority in the approval process, identifies ethically relevant interests affected by such policies, and makes explicit tensions and necessary tradeoffs between these interests. While arguing that the current European regulation gives insufficient weight to environmental considerations, the paper highlights concerns with the strongest policy options, on the grounds that these may very well endanger patients\' access to effective medication.
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  • 文章类型: Journal Article
    应用染料了解感染的病因激发了抗菌化学疗法和第一波抗菌药物。第二波抗菌药物的发现是由天然产物的快速发现推动的,现在占目前抗菌药物的69%。但是现在已经发现了最普遍的天然产物,必须筛选107种新的居住在土壤中的细菌物种,以发现一类新的天然产物。因此,而不是第三波抗菌药物的发现,现在有一个发现瓶颈。与数十亿年的微生物拮抗作用所产生的天然产物不同,广阔的合成化学空间仍然需要通过抗菌药物的治疗科学进行人工管理-对小分子如何与细菌生理学相互作用的系统理解,影响所需的表型,并使主机受益。细菌分子遗传学可以阐明与治疗发展相关的病原体生物学,但它也可以直接应用于理解具有新作用机制的新化学试剂的机制和责任。因此,通过将化学专业知识与细菌感染生物学的系统解剖相结合,可以实现抗菌药物发现的下一阶段。面对雄心勃勃的努力,寻找来自自然界或新自然界的新分子来治愈细菌感染,现代化学生物学和分子遗传学提供的能力可用于寻找新靶标的化学调节剂,以规避普遍的抗性机制。
    The application of dyes to understanding the aetiology of infection inspired antimicrobial chemotherapy and the first wave of antibacterial drugs. The second wave of antibacterial drug discovery was driven by rapid discovery of natural products, now making up 69% of current antibacterial drugs. But now with the most prevalent natural products already discovered, ∼107 new soil-dwelling bacterial species must be screened to discover one new class of natural product. Therefore, instead of a third wave of antibacterial drug discovery, there is now a discovery bottleneck. Unlike natural products which are curated by billions of years of microbial antagonism, the vast synthetic chemical space still requires artificial curation through the therapeutics science of antibacterial drugs - a systematic understanding of how small molecules interact with bacterial physiology, effect desired phenotypes, and benefit the host. Bacterial molecular genetics can elucidate pathogen biology relevant to therapeutics development, but it can also be applied directly to understanding mechanisms and liabilities of new chemical agents with new mechanisms of action. Therefore, the next phase of antibacterial drug discovery could be enabled by integrating chemical expertise with systematic dissection of bacterial infection biology. Facing the ambitious endeavour to find new molecules from nature or new-to-nature which cure bacterial infections, the capabilities furnished by modern chemical biology and molecular genetics can be applied to prospecting for chemical modulators of new targets which circumvent prevalent resistance mechanisms.
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  • 文章类型: Journal Article
    整个坦桑尼亚都可以随时购买强大的药品,全球卫生政策制定者谴责这种情况是危险和无序的,好像没有规则来管理非洲的毒品使用。在流行的全球健康理解中,“真理”在于实验室科学,它涉及药物的制造和正确的处方,而“过度使用”和“误用”等偏差是由于当地人误解了这些药物是什么以及应该如何使用。然而,我在坦桑尼亚的人种学研究表明,具体的认识论经常使医生和患者能够评估各种药物的质量,并通过其材料和感官质量识别chakachua(不合格或掺假)药物-我将其概念化为“逃亡科学”的一种形式(Rusert2017)。鉴于此,我分析了世界卫生组织在坦桑尼亚的抗菌素耐药性国家行动计划,证明这些全球卫生政策是如何忽视这些知识的,采用“无知”和“缺乏卫生”的新殖民主义言论作为日益增长的抗菌素耐药性的来源,同时掩盖了结构性不平等。我认为,这种形式的全球健康监测是通过战争的逻辑和认识论来运作的(Chow2006;Terry2017),使全球南方的人口成为威胁和目标。最后,我建议逃犯科学可以作为卫生安全框架的反证据,因此,代表了对这些军事化逻辑的一种偷偷摸摸的抵抗。
    Powerful pharmaceuticals are readily available for purchase throughout Tanzania and global health policy makers decry this situation as dangerous and disordered, as if no rules govern the use of drugs in Africa. In the prevailing global health understanding, \'truth\' lies in the laboratory science that goes into the making and proper prescription of drugs, and such deviations as \'overuse\' and \'misuse\' result from the fact that locals supposedly misunderstand what these drugs are and how they should be used. However, my ethnographic research in Tanzania reveals that embodied epistemologies frequently enable medical practitioners and patients to evaluate the quality of various drugs and to identify chakachua (substandard or adulterated) pharmaceuticals through their material and sensory qualities-a practice I conceptualize as a form of \'fugitive science\' (Rusert 2017). In light of this, I analyze the WHO\'s National Action Plan for Antimicrobial Resistance in Tanzania, demonstrating how such global health policies disregard this knowledge, employing neocolonial rhetoric that presents \'ignorance\' and \'lack of hygiene\' as the sources of growing antimicrobial resistance while simultaneously obscuring structural inequalities. I argue that such forms of global health surveillance operate through the logics and epistemologies of war (Chow 2006; Terry 2017) in ways that render populations in the Global South into threats and targets. I conclude by suggesting that fugitive science can work as counter-evidence to health security frameworks and, as such, represents a furtive form of resistance to these militarized logics.
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  • 文章类型: Journal Article
    山羊通常是弯曲杆菌的无症状携带者,包括食源性病原体空肠弯曲杆菌。感染可以在人类和动物中具有显著的和经济上有害的健康结果。这项研究的主要目的是估计弯曲杆菌在美国山羊群中的流行率。作为国家动物健康监测系统山羊2019研究的一部分,从3,959只个体动物中的106只和277只山羊手术中的42只分离出弯曲杆菌。加权动物水平患病率为2.3%(SE=0.5%),手术患病率为13.0%(SE=3.2%)。动物水平的患病率从0到70.0%不等,然而,52.4%的阳性手术(22/42)只有一个分离株。空肠杆菌是最常见的分离物种(68.9%;73/106),其次是大肠杆菌(29.3%,31/106)。总共有46.2%(36/78)的活分离株对8种抗微生物剂普遍敏感。在44.9%(35/78)的分离株中观察到对四环素(TET)的耐药性,12.8%(10/78)对环丙沙星(CIP)和萘啶酸(NAL)耐药。在所有分离物中,在3.8%(3/78)的分离株中观察到单一耐药profileCIP-NAL-TET。总共鉴定了35种独特的序列类型(ST),其中11个可能是新的。在48.1%(13/27)的阳性手术中观察到多个空肠弯曲杆菌STs。接触地表水的山羊,报告饲料或水中抗生素的操作(不包括离子载体和抗球虫药),报告流产和无流产后管理任务的手术,弯曲杆菌阳性的可能性显著增加.美国山羊种群的快照丰富了有关美国山羊中弯曲杆菌物种存在的有限知识库。
    Goats are often asymptomatic carriers of Campylobacter, including the foodborne pathogen Campylobacter jejuni. Infections can have significant and economically detrimental health outcomes in both humans and animals. The primary objective of this study was to estimate the prevalence of Campylobacter in U.S. goat herds. Campylobacter species were isolated from 106 of 3,959 individual animals and from 42 of 277 goat operations that participated in fecal sample collection as part of the National Animal Health Monitoring System Goat 2019 study. Weighted animal-level prevalence was 2.3% (SE = 0.5%) and operation prevalence was 13.0% (SE = 3.2%). Animal-level prevalence ranged widely from 0 to 70.0%, however, 52.4% of positive operations (22/42) had only a single isolate. C. jejuni was the most frequently isolated species (68.9%; 73/106), followed by C. coli (29.3%, 31/106). A total of 46.2% (36/78) of viable isolates were pan-susceptible to 8 antimicrobials. Resistance to tetracycline (TET) was observed in 44.9% (35/78) of isolates, while 12.8% (10/78) were resistant to ciprofloxacin (CIP) and nalidixic acid (NAL). Among all isolates, a single resistance profile CIP-NAL-TET was observed in 3.8% (3/78) of isolates. A total of 35 unique sequence types (STs) were identified, 11 of which are potentially new. Multiple C. jejuni STs were observed in 48.1% (13/27) of positive operations. Goats with access to surface water, operations reporting antibiotics in the feed or water (excluding ionophores and coccidiostats), and operations reporting abortions and without postabortion management tasks had significantly greater odds of being Campylobacter positive. This snapshot of the U.S. goat population enriches the limited pool of knowledge on Campylobacter species presence in U.S. goats.
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  • 文章类型: Journal Article
    背景:外科抗菌药物预防(SAP),如果根据循证指南适当使用,可以在不影响患者预后的情况下降低腔内手术后感染并发症的发生率。目的:根据国际指南,调查当前SAP在腔内手术中使用的适当性,并报告其相关结果(尿路感染[UTI]和血流感染[BSI])。设计:前瞻性横断面研究。方法:对接受腔内治疗的患者的医疗记录进行审查,以评估医疗保健提供者对国际指南建议的遵守情况。评估参数包括指示,持续时间,选择,在安曼/约旦的两个医疗中心,以及在腔内手术中使用的抗生素的剂量。此外,患者被要求在术后1个月内进行实验室尿液检查,以确定感染并发症的发生率.结果:研究招募了361名患者。对适应症指南的遵守率,选择,术前抗生素的剂量为90.3%,2.8%,77.8%,分别。仅3.4%的参与者的持续时间与指南一致。41.8%的患者完成了随访。其中,4.6%出现细菌UTIs,0.7%发展了BSI。结论:在腔内泌尿外科程序中,对SAP指南的依从性远非最佳。指南建议实施中的主要偏差已被查明。这些结果对于优化SAP利用率的计划干预措施至关重要。
    Background: Surgical antimicrobial prophylaxis (SAP), when used appropriately based on evidence-based guidelines, can reduce the rate of infectious complications following endourologic procedures without compromising patient outcomes. Objectives: To investigate the appropriateness of the current SAP used in endourologic surgeries based on international guidelines and report their associated outcomes (urinary tract infection [UTI] and blood stream infection [BSI]). Design: Prospective cross-sectional study. Methodology: The medical records of patients undergoing endourologic procedures were reviewed to assess healthcare providers\' adherence to international guideline recommendations. Assessed parameters included indication, duration, choice, and dose of the antibiotics used in endourologic procedures in two medical centers in Amman/Jordan. Furthermore, patients were asked to conduct laboratory urine tests to determine the rate of infectious complications within one month post-procedure. Results: Three hundred and sixty-one patients were recruited for the study. The adherence rates to guidelines regarding indication, choice, and dose of pre-operative antibiotics were 90.3%, 2.8%, and 77.8%, respectively. The duration was concordant with guidelines in only 3.4% of participants. A total of 41.8% of patients completed follow-up. Among those, 4.6% developed bacterial UTIs, and 0.7% developed BSI. Conclusion: Adherence to SAP guidelines in endourologic procedures was far from optimal. Primary deviations in the implementation of guidelines\' recommendations were pinpointed. These results are crucial for planning interventions that optimize SAP utilization.
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  • 文章类型: Journal Article
    目的:头孢他啶-阿维巴坦(CZA)是产生碳青霉烯酶A类(尤其是blaKPC)和D类(blaOXA)的革兰氏阴性杆菌感染的良好选择。然而,尚不清楚它是否会对金属β-内酰胺酶(blaMBL)的选择产生影响。该研究的目的是在引入CZA后的两年内比较碳青霉烯和CZA肺炎克雷伯菌(KPN)的敏感性。
    方法:这项研究是在布宜诺斯艾利斯一家三级医院的36张病床的成人ICU中进行的,阿根廷。抗微生物剂消耗量表示为每100名患者的治疗天数-天(DOT)。
    结果:共分析了第一年的123株KPN菌株和第二年的172株。第二年检测到碳青霉烯敏感性的惊人下降(OR0.5[0.3-0.8]p<.001)。并行,CZA易感性降低(OR0.5[0.3-0.9]p<.05)。这些发现与blaMBL-KPN的上升有关(32.1%与45.1%,或1.7[1.1-2.9],p<.04)第二年。这种新的KPN敏感性曲线促进了CZA的增加(1.0DOT与6.6DOT,OR6.6[4.9-9.1]p<.001)和氨曲南(0.3DOTvs.4.1DOT,或16.3[9.1-29.3]p<.001)消费。因此,碳青霉烯类处方药减少(17.8DOTvs.15.4DOT,或0.8[0.8-0.9]p<.001)。
    结论:在CZA引入两年后,blaMBL-KPN率上升,导致CZA和碳青霉烯敏感性降低,CZA和氨曲南处方增加。
    OBJECTIVE: Ceftazidime-avibactam (CZA) is a good option for Gram-negative bacilli infections that produce carbapenemase Classes A (especially blaKPC) and D (blaOXA). However, it is unknown whether it would have an impact on metallo-β-lactamases (blaMBL) selection. The aim of the study was to compare carbapenem and CZA Klebsiella pneumoniae (KPN) susceptibility profiles for a period of two years following the introduction of CZA.
    METHODS: The study was conducted in a 36-bed adult ICU of a tertiary hospital in Buenos Aires, Argentina. Antimicrobial consumption was expressed as days of treatment per 100 patients-day (DOT).
    RESULTS: A total of 123 KPN strains in the first year and 172 in the second year were analyzed. An alarming decrease in carbapenem susceptibility was detected in the second year (OR 0.5 [0.3-0.8] p<.001). In parallel, there was a decrease in CZA susceptibility (OR 0.5 [0.3-0.9] p<.05). These findings were linked to a rise in blaMBL-KPN (32.1% vs. 45.1%, OR 1.7 [1.1-2.9], p <.04) during the second year. This new KPN susceptibility profile promoted an increment in CZA (1.0 DOT vs. 6.6 DOT, OR 6.6 [4.9-9.1] p<.001) and aztreonam (0.3 DOT vs. 4.1 DOT, OR 16.3 [9.1-29.3] p<.001) consumption. Thus, there was a decrease in carbapenem prescription (17.8 DOT vs. 15.4 DOT, OR 0.8 [0.8-0.9] p<.001).
    CONCLUSIONS: There was an escalation of blaMBL-KPN rate two years after CZA introduction, leading to a decrease in CZA and carbapenem susceptibility and an increase in CZA and aztreonam prescriptions.
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