Universal access to safe water, whether at households or health centres, is central to achieving the sixth sustainable development goal by 2030. A hospital-based survey was conducted to screen for antimicrobial resist...Universal access to safe water, whether at households or health centres, is central to achieving the sixth sustainable development goal by 2030. A hospital-based survey was conducted to screen for antimicrobial resistance among coliforms in samples collected from tap water (n = 54) at surgical wards in Gaza and to investigate the association with free residual chlorine and pH levels. Total coliforms (TC) were detected in 48.1% (26/54) of tested samples and FCs were detected in 25.9% (14/54). Free residual chlorine test ranged from zero to 0.2 mg/l (average: 0.08 mg/l), of which more than half of the samples (53.7%) 29/54 showed no free residual chlorine. The mean value of free residual chlorine in samples tested positive for growth on m-Endo (0.03) was lower than the mean for negative samples (0.14). The pH values were within the acceptable range (average: 7.6) and there was a statistically significant variation between the mean of pH values for samples tested positive on m-Endo (7.29) and that tested negative (7.84). Among coliform positive samples, 23.1% (6/26) had coliform isolates with resistance patterns. More than two-thirds of antimicrobial resistant (AMR) isolates were resistant to amikacin, ceftazidime, ceftriaxone, and imipenem. Moreover, 50% of the isolates were resistant to piperacillin-tazobactam. One-third (33.3%) of isolates were resistant to cefoxitin, and fosfomycin, 16.7% were resistant to ciprofloxacin, and nitrofurantoin. Intermediate resistance was shown in 16.7% of the isolates to cefoxitin and ciprofloxacin. The ESBL and carbapenem resistance genes detected in isolates were TEM (66.7%), NDM (33.3%), OXA (25%), blaCTXM (16.7%), and blaCTXM-3 (16.7%). The finding highlighted the level of contamination with AMR coliform in samples collected from tap water and pointed out the importance of managing water safety through identifying the main source of contamination, in addition to maintaining proper water disinfection at healthcare facilities for the patient, staff and environmental safety.展开更多
Economic losses and market constraints caused by bacterial diseases such as colibacillosis due to avian pathogenic Escherichia coli and necrotic enteritis due to Clostridium perfringens remain major problems for poult...Economic losses and market constraints caused by bacterial diseases such as colibacillosis due to avian pathogenic Escherichia coli and necrotic enteritis due to Clostridium perfringens remain major problems for poultry producers,despite substantial efforts in prevention and control.Antibiotics have been used not only for the treatment and prevention of such diseases,but also for growth promotion.Consequently,these practices have been linked to the selection and spread of antimicrobial resistant bacteria which constitute a significant global threat to humans,ani-mals,and the environment.To break down the antimicrobial resistance(AMR),poultry producers are restricting the antimicrobial use(AMU)while adopting the antibiotic-free(ABF)and organic production practices to satisfy consum-ers’demands.However,it is not well understood how ABF and organic poultry production practices influence AMR profiles in the poultry gut microbiome.Various Gram-negative(Salmonella enterica serovars,Campylobacter jejuni/coli,E.coli)and Gram-positive(Enterococcus spp.,Staphylococcus spp.and C.perfringens)bacteria harboring multiple AMR determinants have been reported in poultry including organically-and ABF-raised chickens.In this review,we discussed major poultry production systems(conventional,ABF and organic)and their impacts on AMR in some potential pathogenic Gram-negative and Gram-positive bacteria which could allow identifying issues and opportuni-ties to develop efficient and safe production practices in controlling pathogens.展开更多
Antimicrobial resistance in the laying hen production industry has become a serious public health problem.The antimicrobial resistance and phylogenetic relationships of the common conditional pathogen Enterococcus alo...Antimicrobial resistance in the laying hen production industry has become a serious public health problem.The antimicrobial resistance and phylogenetic relationships of the common conditional pathogen Enterococcus along the laying hen production chain have not been systematically clarified.105 Enterococcus isolates were obtained from 115 environmental samples (air,dust,feces,fies,sewage,and soil) collected along the laying hen production chain (breeding chicken,chick,young chicken,and commercial laying hen).These Enterococcus isolates exhibited resistance to some clinically relevant antibiotics,such as tetracycline (92.4%),streptomycin (92.4%),and erythromycin (91.4%),and all strains had multidrug resistance phenotypes.Whole genome sequencing characterized 29 acquired antibiotic resistance genes (ARGs) that conferred resistance to 11 classes of antibiotics in 51pleuromutilin-resistant Enterococcus isolates,and lsa(E),which mediates resistance to pleuromutilins,always co-occurred with lnu(B).Alignments with the Mobile Genetic Elements database identified four transposons (Tn554,Tn558,Tn6261,and Tn6674) with several ARGs(erm(A),ant(9)-la,fex(A),and optrA) that mediated resistance to many clinically important antibiotics.Moreover,we identified two new transposons that carried ARGs in the Tn554 family designated as Tn7508 and Tn7492.A complementary approach based on conventional multi-locus sequence typing and whole genome single nucleotide polymorphism analysis showed that phylogenetically related pleuromutilin-resistant Enterococcus isolates were widely distributed in various environments on different production farms.Our results indicate that environmental contamination by antimicrobial-resistant Enterococcus requires greater attention,and they highlight the risk of pleuromutilin-resistant Enterococcus and ARGs disseminating along the laying hen production chain,thereby warranting effective disinfection.展开更多
BACKGROUND In the absence of effective antimicrobials,transplant surgery is not viable,and antirejection immunosuppressants cannot be administered,as resistant infections compromise the life-saving goal of organ trans...BACKGROUND In the absence of effective antimicrobials,transplant surgery is not viable,and antirejection immunosuppressants cannot be administered,as resistant infections compromise the life-saving goal of organ transplantation.AIM To evaluate the efficacy of antimicrobials in preventing resistance in solid organ transplant recipients.METHODS A systematic review was conducted using a search methodology consistent with the preferred reporting items for systematic reviews and meta-analyses.This review included randomized clinical trials that evaluated the efficacy of antimicrobial agents(prophylactic or therapeutic)aimed at preventing antimicrobial resistance.The search strategy involved analyzing multiple databases,including PubMed/MEDLINE,Web of Science,Embase,Scopus,and SciELO,as well as examining gray literature sources on Google Scholar.A comprehensive electronic database search was conducted from the databases’inception until May 2024,with no language restrictions.RESULTS After the final phase of the eligibility assessment,this systematic review ultimate-ly included 7 articles.A total of 2318 patients were studied.The most studied microorganisms were cytomegalovirus,although vancomycinresistant enterococci,Clostridioides difficile,and multidrug-resistant Enterobacterales were also analyzed.The antimicrobials used in the interventions were mainly maribavir,valganciclovir,gancic-lovir,and colistin-neomycin.Of concern,all clinical trials showed significant proportions of resistant microorga-nisms after the interventions,with no statistically significant differences between the groups(mean resistance 13.47%vs 14.39%),except for two studies that demonstrated greater efficacy of maribavir and valganciclovir(mean resistance 22.2%vs 41.1%in the control group;P<0.05).The total reported deaths in three clinical trials were 75,and there were 24 graft rejections in two studies.CONCLUSION All clinical trials reported significant proportions of antimicrobial-resistant microorganisms following interventions.More high-quality randomized clinical trials are needed to corroborate these results.展开更多
Background: The irrational use of medicines remains a key health problem in many developing countries. The overuse of antibiotics is a key driver of antimicrobial resistance (AMR). This study surveyed antibiotic use a...Background: The irrational use of medicines remains a key health problem in many developing countries. The overuse of antibiotics is a key driver of antimicrobial resistance (AMR). This study surveyed antibiotic use and adherence to the World Health Organization (WHO) prescribing indicators at the Request Muntanga Hospital in the Kalomo District of Southern Province, Zambia. Materials and Methods: This cross-sectional study was conducted from July 2023 to September 2023 at Request Muntanga Hospital in Zambia and reviewed 600 medical record prescriptions which were issued from July 1, 2022 to June 30, 2023 using the WHO prescribing indicators. The collected data were analyzed using Statistical Package for Social Sciences version 23.0. Results: From the 600 prescriptions sampled, 1246 medicines were prescribed, with antibiotics making up 86.7% of the encounters. Additionally, the average number of drugs prescribed per encounter was 2.1 and the prevalence of polypharmacy was 61.3%. Further, 17.8% of medicines were prescribed as injectables. Furthermore, 76.7% of the drugs were prescribed from the Zambia Essential Medicines List and 38.9% by generic names. Conclusions: This study found a high use of antibiotics and deviations from the WHO/International Network of Rational Use of Drugs (INRUD) core prescribing indicators at the Request Muntanga Hospital indicating non-adherence to the prescribing indicators. There is a need to promote adherence to the WHO/INRUD core prescribing indicators to promote the rational use of antibiotics and prevent the emergence and spread of AMR.展开更多
The One Health concept acknowledges the importance of multiple dimensions in controlling antimicrobial resistance(AMR).However,our understanding of how anthropological,socioeconomic,and environmental factors drive AMR...The One Health concept acknowledges the importance of multiple dimensions in controlling antimicrobial resistance(AMR).However,our understanding of how anthropological,socioeconomic,and environmental factors drive AMR at a national level remains limited.To explore associations between potential contributing factors and AMR,this study analyzed an extensive database comprising 13 major antibioticresistant bacteria and over 30 predictors(e.g.,air pollution,antibiotic usage,economy,husbandry,public services,health services,education,diet,climate,and population)from 2014 to 2020 across China.The multivariate analysis results indicate that fine particulate matter with a diameter of 2.5 μm or less(PM_(2.5))is associated with AMR,accounting for 12%of the variation,followed by residents’income(10.3%)and antibiotic usage density(5.1%).A reduction in PM_(2.5)of 1 μg·m^(-3)is linked to a 0.17%decrease in aggregate antibiotic resistance(p<0.001,R^(2)=0.74).Under different scenarios of China’s PM_(2.5)airquality projections,we further estimated the premature death toll and economic burden derived from PM_(2.5)-related antibiotic resistance in China until 2060.PM_(2.5)-derived AMR is estimated to cause approximately 27000(95%confidence interval(CI):646848830)premature deaths and about 0.51(95%CI;0.12-0.92)million years of life lost annually in China,equivalent to an annual welfare loss of 8.4(95%CI;2.0-15.0)billion USD.Implementing the“Ambitious Pollution 1.5℃ Goals”scenario to reduce PM_(2.5)concentrations could prevent roughly 14000(95%CI;3324-26320)premature deaths—with a potential monetary value of 9.8(95%CI;2.2-17.6)billion USD—from AMR by 2060.These results suggest that reducing air pollution may offer co-benefits in the health and economic sectors by mitigating AMR.展开更多
The rapid emergence of drug-resistant microbial pathogens has posed challenges to global health in the twenty-first century.This development has significantly made most antibiotics ineffective in the treatment of infe...The rapid emergence of drug-resistant microbial pathogens has posed challenges to global health in the twenty-first century.This development has significantly made most antibiotics ineffective in the treatment of infections they cause,resulting in increasing treatment costs and annual death rates.To address the challenge posed by these pathogens,we explore the potential of secondary metabolites from Aspergillus species as a source of new and effective therapeutic agents to treat drug-resistant infections.Terpenoids,a distinct group of natural products,are extensively distributed in plants and fungi,and have been attributed with significant antibacterial,anticancer,and antiviral activities.In this review,we present an overview of Aspergillus species,and review the novel terpenoids isolated from them from 2019 to April 2024,highlighting anti-infective activity against members of the ESKAPE pathogens.We further focus on the strategies through which the structural framework of these new terpenoids could be modified and/or optimized to feed a pipeline of new lead compounds targeting microbial pathogens.Overall,this review provides insight into the therapeutic applications of terpenoids sourced from Aspergillus species and the potential for the discovery of new compounds from these fungi to combat antimicrobial resistance.展开更多
Background:Community-acquired bacterial pneumonia(CABP)poses a serious public health threat,particularly with the emergence of drug-resistant bacterial strains.This study aims to investigate the molecular interactions...Background:Community-acquired bacterial pneumonia(CABP)poses a serious public health threat,particularly with the emergence of drug-resistant bacterial strains.This study aims to investigate the molecular interactions of Nafithromycin(Miqnaf®),India’s first indigenous next-generation macrolide antibiotic,and evaluate its potential against Streptococcus pneumoniae,a key pathogen responsible for CABP.Targeting 23S rRNA is critical for overcoming antibiotic resistance since it is involved in bacterial protein production.Many antibiotics,including macrolides target this rRNA.Mutations in 23S rRNA frequently result in resistance;therefore,designing medicines that bind new or conserved areas of 23S rRNA can circumvent current resistance mechanisms and restore antibiotic potency.Nafithromycin has excellent therapeutic potential,with a short three-day regimen and much higher efficacy than conventional macrolides.Its high lung tissue penetration and robust effectiveness against drug-resistant respiratory bacteria make it a promising next-generation antibiotic.Methods:To elucidate the interaction of Nafithromycin with bacterial ribosomal RNA,molecular docking studies were performed using AutoDock Vina.The three-dimensional structure of Streptococcus pneumoniae 23S rRNA was retrieved from the Protein Data Bank(PDB).The ligand structure of Nafithromycin was obtained from the PubChem database and prepared using Open Babel.Docking simulations targeted key functional regions-Domains II and V of 23S rRNA-known to be critical for bacterial protein synthesis.Binding affinities were calculated,and molecular interactions such as hydrogen bonds,hydrophobic contacts,and conformational stabilities were analyzed using Discovery Studio and PyMOL.Results:Nafithromycin exhibited a high binding affinity of-10.3 kcal/mol toward S.pneumoniae 23S rRNA.The compound formed stable interactions with both Domain II and Domain V,crucial regions involved in the inhibition of bacterial protein synthesis.Hydrogen bonding and hydrophobic interactions further stabilized the ligand-receptor complex.Compared to azithromycin,Nafithromycin demonstrated superior binding efficacy and a greater potential to inhibit resistant bacterial strains,indicating its structural advantages and enhanced ribosomal targeting.Conclusion:Nafithromycin demonstrates significant potential as a potent therapeutic agent against drug-resistant CABP.Its strong binding affinity,stable interactions with bacterial rRNA,favorable pharmacokinetic profile,and reduced resistance risk support its clinical utility and suggest its advantage over traditional macrolide antibiotics such as azithromycin.展开更多
BACKGROUND Sepsis is a critical medical condition,and poses a substantial global health burden,with significant morbidity,mortality,and economic costs,particularly pronounced in low-and middle-income countries.Effecti...BACKGROUND Sepsis is a critical medical condition,and poses a substantial global health burden,with significant morbidity,mortality,and economic costs,particularly pronounced in low-and middle-income countries.Effective management of sepsis relies on early recognition and appropriate intervention,underscoring the importance of accurate classification to guide treatment decisions.The correct diagnosis will lead to effective antimicrobial stewardship practices.AIM To assess the distribution of sepsis categories and the use of empirical antibiotics classified by the World Health Organization(WHO)Access,Watch,and Reserve(AWaRe)system in a tertiary care hospital in Northern India and to correlate antibiotic usage with sepsis classifications.METHODS This longitudinal observational study in the Department of General Medicine,in a tertiary care hospital in Northern India,from 2023 to 2024,aimed to assess the use of empirical antibiotics classified by the WHO AWaRe system.The study also aimed to correlate antibiotic usage.Patients were categorized into sepsis classes(Asepsis,Possible Sepsis,Probable Sepsis,Confirmed Sepsis)and followed until discharge or Day-28.Descriptive and inferential statistical analyses were employed to assess sepsis categories and empirical antibiotic usage classified by the WHO AWaRe system.RESULTS A total of 1867 patients admitted with suspected sepsis were screened,with 230 meeting the inclusion criteria.Among the study cohort(mean age 40.70±14.49 years,50.9% female),initial sepsis classification predominantly included probable sepsis(51.3%)and possible sepsis(35.7%),evolving to asepsis(57.8%)upon final classification,but all received antibiotics.Empirical antibiotic use showed a predominance of Watch group antibiotics(72.2%),with ceftriaxone and piperacillin-tazobactam being the most commonly prescribed;however,no statistical association could be established among the different classes of sepsis with the AWaRe groups.CONCLUSION Accurate sepsis classification is pivotal for clinical decision-making,optimizing antibiotic use,and combating antimicrobial resistance.The majority of the asepsis category was labelled as probable or possible sepsis and given antibiotics at initial hospitalization.The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation,potentially reducing unnecessary antibiotic exposure.Future efforts should focus on establishing sepsis classification checklists as in this study and promoting adherence to antimicrobial stewardship principles to mitigate the global threat of antimicrobial resistance.展开更多
BACKGROUND Outpatient parenteral antimicrobial therapy(OPAT)offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings,allowing patients to complete treatment safel...BACKGROUND Outpatient parenteral antimicrobial therapy(OPAT)offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings,allowing patients to complete treatment safely while avoiding many hospital-acquired complications.This is a major boost or low-hanging fruit intervention in antimicrobial stewardship practices with multiple targets like decreasing hospital stays,its related complications,the economy,the burden on hospitals,etc.However,resource-constrained countries like India practices rarely OPAT in an evidence-based way.AIM To evaluate the effectiveness,safety,and feasibility along with barriers and facilitators of OPAT practices in resource-poor settings,with a focus on its role in antimicrobial stewardship.METHODS This pilot longitudinal observational study included patients who met OPAT checklist criteria and were committed to post-discharge follow-up.Pre-discharge education and counselling were provided,and demographic data were recorded.Various outcome measures,including barriers and facilitators,were identified through an extensive literature review,fishbone diagram preparation,data collection and analysis,and patient feedback.All healthcare workers who were taking care of the patients discharged with OPAT were contacted with openended questions to get data on feasibility.The study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences,Rishikesh.We used descriptive analysis and theχ2 test to analyze data.P value<0.05 was considered significant.RESULTS Out of 20 patients,the mean age was 37 years.The cohort comprised 13 males.OPAT was administered at home in 15 cases and at nursing homes in 5 cases,with nine patients receiving treatment from family members and 11 patients receiving care from a local nurse.The infections requiring OPAT included:Kidney-urinary tract(6 cases),gastrointestinal tract(4 cases),respiratory tract(4 cases),meningitis(3 cases),endocarditis(2 cases),and multiple visceral abscesses(1 case).Nineteen out of 20 patients achieved afebrile status.Half of the patients did not receive education,counselling,or demonstrations prior to discharge,but all patients rated the service as good/excellent.According to doctors’feedback,OPAT is highly beneficial and effective for patients when systematically implemented with daily telephonic monitoring,but faces challenges due to the lack of standardized protocols,dedicated teams,and adequate resources.The implementation of OPAT resulted in a reduction of hospitalization duration by an average of two weeks.CONCLUSION This pilot study proves that OPAT is safe,feasible,and efficacious by reducing two weeks of hospitalization in resource-poor settings.OPAT contributes directly to antimicrobial stewardship by reducing hospital stays and hospital-acquired complications,which is vital in combating antimicrobial resistance(AMR)and aligns with the global action plan for AMR in infection prevention and optimal antimicrobial utilization.展开更多
Background: Antimicrobial Resistance (AMR) has been recognized as a global public health problem of utmost importance that needs to be tackled. Low-income countries such as Uganda have the greatest burden of severe an...Background: Antimicrobial Resistance (AMR) has been recognized as a global public health problem of utmost importance that needs to be tackled. Low-income countries such as Uganda have the greatest burden of severe and life-threatening infections and are most likely to suffer more from the spread of untreatable resistant bacteria. Despite the generally increasing trends in AMR, there is hardly any documented data on AMR in orthopedic care. Methods: We analyzed data from the pathogenic isolates from pus and tissue from the laboratory from 2019 to 2023. We calculated the proportions of isolates resistant to commonly used antimicrobial classes. We used the chi-square test for trends to evaluate changes in AMR across the study period. Results: Out of the 286 isolates, 104 (43.5%) were from pus, 112 (46.9%) were from tissue samples and the remaining 9.6% were from different fluid aspirates like synovial fluid. Most of the isolates were from males (64.2%) and aged between 19 and 45 years (46.2%). The distribution of whether the bacteria were gram-positive or negative was relatively equal with 114 (45.2%) being gram-negative and 120 (47.6%) gram-positive. Generally, there was increased AMR across all antibiotics from 2019 to 2021 e.g. for Imipinem, it went from 0% in 2019 to 70.8% in 2021 and for Amoxyclav, it went from 10% in 2019 to 93.2% in 2021. There was a general decline in AMR noted from 2021 to 2023. However, currently, the highest resistance is noted in ceftriaxone (80.0%) and the lowest in Imipinem (11.76%). Conclusion: There is a general decreasing trend in AMR, most probably due to increasing policies governing the use of antibiotics. However, there is still high resistance to commonly used and affordable antibiotics. Continuous monitoring of AMR is still recommended to reduce the AMR problem in Uganda at large through public health policy and planning.展开更多
Monitoring the prevalence of antimicrobial resistance genes(ARGs)is vital for addressing the global crisis of antibiotic-resistant bacterial infections.Despite its importance,the characterization of ARGs and microbiom...Monitoring the prevalence of antimicrobial resistance genes(ARGs)is vital for addressing the global crisis of antibiotic-resistant bacterial infections.Despite its importance,the characterization of ARGs and microbiome structures,as well as the identification of indicators for routine ARG monitoring in pig farms,are still lacking,particularly concerning variations in antimicrobial exposure in different countries or regions.Here,metagenomics and random forest machine learning were used to elucidate the ARG profiles,microbiome structures,and ARG contamination indicators in pig manure under different antimicrobial pressures between China and Europe.Results showed that Chinese pigs exposed to high-level antimicrobials exhibited higher total and plasmid-mediated ARG abundances compared to those in European pigs(P<0.05).ANT(6)-Ib,APH(3')-IIIa,and tet(40)were identified as shared core ARGs between the two pig populations.Furthermore,the core ARGs identified in pig populations were correlated with those found in human populations within the same geographical regions.Lactobacillus and Prevotella were identified as the dominant genera in the core microbiomes of Chinese and European pigs,respectively.Forty ARG markers and 43 biomarkers were able to differentiate between the Chinese and European pig manure samples with accuracies of 100%and 98.7%,respectively.Indicators for assessing ARG contamination in Chinese and European pigs also achieved high accuracy(r=0.72-0.88).Escherichia flexneri in both Chinese and European pig populations carried between 21 and 37 ARGs.The results of this study emphasize the importance of global collaboration in reducing antimicrobial resistance risk and provide validated indicators for evaluating the risk of ARG contamination in pig farms.展开更多
Objective:To determine the clinical distribution of multi-drug resistant organism(MDRO)in Jiangyan Hospital and the monitoring and warning of drug-resistance bacteria to provide an important basis for guiding the appl...Objective:To determine the clinical distribution of multi-drug resistant organism(MDRO)in Jiangyan Hospital and the monitoring and warning of drug-resistance bacteria to provide an important basis for guiding the application of broad-spectrum antibiotics in clinical treatment and reducing the occurrence of nosocomial infection.Methods:Retrospective screening and analysis were conducted on the pathogenic strains of hospitalized patients in our hospital in 2022.Results:A total of 2,769 strains of pathogenic bacteria and 390 strains of MDRO were detected and isolated in our hospital in 2022;the detection rate of MDRO was 14.08%.A total of 516 strains(18.64%)Klebsiella pneumoniae(KP)and 62 strains(12.02%)of carbapenem-resistant Klebsiella pneumoniae(CR-KP)were detected;436 strains(15.75%)of Escherichia coli(ECO)were detected,including 8 strains(1.83%)of CR-ECO;342 strains(12.35%)of Pseudomonas aeruginosa(PA)and 116 strains(33.92%)of CR-PA were detected;there were 194 strains(7.01%)of Acinetobacter baumannii(AB),among which 125 strains(64.43%)were CR-AB;there were 291 strains(10.51%)of Staphylococcus aureus,among which 79 strains(27.15%)of methicillin-resistant Staphylococcus aureus(MRSA)were detected;78 strains(2.82%)of Enterococcus faecalis were detected,and vancomycin-resistant enterococcus(VRE)was not detected.The first five MDROs were CR-AB,CR-PA,MRSA,CR-KP,and CR-ECO.The top five departments with the highest MDRO detection rate in 2022 were the ICU(37.44%),the Pulmonology Department(ward 13;31.03%),the Department of Rehabilitation(ward 5;6.67%),the Department of Neurosurgery(ward 11;4.62%),and the Department of General Surgery(ward 10;3.59 The resistance rate of antibacterial drugs is divided into four levels for early warning:30%to 40%,41%to 50%,51%to 75%,and 75%or more.Conclusion:Our hospital should strengthen the monitoring of antimicrobial resistance warning related to MDRO and the abuse of antimicrobial drugs.Based on the results of drug sensitivity and antimicrobial resistance warning,the use of antibiotics should be standardized in clinical practice to reduce nosocomial infection。展开更多
Since the discovery of penicillin in 1928,antibiotics have revolutionized modern medicine by effectively treating infectious diseases and saving countless lives.However,the widespread development of antimicrobial resi...Since the discovery of penicillin in 1928,antibiotics have revolutionized modern medicine by effectively treating infectious diseases and saving countless lives.However,the widespread development of antimicrobial resistance(AMR)now threatens the efficacy and longevity of these critical drugs.A study published in The Lancet reported that bacterial AMR contributed to approximately 4.95 million deaths globally in 2019,with 1.27 million directly attributable to AMR(Fig.1)[1].Natural products(NPs)continue to play a crucial role in discovering new antibiotics.展开更多
Background: Antimicrobial resistance (AMR) is a growing public health concern, with far-reaching consequences for modern medicine. Zambia, like many other low- and middle-income countries, faces significant challenges...Background: Antimicrobial resistance (AMR) is a growing public health concern, with far-reaching consequences for modern medicine. Zambia, like many other low- and middle-income countries, faces significant challenges in addressing AMR. Further, high rates of resistance have been reported among various microorganisms in Zambia. This review paper aims to summarize the current situation of the burden of AMR in Zambia, including the prevalence, risk factors contributing to its emergence and spread, challenges in addressing this issue, and the required solutions to combat this growing public health threat. Additionally, the paper also outlines existing efforts to combat AMR and proposes required solutions and recommendations to address this threat to public health. Materials and Methods: This study employed a comprehensive narrative review design that included studies published from January 2000 to November 2024. The literature search was done using PubMed, Scopus, Web of Science, and Google Scholar. Results: In 2019, 1.27 million deaths were attributed to AMR of which 255,000 were from sub-Saharan Africa. Currently, the burden of AMR in Zambia is not well understood. This study found that the drug resistance index (DRI) in Zambia was 60.9%, demonstrating high resistance rates of pathogens to antimicrobials commonly used in humans and animals. The high DRI indicates the low effectiveness of antibiotics in treatment of infections. Most pathogens with high resistance to antimicrobials include Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Salmonella species, Enterococcus species, Mycobacterium tuberculosis, Acinetobacter baumannii, and Pseudomonas aeruginosa. Additionally, the study found that there was low awareness, knowledge, attitudes, and suboptimal practices regarding AMR in Zambia. The contributing factors to the emergence and spread of AMR include self-medication practices, overuse and misuse of antimicrobials in humans and animals, non-adherence to treatment guidelines, limited diagnostic capacity, substandard and falsified antimicrobials, and a lack of surveillance of AMR. There is a need to develop strategies to address the identified gaps in Zambia to successfully combat AMR. Conclusion: This study revealed high resistance of microbes to antimicrobials in Zambia. The high prevalence of AMR in Zambia indicates its burden on the country, thereby providing opportunities for further research to quantify this problem. The findings highlight the need for a One Health multi-sectoral approach to address AMR in Zambia, including strengthening surveillance and monitoring, improving antimicrobial stewardship and prescribing practices, enhancing infection prevention and control practices, increasing access to quality healthcare and diagnostic services, promoting public awareness and education, and encouraging research and development of new antimicrobial agents. The proposed solutions and recommendations can serve to strengthen the implementation of the Zambia National Action Plan (NAP) to combat AMR.展开更多
Objective:To investigate the distribution characteristics of common bacteria and changes in antimicrobial resistance in intensive care unit(ICU)patients in 58 hospitals in Hubei Province from 2020–2023.Method:The ant...Objective:To investigate the distribution characteristics of common bacteria and changes in antimicrobial resistance in intensive care unit(ICU)patients in 58 hospitals in Hubei Province from 2020–2023.Method:The antimicrobial agents for antimicrobial susceptibility tests was selected based on the 2022 China Antimicrobial Resistance surveillance system(CARSS)technical scheme,and the specific experimental operation was based on the requirements of the CLSI M02 and M07 documents.The commercial instruments were used following the manufacturer’s instructions.The interpretation of antimicrobial susceptibility test results was based on the 2023 CLSI M100 standard.Results:There were 15585,19258,23423 and 22395 clinical isolates in the ICU from 2020 to 2023,respectively.Among them,gram-positive bacteria accounted for 20.5%(3190/15585),21.2%(4089/19258),21.6%(5067/23423)and 21.6%(4831/22395),respectively.Gram-negative bacteria accounted for 79.5%(12395/15585),78.8%(15169/19258),78.4%(18356/23423)and 78.4%(17564/22395)of the bacteria,respectively.The top 5 isolates of gram-positive bacteria were Staphylococcus aureus,Enterococcus faecium,Streptococcus pneumoniae,Enterococcus faecalis,Staphylococcus epidermidis and gram-negative bacteria were Klebsiella pneumoniae,Acinetobacter baumannii,Escherichia coli,Pseudomonas aeruginosa and Stenotrophomonas maltophil,respectively,but the proportions and rankings of the isolates in different years slightly differed.The detection rate of methicillin-resistant S.aureus(MRSA)decreased from 44.4%in 2020 to 36%in 2023,and that of methicillin-resistant coagulase-negative Staphylococcus(MRCNS)decreased from 79.8%in 2020 to 73.8%in 2022 and increased to 78.4%in 2023.The detection rates of both vancomycin-resistant E.faecium and E.faecalis were lower than 1%.The detection rate of carbapenem-resistant P.aeruginosa(CRPA)decreased from 25%in 2020 to 19.7%in 2022 and increased slightly to 20.6%in 2023.The detection rate of carbapenem-resistant A.baumannii(CRAB)decreased from 81.9%in 2020 to 79.7%in 2022 and increased to 82.9%in 2023.The detection rate of third-generation cephalosporin-resistant E.coli decreased from 59.8%in 2020 to 53.1%in 2022 and increased to 52.5%in 2023.The detection rate of fluoroquinolone-resistant E.coli decreased from 62.7%in 2020 to 50.2%in 2022 and increased slightly to 51.0%in 2023.The detection rate of carbapenem-resistant E.coli(CRECO)decreased from 3.3%in 2020 to 1.8%in 2022 and slightly increased to 2.1%in 2023.The detection rate of third-generation cephalosporin-resistant K.pneumoniae decreased from 34.3%in 2020 to 26.3%in 2022 and then increased to 32.4%in 2023.The detection rate of carbapenem-resistant K.pneumoniae(CRKPN)increased from 17.9%to 19.4%in 2020,decreased to 13.2%in 2022,and rose sharply to 20.4%in 2023.Conclusion:MRSA showed a continuous downwards trend from 2020 to 2023,while the detection rates of MRCNS and most multidrug-resistant gram-negative bacteria continuously decreased from 2020 to 2022 but tended to increase in 2023.Therefore,it is still necessary to strengthen the monitoring of bacterial resistance and rational application of antibiotics and actively and effectively control nosocomial infections.展开更多
Background:Antimicrobial resistance(AMR)is a global public health threat that requires actions through One Health intervention.This study aims to trace the historical development of One Health research on AMR to provi...Background:Antimicrobial resistance(AMR)is a global public health threat that requires actions through One Health intervention.This study aims to trace the historical development of One Health research on AMR to provide evidence supporting future research and actions.Methods:A bibliometric analysis is conducted with One Health articles in the field of antimicrobial resistance(AMR-OH articles)retrieved from the Web of Science Core Collection(WoSCC).AMR-OH articles refer to articles in the field of AMR that simultaneously involve elements from human health and at least one other domain,including animals,environment,or plants.Three research periods were identified based on the development of global actions in combating AMR.Descriptive analysis of publications,keyword cluster analysis,annual trending topic analysis,and co-authorship analysis were conducted using R software,VOSViewer,and Pajek.Results:The results indicated that the percentage of AMR-OH articles among all AMR articles increased from 5.21%in 1990 to 20.01%in 2023.Key topics in the current AMR-OH articles included the mechanism of AMR,AMR epidemiology,and public health control strategies.Epidemiological research initially focused on human and animal health and then shifted to environmental factors in the third period.Research at the molecular level focused on the mechanisms of AMR transmission in various domains,along with the dynamics and diversity of antibiotic resistance genes(ARGs).The co-authorship analysis suggested a significant increase in cooperation among low-and middle-income countries in the third period.Conclusion:The scope of epidemiological research on AMR has expanded by including human,animal,and environmental areas.Moreover,genetic and molecular level research represents the forefront of this field,offering innovative tools to combat AMR in the future.This study suggests further research to translate existing findings into practical implementation of the One Health strategy,and to support globally consistent action in combating AMR.展开更多
Klebsiella pneumoniae infections(KPIs),particularly carbapenem-resistant Klebsiella pneumoniae(CRKP),pose significant challenges in liver transplantation(LT)recipients,with high morbidity and mortality.Guo et al’s st...Klebsiella pneumoniae infections(KPIs),particularly carbapenem-resistant Klebsiella pneumoniae(CRKP),pose significant challenges in liver transplantation(LT)recipients,with high morbidity and mortality.Guo et al’s study highlights risk factors,such as elevated day-one alanine aminotransferase levels and prolonged catheterization,and identifies polymyxin B and ceftazidime/avibactam as effective treatments.However,limitations like the absence of pre-transplant colonization data and host-pathogen interaction insights highlight the need for enhanced strategies.Future directions should include routine CRKP colonization surveillance,immune and genomic profiling,and the development of novel therapeutics.By integrating these approaches,we can improve the prevention,diagnosis,and treatment of KPIs in LT patients.展开更多
Background:This retrospective cross-sectional study evaluated the antibiogram profile of Gram-negative bacterial infections at Yastebsheron Hospital.The study aimed to identify prevalent pathogens,assess antimicrobial...Background:This retrospective cross-sectional study evaluated the antibiogram profile of Gram-negative bacterial infections at Yastebsheron Hospital.The study aimed to identify prevalent pathogens,assess antimicrobial susceptibility patterns,and develop evidence-based recommendations for empirical antibiotic therapy.Methods:A total of 1,182 clinical specimens(urine,swabs,aspirates,and cerebrospinal fluid)collected in 2022 were analyzed following standard microbiological procedures.Culture and sensitivity testing were performed according to established protocols.Data were analyzed using SPSS version 23 and Microsoft Excel,with results presented through descriptive statistics.Results:Gram-negative bacteria accounted for 48.4%of isolates.Urinary tract infections(UTIs)were the most prevalent,with a significantly higher incidence among female patients(67%).Escherichia coli(59.8%)was the predominant uropathogen.Among the frequently isolated pathogens E.coli(52.5%),Enterobacter spp.(21.9%),Proteus mirabilis(9.8%),and Pseudomonas aeruginosa(8.4%)meropenem demonstrated the highest efficacy.Levofloxacin showed excellent activity against Enterobacter spp.and P.mirabilis(92%susceptibility),while amikacin exhibited moderate effectiveness against E.coli(78%).Morganella morganii displayed the highest multidrug-resistance rates.Colistin was universally effective against P.aeruginosa.Third-generation cephalosporins and nalidixic acid showed limited efficacy against E.coli(21-41%susceptibility).P.mirabilis,Klebsiella pneumoniae,and M.morganii demonstrated low susceptibility to most tested antibiotics.Conclusion:Regular antibiogram updates are essential for monitoring antimicrobial resistance trends and guiding empirical therapy.The study findings support the use of meropenem and levofloxacin as first-line options while highlighting concerning resistance patterns to cephalosporins and quinolones.Local susceptibility data remain crucial for optimizing antibiotic selection and stewardship efforts.展开更多
The rapid emergence and spread of colistin-resistant gram-negative bacteria has raised worldwide public health concerns,and phosphoethanolamine(PEtn)transferase modification-mediated colistin resistance has been widel...The rapid emergence and spread of colistin-resistant gram-negative bacteria has raised worldwide public health concerns,and phosphoethanolamine(PEtn)transferase modification-mediated colistin resistance has been widely documented in multiple gram-negative bacterial species.However,whether such a mechanism exists in the zoonotic pathogen Pasteurella multocida is still unknown.Recently,a novel PEtn transferase,PetL,was identified in P.multo-cida,but whether it is associated with colistin resistance remains to be elucidated.In this study,we found that PetL in P.multocida(PetL^(PM))exhibited structural characteristics similar to those of the mobile-colistin-resistant(MCR)protein and the PEtn transferase characterized in Neisseria meningitidis.The transformation of petLPM into E.coli or K.pneumoniae changed the phenotype of several tested strains from colistin sensitive to colistin resistant.Deletion of this gene decreased the colistin minimum inhibitory concentration(MIC)of P.multocida by 64-fold.Our extensive analysis by MALDI-TOF-MS demonstrated that PetLPM participated in the modification of bacterial lipopolysaccharide(LPS)-lipid A.Deletion of petL^(PM) led to an increase in membrane charge but a decrease in cell-surface hydrophobicity and cell permeability in P.multocida.The present study is the first to report the presence of PEtn transferase-mediated colistin resistance in the zoonotic pathogen P.multocida.展开更多
文摘Universal access to safe water, whether at households or health centres, is central to achieving the sixth sustainable development goal by 2030. A hospital-based survey was conducted to screen for antimicrobial resistance among coliforms in samples collected from tap water (n = 54) at surgical wards in Gaza and to investigate the association with free residual chlorine and pH levels. Total coliforms (TC) were detected in 48.1% (26/54) of tested samples and FCs were detected in 25.9% (14/54). Free residual chlorine test ranged from zero to 0.2 mg/l (average: 0.08 mg/l), of which more than half of the samples (53.7%) 29/54 showed no free residual chlorine. The mean value of free residual chlorine in samples tested positive for growth on m-Endo (0.03) was lower than the mean for negative samples (0.14). The pH values were within the acceptable range (average: 7.6) and there was a statistically significant variation between the mean of pH values for samples tested positive on m-Endo (7.29) and that tested negative (7.84). Among coliform positive samples, 23.1% (6/26) had coliform isolates with resistance patterns. More than two-thirds of antimicrobial resistant (AMR) isolates were resistant to amikacin, ceftazidime, ceftriaxone, and imipenem. Moreover, 50% of the isolates were resistant to piperacillin-tazobactam. One-third (33.3%) of isolates were resistant to cefoxitin, and fosfomycin, 16.7% were resistant to ciprofloxacin, and nitrofurantoin. Intermediate resistance was shown in 16.7% of the isolates to cefoxitin and ciprofloxacin. The ESBL and carbapenem resistance genes detected in isolates were TEM (66.7%), NDM (33.3%), OXA (25%), blaCTXM (16.7%), and blaCTXM-3 (16.7%). The finding highlighted the level of contamination with AMR coliform in samples collected from tap water and pointed out the importance of managing water safety through identifying the main source of contamination, in addition to maintaining proper water disinfection at healthcare facilities for the patient, staff and environmental safety.
基金supported by Agriculture and Agri-Food Canada to M.S.Diarra through the Genomics Research and Development Initiative (PSS#1858 J-001262) and A-Base (PSS#3441,J-002363) projects on “Mitigating Antimicrobial Resistance”.
文摘Economic losses and market constraints caused by bacterial diseases such as colibacillosis due to avian pathogenic Escherichia coli and necrotic enteritis due to Clostridium perfringens remain major problems for poultry producers,despite substantial efforts in prevention and control.Antibiotics have been used not only for the treatment and prevention of such diseases,but also for growth promotion.Consequently,these practices have been linked to the selection and spread of antimicrobial resistant bacteria which constitute a significant global threat to humans,ani-mals,and the environment.To break down the antimicrobial resistance(AMR),poultry producers are restricting the antimicrobial use(AMU)while adopting the antibiotic-free(ABF)and organic production practices to satisfy consum-ers’demands.However,it is not well understood how ABF and organic poultry production practices influence AMR profiles in the poultry gut microbiome.Various Gram-negative(Salmonella enterica serovars,Campylobacter jejuni/coli,E.coli)and Gram-positive(Enterococcus spp.,Staphylococcus spp.and C.perfringens)bacteria harboring multiple AMR determinants have been reported in poultry including organically-and ABF-raised chickens.In this review,we discussed major poultry production systems(conventional,ABF and organic)and their impacts on AMR in some potential pathogenic Gram-negative and Gram-positive bacteria which could allow identifying issues and opportuni-ties to develop efficient and safe production practices in controlling pathogens.
基金supported by the National Key Research and Development Program of China (Nos.2022YFC2303900 and2022YFD1800400)the General Program of National Natural Science Foundation of China (Nos.U21A20257 and 31830098)+1 种基金the National System of Layer Production Technology (No.CARS-40-K-14)the Key R&D Program of Sichuan Province (Nos.2022ZDZX0017 and 2021YFH0192)。
文摘Antimicrobial resistance in the laying hen production industry has become a serious public health problem.The antimicrobial resistance and phylogenetic relationships of the common conditional pathogen Enterococcus along the laying hen production chain have not been systematically clarified.105 Enterococcus isolates were obtained from 115 environmental samples (air,dust,feces,fies,sewage,and soil) collected along the laying hen production chain (breeding chicken,chick,young chicken,and commercial laying hen).These Enterococcus isolates exhibited resistance to some clinically relevant antibiotics,such as tetracycline (92.4%),streptomycin (92.4%),and erythromycin (91.4%),and all strains had multidrug resistance phenotypes.Whole genome sequencing characterized 29 acquired antibiotic resistance genes (ARGs) that conferred resistance to 11 classes of antibiotics in 51pleuromutilin-resistant Enterococcus isolates,and lsa(E),which mediates resistance to pleuromutilins,always co-occurred with lnu(B).Alignments with the Mobile Genetic Elements database identified four transposons (Tn554,Tn558,Tn6261,and Tn6674) with several ARGs(erm(A),ant(9)-la,fex(A),and optrA) that mediated resistance to many clinically important antibiotics.Moreover,we identified two new transposons that carried ARGs in the Tn554 family designated as Tn7508 and Tn7492.A complementary approach based on conventional multi-locus sequence typing and whole genome single nucleotide polymorphism analysis showed that phylogenetically related pleuromutilin-resistant Enterococcus isolates were widely distributed in various environments on different production farms.Our results indicate that environmental contamination by antimicrobial-resistant Enterococcus requires greater attention,and they highlight the risk of pleuromutilin-resistant Enterococcus and ARGs disseminating along the laying hen production chain,thereby warranting effective disinfection.
文摘BACKGROUND In the absence of effective antimicrobials,transplant surgery is not viable,and antirejection immunosuppressants cannot be administered,as resistant infections compromise the life-saving goal of organ transplantation.AIM To evaluate the efficacy of antimicrobials in preventing resistance in solid organ transplant recipients.METHODS A systematic review was conducted using a search methodology consistent with the preferred reporting items for systematic reviews and meta-analyses.This review included randomized clinical trials that evaluated the efficacy of antimicrobial agents(prophylactic or therapeutic)aimed at preventing antimicrobial resistance.The search strategy involved analyzing multiple databases,including PubMed/MEDLINE,Web of Science,Embase,Scopus,and SciELO,as well as examining gray literature sources on Google Scholar.A comprehensive electronic database search was conducted from the databases’inception until May 2024,with no language restrictions.RESULTS After the final phase of the eligibility assessment,this systematic review ultimate-ly included 7 articles.A total of 2318 patients were studied.The most studied microorganisms were cytomegalovirus,although vancomycinresistant enterococci,Clostridioides difficile,and multidrug-resistant Enterobacterales were also analyzed.The antimicrobials used in the interventions were mainly maribavir,valganciclovir,gancic-lovir,and colistin-neomycin.Of concern,all clinical trials showed significant proportions of resistant microorga-nisms after the interventions,with no statistically significant differences between the groups(mean resistance 13.47%vs 14.39%),except for two studies that demonstrated greater efficacy of maribavir and valganciclovir(mean resistance 22.2%vs 41.1%in the control group;P<0.05).The total reported deaths in three clinical trials were 75,and there were 24 graft rejections in two studies.CONCLUSION All clinical trials reported significant proportions of antimicrobial-resistant microorganisms following interventions.More high-quality randomized clinical trials are needed to corroborate these results.
文摘Background: The irrational use of medicines remains a key health problem in many developing countries. The overuse of antibiotics is a key driver of antimicrobial resistance (AMR). This study surveyed antibiotic use and adherence to the World Health Organization (WHO) prescribing indicators at the Request Muntanga Hospital in the Kalomo District of Southern Province, Zambia. Materials and Methods: This cross-sectional study was conducted from July 2023 to September 2023 at Request Muntanga Hospital in Zambia and reviewed 600 medical record prescriptions which were issued from July 1, 2022 to June 30, 2023 using the WHO prescribing indicators. The collected data were analyzed using Statistical Package for Social Sciences version 23.0. Results: From the 600 prescriptions sampled, 1246 medicines were prescribed, with antibiotics making up 86.7% of the encounters. Additionally, the average number of drugs prescribed per encounter was 2.1 and the prevalence of polypharmacy was 61.3%. Further, 17.8% of medicines were prescribed as injectables. Furthermore, 76.7% of the drugs were prescribed from the Zambia Essential Medicines List and 38.9% by generic names. Conclusions: This study found a high use of antibiotics and deviations from the WHO/International Network of Rational Use of Drugs (INRUD) core prescribing indicators at the Request Muntanga Hospital indicating non-adherence to the prescribing indicators. There is a need to promote adherence to the WHO/INRUD core prescribing indicators to promote the rational use of antibiotics and prevent the emergence and spread of AMR.
基金funded by the National Natural Science Foun-dation of China(22406168,W2411031,and 52270201)the China Postdoctoral Science Foundation(2023M733061)the Zhejiang University Global Partnership Fund(100000-11320/198).
文摘The One Health concept acknowledges the importance of multiple dimensions in controlling antimicrobial resistance(AMR).However,our understanding of how anthropological,socioeconomic,and environmental factors drive AMR at a national level remains limited.To explore associations between potential contributing factors and AMR,this study analyzed an extensive database comprising 13 major antibioticresistant bacteria and over 30 predictors(e.g.,air pollution,antibiotic usage,economy,husbandry,public services,health services,education,diet,climate,and population)from 2014 to 2020 across China.The multivariate analysis results indicate that fine particulate matter with a diameter of 2.5 μm or less(PM_(2.5))is associated with AMR,accounting for 12%of the variation,followed by residents’income(10.3%)and antibiotic usage density(5.1%).A reduction in PM_(2.5)of 1 μg·m^(-3)is linked to a 0.17%decrease in aggregate antibiotic resistance(p<0.001,R^(2)=0.74).Under different scenarios of China’s PM_(2.5)airquality projections,we further estimated the premature death toll and economic burden derived from PM_(2.5)-related antibiotic resistance in China until 2060.PM_(2.5)-derived AMR is estimated to cause approximately 27000(95%confidence interval(CI):646848830)premature deaths and about 0.51(95%CI;0.12-0.92)million years of life lost annually in China,equivalent to an annual welfare loss of 8.4(95%CI;2.0-15.0)billion USD.Implementing the“Ambitious Pollution 1.5℃ Goals”scenario to reduce PM_(2.5)concentrations could prevent roughly 14000(95%CI;3324-26320)premature deaths—with a potential monetary value of 9.8(95%CI;2.2-17.6)billion USD—from AMR by 2060.These results suggest that reducing air pollution may offer co-benefits in the health and economic sectors by mitigating AMR.
基金supported by grants awarded to RAD by the South African Medical Research Council(SAMRC),with funds received from the South African National Department of Health,and the UK Medical Research Council,with funds received from the UK Government's Newton Fund(Grant No.:96185)by South African National Research Foundation(NRF)through the DSI/NRF South African Research Chair Initiative(NRF UID 87583)+2 种基金OO was supported by a Rhodes University Post-Doctoral FellowshipIN and TS received Post-Doctoral Fellowships from the SAMRCDA was supported by DAAD Scholarship(Reference number:91758998).
文摘The rapid emergence of drug-resistant microbial pathogens has posed challenges to global health in the twenty-first century.This development has significantly made most antibiotics ineffective in the treatment of infections they cause,resulting in increasing treatment costs and annual death rates.To address the challenge posed by these pathogens,we explore the potential of secondary metabolites from Aspergillus species as a source of new and effective therapeutic agents to treat drug-resistant infections.Terpenoids,a distinct group of natural products,are extensively distributed in plants and fungi,and have been attributed with significant antibacterial,anticancer,and antiviral activities.In this review,we present an overview of Aspergillus species,and review the novel terpenoids isolated from them from 2019 to April 2024,highlighting anti-infective activity against members of the ESKAPE pathogens.We further focus on the strategies through which the structural framework of these new terpenoids could be modified and/or optimized to feed a pipeline of new lead compounds targeting microbial pathogens.Overall,this review provides insight into the therapeutic applications of terpenoids sourced from Aspergillus species and the potential for the discovery of new compounds from these fungi to combat antimicrobial resistance.
文摘Background:Community-acquired bacterial pneumonia(CABP)poses a serious public health threat,particularly with the emergence of drug-resistant bacterial strains.This study aims to investigate the molecular interactions of Nafithromycin(Miqnaf®),India’s first indigenous next-generation macrolide antibiotic,and evaluate its potential against Streptococcus pneumoniae,a key pathogen responsible for CABP.Targeting 23S rRNA is critical for overcoming antibiotic resistance since it is involved in bacterial protein production.Many antibiotics,including macrolides target this rRNA.Mutations in 23S rRNA frequently result in resistance;therefore,designing medicines that bind new or conserved areas of 23S rRNA can circumvent current resistance mechanisms and restore antibiotic potency.Nafithromycin has excellent therapeutic potential,with a short three-day regimen and much higher efficacy than conventional macrolides.Its high lung tissue penetration and robust effectiveness against drug-resistant respiratory bacteria make it a promising next-generation antibiotic.Methods:To elucidate the interaction of Nafithromycin with bacterial ribosomal RNA,molecular docking studies were performed using AutoDock Vina.The three-dimensional structure of Streptococcus pneumoniae 23S rRNA was retrieved from the Protein Data Bank(PDB).The ligand structure of Nafithromycin was obtained from the PubChem database and prepared using Open Babel.Docking simulations targeted key functional regions-Domains II and V of 23S rRNA-known to be critical for bacterial protein synthesis.Binding affinities were calculated,and molecular interactions such as hydrogen bonds,hydrophobic contacts,and conformational stabilities were analyzed using Discovery Studio and PyMOL.Results:Nafithromycin exhibited a high binding affinity of-10.3 kcal/mol toward S.pneumoniae 23S rRNA.The compound formed stable interactions with both Domain II and Domain V,crucial regions involved in the inhibition of bacterial protein synthesis.Hydrogen bonding and hydrophobic interactions further stabilized the ligand-receptor complex.Compared to azithromycin,Nafithromycin demonstrated superior binding efficacy and a greater potential to inhibit resistant bacterial strains,indicating its structural advantages and enhanced ribosomal targeting.Conclusion:Nafithromycin demonstrates significant potential as a potent therapeutic agent against drug-resistant CABP.Its strong binding affinity,stable interactions with bacterial rRNA,favorable pharmacokinetic profile,and reduced resistance risk support its clinical utility and suggest its advantage over traditional macrolide antibiotics such as azithromycin.
文摘BACKGROUND Sepsis is a critical medical condition,and poses a substantial global health burden,with significant morbidity,mortality,and economic costs,particularly pronounced in low-and middle-income countries.Effective management of sepsis relies on early recognition and appropriate intervention,underscoring the importance of accurate classification to guide treatment decisions.The correct diagnosis will lead to effective antimicrobial stewardship practices.AIM To assess the distribution of sepsis categories and the use of empirical antibiotics classified by the World Health Organization(WHO)Access,Watch,and Reserve(AWaRe)system in a tertiary care hospital in Northern India and to correlate antibiotic usage with sepsis classifications.METHODS This longitudinal observational study in the Department of General Medicine,in a tertiary care hospital in Northern India,from 2023 to 2024,aimed to assess the use of empirical antibiotics classified by the WHO AWaRe system.The study also aimed to correlate antibiotic usage.Patients were categorized into sepsis classes(Asepsis,Possible Sepsis,Probable Sepsis,Confirmed Sepsis)and followed until discharge or Day-28.Descriptive and inferential statistical analyses were employed to assess sepsis categories and empirical antibiotic usage classified by the WHO AWaRe system.RESULTS A total of 1867 patients admitted with suspected sepsis were screened,with 230 meeting the inclusion criteria.Among the study cohort(mean age 40.70±14.49 years,50.9% female),initial sepsis classification predominantly included probable sepsis(51.3%)and possible sepsis(35.7%),evolving to asepsis(57.8%)upon final classification,but all received antibiotics.Empirical antibiotic use showed a predominance of Watch group antibiotics(72.2%),with ceftriaxone and piperacillin-tazobactam being the most commonly prescribed;however,no statistical association could be established among the different classes of sepsis with the AWaRe groups.CONCLUSION Accurate sepsis classification is pivotal for clinical decision-making,optimizing antibiotic use,and combating antimicrobial resistance.The majority of the asepsis category was labelled as probable or possible sepsis and given antibiotics at initial hospitalization.The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation,potentially reducing unnecessary antibiotic exposure.Future efforts should focus on establishing sepsis classification checklists as in this study and promoting adherence to antimicrobial stewardship principles to mitigate the global threat of antimicrobial resistance.
文摘BACKGROUND Outpatient parenteral antimicrobial therapy(OPAT)offers a crucial method for administering intravenous/intramuscular antimicrobials outside of hospital settings,allowing patients to complete treatment safely while avoiding many hospital-acquired complications.This is a major boost or low-hanging fruit intervention in antimicrobial stewardship practices with multiple targets like decreasing hospital stays,its related complications,the economy,the burden on hospitals,etc.However,resource-constrained countries like India practices rarely OPAT in an evidence-based way.AIM To evaluate the effectiveness,safety,and feasibility along with barriers and facilitators of OPAT practices in resource-poor settings,with a focus on its role in antimicrobial stewardship.METHODS This pilot longitudinal observational study included patients who met OPAT checklist criteria and were committed to post-discharge follow-up.Pre-discharge education and counselling were provided,and demographic data were recorded.Various outcome measures,including barriers and facilitators,were identified through an extensive literature review,fishbone diagram preparation,data collection and analysis,and patient feedback.All healthcare workers who were taking care of the patients discharged with OPAT were contacted with openended questions to get data on feasibility.The study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences,Rishikesh.We used descriptive analysis and theχ2 test to analyze data.P value<0.05 was considered significant.RESULTS Out of 20 patients,the mean age was 37 years.The cohort comprised 13 males.OPAT was administered at home in 15 cases and at nursing homes in 5 cases,with nine patients receiving treatment from family members and 11 patients receiving care from a local nurse.The infections requiring OPAT included:Kidney-urinary tract(6 cases),gastrointestinal tract(4 cases),respiratory tract(4 cases),meningitis(3 cases),endocarditis(2 cases),and multiple visceral abscesses(1 case).Nineteen out of 20 patients achieved afebrile status.Half of the patients did not receive education,counselling,or demonstrations prior to discharge,but all patients rated the service as good/excellent.According to doctors’feedback,OPAT is highly beneficial and effective for patients when systematically implemented with daily telephonic monitoring,but faces challenges due to the lack of standardized protocols,dedicated teams,and adequate resources.The implementation of OPAT resulted in a reduction of hospitalization duration by an average of two weeks.CONCLUSION This pilot study proves that OPAT is safe,feasible,and efficacious by reducing two weeks of hospitalization in resource-poor settings.OPAT contributes directly to antimicrobial stewardship by reducing hospital stays and hospital-acquired complications,which is vital in combating antimicrobial resistance(AMR)and aligns with the global action plan for AMR in infection prevention and optimal antimicrobial utilization.
文摘Background: Antimicrobial Resistance (AMR) has been recognized as a global public health problem of utmost importance that needs to be tackled. Low-income countries such as Uganda have the greatest burden of severe and life-threatening infections and are most likely to suffer more from the spread of untreatable resistant bacteria. Despite the generally increasing trends in AMR, there is hardly any documented data on AMR in orthopedic care. Methods: We analyzed data from the pathogenic isolates from pus and tissue from the laboratory from 2019 to 2023. We calculated the proportions of isolates resistant to commonly used antimicrobial classes. We used the chi-square test for trends to evaluate changes in AMR across the study period. Results: Out of the 286 isolates, 104 (43.5%) were from pus, 112 (46.9%) were from tissue samples and the remaining 9.6% were from different fluid aspirates like synovial fluid. Most of the isolates were from males (64.2%) and aged between 19 and 45 years (46.2%). The distribution of whether the bacteria were gram-positive or negative was relatively equal with 114 (45.2%) being gram-negative and 120 (47.6%) gram-positive. Generally, there was increased AMR across all antibiotics from 2019 to 2021 e.g. for Imipinem, it went from 0% in 2019 to 70.8% in 2021 and for Amoxyclav, it went from 10% in 2019 to 93.2% in 2021. There was a general decline in AMR noted from 2021 to 2023. However, currently, the highest resistance is noted in ceftriaxone (80.0%) and the lowest in Imipinem (11.76%). Conclusion: There is a general decreasing trend in AMR, most probably due to increasing policies governing the use of antibiotics. However, there is still high resistance to commonly used and affordable antibiotics. Continuous monitoring of AMR is still recommended to reduce the AMR problem in Uganda at large through public health policy and planning.
基金supported by the Foundation for the National Key R&D Program(2022YFD1800400)Innovative Research Groups of the National Natural Science Foundation of China(32121004)Natural Science Foundation of Guangdong Province of China(2021A1515011159)。
文摘Monitoring the prevalence of antimicrobial resistance genes(ARGs)is vital for addressing the global crisis of antibiotic-resistant bacterial infections.Despite its importance,the characterization of ARGs and microbiome structures,as well as the identification of indicators for routine ARG monitoring in pig farms,are still lacking,particularly concerning variations in antimicrobial exposure in different countries or regions.Here,metagenomics and random forest machine learning were used to elucidate the ARG profiles,microbiome structures,and ARG contamination indicators in pig manure under different antimicrobial pressures between China and Europe.Results showed that Chinese pigs exposed to high-level antimicrobials exhibited higher total and plasmid-mediated ARG abundances compared to those in European pigs(P<0.05).ANT(6)-Ib,APH(3')-IIIa,and tet(40)were identified as shared core ARGs between the two pig populations.Furthermore,the core ARGs identified in pig populations were correlated with those found in human populations within the same geographical regions.Lactobacillus and Prevotella were identified as the dominant genera in the core microbiomes of Chinese and European pigs,respectively.Forty ARG markers and 43 biomarkers were able to differentiate between the Chinese and European pig manure samples with accuracies of 100%and 98.7%,respectively.Indicators for assessing ARG contamination in Chinese and European pigs also achieved high accuracy(r=0.72-0.88).Escherichia flexneri in both Chinese and European pig populations carried between 21 and 37 ARGs.The results of this study emphasize the importance of global collaboration in reducing antimicrobial resistance risk and provide validated indicators for evaluating the risk of ARG contamination in pig farms.
文摘Objective:To determine the clinical distribution of multi-drug resistant organism(MDRO)in Jiangyan Hospital and the monitoring and warning of drug-resistance bacteria to provide an important basis for guiding the application of broad-spectrum antibiotics in clinical treatment and reducing the occurrence of nosocomial infection.Methods:Retrospective screening and analysis were conducted on the pathogenic strains of hospitalized patients in our hospital in 2022.Results:A total of 2,769 strains of pathogenic bacteria and 390 strains of MDRO were detected and isolated in our hospital in 2022;the detection rate of MDRO was 14.08%.A total of 516 strains(18.64%)Klebsiella pneumoniae(KP)and 62 strains(12.02%)of carbapenem-resistant Klebsiella pneumoniae(CR-KP)were detected;436 strains(15.75%)of Escherichia coli(ECO)were detected,including 8 strains(1.83%)of CR-ECO;342 strains(12.35%)of Pseudomonas aeruginosa(PA)and 116 strains(33.92%)of CR-PA were detected;there were 194 strains(7.01%)of Acinetobacter baumannii(AB),among which 125 strains(64.43%)were CR-AB;there were 291 strains(10.51%)of Staphylococcus aureus,among which 79 strains(27.15%)of methicillin-resistant Staphylococcus aureus(MRSA)were detected;78 strains(2.82%)of Enterococcus faecalis were detected,and vancomycin-resistant enterococcus(VRE)was not detected.The first five MDROs were CR-AB,CR-PA,MRSA,CR-KP,and CR-ECO.The top five departments with the highest MDRO detection rate in 2022 were the ICU(37.44%),the Pulmonology Department(ward 13;31.03%),the Department of Rehabilitation(ward 5;6.67%),the Department of Neurosurgery(ward 11;4.62%),and the Department of General Surgery(ward 10;3.59 The resistance rate of antibacterial drugs is divided into four levels for early warning:30%to 40%,41%to 50%,51%to 75%,and 75%or more.Conclusion:Our hospital should strengthen the monitoring of antimicrobial resistance warning related to MDRO and the abuse of antimicrobial drugs.Based on the results of drug sensitivity and antimicrobial resistance warning,the use of antibiotics should be standardized in clinical practice to reduce nosocomial infection。
文摘Since the discovery of penicillin in 1928,antibiotics have revolutionized modern medicine by effectively treating infectious diseases and saving countless lives.However,the widespread development of antimicrobial resistance(AMR)now threatens the efficacy and longevity of these critical drugs.A study published in The Lancet reported that bacterial AMR contributed to approximately 4.95 million deaths globally in 2019,with 1.27 million directly attributable to AMR(Fig.1)[1].Natural products(NPs)continue to play a crucial role in discovering new antibiotics.
文摘Background: Antimicrobial resistance (AMR) is a growing public health concern, with far-reaching consequences for modern medicine. Zambia, like many other low- and middle-income countries, faces significant challenges in addressing AMR. Further, high rates of resistance have been reported among various microorganisms in Zambia. This review paper aims to summarize the current situation of the burden of AMR in Zambia, including the prevalence, risk factors contributing to its emergence and spread, challenges in addressing this issue, and the required solutions to combat this growing public health threat. Additionally, the paper also outlines existing efforts to combat AMR and proposes required solutions and recommendations to address this threat to public health. Materials and Methods: This study employed a comprehensive narrative review design that included studies published from January 2000 to November 2024. The literature search was done using PubMed, Scopus, Web of Science, and Google Scholar. Results: In 2019, 1.27 million deaths were attributed to AMR of which 255,000 were from sub-Saharan Africa. Currently, the burden of AMR in Zambia is not well understood. This study found that the drug resistance index (DRI) in Zambia was 60.9%, demonstrating high resistance rates of pathogens to antimicrobials commonly used in humans and animals. The high DRI indicates the low effectiveness of antibiotics in treatment of infections. Most pathogens with high resistance to antimicrobials include Klebsiella pneumoniae, Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Salmonella species, Enterococcus species, Mycobacterium tuberculosis, Acinetobacter baumannii, and Pseudomonas aeruginosa. Additionally, the study found that there was low awareness, knowledge, attitudes, and suboptimal practices regarding AMR in Zambia. The contributing factors to the emergence and spread of AMR include self-medication practices, overuse and misuse of antimicrobials in humans and animals, non-adherence to treatment guidelines, limited diagnostic capacity, substandard and falsified antimicrobials, and a lack of surveillance of AMR. There is a need to develop strategies to address the identified gaps in Zambia to successfully combat AMR. Conclusion: This study revealed high resistance of microbes to antimicrobials in Zambia. The high prevalence of AMR in Zambia indicates its burden on the country, thereby providing opportunities for further research to quantify this problem. The findings highlight the need for a One Health multi-sectoral approach to address AMR in Zambia, including strengthening surveillance and monitoring, improving antimicrobial stewardship and prescribing practices, enhancing infection prevention and control practices, increasing access to quality healthcare and diagnostic services, promoting public awareness and education, and encouraging research and development of new antimicrobial agents. The proposed solutions and recommendations can serve to strengthen the implementation of the Zambia National Action Plan (NAP) to combat AMR.
文摘Objective:To investigate the distribution characteristics of common bacteria and changes in antimicrobial resistance in intensive care unit(ICU)patients in 58 hospitals in Hubei Province from 2020–2023.Method:The antimicrobial agents for antimicrobial susceptibility tests was selected based on the 2022 China Antimicrobial Resistance surveillance system(CARSS)technical scheme,and the specific experimental operation was based on the requirements of the CLSI M02 and M07 documents.The commercial instruments were used following the manufacturer’s instructions.The interpretation of antimicrobial susceptibility test results was based on the 2023 CLSI M100 standard.Results:There were 15585,19258,23423 and 22395 clinical isolates in the ICU from 2020 to 2023,respectively.Among them,gram-positive bacteria accounted for 20.5%(3190/15585),21.2%(4089/19258),21.6%(5067/23423)and 21.6%(4831/22395),respectively.Gram-negative bacteria accounted for 79.5%(12395/15585),78.8%(15169/19258),78.4%(18356/23423)and 78.4%(17564/22395)of the bacteria,respectively.The top 5 isolates of gram-positive bacteria were Staphylococcus aureus,Enterococcus faecium,Streptococcus pneumoniae,Enterococcus faecalis,Staphylococcus epidermidis and gram-negative bacteria were Klebsiella pneumoniae,Acinetobacter baumannii,Escherichia coli,Pseudomonas aeruginosa and Stenotrophomonas maltophil,respectively,but the proportions and rankings of the isolates in different years slightly differed.The detection rate of methicillin-resistant S.aureus(MRSA)decreased from 44.4%in 2020 to 36%in 2023,and that of methicillin-resistant coagulase-negative Staphylococcus(MRCNS)decreased from 79.8%in 2020 to 73.8%in 2022 and increased to 78.4%in 2023.The detection rates of both vancomycin-resistant E.faecium and E.faecalis were lower than 1%.The detection rate of carbapenem-resistant P.aeruginosa(CRPA)decreased from 25%in 2020 to 19.7%in 2022 and increased slightly to 20.6%in 2023.The detection rate of carbapenem-resistant A.baumannii(CRAB)decreased from 81.9%in 2020 to 79.7%in 2022 and increased to 82.9%in 2023.The detection rate of third-generation cephalosporin-resistant E.coli decreased from 59.8%in 2020 to 53.1%in 2022 and increased to 52.5%in 2023.The detection rate of fluoroquinolone-resistant E.coli decreased from 62.7%in 2020 to 50.2%in 2022 and increased slightly to 51.0%in 2023.The detection rate of carbapenem-resistant E.coli(CRECO)decreased from 3.3%in 2020 to 1.8%in 2022 and slightly increased to 2.1%in 2023.The detection rate of third-generation cephalosporin-resistant K.pneumoniae decreased from 34.3%in 2020 to 26.3%in 2022 and then increased to 32.4%in 2023.The detection rate of carbapenem-resistant K.pneumoniae(CRKPN)increased from 17.9%to 19.4%in 2020,decreased to 13.2%in 2022,and rose sharply to 20.4%in 2023.Conclusion:MRSA showed a continuous downwards trend from 2020 to 2023,while the detection rates of MRCNS and most multidrug-resistant gram-negative bacteria continuously decreased from 2020 to 2022 but tended to increase in 2023.Therefore,it is still necessary to strengthen the monitoring of bacterial resistance and rational application of antibiotics and actively and effectively control nosocomial infections.
文摘Background:Antimicrobial resistance(AMR)is a global public health threat that requires actions through One Health intervention.This study aims to trace the historical development of One Health research on AMR to provide evidence supporting future research and actions.Methods:A bibliometric analysis is conducted with One Health articles in the field of antimicrobial resistance(AMR-OH articles)retrieved from the Web of Science Core Collection(WoSCC).AMR-OH articles refer to articles in the field of AMR that simultaneously involve elements from human health and at least one other domain,including animals,environment,or plants.Three research periods were identified based on the development of global actions in combating AMR.Descriptive analysis of publications,keyword cluster analysis,annual trending topic analysis,and co-authorship analysis were conducted using R software,VOSViewer,and Pajek.Results:The results indicated that the percentage of AMR-OH articles among all AMR articles increased from 5.21%in 1990 to 20.01%in 2023.Key topics in the current AMR-OH articles included the mechanism of AMR,AMR epidemiology,and public health control strategies.Epidemiological research initially focused on human and animal health and then shifted to environmental factors in the third period.Research at the molecular level focused on the mechanisms of AMR transmission in various domains,along with the dynamics and diversity of antibiotic resistance genes(ARGs).The co-authorship analysis suggested a significant increase in cooperation among low-and middle-income countries in the third period.Conclusion:The scope of epidemiological research on AMR has expanded by including human,animal,and environmental areas.Moreover,genetic and molecular level research represents the forefront of this field,offering innovative tools to combat AMR in the future.This study suggests further research to translate existing findings into practical implementation of the One Health strategy,and to support globally consistent action in combating AMR.
基金Supported by the Second Batch of Social Development Science and Technology Program Projects of Taizhou Science and Technology Bureau in 2023,No.24ywb80.
文摘Klebsiella pneumoniae infections(KPIs),particularly carbapenem-resistant Klebsiella pneumoniae(CRKP),pose significant challenges in liver transplantation(LT)recipients,with high morbidity and mortality.Guo et al’s study highlights risk factors,such as elevated day-one alanine aminotransferase levels and prolonged catheterization,and identifies polymyxin B and ceftazidime/avibactam as effective treatments.However,limitations like the absence of pre-transplant colonization data and host-pathogen interaction insights highlight the need for enhanced strategies.Future directions should include routine CRKP colonization surveillance,immune and genomic profiling,and the development of novel therapeutics.By integrating these approaches,we can improve the prevention,diagnosis,and treatment of KPIs in LT patients.
文摘Background:This retrospective cross-sectional study evaluated the antibiogram profile of Gram-negative bacterial infections at Yastebsheron Hospital.The study aimed to identify prevalent pathogens,assess antimicrobial susceptibility patterns,and develop evidence-based recommendations for empirical antibiotic therapy.Methods:A total of 1,182 clinical specimens(urine,swabs,aspirates,and cerebrospinal fluid)collected in 2022 were analyzed following standard microbiological procedures.Culture and sensitivity testing were performed according to established protocols.Data were analyzed using SPSS version 23 and Microsoft Excel,with results presented through descriptive statistics.Results:Gram-negative bacteria accounted for 48.4%of isolates.Urinary tract infections(UTIs)were the most prevalent,with a significantly higher incidence among female patients(67%).Escherichia coli(59.8%)was the predominant uropathogen.Among the frequently isolated pathogens E.coli(52.5%),Enterobacter spp.(21.9%),Proteus mirabilis(9.8%),and Pseudomonas aeruginosa(8.4%)meropenem demonstrated the highest efficacy.Levofloxacin showed excellent activity against Enterobacter spp.and P.mirabilis(92%susceptibility),while amikacin exhibited moderate effectiveness against E.coli(78%).Morganella morganii displayed the highest multidrug-resistance rates.Colistin was universally effective against P.aeruginosa.Third-generation cephalosporins and nalidixic acid showed limited efficacy against E.coli(21-41%susceptibility).P.mirabilis,Klebsiella pneumoniae,and M.morganii demonstrated low susceptibility to most tested antibiotics.Conclusion:Regular antibiogram updates are essential for monitoring antimicrobial resistance trends and guiding empirical therapy.The study findings support the use of meropenem and levofloxacin as first-line options while highlighting concerning resistance patterns to cephalosporins and quinolones.Local susceptibility data remain crucial for optimizing antibiotic selection and stewardship efforts.
基金supported in part by the Hubei Provincial Natural Science Foundation of China(grant no.2023AFA094)the Yingzi Tech&Huazhong Agricultural University Intelligent Research Institute of Food Health(No.IRIFH202209)+1 种基金Fundamental Research Funds for the Central Universities(Project 2662023PY005)the Hubei Hongshan Laboratory&Huazhong Agricultural University Start-up Fund.
文摘The rapid emergence and spread of colistin-resistant gram-negative bacteria has raised worldwide public health concerns,and phosphoethanolamine(PEtn)transferase modification-mediated colistin resistance has been widely documented in multiple gram-negative bacterial species.However,whether such a mechanism exists in the zoonotic pathogen Pasteurella multocida is still unknown.Recently,a novel PEtn transferase,PetL,was identified in P.multo-cida,but whether it is associated with colistin resistance remains to be elucidated.In this study,we found that PetL in P.multocida(PetL^(PM))exhibited structural characteristics similar to those of the mobile-colistin-resistant(MCR)protein and the PEtn transferase characterized in Neisseria meningitidis.The transformation of petLPM into E.coli or K.pneumoniae changed the phenotype of several tested strains from colistin sensitive to colistin resistant.Deletion of this gene decreased the colistin minimum inhibitory concentration(MIC)of P.multocida by 64-fold.Our extensive analysis by MALDI-TOF-MS demonstrated that PetLPM participated in the modification of bacterial lipopolysaccharide(LPS)-lipid A.Deletion of petL^(PM) led to an increase in membrane charge but a decrease in cell-surface hydrophobicity and cell permeability in P.multocida.The present study is the first to report the presence of PEtn transferase-mediated colistin resistance in the zoonotic pathogen P.multocida.
