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Environmental Research Apr 2024The Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) have effectively kept lower antibiotic-resistant bacterial (ARB) pathogen rates than many other... (Review)
Review
The Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) have effectively kept lower antibiotic-resistant bacterial (ARB) pathogen rates than many other countries. However, in recent years, these five countries have encountered a rise in ARB cases and challenges in treating infections due to the growing prevalence of ARB pathogens. Wastewater-based surveillance (WBS) is a valuable supplement to clinical methods for ARB surveillance, but there is a lack of comprehensive understanding of WBS application for ARB in the Nordic countries. This review aims to compile the latest state-of-the-art developments in WBS for ARB monitoring in the Nordic countries and compare them with clinical surveillance practices. After reviewing 1480 papers from the primary search, 54 were found relevant, and 15 additional WBS-related papers were included. Among 69 studies analyzed, 42 dedicated clinical epidemiology, while 27 focused on wastewater monitoring. The PRISMA review of the literature revealed that Nordic countries focus on four major WBS objectives of ARB: assessing ARB in the human population, identifying ARB evading wastewater treatment, quantifying removal rates, and evaluating potential ARB evolution during the treatment process. In both clinical and wastewater contexts, the most studied targets were pathogens producing carbapenemase and extended-spectrum beta-lactamase (ESBL), primarily Escherichia coli and Klebsiella spp. However, vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) have received more attention in clinical epidemiology than in wastewater studies, probably due to their lower detection rates in wastewater. Clinical surveillance has mostly used culturing, antibiotic susceptibility testing, and genotyping, but WBS employed PCR-based and metagenomics alongside culture-based techniques. Imported cases resulting from international travel and hospitalization abroad appear to have frequently contributed to the rise in ARB pathogen cases in these countries. The many similarities between the Nordic countries (e.g., knowledge exchange practices, antibiotic usage patterns, and the current ARB landscape) could facilitate collaborative efforts in developing and implementing WBS for ARB in population-level screening.
Topics: Humans; Wastewater; Methicillin-Resistant Staphylococcus aureus; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anti-Bacterial Agents; Drug Resistance, Microbial; beta-Lactamases; Escherichia coli; Scandinavian and Nordic Countries
PubMed: 38163547
DOI: 10.1016/j.envres.2023.118052 -
Research in Pharmaceutical Sciences 2023, the most popular probiotic, has recently gained more attention because it is a potential reservoir of antibiotic resistance. This review summarized and discussed the... (Review)
Review
BACKGROUND AND PURPOSE
, the most popular probiotic, has recently gained more attention because it is a potential reservoir of antibiotic resistance. This review summarized and discussed the phenotypic-genotypic characteristics of antibiotic resistance.
EXPERIMENTAL APPROACH
Google Scholar, PubMed, Web of Science, and Scopus were searched up to February 2022. The inclusion criteria were all studies testing antibiotic resistance of probiotic strains present in human food supplementation and all human/animal model studies in which transferring antibiotic-resistant genes from strains to another bacterium were investigated.
FINDINGS/RESULTS
Phenotypic and genotypic characterization of probiotics showed that the most antibiotic resistance was against protein synthesis inhibitors (fourteen studies, 87.5%) and cell wall synthesis inhibitors (ten studies, 62.5%). Nine of these studies reported the transfer of antibiotic resistance from probiotic as donor species to pathogenic bacteria and mostly used methods for resistance gene transfer.
CONCLUSION AND IMPLICATIONS
The transferability of resistance genes such as and in increases the risk of spreading antibiotic resistance. Further studies need to be conducted to evaluate the potential spread of antibiotic resistance traits probiotics, especially in elderly people and newborns.
PubMed: 37842520
DOI: 10.4103/1735-5362.383703 -
Microbial Pathogenesis Oct 2023Brucellosis is a zoonotic disease that can be transmitted from animals to humans. Brucellosis is caused by bacteria of the genus Brucella, which are typically... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Brucellosis is a zoonotic disease that can be transmitted from animals to humans. Brucellosis is caused by bacteria of the genus Brucella, which are typically transmitted through contact with infected animals, unpasteurized dairy products, or airborne pathogens. Tetracyclines (tetracycline and doxycycline) are antibiotics commonly used to treat brucellosis; however, antibiotic resistance has become a major concern. This study assessed the worldwide prevalence of tetracycline-resistant Brucella isolates.
METHODS
A systematic search was conducted in Scopus, PubMed, Web of Science, and EMBASE using relevant keywords and Medical Subject Headings (MeSH) terms until August 13, 2022, to identify relevant studies for meta-analysis. A random effects model was used to estimate the proportion of resistance. Meta-regression analysis, subgroup analysis, and examination of outliers and influential studies were also performed.
RESULTS
The prevalence rates of resistance to tetracycline and doxycycline were estimated to be 0.017 (95% confidence interval [CI], 0.009-0.035) and 0.017 (95%CI, 0.011-0.026), respectively, based on 51 studies conducted from 1983 to 2020. Both drugs showed increasing resistance over time (tetracycline: r = 0.077, P = 0.012; doxycycline: r = 0.059, P = 0.026).
CONCLUSION
The prevalence of tetracycline and doxycycline resistance in Brucella was low (1.7%) but increased over time. This increase in tetracycline and doxycycline resistance highlights the need for further research to understand resistance mechanisms and develop more effective treatments.
Topics: Animals; Humans; Brucella melitensis; Brucella abortus; Tetracycline; Doxycycline; Prevalence; Brucellosis; Anti-Bacterial Agents; Tetracyclines
PubMed: 37673354
DOI: 10.1016/j.micpath.2023.106321 -
The Journal of Hospital Infection Nov 2023Vancomycin-resistant enterococci (VRE) cause many infections in the healthcare context. Knowledge regarding the epidemiology and burden of VRE infections, however,... (Meta-Analysis)
Meta-Analysis Review
Vancomycin-resistant enterococci (VRE) cause many infections in the healthcare context. Knowledge regarding the epidemiology and burden of VRE infections, however, remains fragmented. We aimed to summarize recent studies on VRE epidemiology and outcomes in hospitals, long-term-care facilities (LTCFs) and nursing homes worldwide based on current epidemiological reports. We searched MEDLINE/PubMed, the Cochrane Library, and Web of Science for observational studies, which reported on VRE faecium and faecalis infections in in-patients published between January 2014 and December 2020. Outcomes were incidence, infection rate, mortality, length of stay (LOS), and healthcare costs. We conducted a meta-analysis on mortality (PROSPERO registration number: CRD42020146389). Of 681 identified publications, 57 studies were included in the analysis. Overall quality of evidence was moderate to low. VRE incidence was rarely and heterogeneously reported. VRE infection rate differed highly (1-55%). The meta-analysis showed a higher mortality for VRE faecium bloodstream infections (BSIs) compared with VSE faecium BSIs (risk ratio, RR 1.46; 95% confidence interval (CI) 1.17-1.82). No difference was observed when comparing VRE faecium vs VRE faecalis BSI (RR 1.00, 95% CI 0.52-1.93). LOS was higher in BSIs caused by E. faecium vs E. faecalis. Only three studies reported healthcare costs. In contrast to previous findings, our meta-analysis of included studies indicates that vancomycin resistance independent of VRE species may be associated with a higher mortality. We identified a lack of standardization in reporting outcomes, information regarding healthcare costs, and state-of-the-art microbiological species identification methodology, which may inform the set-up and reporting of future studies.
Topics: Humans; Vancomycin; Anti-Bacterial Agents; Enterococcus faecalis; Enterococcus faecium; Gram-Positive Bacterial Infections; Vancomycin-Resistant Enterococci; Sepsis
PubMed: 37734679
DOI: 10.1016/j.jhin.2023.09.008 -
Oral Diseases Oct 2023The objective of the study was to evaluate the prevalence and proportions of antibiotic-resistant species in periodontitis patients. (Review)
Review
OBJECTIVES
The objective of the study was to evaluate the prevalence and proportions of antibiotic-resistant species in periodontitis patients.
METHODS
A systematic scoping review of randomized clinical trials (RCTs) was conducted using the PRISMA extension for scoping reviews involving different databases. MeSH terms and keywords were provided to examine only RCTs with antibiotic-resistant results that included at least 3 months of follow-up of systematically healthy patients diagnosed with periodontitis and treated with systemic or local antibiotics adjunctive to subgingival debridement. RCTs that managed participants surgically, duplicate publications, and investigations implemented on animals were discarded.
RESULTS
Six RCTs were chosen. These studies included 465 patients. Most investigations observed that while Aggregatibacter actinomycetemcomitans, Tannerella forsythia, and Porphyromonas gingivalis had low resistance to amoxicillin, microorganisms in many sites showed resistance to tetracycline, metronidazole, and azithromycin pretreatment. A. actinomycetemcomitans showed high resistance to tetracycline pre- and post-therapy. The proportion of antibiotic-resistant samples augmented rapidly after the prescription of antibiotics in all test groups. The percentage of antibiotic-resistant microorganisms decreased over time; at the end of the follow-up period, resistance levels were close to baseline levels.
CONCLUSIONS
Adjunctive local and systemic antibiotic treatment temporarily increased the antibiotic resistance of subgingival microorganisms; nonetheless, many bacteria remained susceptible to antibiotics during their administration.
Topics: Humans; Randomized Controlled Trials as Topic; Periodontitis; Anti-Bacterial Agents; Tetracycline; Porphyromonas gingivalis; Drug Resistance, Microbial; Aggregatibacter actinomycetemcomitans
PubMed: 35735133
DOI: 10.1111/odi.14288 -
Military Medical Research Jan 2024Antimicrobial resistance is a global public health threat, and the World Health Organization (WHO) has announced a priority list of the most threatening pathogens... (Review)
Review
Antimicrobial resistance is a global public health threat, and the World Health Organization (WHO) has announced a priority list of the most threatening pathogens against which novel antibiotics need to be developed. The discovery and introduction of novel antibiotics are time-consuming and expensive. According to WHO's report of antibacterial agents in clinical development, only 18 novel antibiotics have been approved since 2014. Therefore, novel antibiotics are critically needed. Artificial intelligence (AI) has been rapidly applied to drug development since its recent technical breakthrough and has dramatically improved the efficiency of the discovery of novel antibiotics. Here, we first summarized recently marketed novel antibiotics, and antibiotic candidates in clinical development. In addition, we systematically reviewed the involvement of AI in antibacterial drug development and utilization, including small molecules, antimicrobial peptides, phage therapy, essential oils, as well as resistance mechanism prediction, and antibiotic stewardship.
Topics: Humans; Artificial Intelligence; Anti-Bacterial Agents; Drug Resistance, Bacterial; Public Health
PubMed: 38254241
DOI: 10.1186/s40779-024-00510-1 -
Journal of Global Health Jul 2023Diarrhoea is the second most common cause of death among children under the age of five worldwide. The World Health Organization (WHO) recommends treating diarrhoea with...
BACKGROUND
Diarrhoea is the second most common cause of death among children under the age of five worldwide. The World Health Organization (WHO) recommends treating diarrhoea with oral rehydration therapy, intravenous fluids for severe dehydration, and zinc supplements. Antibiotics are only recommended to treat acute, invasive diarrhoea. Rising antibiotic resistance has led to a decrease in the effectiveness of treatments for diarrhoea.
METHODS
A systematic literature review in PubMed, Web of Science, and EMBASE was conducted to identify articles relevant to antibiotic-resistant childhood diarrhoea. Articles in English published between 1990 to 2020 that described antibiotic resistance patterns of common pathogens causing childhood diarrhoea in low- and middle-income countries were included. The studies were limited to papers that categorized children as 0-5 years or 0-10 years old. The proportion of isolates with resistance to major classes of antibiotics stratified by major WHO global regions and time was determined.
RESULTS
Quantitative data were extracted from 44 articles that met screening criteria; most focused on children under five years. Escherichia coli isolates had relatively high resistance rates to ampicillin and tetracycline in the African (AFR), American (AMR), and Eastern Mediterranean Regions (EMR). There was moderate to high resistance to ampicillin and third generation cephalosporins among Salmonella spp in the AFR, EMR, and the Western Pacific Region (WPR). Resistance rates for ampicillin, co-trimoxazole, and chloramphenicol for Shigella in the AFR started at an alarmingly high rate ( ~ 90%) in 2006 and fluctuated over time. There were limited antibiotic resistance data for Aeromonas, Yersinia, and V. cholerae. The 161 isolates of Campylobacter analysed showed initially low rates of fluoroquinolone resistance with high rates of resistance in recent years, especially in the Southeast Asian Region.
CONCLUSIONS
Resistance to inexpensive antibiotics for treatment of invasive diarrhoea in children under ten years is widespread (although data on 6- to 10-year-old children are limited), and resistance rates to fluoroquinolones and later-generation cephalosporins are increasing. A strong regional surveillance system is needed to carefully monitor trends in antibiotic resistance, future studies should include school-aged children, and interventions are needed to reduce inappropriate use of antibiotics for the treatment of community-acquired, non-invasive diarrhoea.
REGISTRATION
This systematic review was registered in Prospero (registration number CRD42020204004) in August 2020.
Topics: Child; Humans; Child, Preschool; Developing Countries; Anti-Bacterial Agents; Ampicillin; Diarrhea; Cephalosporins; Drug Resistance, Microbial
PubMed: 37475599
DOI: 10.7189/jogh.13.04060 -
Journal of Clinical Medicine Sep 2023In the era of antibiotic overuse and increasing antibiotic resistance, there is a gap in evidence regarding antibiotic stewardship, and in particular, perioperative... (Review)
Review
In the era of antibiotic overuse and increasing antibiotic resistance, there is a gap in evidence regarding antibiotic stewardship, and in particular, perioperative antibiotic prophylaxis after urethral reconstruction. The aim of this systematic review was to evaluate the effectiveness and relevance of postoperative antibiotic prophylaxis after male pediatric and adult urethral reconstruction. An online search of MEDLINE database via PubMed was performed. The systematic review was registered in PROSPERO (CRD42022348555) and was conducted according to the PRISMA guidelines and AMSTAR 2 checklist. A narrative synthesis of included studies was performed. After the screening of 1176 publications, six studies regarding antibiotic prophylaxis after hypospadias reconstruction and two studies regarding antibiotic prophylaxis after urethroplasty in adults were eligible to be included in the systematic review. All but one of the studies on hypospadias repair showed no benefit from postoperative antibiotic prophylaxis. The level of evidence on postoperative antibiotic prophylaxis after urethroplasty in adults is low. Neither of the two studies included in the review showed a benefit from antibiotic use. Postoperative prophylaxis after hypospadias repair is not effective in preventing urinary tract infections and wound infections. It seems that the use of postoperative prophylaxis after urethroplasty in adults is also not beneficial, but there is a high need for high-quality scientific data.
PubMed: 37834807
DOI: 10.3390/jcm12196162 -
Iranian Journal of Public Health Nov 2023Non-tuberculous mycobacteria (NTM) infections have been continuously increasing as major concerns of public health in Iran. Because innate resistance of NTM species, the... (Review)
Review
BACKGROUND
Non-tuberculous mycobacteria (NTM) infections have been continuously increasing as major concerns of public health in Iran. Because innate resistance of NTM species, the treatment of these infections is difficult task, but until now resistance pattern of NTM and suitable regimens are not determined.
METHODS
We systematically searched the relevant studies in PubMed, Scopus, and Embase (Until Dec 2022). All statistical analyses were carried out using the statistical package R.
RESULTS
Eleven studies included in the analysis were performed in 6 provinces and investigated 1223 NTM clinical species. The majority of the studies originated in Tehran. Among the first-line anti-TB drugs, almost all NTM species were highly resistant to first-line anti-TB drugs. No significant difference in the isoniazid resistance rate was found in the slow or rapid-growing species and Runyon's classification of NTM isolates. A decreased in the prevalence of ciprofloxacin, clarithromycin, and moxifloxacin resistance were showed in during 2013-2022 years.
CONCLUSION
Most investigated antibiotics have a minor effect on NTM species and a steady increase of resistance has been seen in last few years then, need more-effective alternative regimens is clear.
PubMed: 38106824
DOI: 10.18502/ijph.v52i11.14028 -
Research in Veterinary Science Aug 2023Staphylococcus aureus (S. aureus) is a frequent and major etiological agent of bacterial bovine mastitis, leading to high economic losses. This pathogen readily becomes... (Meta-Analysis)
Meta-Analysis Review
Staphylococcus aureus (S. aureus) is a frequent and major etiological agent of bacterial bovine mastitis, leading to high economic losses. This pathogen readily becomes resistant to many antibiotics, resulting in persistent noncurable intramammary infection (IMI) in animals and the development of multidrug-resistant (MDR) strains. The objectives of this study were to evaluate the prevalence of antimicrobial resistance (AMR) of S. aureus strains causing bovine mastitis in Iran according to published data from 2000 to 2021. As there is still a dearth of information on the AMR of S. aureus from Iranian bovine mastitis, the primary focus and subgroup analysis of the present study was performed on Iranian isolates. A systematic review was done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Based on the initial search, 1006 article were identified. According to inclusion and exclusion criteria and removing duplications, 55 English articles and 13 Persian articles (a total of 68 articles) were finally analyzed. The highest overall prevalence of resistance was reported against penicillin G (p-estimate = 0.568 for all isolates, and p-estimate = 0.838 for Iranian isolates), followed by ampicillin (p-estimate = 0.554, and p-estimate = 0.670 for all isolates and Iranian isolates, respectively) and amoxicillin (p-estimate = 0.391, and p-estimate = 0.695 for all isolates and Iranian isolates, respectively). Besides, the lowest prevalence of resistant isolates was related to trimethoprim-sulfamethoxazole (p-estimate = 0.108 and 0.118 for all isolates and Iranian isolates, respectively) and gentamycin (p-estimate = 0.163 and 0.190, for all isolates and Iranian isolates, respectively). Our analysis showed that the Iranian isolates were more resistant to all antibiotics than those of all isolates. This difference was significant in the case of penicillin G, ampicillin, and erythromycin at 5%. To the best of our knowledge, except for ampicillin, AMR has increased over time for all the studied antibiotics in Iranian isolates. This increased rate was significant for penicillin G, amoxicillin, and tetracycline (p < 0.1). No differences in AMR were detected regarding the mastitis types (clinical vs. subclinical mastitis) for almost evaluated antibiotics. In conclusion, the prevalence of AMR S. aureus isolated from IMI was high particularly for bovine mastitis used antibiotics like penicillin G and ampicillin. Additionally, according to the increasing rate of AMR S. aureus in recent years in Iran, control strategies should be reinforced to avoid the spread of this pathogen and drug resistance.
Topics: Animals; Cattle; Female; Anti-Bacterial Agents; Staphylococcus aureus; Iran; Mastitis, Bovine; Microbial Sensitivity Tests; Staphylococcal Infections; Ampicillin; Drug Resistance, Microbial; Amoxicillin; Cattle Diseases
PubMed: 37302281
DOI: 10.1016/j.rvsc.2023.05.016