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Tropical Medicine & International... Oct 2021Increasing antimicrobial resistance (AMR) raises serious health and financial concerns. However, the main drivers of the emergence, spread and subsequent colonisation of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Increasing antimicrobial resistance (AMR) raises serious health and financial concerns. However, the main drivers of the emergence, spread and subsequent colonisation of resistant bacterial strains between humans, animals and the environment are still poorly understood.
OBJECTIVE
The aim of this review was to identify molecular studies on AMR in One Health settings in Africa and to determine the prevalence of antimicrobial resistance genes in humans, animals and the environment. Due to the very low number of studies including environmental samples, the meta-analysis only includes data obtained from animals and humans.
METHODS
The PubMed, Web of Science and Scopus databases were searched, identifying 10 464 publications on AMR in Africa from January 1st, 2000 until June 1st, 2020. Inclusion criteria were: (i) Integrated studies assessing AMR simultaneously in an animal-human, animal-environment, human-environment or animal-human-environment context, (ii) Genotypic characterisation of AMR and (iii) temporal and spatial relationship between samples from humans and animals. Statistical random-effects model meta-analysis was performed.
RESULTS
Overall, 18 studies met our eligibility criteria and were included in this review. Six studies investigated Escherichia coli and Salmonella spp. (N = 6). The most prevalent AMR genes in animals included sul1 (36.2%), sul2 (32.0%), tetA (31.5%), strB (30.8%) and blaTEM (30.0%), whereas sul2 (42.4%), tetA (42.0%), strB (34.9%), blaTEM (28.8%) and sul1 (27.8%) were most prevalent in humans. We observed no clear pattern for a higher prevalence in either the animal or the human reservoir.
CONCLUSION
To date, data on AMR in a One Health perspective in Africa are scarce. Prospective and longitudinal studies using an integrated One Health approach assessing the environment, animals and humans at the same time are needed to better understand the main drivers of AMR sharing in Africa.
Topics: Africa; Animals; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Drug Resistance, Bacterial; Humans; One Health
PubMed: 34139031
DOI: 10.1111/tmi.13642 -
Clinical Microbiology and Infection :... Jul 2024Scant data are available on the link between armed conflicts and the development and spread of antimicrobial resistance. (Review)
Review
BACKGROUND
Scant data are available on the link between armed conflicts and the development and spread of antimicrobial resistance.
OBJECTIVES
We performed a systematic review with the aim to summarize the available data on the prevalence and features of antibiotic resistance and the causes of antibiotic resistance development during armed conflicts in the 21st century.
METHODS
Data sources: PubMed and SCOPUS databases were searched from 1 January 2000 to 30 November 2023.
STUDY ELIGIBILITY CRITERIA
Original articles reporting data on armed conflicts and antimicrobial resistance were included in this systematic review. No attempt was made to obtain information from unpublished studies. No language restriction was applied. Methods of data synthesis: Both quantitative and qualitative information were summarized by means of textual descriptions.
PARTICIPANTS
Patients or soldiers deployed in armed conflict zones.
TESTS
culture-dependent antibiotic sensitivity testing or molecular detection of the genetic determinants of antibiotic resistance after a confirmed diagnosis of bacterial infection. Assessment of risk of bias: To evaluate the quality of the included studies, we adapted the tool recommended by the Joanna Briggs Institute.
RESULTS
Thirty-four studies were identified, published between November 2004 and November 2023. The quality of included studies was high and medium in 47% and 53% of the studies, respectively. The included studies reported high infection and colonization rates of multidrug-resistant bacteria. Studies performed during the Eastern Ukraine conflict reported high rates of New Delhi metallo-β-lactamase producers.
DISCUSSION
Our findings confirm that wars lead to a large pool of multidrug-resistant infections that could potentially spread. Infection control in healthcare facilities in conflict zones and proper antimicrobial stewardship are crucial.
Topics: Humans; Armed Conflicts; Anti-Bacterial Agents; Drug Resistance, Bacterial; Bacterial Infections; Microbial Sensitivity Tests; Global Health; Prevalence; Bacteria
PubMed: 38556213
DOI: 10.1016/j.cmi.2024.03.029 -
Environmental Pollution (Barking, Essex... Feb 2023The extensive use of antibiotics in food animal production and disposal of untreated wastewater from food animal slaughter facilities may create a shift in microbiomes... (Review)
Review
The extensive use of antibiotics in food animal production and disposal of untreated wastewater from food animal slaughter facilities may create a shift in microbiomes of different ecosystems by generating reservoirs of antimicrobial resistance along the human-animal-environmental interface. This epidemiological problem has been studied, but its magnitude and impact on a global scale is poorly characterised. A systematic review was done to determine global prevalence and distribution patterns of antimicrobial resistance in effluent wastewater from animal slaughter facilities. Extracted data were stratified into rational groups for secondary analyses and presented as percentages. Culture and sensitivity testing was the predominant method; Escherichia spp., Enterococcus spp., and Staphylococcus aureus were the most targeted isolates. Variable incidences of resistance were detected against all major antimicrobial classes including reserved drugs such as ceftazidime, piperacillin, gentamicin, ciprofloxacin, and chloramphenicol; the median frequency and range in resistant Gram-negative isolates were: 11 (0-100), 62 (0-100), 8 (0-100), 14 (0-93) and 12 (0-62) respectively. Ciprofloxacin was the most tested drug with the highest incidences of resistance in livestock slaughterhouses in Iran (93%), Nigeria (50%) and China (20%), and poultry slaughterhouses in Germany (21-81%) and Spain (56%). Spatial global distribution patterns for antimicrobial resistance were associated with previously reported magnitude of antibiotic use in livestock or poultry farming and, the implicit existence of jurisdictional policies to regulate antibiotic use. These data indicate that anthropogenic activities in farming systems are a major contributor to the cause and dissemination of antimicrobial resistance into the environment via slaughterhouse effluents.
Topics: Animals; Humans; Wastewater; Anti-Bacterial Agents; Drug Resistance, Bacterial; Ecosystem; Prevalence; Poultry; Ciprofloxacin; Microbial Sensitivity Tests
PubMed: 36563990
DOI: 10.1016/j.envpol.2022.120848 -
Preventive Veterinary Medicine Dec 2020A variety of antimicrobials and antiparasitics are used to treat British cattle and sheep to ensure animal welfare, a safe food supply, and maintain farm incomes....
A variety of antimicrobials and antiparasitics are used to treat British cattle and sheep to ensure animal welfare, a safe food supply, and maintain farm incomes. However, with increasing global concern about antimicrobial resistance in human and animal populations, there is increased scrutiny of the use of antimicrobials in food-producing animals. This systematic review sought to identify and describe peer and non-peer reviewed sources, published over the last ten years, detailing the usage of, and resistance to, antimicrobials and antiparasitics in sheep and cattle farming systems in Britain as well as identify knowledge gaps. Applying the PRISMA review protocol and guidelines for including grey literature; Scopus, Web of Science, Medline, and government repositories were searched for relevant articles and reports. Seven hundred and seventy titles and abstracts and 126 full-text records were assessed, of which 40 scholarly articles and five government reports were included for data extraction. Antibiotic usage in sheep and cattle in Britain appear to be below the UK average for all livestock and tetracyclines and beta-lactam antibiotics were found to be the most commonly used. However, the poor level of coverage afforded to these species compared to other livestock reduced the certainty of these findings. Although resistance to some antibiotics (using Escherichia coli as a marker) appeared to have decreased in sheep and cattle in England and Wales over a five-year period (2013-2018), levels of resistance remain high to commonly used antibiotics. The small number and fragmented nature of studies identified by this review describing anthelmintic usage, and the lack of available national sales data, prevented the identification of trends in either sheep or cattle. We recommend that additional efforts are taken to collect farm or veterinary level data and argue that extraction of this data is imperative to the development of antimicrobial and antiparasitic resistance strategies in Britain, both of which are needed to reduce usage of these anti-infective agents, curb the development of resistance, and safeguard national agricultural production. Finally, metrics produced by this data should be generated in a way to allow for maximum comparability across species, sectors, and countries.
Topics: Animals; Anti-Infective Agents; Antiparasitic Agents; Cattle; Cattle Diseases; Drug Resistance; Drug Resistance, Bacterial; England; Scotland; Sheep; Sheep Diseases; Wales
PubMed: 33189057
DOI: 10.1016/j.prevetmed.2020.105174 -
Malaria Journal Jun 2022The World Health Organization (WHO) recommends surveillance of molecular markers of resistance to anti-malarial drugs. This is particularly important in the case of mass... (Review)
Review
The World Health Organization (WHO) recommends surveillance of molecular markers of resistance to anti-malarial drugs. This is particularly important in the case of mass drug administration (MDA), which is endorsed by the WHO in some settings to combat malaria. Dihydroartemisinin-piperaquine (DHA-PPQ) is an artemisinin-based combination therapy which has been used in MDA. This review analyses the impact of MDA with DHA-PPQ on the evolution of molecular markers of drug resistance. The review is split into two parts. Section I reviews the current evidence for different molecular markers of resistance to DHA-PPQ. This includes an overview of the prevalence of these molecular markers in Plasmodium falciparum Whole Genome Sequence data from the MalariaGEN Pf3k project. Section II is a systematic literature review of the impact that MDA with DHA-PPQ has had on the evolution of molecular markers of resistance. This systematic review followed PRISMA guidelines. This review found that despite being a recognised surveillance tool by the WHO, the surveillance of molecular markers of resistance following MDA with DHA-PPQ was not commonly performed. Of the total 96 papers screened for eligibility in this review, only 20 analysed molecular markers of drug resistance. The molecular markers published were also not standardized. Overall, this warrants greater reporting of molecular marker prevalence following MDA implementation. This should include putative pfcrt mutations which have been found to convey resistance to DHA-PPQ in vitro.
Topics: Antimalarials; Artemisinins; Biomarkers; Drug Resistance; Humans; Malaria, Falciparum; Mass Drug Administration; Piperazines; Plasmodium falciparum; Quinolines
PubMed: 35690758
DOI: 10.1186/s12936-022-04181-y -
PloS One 2017Despite evidence of the high prevalence of antibiotic resistant infections in developing countries, studies on the clinical and economic impact of antibiotic resistance... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Despite evidence of the high prevalence of antibiotic resistant infections in developing countries, studies on the clinical and economic impact of antibiotic resistance (ABR) to inform interventions to contain its emergence and spread are limited. The aim of this study was to analyze the published literature on the clinical and economic implications of ABR in developing countries.
METHODS
A systematic search was carried out in Medline via PubMed and Web of Sciences and included studies published from January 01, 2000 to December 09, 2016. All papers were considered and a quality assessment was performed using the Newcastle-Ottawa quality assessment scale (NOS).
RESULTS
Of 27 033 papers identified, 40 studies met the strict inclusion and exclusion criteria and were finally included in the qualitative and quantitative analysis. Mortality was associated with resistant bacteria, and statistical significance was evident with an odds ratio (OR) 2.828 (95%CI, 2.231-3.584; p = 0.000). ESKAPE pathogens was associated with the highest risk of mortality and with high statistical significance (OR 3.217; 95%CIs; 2.395-4.321; p = 0.001). Eight studies showed that ABR, and especially antibiotic-resistant ESKAPE bacteria significantly increased health care costs.
CONCLUSION
ABR is associated with a high mortality risk and increased economic costs with ESKAPE pathogens implicated as the main cause of increased mortality. Patients with non-communicable disease co-morbidities were identified as high-risk populations.
Topics: Developing Countries; Drug Resistance, Microbial; Health Care Costs; Humans
PubMed: 29267306
DOI: 10.1371/journal.pone.0189621 -
Preventive Veterinary Medicine Mar 2021Staphylococcus aureus, one of the main contagious mastitis pathogens worldwide, is characterized for causing chronic intramammary infections that respond poorly to... (Meta-Analysis)
Meta-Analysis
Staphylococcus aureus, one of the main contagious mastitis pathogens worldwide, is characterized for causing chronic intramammary infections that respond poorly to antimicrobial therapy, disseminating within the herd leading to high economic losses. The aim of this study was to determine the prevalence of phenotypic resistance to antimicrobial agents among S. aureus collected worldwide in the context of bovine intramammary infections between the years 1969-2020. A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). One hundred and fifty-five articles were eligible for quantitative review. Most of studies included in this meta-analysis were from Europe (88), followed by Asia (56), Latin America (39), Africa (32), North America (26), and Oceania (8). The highest overall prevalence of resistant S. aureus was against penicillin (pestimate 0.451, CI95 % 0.415-0.487), followed by clindamycin, erythromycin, and gentamycin (p-estimate = 0.149, 0.085, and 0.069, respectively). Ceftiofur and cephalotin presented the lowest overall prevalence of antimicrobial resistance (AMR, p-estimate = 0.020 and 0.015, respectively). The AMR to almost all the antimicrobials evaluated presented an increasing pattern over time, more apparent from 2009 onwards. The antimicrobials with a higher increase in their AMR prevalence over time were clindamycin, gentamycin, and oxacillin. Africa, Asia and Latin America were the continents with higher AMR to most compounds included in this study. No differences in AMR were detected regarding the clinical origin of the isolates (subclinical vs clinical mastitis) for almost all antibiotics evaluated. Differences in the method for testing AMR (disc diffusion method vs minimum inhibitory concentration) and type of study design for monitoring AMR were detected underscoring the importance of these variables as critical factors to enable comparisons for evaluating emergence of AMR.
Topics: Animals; Anti-Infective Agents; Cattle; Drug Resistance, Bacterial; Female; Mastitis, Bovine; Staphylococcus aureus
PubMed: 33508662
DOI: 10.1016/j.prevetmed.2021.105261 -
PloS One 2021Drug resistance frequently led to the failure of chemotherapy for malignant cancers, hence causing cancer relapse. Thus, understanding mechanism of drug resistance in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Drug resistance frequently led to the failure of chemotherapy for malignant cancers, hence causing cancer relapse. Thus, understanding mechanism of drug resistance in cancer is vital to improve the treatment efficacy. Here, we aim to evaluate the association between SMAD4 expression and the drug resistance in cancers by performing a meta-analysis.
METHOD
Relevant studies detecting SMAD4 expression in cancer patients treated with chemo-drugs up till December 2020 were systematically searched in four common scientific databases using selected keywords. The pooled hazard ratio (HR) was the ratio of hazard rate between SMAD4neg population vs SMAD4pos population. The HRs and risk ratios (RRs) with 95% confidence intervals (CIs) were used to explore the association between SMAD4 expression losses with drug resistance in cancers.
RESULT
After an initial screening according to the inclusion and exclusion criteria, eleven studies were included in the meta-analysis. There were a total of 2092 patients from all the included studies in this analysis. Results obtained indicated that loss of SMAD4 expression was significantly correlated with drug resistance with pooled HRs (95% CI) of 1.23 (1.01-1.45), metastasis with pooled RRs (95% CI) of 1.10 (0.97-1.25) and recurrence with pooled RRs (95% CI) of 1.32 (1.06-1.64). In the subgroup analysis, cancer type, drug type, sample size and antibody brand did not affect the significance of association between loss of SMAD4 expression and drug resistance. In addition, there was no evidence of publication bias as suggested by Begg's test.
CONCLUSION
Findings from our meta-analysis demonstrated that loss of SMAD4 expression was correlated with drug resistance, metastasis and recurrence. Therefore, SMAD4 expression could be potentially used as a molecular marker for cancer resistance.
Topics: Biomarkers, Tumor; Drug Resistance, Neoplasm; Humans; Neoplasm Metastasis; Neoplasms; Prognosis; Smad4 Protein
PubMed: 34048444
DOI: 10.1371/journal.pone.0250634 -
COPD Dec 2021A concern of antibiotic use in chronic obstructive pulmonary disease (COPD) is the emergence and propagation of antimicrobial resistance (AMR). A systematic review was...
A concern of antibiotic use in chronic obstructive pulmonary disease (COPD) is the emergence and propagation of antimicrobial resistance (AMR). A systematic review was conducted to determine prevalence, pattern, risk factors and consequences of AMR in COPD. Bibliographic databases were searched from inception to November 2020, with no language restrictions, including studies of any design that included patients with COPD and reported prevalence and pattern of AMR. 2748 unique titles and abstracts were identified, of which 63 articles, comprising 26,387 patients, met inclusion criteria. Forty-four (69.8%) studies were performed during acute exacerbation. The median prevalence of AMR ranged from 0-100% for and . Median resistance rates of and were lower by comparison, with maximum rates ≤40% and ≤46%, respectively, and higher for . There was a trend towards higher rates of AMR in patients with poorer lung function and greater incidence of previous antibiotic exposure and hospitalisation. The impact of AMR on mortality was unclear. Data regarding antimicrobial susceptibility testing techniques and the impact of other risk factors or consequences of AMR were variable or not reported. This is the first review to systematically unify data regarding AMR in COPD. AMR is relatively common and strategies to optimise antibiotic use could be valuable to prevent the currently under-investigated potential adverse consequences of AMR.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.2000957 .
Topics: Acinetobacter baumannii; Anti-Bacterial Agents; Drug Resistance, Bacterial; Humans; Prevalence; Pulmonary Disease, Chronic Obstructive
PubMed: 35016569
DOI: 10.1080/15412555.2021.2000957 -
Omics : a Journal of Integrative Biology Dec 2023One Health (OH) offers conceptual and applied prospects to advance planetary health and integrative biology in the 21st century. For example, The World Health...
One Health (OH) offers conceptual and applied prospects to advance planetary health and integrative biology in the 21st century. For example, The World Health Organization (WHO) has declared antimicrobial resistance (AMR) one of humanity's top 10 health threats worldwide (AMR). The AMR research, as seen through the OH lens, recognizes the interdependence and the coproduction of the health of humans, nonhuman animals, and the environment (the OH triad). Moreover, research and development (R&D) is required to generate potential solutions to prevent, diagnose, and treat infections and control the spread and emergence of AMR. However, it is still unclear how well the OH approach is integrated into current AMR R&D. In this study, we present a systematic review on the OH funding landscape for cross-sectoral AMR R&D, and its alignment/gaps with the current global strategic agenda on AMR. A systematic literature review was conducted using public databases covering the period between January 2015 and May 2022. We included the studies and reviews on AMR encompassing more than one sector of the OH triad. Out of the 777 included studies, 475 (61%) encompassed the three OH sectors. A key finding of the present systematic review is that the environment was the most neglected sector in the OH triad. AMR surveillance, transmission, and interventions are the most commonly studied priority topics. In addition, both cross-sectoral AMR literature and investments have been increasing since 2017. The operational aspect of AMR is the most researched and funded area. However, certain priority topics in the strategic research and innovation agenda of the Joint Programming Initiative on AMR are underrepresented in OH AMR research, such as diagnosis and therapeutics. To the best of authors' knowledge, this is the first study that systematically reviews the cross-sectoral literature on AMR, classifies it, and aligns and contextualizes it in regard to the funding landscape of AMR. This systematic review identifies neglected areas in AMR R&D and could serve as critical information for policymaking so as to realize the objectives of the Global Action Plan on AMR. Going forward, more cross-sectoral AMR research and funding are needed. As integrative biology and omics systems science are poised to benefit from a rapprochement with the OH lens, the present article highlights the AMR research and funding landscapes.
Topics: Animals; Humans; Anti-Bacterial Agents; Drug Resistance, Bacterial; One Health; Databases, Factual
PubMed: 37851996
DOI: 10.1089/omi.2023.0049