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PubMed2000

Antimicrobial resistance.

Antimicrobial resistance is not a new concept. For over half a century, health care providers have been faced with this problem. The overuse and misuse of antimicrobial therapy by health care providers has contributed largely to the problem, but several other factors have also been associated with antimicrobial resistance. This article reviews current literature regarding antimicrobial resistance in an effort to educate health care providers to make judicious decisions in the treatment of bacterial infections and stem the rise of antibiotic resistance by carefully scrutinizing prescribing practices. Contributing factors to antimicrobial resistance and recommendations for the control of antimicrobial resistance will be reviewed. Treatment recommendations for common health ailments (i.e., acute otitis media, rhinitis, sinusitis, and pharyngitis) are provided.

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PubMed2003

Impact of travel on international spread of antimicrobial resistance.

Antimicrobial resistance, an escalating problem worldwide, affects a broad range of human diseases. Excessive and inappropriate drug usage is the key driver for the emergence of resistant organisms. Travel, trade and mass migration form an important mode for their spread. The use of molecular biology provides the means of understanding the genesis and spread of the genes for drug resistance. Antimicrobial use in veterinary practice as food additives causes selection of resistant zoonotic pathogens that may spread to humans. Comprehensive surveillance systems should be designed and implemented at local and national levels and a national resistance surveillance database operationalized. There is also need for better regulation of the use of antibiotics and education of the medical fraternity, veterinarians and the public in the appropriate use of antimicrobials.

Animals↗

PubMed1993

Use of nasopharyngeal isolates of Streptococcus pneumoniae and Haemophilus influenzae from children in Pakistan for surveillance for antimicrobial resistance.

Antimicrobial resistance of Streptococcus pneumoniae and Haemophilus influenzae presents a challenge to clinical case management, particularly in programs for acute respiratory tract infection (ARI), including pneumonia, in developing countries. To determine whether nasopharyngeal isolates of S. pneumoniae and H. influenzae from a clinically defined group of children could be used to predict the prevalence of antimicrobial resistance of strains that cause disease, 601 urban children with ARI, 133 healthy urban children and 285 rural children were evaluated in Pakistan. Of the urban children with ARI, 216 (35.9%) were bacteremic, predominantly with S. pneumoniae (108 children) and H. influenzae (100 children). Overall 631 (61.9%) children carried S. pneumoniae and 381 (37.4%) carried H. influenzae. The proportions of nasopharyngeal isolates of both organisms from urban children with ARI resistant to penicillin or ampicillin, trimethoprim/sulfamethoxazole, chloramphenicol and erythromycin were similar to the proportions of resistant blood isolates. Nasopharyngeal isolates from rural children had lower rates of resistance to some antimicrobial agents. These findings suggest that nasopharyngeal isolates of S. pneumoniae and H. influenzae from children with ARI can be used to conduct surveillance for antimicrobial resistance in a defined geographic area. Such surveillance would aid programs in developing countries in making a rational choice of antimicrobial agents for use in clinical management of bacterial diseases, including pneumonia.

Acute Disease↗

PubMed2006

Genetics of antimicrobial resistance.

Antimicrobial resistant strains of bacteria are an increasing threat to animal and human health. Resistance mechanisms to circumvent the toxic action of antimicrobials have been identified and described for all known antimicrobials currently available for clinical use in human and veterinary medicine. Acquired bacterial antibiotic resistance can result from the mutation of normal cellular genes, the acquisition of foreign resistance genes, or a combination of these two mechanisms. The most common resistance mechanisms employed by bacteria include enzymatic degradation or alteration of the antimicrobial, mutation in the antimicrobial target site, decreased cell wall permeability to antimicrobials, and active efflux of the antimicrobial across the cell membrane. The spread of mobile genetic elements such as plasmids, transposons, and integrons has greatly contributed to the rapid dissemination of antimicrobial resistance among several bacterial genera of human and veterinary importance. Antimicrobial resistance genes have been shown to accumulate on mobile elements, leading to a situation where multidrug resistance phenotypes can be transferred to a susceptible recipient via a single genetic event. The increasing prevalence of antimicrobial resistant bacterial pathogens has severe implications for the future treatment and prevention of infectious diseases in both animals and humans. The versatility with which bacteria adapt to their environment and exchange DNA between different genera highlights the need to implement effective antimicrobial stewardship and infection control programs in both human and veterinary medicine.

Animals↗

PubMed2001

Implementation of strategies to control antimicrobial resistance.

Antimicrobial resistance has emerged as a major public health issue in recent years. A steady increase in resistance continues despite the introduction of new antibiotics, and resistant bacteria have been associated with increased patient morbidity and mortality as well as with increased costs. Addressing the problem of antimicrobial resistance requires both infection control and regulation of antibiotic use; addressing either alone is insufficient. Mounting evidence shows that control of the use of broad-spectrum antibiotics (especially vancomycin and third-generation cephalosporins) and implementation of infection control measures can result in decreased incidence of antibiotic-resistant bacteria such as vancomycin-resistant enterococci and extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella. Recent reports from professional organizations and a consensus of experts have outlined strategies for the control of resistance in hospitals, with specific measures identified for antibiotic control and infection control. These reports have emphasized the importance of a multidisciplinary approach in tackling this problem in hospitals and have suggested that a quality-improvement model be used to address antimicrobial resistance. A close collaboration among the disciplines of infectious diseases, microbiology, hospital epidemiology, pharmacy, and nursing, with particular emphasis in ICUs, and with strong support from hospital leadership, can result in an effective program that can be readily incorporated into the quality-improvement goals of any health-care organization.

Bacterial Infections↗

PubMed1997

Epidemiological factors influencing the emergence of antimicrobial resistance.

Antimicrobial resistance is becoming an important public health problem for both hospital- and community-acquired infections. In the hospital, infections caused by drug-resistant Staphylococcus aureus, Mycobacterium tuberculosis, enterococci, and a variety of Gram-negative rods are resulting in increased morbidity, mortality and costs, in part because of prolonged hospitalization and the use of more expensive antimicrobial agents. Drug-resistant, community-acquired infections are also causing important problems in both the developed and the developing world. Although the relative importance of specific pathogens varies with the geographical area, community-acquired pathogens including Salmonella, Shigella, Neisseria gonorrhoeae, Haemophilus influenzae and Streptococcus pneumoniae are causing both sporadic cases and outbreaks of drug-resistant illness. The emergence of antimicrobial resistance is being attributed to a series of societal, technological, environmental and microbial changes. These include increasing populations of susceptible hosts, international travel and commerce, changes in technology and industry, microbial adaptation and change, and the breakdown of public health measures. Addressing emerging problems and antimicrobial resistance will require enhanced surveillance, prudent use of existing antimicrobial drugs, development of new antimicrobial agents, increased emphasis on infection control and hygienic practices, effective disease control programs, better use of existing vaccines, and development of more and better vaccines.

Anti-Bacterial Agents↗

PubMed2026

A comprehensive review of AI innovations for tackling antimicrobial resistance.

Antimicrobial resistance (AMR) represents a major global public health concern, rendering available antimicrobials ineffective and leading to infections that are difficult to treat. Artificial intelligence (AI) has been increasingly applied across the AMR continuum, including resistance prediction, rapid diagnostics, new antimicrobial discovery, drug repurposing, antimicrobial surveillance, and clinical decision support. In this review, we aim to highlight recent developments in the use of artificial intelligence (AI) to address antimicrobial resistance (AMR). In addition, we review computational methods that help interpret genomic, phenomic, clinical, and epidemiological data to support the development of treatment strategies and novel antimicrobial agents. The key issues addressed include data quality, model interpretability, external validation, regulatory requirements, privacy, and fairness. While AI is not a complete solution to AMR, it can certainly strengthen the global AMR response by complementing key areas of AMR such as antimicrobial stewardship, infection prevention, laboratory diagnostics, and global surveillance.

Antimicrobial resistance (AMR)↗

PubMed2006

[Surveillance of antimicrobial resistance and antimicrobial use in a university-affiliated hospital: implementation of a computerized system].

UNLABELLED: After half a century of antibiotic use, the increasing problem of the emergence and spread of antimicrobial-resistant pathogens has created a problem of public health. The causes of this problem are multifactorial, but the excessive and inappropriate use of antimicrobials is the principal cause. The current guidelines for the control of antimicrobial resistance in hospitals recommend the implementation of a surveillance system of antimicrobial use and antimicrobial resistance data. AIM OF THE STUDY: The objective of our project was to develop a computerised tool to survey the antibiotic consumption data and the antimicrobial resistance. MATERIALS AND METHODS: We have collected antimicrobial resistance data from the software of the bacteriology laboratory, antibiotic use data from the pharmacy and demographical data from the hospital's admission department. These data were integrated in a database server and available with a web application. Antimicrobial resistance data of 15 major microorganisms were extracted and expressed as a frequency with elimination of repeats by using time criteria (7, 14 or 28 days). Antibiotic use data were converted into defined daily doses (DDD) and expressed per 1000 patient-days. RESULTS: Data are available for consultation in the form of tables or graphs per unit, type of units (medicine, surgery, pediatrics, intensive care units) or in the whole hospital. The system allows the confrontation on the same graph of antimicrobial resistance and antibiotic use data. CONCLUSION: Our surveillance system constitutes a needed prerequisite to the implementation of a global strategy of antibiotic use improvement in our hospital.

Anti-Infective Agents↗

PubMed2002

Antibiotic utilization strategies to limit antimicrobial resistance.

Antimicrobial resistance is now being recognized as a major factor determining morbidity, mortality, and cost in the intensive care unit (ICU). Various strategies to limit its spread have evolved with our understanding and are based on four basic principles: infection prevention, infection eradication, containment of resistant species, and optimization of antibiotic utilization. The optimization of antibiotic utilization, at its most basic level, is the appropriate use of antibiotics and the limitation of unnecessary antibiotic administration/exposure consisting of appropriate diagnosis, acquiring appropriate culture and sensitivity data, implementing the most appropriate treatment, selecting appropriate antibiotics, and dosing appropriately. In addition various antibiotic utilization strategies including antibiotic utilization guidelines, formulary restriction, and antibiotic cycling or rotation have evolved from our understanding of the impact of changes in antibiotic utilization on subsequent antibiotic susceptibility patterns. These strategies can be utilized as a part of a multidisciplinary approach to limit the appearance and dissemination of antimicrobial resistance in our ICUs.

Journal Article↗

PubMed2001

The rise and fall of antimicrobial resistance.

Antimicrobial resistance is a growing problem in nearly every infectious disease, but the extent and rate of increase of the problem varies widely with different pathogen-drug combinations. The rate of increase of resistance depends primarily on the availability of resistant variants and the intensity of selection imposed by antimicrobial treatment (appropriately measured). Declines in resistance following antimicrobial control measures are typically faster in hospital-acquired infections than in community-acquired ones, probably owing to the dependence in the latter case on the fitness cost of resistance. Open questions and approaches for testing the hypotheses proposed here are outlined.

Bacteria↗

PubMed2006

Update on antimicrobial resistance.

Antimicrobial resistance is a natural biological phenomenon, but human misuse and neglect have accelerated the rate at which resistance develops and spreads. Through overuse of antimicrobials in developed nations, and misuse and underuse of them in developing nations, drug resistance has turned into a significant global health problem.

Journal Article↗

PubMed2006

How to fight antimicrobial resistance.

Antimicrobial misuse results in the development of resistance and superbugs. Over recent decades, resistance has been increasing despite continuing efforts to control it, resulting in increased mortality and cost. Many authorities have proposed local, regional and national guidelines to fight against this phenomenon, and the usefulness of these programmes has been evaluated. Multifaceted intervention seems to be the most efficient method to control antimicrobial resistance. Monitoring of bacterial resistance and antibiotic use is essential, and the methodology has now been homogenized. The implementation of guidelines and infection control measures does not control antimicrobial resistance and needs to be reinforced by associated measures. Educational programmes and rotation policies have not been evaluated sufficiently in the literature. Combination antimicrobial therapy is inefficient in controlling antimicrobial resistance.

Anti-Bacterial Agents↗

PubMed1998

Resistance to antimicrobial agents used for animal therapy in pathogenic-, zoonotic- and indicator bacteria isolated from different food animals in Denmark: a baseline study for the Danish Integrated Antimicrobial Resistance Monitoring Programme (DANMAP).

This study describes the establishment and first results of a continuous surveillance system of antimicrobial resistance among bacteria isolated from pigs, cattle and broilers in Denmark. The three categories of bacteria tested were: 1) indicator bacteria (Escherichia coli, Enterococcus faecalis, Enterococcus faecium), 2) zoonotic bacteria (Campylobacter coli/jejuni, Salmonella enterica, Yersinia enterocolitica), and 3) animal pathogens (E. coli, Staphylococcus aureus, coagulase-negative staphylococci (CNS), Staphylococcus hyicus, Actinobacillus pleuropneumoniae). A total of 3304 bacterial isolates collected from October 1995 through December 1996 were tested for susceptibility to all major classes of antimicrobial agents used for therapy in Denmark. Bacterial species intrinsically resistant to an antimicrobial were not tested towards that antimicrobial. Acquired resistance to all antimicrobials was found. The occurrence of resistance varied by animal origin and bacterial species. In general, resistance was observed more frequently among isolates from pigs than from cattle and broilers. The association between the occurrence of resistance and the consumption of the antimicrobial is discussed, as is the occurrence of resistance in other countries. The results of this study show the present level of resistance to antimicrobial agents among a number of bacterial species isolated from food animals in Denmark. Thus, the baseline for comparison with future prospective studies has been established, enabling the determination of trends over time.

Animal Diseases↗

PubMed2003

Insecticide resistance versus antimicrobial resistance. Biological issues in historical perspective.

The developments of insecticide resistance in insects and antimicrobial resistance in bacteria seem to have not too many aspects in common, due to the diverse nature of eukaryotes and prokaryotes cells and organisms. However, there are several approaches, both in the history of ecological systems and in the History of Science, that can successfully be applied to explain aspects of developments shared by both phenomena of resistance. Looking back to a century of discoveries, scientific explanations, industrial, agricultural, and medical practice, the historian is especially well placed for investigating the lessons to be learned and to be exchanged at the boundaries of research on resistant insects and microbes.

Animals↗

PubMed2001

Antimicrobial resistance: harmonisation of national antimicrobial resistance monitoring and surveillance programmes in animals and in animal-derived food.

A guideline on the harmonisation of national antimicrobial resistance monitoring and surveillance programmes in animals and animal-derived foods has been developed by the Ad hoc Group of experts on antimicrobial resistance of the Office International des Epizooties. The objective of the guideline is to allow the generation of comparable data from various national surveillance and monitoring systems in order to compare the situations in different regions or countries and to consolidate results at the national, regional and international level. Definitions of surveillance and monitoring are provided. National systems should be able to detect the emergence of resistance, and to determine the prevalence of resistant bacteria. The resulting data should be used in the assessment of risks to public health and should contribute to the establishment of a risk management policy. Specific factors identified for harmonisation include the animal species, food commodities, sampling plans, bacterial species, antimicrobials to be tested, laboratory methods, data reporting, database structure and the structure of reports.

Animals↗

PubMed2001

Epidemiology of shigellosis in Lagos, Nigeria: trends in antimicrobial resistance.

Antimicrobial susceptibility of Shigella spp. and Escherichia coli, isolated from diarrhoeal patients in Lagos, was studied from March 1999 to February 2000. Four hundred fifty-nine isolates were identified as shigellae (62) and E. coli (397). Shigella flexneri, S. dysenteriae, S. boydii, and S. sonnei accounted, respectively, for 51.6%, 17.7%, 17.7%, and 13% of the total number of shigellae isolated. Eleven cases of shigellosis occurred in the age group of 0-9 years, 22 cases in the age group of 10-19 years, and 29 cases in the age group of > or = 20 years. Of the 397 E. coli isolates, 11 were enteropathogenic E. coli (EPEC), and 7 of these strains were isolated with shigellae from stools of patients aged 0-9 year(s) (71.4%) and 10-19 years (28.6%). Over 70% of the Shigella isolates were resistant to two or more drugs, including ampicillin and tetracycline. Twenty-one distinct multidrug resistance patterns were observed in these isolates. During 1990-2000, resistance to ampicillin increased from 70% to 90%, co-trimoxazole from 77% to 85%, chloramphenicol from 71% to 77%, streptomycin from 71% to 79%, and nalidixic acid from 0% to 11.3%. Resistance to tetracycline decreased from 89% to 79% but with MIC50 and MIC90 values outside the susceptible range. While resistance to ciprofloxacin and ofloxacin remained nil with MIC50 and MIC90 values of 0.008 and 0.0016 microgram/mL respectively. The results of this study revealed the endemicity of shigellosis with S. flexneri as the predominant serogroup in Lagos. Children and young adults were at a higher risk of severe shigellosis. The results also suggest that ampicillin, tetracycline, co-trimoxazole, and streptomycin should not be used as the first-line drugs in the treatment of shigellosis. Nalidixic acid should still be selectively used for treatment, while ciprofloxacin and ofloxacin can be ideal alternatives.

Adolescent↗

PubMed1992

A national collaborative study of resistance to antimicrobial agents in Haemophilus influenzae in Australian hospitals. The Australian Group for Antimicrobial Resistance (AGAR).

An Australia-wide survey of the prevalence of resistance to antimicrobial agents among Haemophilus influenzae was conducted on clinically significant isolates collected between July 1988 and September 1990. Laboratories from the capital cities of each Australian state and territory participated. Nine hundred and seventy clinical isolates were examined for beta-lactamase production and the MICs of ampicillin, coamoxiclav, chloramphenicol, cefaclor, ceftriaxone, cefotaxime, tetracycline, rifampicin, trimethoprim, sulphamethoxazole and co-trimoxazole were determined using the NCCLS agar dilution method with Haemophilus Test Medium. A smaller number of isolates were tested against penicillin V, penicillin G, ciprofloxacin, piperacillin and erythromycin in addition. The proportion of beta-lactamase producing strains was higher among invasive strains (21.6%) than non-invasive strains (14.2%) and varies considerably between states. The highest prevalence of ampicillin resistance was found in invasive strains from Canberra (40.8%), the lowest in non-invasive strains from Adelaide (5.1%). Paradoxically, in non-invasive strains, although beta-lactamase production was less common, resistance to other antimicrobials was commoner than in invasive strains and also varied between states.

Anti-Bacterial Agents↗

PubMed2026

National Antimicrobial Resistance Monitoring System: Three Decades of Advancing Public Health Through Integrated Surveillance of Antimicrobial Resistance.

Antimicrobial resistance (AMR) occurs when bacteria and other microorganisms adapt in ways that make medicines less effective, causing infections that are harder to treat and more likely to spread. According to the Centers for Disease Control and Prevention (CDC), AMR infections affect millions of Americans each year and contribute to thousands of deaths (CDC, 2019). After three decades of operation, the U.S. National Antimicrobial Resistance Monitoring System (NARMS) stands as a model of sustained, collaborative public health surveillance. What began in 1996 as an effort to track resistance in Salmonella and E. coli O157 has evolved into a One Health surveillance network monitoring AMR across the farm-to-fork continuum. Through a partnership among CDC, the Food and Drug Administration (FDA), the U.S. Department of Agriculture (USDA), state and local health departments, and universities, NARMS has become the backbone of foodborne AMR surveillance in the United States. The past decade has been particularly transformative. NARMS explored new sampling to include companion animals, minor livestock, aquaculture, surface water, and wildlife. Whole-genome sequencing (WGS) revolutionized the program's capabilities, enabling timely identification of emerging pathogens and revealing how resistance genes spread. Near real-time public dashboards make NARMS data accessible to researchers, clinicians, regulators, and policymakers. NARMS data shape decisions about new animal drug approvals, guide stewardship programs, and inform clinical treatment guidelines nationwide. As NARMS enters its fourth decade with a 2026-2030 strategic plan, the program will leverage artificial intelligence and metagenomics while expanding surveillance to fill remaining gaps ensuring this vital system continues to protect the food supply and both human and animal health from AMR.

Antimicrobial Resistance (AMR)↗