Emergence and selection of antimicrobial is a very serious concern article pdf 2018
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- Antibiotic resistance: What you need to know
- Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis
- The evolving response to antibiotic resistance (1945–2018)
Antibiotic resistance: What you need to know
Metrics details. Antimicrobial resistance AMR is an increasing threat to global health. The disease is primarily controlled by antimicrobial treatment, but this is becoming increasingly difficult due to AMR. Our objectives were to assess the prevalence and geographic distribution of AMR in Salmonella enterica serovars Typhi and Paratyphi A infections globally, to evaluate the extent of the problem, and to facilitate the creation of geospatial maps of AMR prevalence to help targeted public health intervention.
We performed a systematic review of the literature by searching seven databases for studies published between and We recategorised isolates to allow the analysis of fluoroquinolone resistance trends over the study period.
The prevalence of multidrug resistance MDR and fluoroquinolone non-susceptibility FQNS in individual studies was illustrated by forest plots, and a random effects meta-analysis was performed, stratified by Global Burden of Disease GBD region and 5-year time period. Heterogeneity was assessed using the I 2 statistics. We present a descriptive analysis of ceftriaxone and azithromycin resistance. We identified articles, of which , comprising , isolates 94, S.
Typhi and 29, S. Paratyphi A met the pre-specified inclusion criteria. With the exception of MDR S. Paratyphi A, which remained at low levels, resistance trends worsened for all antimicrobials in all regions. We identified several data gaps in Africa and the Middle East. Incomplete reporting of antimicrobial susceptibility testing AST and lack of quality assurance were identified. Drug-resistant enteric fever is widespread in low- and middle-income countries, and the situation is worsening.
It is essential that public health and clinical measures, which include improvements in water quality and sanitation, the deployment of S. Typhi vaccination, and an informed choice of treatment are implemented. However, there is no licenced vaccine for S. Paratyphi A. The standardised reporting of AST data and rollout of external quality control assessment are urgently needed to facilitate evidence-based policy and practice.
Peer Review reports. Enteric fever, a serious bloodstream infection caused by the human-restricted bacterial pathogens Salmonella enterica serovars Typhi S. Typhi and Paratyphi A, is an important cause of morbidity and mortality in the developing world. Transmission occurs faeco-orally through contaminated water and food.
An estimated Notably, paratyphoid fever is clinically indistinguishable from typhoid fever [ 4 ]. Enteric fever is an important cause of acute undifferentiated febrile illness [ 6 ].
There is heterogeneity in the aetiologies of febrile illness according to geographic location, age group, diagnostic testing panel and seasonality [ 6 , 7 , 8 ]. Enteric fever has been eliminated in industrialised countries by improving drinking water and sanitation; vaccination can also be deployed to reduce the burden of typhoid fever there is no vaccine against S. Paratyphi A , but effective treatment is critical to reduce morbidity and mortality.
However, the development and spread of antimicrobial drug resistance AMR threatens the effectiveness of antimicrobials and may lead to a resurgence of enteric fever in many parts of the world. As is true for many bacterial infections, there is no simple and reliable point-of-care test that can diagnose enteric fever, define the antimicrobial susceptibility profile and inform patient management.
Antimicrobial susceptibility testing AST and surveillance play a critical role in capturing local susceptibility patterns and guiding empirical treatment; however, microbiological facilities and the relevant expert knowledge are lacking in many low- and middle-income countries LMICs [ 15 , 16 , 17 ]. Significantly, S. Typhi and S. The WHO currently recommends chloramphenicol, ampicillin and cotrimoxazole trimethoprim-sulfamethoxazole , fluoroquinolones, third-generation cephalosporines ceftriaxone, cefixime and azithromycin for the treatment of enteric fever [ 11 ].
Unfortunately, AMR is widespread, and patients treated with ineffective antimicrobials show a poor clinical response and a higher rate of complications and deaths, as well as prolonged faecal shedding, which sustains transmission and induces secondary cases [ 18 , 19 , 20 ]. Here, we performed a systematic review and meta-analysis of the literature to evaluate the prevalence of AMR in S. Paratyphi A and to determine the spatial and temporal distribution of drug-resistant enteric fever at the regional level, grouped by Global Burden of Disease GBD study region from to The ultimate aim of our work is to create fine-scaled geospatial maps of the distribution of AMR to aid targeted public health interventions for this preventable disease [ 21 ].
The protocol was registered with the international prospective register of systematic reviews CRD The search strategy was devised by an academic librarian EH. Typhi, S. Paratyphi A, enteric fever with terms for antimicrobial resistance e.
The extended search was conducted in October and updated in March The search was limited to publications from onwards; no restrictions on language or filters e. Included studies were required to report quantifiable in vitro antimicrobial susceptibility data for S. Paratyphi A isolated from blood culture, examining at least 10 representative organisms and indicating the study location.
Reports from travellers being diagnosed in high-income countries were excluded. Studies with pooled S. Paratyphi A susceptibility data, studies reporting on isolates from stool culture and duplicate isolates were also excluded. Prospective and retrospective hospital-, laboratory- and community-based studies were included, if they met the specified inclusion criteria.
Review articles were scanned for relevant references. Studies were screened at title, abstract and full-text stage by one author CD and reviewed by a second author AB. Disagreements were resolved by discussion. Susceptibility data for antimicrobials recommended for the treatment of enteric fever by WHO, i. We also recorded case fatalities and clinical outcomes when available. Additionally, the testing standard e. Clinical and Laboratory Standards Institute CLSI and interpretive criteria including version or year used to determine resistance, use of internal quality controls and participation in external quality assessments schemes were recorded.
The study setting, precise study location, country and GBD study region were recorded for each study. Data were disaggregated by serovar and study location.
We aimed to control for bias and allow for comparison across studies by adhering to the predefined inclusion and exclusion criteria. We expected that there would be differences in the quality of the AST and interpretation of results, reflecting the reality in many LMICs.
We adapted a descriptive tool for quality assessment used by Arndt, based on sample size and microbiological testing methodology [ 23 ]. No study was excluded based on this assessment, due to the lack of standardised reporting guidelines for microbiological studies. Each study was assigned to a year based on the midyear of the study. Studies were grouped based on the GBD region and 5-year time period —; —; —; —; —; — If study dates were not provided, these were imputed as the publication date minus the median difference between the publication date and the mid-year for the remaining studies in the dataset.
Typhoid-specific lower breakpoints against fluoroquinolones FQ came into effect during our study period [ 24 ]. To allow the analysis of resistance trends over time, we classified ciprofloxacin intermediate minimum inhibitory concentration MIC 0. If ciprofloxacin data were not available or it was not clear which breakpoints were used, nalidixic acid resistance data were used instead. For all other antimicrobials, we classified intermediate susceptible organisms as resistant.
We determined the percentage of patients with resistant S. Typhi or S. We combined individual studies using random effect meta-analysis to arrive at pooled prevalence rates of MDR and FQNS for each region, time period and serovar. Heterogeneity was assessed visually using forest plots and quantitatively using the I 2 statistic and its associated p value [ 26 ].
Stacked bar plots were used to illustrate changes in the distribution of ciprofloxacin MICs over the study period. Ceftriaxone and azithromycin are recommended for the treatment of MDR and FQ-resistant enteric fever [ 11 ]. We also provide a descriptive analysis of ceftriaxone and azithromycin resistance as part of this review. We used double arcsine transformation to stabilise the variance of proportions and performed random effects meta-analysis using the REML heterogeneity variance estimator [ 27 ].
Pooled prevalence was calculated for sub-groups that included at least three studies. Our online database searches identified articles, with an additional 22 obtained through reference tracking. A total of studies were excluded at abstract review and at full-text review; the main reasons for exclusion are shown in Fig.
Ultimately, data were extracted from articles yielding information for , isolates: 94, S. There were data points for MDR S. Typhi, 73 data points for MDR S. Paratyphi A Fig. One study could contribute several data points due to reporting on multiple antimicrobials, serovars and locations. No data were identified from Oceania Fig. Table 1 shows the study characteristics. Study selection. Five studies reported participation in international and two studies in national EQA schemes, whilst 23 studies reported confirmation of AST results by national or international reference laboratories Table 2.
Clinical outcomes including case fatalities were presented by 91 studies Tables 1 and 2. This further supported our decision not to exclude studies based on the risk of bias assessment. MDR S. Typhi in South Asia. Forest plots illustrating the prevalence of MDR amongst S.
Drug-resistant enteric fever worldwide, 1990 to 2018: a systematic review and meta-analysis
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections , and antibiotic medications are widely used in the treatment and prevention of such infections. A limited number of antibiotics also possess antiprotozoal activity. However, both classes have the same goal of killing or preventing the growth of microorganisms, and both are included in antimicrobial chemotherapy. Antibiotics have been used since ancient times. Many civilizations used topical application of mouldy bread, with many references to its beneficial effects arising from ancient Egypt, Nubia, China, Serbia, Greece, and Rome.
The popularity of fermented foods and beverages is due to their enhanced shelf-life, safety, functionality, sensory, and nutritional properties. The latter includes the presence of bioactive molecules, vitamins, and other constituents with increased availability due to the process of fermentation. Many fermented foods also contain live microorganisms that may improve gastrointestinal health and provide other health benefits, including lowering the risk of type two diabetes and cardiovascular diseases. The number of organisms in fermented foods can vary significantly, depending on how products were manufactured and processed, as well as conditions and duration of storage. In this review, we surveyed published studies in which lactic acid and other relevant bacteria were enumerated from the most commonly consumed fermented foods, including cultured dairy products, cheese, fermented sausage, fermented vegetables, soy-fermented foods, and fermented cereal products.
; – Antimicrobial resistance (AMR) poses a serious global threat of growing These factors contribute to genetic selection pressure for the emergence of Currently, medical experts are raising real concern for a return to the Another very significant trait of AMR that was absent in the.
The evolving response to antibiotic resistance (1945–2018)
The aggregate data supporting findings contained within this manuscript will be shared upon request submitted to the corresponding author. Identifying patient data will not be shared. The advent of multidrug resistance among pathogenic bacteria is imperiling the worth of antibiotics, which have previously transformed medical sciences. The crisis of antimicrobial resistance has been ascribed to the misuse of these agents and due to unavailability of newer drugs attributable to exigent regulatory requirements and reduced financial inducements. Comprehensive efforts are needed to minimize the pace of resistance by studying emergent microorganisms, resistance mechanisms, and antimicrobial agents.
For the last 70 years, doctors have prescribed drugs known as antimicrobial agents to treat infectious diseases. These are diseases that occur due to microbes, such as bacteria, viruses, and parasites. Some of these diseases can be life-threatening. However, the use of these drugs is now so common that some microbes have adapted and started to resist them. This is potentially dangerous because it could result in a lack of effective treatments for some diseases.