Suchergebnisse

Traditionally, antibiotics are included in animal feed at subtherapeutic levels for growth promotion and disease prevention. However, recent links between in-feed antibiotics and a rise in antibiotic-resistant pathogens have led to a ban of all antibiotics in livestock production by the European Union in January 2006 and a removal of medically important antibiotics in animal feeds in the United States in January 2017. An urgent need arises for antibiotic alternatives capable of maintaining animal health and productivity without triggering antimicrobial resistance. Host defense peptides (HDP) are a critical component of the animal innate immune system with direct antimicrobial and immunomodulatory activities. While in-feed supplementation of recombinant or synthetic HDP appears to be effective in maintaining animal performance and alleviating clinical symptoms in the context of disease, dietary modulation of the synthesis of endogenous host defense peptides has emerged as a cost-effective, antibiotic-alternative approach to disease control and prevention. Several different classes of small-molecule compounds have been found capable of promoting HDP synthesis. Among the most efficacious compounds are butyrate and vitamin D. Moreover, butyrate and vitamin D synergize with each other in enhancing HDP synthesis. This review will focus on the regulation of HDP synthesis by butyrate and vitamin D in humans, chickens, pigs, and cattle and argue for potential application of HDP-inducing compounds in antibiotic-free livestock production.

Objective: Irrational use of antimicrobials is a major driver of antimicrobial resistance, exacerbated by dispensing antibiotics without a prescription. Our previous study suggested this was a problem in the Republic of Srpska despite legislation. Since then, a number of activities have been initiated. Consequently, the study aimed to ascertain whether these multiple initiatives had reduced this. Methods: Patients visiting all community pharmacies in the Republic from October 2014 to July 2015 presenting with symptoms typical of an acute, viral and mostly uncomplicated upper respiratory tract infection, with results compared to the previous study. If an antibiotic was suggested, the maximum allowance was Euro 3/ pack. Findings: Self-medication with antibiotics significantly decreased from 58% to 18.5% of pharmacies. In both studies, most patients were offered over-the-counter medication. The most common reason for not dispensing an antibiotic was 'antibiotics can be dispensed with a prescription only'. The penicillins were the most dispensed antibiotic. Fewer patients than the previous study were given instructions about antibiotic use and no discussion on their side-effects. Conclusion: Whilst encouraging that self-medication decreased significantly, 18.5% was disappointing given recent initiatives Fewer instructions about antibiotics if an antibiotic was dispensed was also disappointing. This suggests the need for even stronger enforcement of the laws as well as further training of pharmacy personnel to ensure future appropriate use of medicines.

To understand the overall of current veterinary hygiene situation concerning microbiological contamination of food, we have conducted a survey, interview, collecting and analyzing samples derived from poultry (alive and carcasses), slaughter environment of 36 small slaughter houses in the rural area of Hanoi. Almost all small slaughter houses (98% indoor and 100% at the bazaars/day-market) in the lowest veterinary ranking according to the government criteria. The rate of Salmonella contamination was 29.2% for the cloacal swab, 40.6% for carcasses, 2.9% for rinse water, 80.6% for waste water, 30.6% for slaughter floor and 63.9% for tools. Among the isolates from the most noticeable contamination carcasses, it was important to note that there were present of 2 serotype (S.enteritidis and S.typhimurium) that belong to the high risk group of food poisoning, originated from poultry during slaughtering processes. The Salmonella isolates had the antimicrobial resistance properties to most common antimicrobials, readily spreading along with the poultry meat chain. Water source and waste were both the highest risk factors leading to the Salmonella contamination for carcasses. There were two main recommendations to improve the hygiene condition at the time being, which were (i) to make awareness of high risk of bacterial contamination to the owners and butchers, (ii) improve the quality of water source as well as the waste treatment.

Resistance to third and fourth generation cephalosporins is rapidly increasing in bacteria infecting humans. Although many of these problems are linked to human to human transmission and to use of antimicrobials in human medicine, the potential role of community reservoirs such as food producing animals needs to be scrutinized. Resistance to third and fourth generation cephalosporins is emerging in enteric bacteria of food producing animals and also in food of animal origin. The genes encoding resistance to these cephalosporins are transferrable and often linked to other resistance genes. Systemic use of third and fourth cephalosporins selects for resistance, but co-selection by other antimicrobials is also likely to influence prevalence of resistance. Although there are many uncertainties, the potential consequences of a further increase of resistance to this critically important class of antimicrobials in bacteria colonising animals are serious. Measures to counter a further increase and spread of resistance among animals should therefore be considered. ; IT; en; stefano.morabito@iss.it

Background: Antimicrobial resistance is highly prevalent in low-income and middle-income countries. International travel contributes substantially to the global spread of intestinal multidrug-resistant Gram-negative bacteria. Hundreds of millions of annual visitors to low-income and middle-income countries are all exposed to intestinal multidrug-resistant Gram-negative bacteria resulting in 30–70% of them being colonised at their return. The colonisation process in high-exposure environments is poorly documented because data have only been derived from before travel and after travel sampling. We characterised colonisation dynamics by exploring daily stool samples while visiting a low-income and middle-income countries. Methods: In this prospective, daily, real-time sampling study 20 European visitors to Laos volunteered to provide daily stool samples and completed daily questionnaires for 22 days. Samples were initially assessed at Mahosot Hospital, Vientiane, Laos, for acquisition of extended-spectrum β-lactamase-producing (ESBL) Gram-negative bacteria followed by whole-genome sequencing of isolates at MicrobesNG, University of Birmingham, Birmingham, UK. The primary outcome of the study was to obtain data on the dynamics of intestinal multidrug-resistant bacteria acquisition. Findings: Between Sept 18 and Sept 20, 2015, 23 volunteers were recruited, of whom 20 (87%) European volunteers were included in the final study population. Although colonisation rates were 70% at the end of the study, daily sampling revealed that all participants had acquired ESBL-producing Gram-negative bacteria at some point during the study period; the colonisation status varied day by day. Whole-genome sequencing analysis ascribed the transient pattern of colonisation to sequential acquisition of new strains, resulting in a loss of detectable colonisation by the initial multidrug-resistant Gram-negative strains. 19 (95%) participants acquired two to seven strains. Of the 83 unique strains identified (53 Escherichia coli, 10 Klebsiella spp, and 20 other ESBL-producing Gram-negative bacteria), some were shared by as many as four (20%) participants. Interpretation: To our knowledge, this is the first study to characterise in real-time the dynamics of acquiring multidrug-resistant Gram-negative bacterial colonisation during travel. Our data show multiple transient colonisation events indicative of constant microbial competition and suggest that travellers are exposed to a greater burden of multidrug-resistant bacteria than previously thought. The data emphasise the need for preventing travellers' diarrhoea and limiting antibiotic use, addressing the two major factors predisposing colonisation. Funding: The Finnish Governmental Subsidy for Health Science Research, The Scandinavian Society for Antimicrobial Chemotherapy, the Sigrid Jusélius Foundation, Biotechnology and Biological Sciences Research Council; Wellcome Trust, Medical Research Council; The Royal Society; Joint Programming Initiative on Antimicrobial Resistance, and European Research Council.

The surveillance of drug resistance among tuberculosis (TB) patients is central to preventing the spread of antimicrobial resistance. The Democratic Republic of the Congo (DR Congo) is classified by the World Health Organization (WHO) as a country with a high burden of TB and multidrug-resistant TB (MDR-TB), but there are no nationally representative data on drug resistance. In 2016–2017, a national survey of TB patients was conducted in 108 microscopy centres across all 11 provinces of the country using innovative molecular approaches. Sputum samples were collected from 1,545 new and 163 previously treated patients. These were tested by the Xpert MTB/RIF assay, followed by targeted next-generation sequencing performed directly on sputum. The prevalence of rifampicin resistance was low, at 1.8% (95% CI: 1.0–3.2) among new and 17.3% (95% CI: 11.9–24.4) among previously treated patients. Resistance to pyrazinamide, fluoroquinolones and second-line injectables was also low. The prevalence of resistance to isoniazid among rifampicin-susceptible patients was higher, at 6.6% (95% CI: 4.4–9.8) among new and 8.7% (95% : 3.2–21.2) among previously treated patients. Diagnosing and treating isoniazid-resistant patients remains a challenge, given that many will be missed by the current national diagnostic algorithm that is driven by detecting rifampicin resistance by Xpert MTB/RIF. This is the first nationwide survey incorporating targeted sequencing directly on sputum. It serves as a proof-of-concept for other settings that do yet have rapid specimen transport networks or capacity to conduct culture.

The surveillance of drug resistance among tuberculosis (TB) patients is central to preventing the spread of antimicrobial resistance. The Democratic Republic of the Congo (DR Congo) is classified by the World Health Organization (WHO) as a country with a high burden of TB and multidrug-resistant TB (MDR-TB), but there are no nationally representative data on drug resistance. In 2016-2017, a national survey of TB patients was conducted in 108 microscopy centres across all 11 provinces of the country using innovative molecular approaches. Sputum samples were collected from 1,545 new and 163 previously treated patients. These were tested by the Xpert MTB/RIF assay, followed by targeted next-generation sequencing performed directly on sputum. The prevalence of rifampicin resistance was low, at 1.8% (95% CI: 1.0-3.2) among new and 17.3% (95% CI: 11.9-24.4) among previously treated patients. Resistance to pyrazinamide, fluoroquinolones and second-line injectables was also low. The prevalence of resistance to isoniazid among rifampicin-susceptible patients was higher, at 6.6% (95% CI: 4.4-9.8) among new and 8.7% (95% : 3.2-21.2) among previously treated patients. Diagnosing and treating isoniazid-resistant patients remains a challenge, given that many will be missed by the current national diagnostic algorithm that is driven by detecting rifampicin resistance by Xpert MTB/RIF. This is the first nationwide survey incorporating targeted sequencing directly on sputum. It serves as a proof-of-concept for other settings that do yet have rapid specimen transport networks or capacity to conduct culture.

The surveillance of drug resistance among tuberculosis (TB) patients is central to preventing the spread of antimicrobial resistance. The Democratic Republic of the Congo (DR Congo) is classified by the World Health Organization (WHO) as a country with a high burden of TB and multidrug-resistant TB (MDR-TB), but there are no nationally representative data on drug resistance. In 2016-2017, a national survey of TB patients was conducted in 108 microscopy centres across all 11 provinces of the country using innovative molecular approaches. Sputum samples were collected from 1,545 new and 163 previously treated patients. These were tested by the Xpert MTB/RIF assay, followed by targeted next-generation sequencing performed directly on sputum. The prevalence of rifampicin resistance was low, at 1.8% (95% CI: 1.0-3.2) among new and 17.3% (95% CI: 11.9-24.4) among previously treated patients. Resistance to pyrazinamide, fluoroquinolones and second-line injectables was also low. The prevalence of resistance to isoniazid among rifampicin-susceptible patients was higher, at 6.6% (95% CI: 4.4-9.8) among new and 8.7% (95% : 3.2-21.2) among previously treated patients. Diagnosing and treating isoniazid-resistant patients remains a challenge, given that many will be missed by the current national diagnostic algorithm that is driven by detecting rifampicin resistance by Xpert MTB/RIF. This is the first nationwide survey incorporating targeted sequencing directly on sputum. It serves as a proof-of-concept for other settings that do yet have rapid specimen transport networks or capacity to conduct culture.

Cover -- Half Title -- Title Page -- Copyright Page -- Table of Contents -- Contributors -- Abbreviations -- Preface -- Part I: Biological Hazards in Foods and Food Products -- Chapter 1: Potential Threat of Mycotoxins to Food Safety and Security -- Chapter 2: Potential Concern of Foodborne Pathogens in the Food Industry -- Chapter 3: Rapid Isothermal Nucleic Acid Dependent Techniques for On-Site Diagnosis of Foodborne Pathogens -- Chapter 4: Antimicrobial Resistance in Food Grade Lactic Acid Bacteria -- Chapter 5: Zoonoses: Infectious Diseases in Humans -- Part II: Chemical Hazards in Milk and Milk Products -- Chapter 6: Milk Adulteration: Current Scenario and Challenges -- Chapter 7: Antibiotic Residues in Milk: Control Strategies in Dairy Animals -- Chapter 8: Heavy Metal Contamination in Milk and Milk Products -- Chapter 9: Detection of Pesticides Residues in Milk and Milk Products -- Part III: Food Safety Hazards: Practices and Management -- Chapter 10: Food Safety Management Systems in the Food Processing Industry -- Chapter 11: Current Trends and Advances in Food Allergy Management -- Chapter 12: Anti-Nutritive and Therapeutic Properties of Lectins -- Chapter 13: Recall of Food Products: Practices and Lessons -- Index.

This open access book explores a special species of trouble afflicting modern societies: creeping crises. These crises evolve over time, reveal themselves in different ways, and resist comprehensive responses despite periodic public attention. As a result, these crises continue to creep in front of our eyes. This book begins by defining the concept of a creeping crisis, showing how existing literature fails to properly define and explore this phenomenon and outlining the challenges such crises pose to practitioners. Drawing on ongoing research, this book presents a diverse set of case studies on: antimicrobial resistance, climate change-induced migration, energy extraction, big data, Covid-19, migration, foreign fighters, and cyberattacks. Each chapter explores how creeping crises come into existence, why they can develop unimpeded, and the consequences they bring in terms of damage and legitimacy loss. The book provides a proof-of-concept to help launch the systematic study of creeping crises. Our analysis helps academics understand a new species of threat and practitioners recognize and prepare for creeping crises.

Abstract
The sixth UN Sustainable Development Goal, Clean Water and Sanitation, directly underpins other goals of Health, Life in Water and Sustainable Cities. We highlight that poor sanitation, exemplified through some of the highest concentrations of pharmaceuticals ever detected in rivers, will amplify societal and environmental stress where climate-induced reductions in flow are predicted. Rapidly growing urban centres with inadequate water treatment works will need to prioritise water quality improvement before supply reductions become a reality. For 23 river locations within Kathmandu City and the Annapurna region, Nepal, we show the presence of 28 of 35 monitored human-use pharmaceuticals. Concentrations of antibiotics measured in this sampling campaign in both Kathmandu City (sulfamethazine, metronidazole and ciprofloxacin) and rural locations (ciprofloxacin) are in excess of predicted no effect concentrations, suggesting these sites are at risk of proliferating antimicrobial resistance as well as affecting other ecotoxicological endpoints. It is anticipated that climate-induced reductions in flow combined with contaminated river systems will amplify future societal and environmental stress.

Antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity, especially in low-resource settings, and requires an interdisciplinary response across academia, government, countries, and societies. If unchecked, AMR will hamper progress towards reaching the United Nations Sustainable Development Goals (SDGs), including ending poverty and hunger, promoting healthy lives and well-being, and achieving sustained economic growth. There are many global initiatives to curb the effects of AMR, but significant gaps remain. New ways of thinking and operating in the context of the SDGs are essential to making progress. In this entry, we define the next generation of the AMR research network, its composition, and strategic activities that can help mitigate the threats due to AMR at the local, regional, and global levels. This is supported by a review of recent literature and bibliometric and network analyses to examine the current and future state of AMR research networks for global health and sustainable development.

Military metaphors shape the limits and possibilities for conceptualising and responding to complex challenges of contagion. Although they are effective at communicating risk and urgency and at mobilising resources, military metaphors collapse diverse interests and communities into 'fronts', obscure alternative responses, and promote human exceptionalism. In this article, I draw from criticisms of the use of military metaphor in scientific and policy descriptions of antimicrobial resistance (AMR) over the past sixty years on order to compare with and explore the use of military metaphors in descriptions of the COVID-19 pandemic. As AMR research has recognised the importance of symbiotic human–microbe relationships and new areas of interdisciplinary collaboration in recent years, a corresponding decline in the use of military metaphor in scientific discourse has begun to emerge. I ask how the legacy of the military metaphor in AMR research can offer lessons regarding or alternatives to the martial language currently saturating responses to the COVID-19 pandemic in the UK.

Antimicrobial resistance (AMR) requires a multifaceted response via a One Health approach. Antibiotics make procedures including joint replacement, transplantation, cancer chemotherapy, and premature newborn care possible. The U.S. Centers for Disease Control and Prevention (CDC) estimates that 2 million Americans are infected and >35,900 die from AMR, costing over $20 billion/year. Projections are that this will increase to 350 million cumulative AMR deaths by 2050. In its 2004 report entitled "Bad Bugs, No Drugs: As Antibiotic R&D Stagnates, A Public Health Crisis Brews," the Infectious Diseases Society of America (IDSA) raised alarm and proposed solutions. In the face of decreasing Food and Drug Administration (FDA) approvals and several program failures, scientific collaboration and regulatory innovation led to updated guidance for common, life-threatening infections. The IDSA and others worked to advance policies for discovery and development of drugs for the most resistant infections. Successes include legislation and public-private partnerships that provide push incentives. Need exists for pull incentives; several models are currently being explored.

The medical professions will lose an indispensable tool in clinical practice if even simple infections cannot be cured because antibiotics have lost effectiveness. This article presents results from an exploratory enquiry into "good doctoring" in the case of antibiotic prescribing at a time when the knowledge base in the healthcare field is shifting. Drawing on in-depth interviews about diagnosing and prescribing, the article demonstrates how the problem of antimicrobial resistance is understood and engaged with by Danish general practitioners. When general practitioners speak of managing "non-medical issues," they refer to routines, clinical expertise, experiences with their patients, and decision-making based more on contextual circumstances than molecular conditions—and on the fact that such conditions can be hard to assess. This article's contribution to knowledge about how new and global health problems challenge professional actors affirms the importance of such a research agenda and the need for further exploration of the core problems posed by transnational sociology of professions.