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Our poster discusses an overview of antibiotic resistance. It goes into detail about what it is, how it came to be, and what medical professionals can do in their attempt to prevent it, as well as the general public. It also discusses the impact the impact antibiotic resistance has had on pharmacy, as well as the science behind it. A few organizations working towards this problem, and who keep a close eye on this issue are mentioned as well. We also discuss the determinants of health, which is essentially what is being done about it politically, individually, and the health services provided. Our goal is to stress the importance of properly taking antibiotics, and the potential to prevent this problem from happening. We hope you take some insight behind this issue after reading, and sparks an interest in this topic. ; https://digitalcommons.cedarville.edu/public_health_posters/1020/thumbnail.jpg

Immediately after their introduction in the beginning of the fourties of the previous century, the agents used to combat infectious diseases caused by bacteria were regarded with suspicion, but not long thereafter antibiotics had the status of miracle drugs. For decades mankind has lived under the impression that infectious diseases were no longer a threat to human health. This optimism was so high at a certain moment that antibiotics were also used against viral infections, whereas viruses are not even sensitive to antibiotics. This wrong use, or if one likes, misuse of antibiotics took also place in animal husbandry, where many tons of antibiotics were added to the feed of healthy animals, just because they grew so nicely from these additives. However, also in the use of antibiotics an ancient law in physics, "action equals reaction" turned out to be applicable. Bacteria reacted to the fact that they were attacked by changing their hereditary properties (through mutation) or by taking up parts of the hereditary properties of organisms (bacteria and fungi) able to produce certain antibiotics themselves. As a result of this reaction, already a short while after the introduction of antibiotics, the first bacteria could be isolated that had become insensitive (immune) for particular antibiotics. The bacteria in fact, had even more surprises in store. They turned out to be fanatic collectors of the pieces of hereditary properties that made them immune for antibiotics and like a stamp collector puts his stamps in an album, they also put their collection in an album (an integron). In this way, the best collectors have now become insensitive to more than ten different types of antibiotics. At the moment there are even bacteria that are not sensitive anymore to whatever type of antibiotic and for these bacteria treatment with antimicrobial agents is no longer available. Where, "work together, live together" is the current motto of the Dutch government, "work together to survive together" might be the motto of bacteria. They put this into practice by passing on their album with its integron collection from one bacterial species to the other. In this way a bacterium that used to be sensitive and could very well be treated with antibiotics can in one stroke become resistant to sometimes thirteen different antimicrobial agents, resulting in the fact that an infection with such a bacterium becomes untreatable. In this thesis research with respect to the sensitivity of the bacterium Salmonella, which can cause intestinal infections in human and animals, for antimicrobial agents is described. Since the (wrong) use of antibiotics can influence the development of resistance to antibiotics, in these studies a comparison has been made between Salmonella bacteria isolated from human, pigs, cattle and poultry in Vietnam and The Netherlands. Whereas in The Netherlands antibiotics are only available on prescription by a physician or veterinarian, antibiotics can be purchased over the counter in Vietnam. This leads to a significantly different attitude in both countries with respect to handling antibiotics. Examples are i.e. not taking a course of antibiotics of the correct dose, not taking a course of antibiotics of sufficient duration, not only taking a course of antibiotics in the case of bacterial infections and the continuing use of antibiotics as growth promoters in Vietnam. Resistance to antibiotics in Salmonella bacteria isolated in Vietnam turned out to occur frequently. In the Netherlands where the development of resistance has been monitored and registered for years the problem was hardly less. In Salmonella isolates from some animal species even resistance to antibiotics for which the use of that antibiotic is not allowed in that animal, was observed. In the current studies Salmonella bacteria have been isolated, both in Vietnam and in the Netherlands that have a collection in their integron album which is unique and has not been described before. At the end of the thesis the measures that could be taken to counteract the development of antibiotic resistance are discussed. The necessity of continuously making an inventory of the situation at local, regional, national and global level is accentuated, as is the shared responsibility that the government and civilians have with respect to the improper use of antibiotics.

The discovery and subsequent clinical introduction of antibiotics is one of the most important game changers in the history of medicine. Antibiotics are widely used in dental practice both for therapeutic and prophylactic reason. Unfortunately, in recent years the use of antibiotics has been accompanied by the rapid emergence of antimicrobial resistance causing a major threat to healthcare system. Solid guideline or recommendation is often lacking regarding prescription of antibiotic in dentistry.Issuing antibiotic prescribing guidelines, antibiotic stewardship program, addressing over the counter sale of antibiotics,education programmes can be considered useful for curbing antibiotic abuse. To highlight the severity of the issue, several international declarations have been published to call upon the government around the globe to take action on antibiotic resistance.

INTRODUCTION: Antibiotic-resistant infections have become increasingly prevalent nowadays. As a result, it is essential to examine the key socioeconomic and political factors which contribute to the rise in the prevalence of antibiotic resistance in developing and developed nations. This study aims to identify the various contributors to the development of antibiotic resistance in each type of nation. METHODS: PUBMED was used to identify primary research, systematic reviews, and narrative reviews published before Jan 2017. Search terms included antibiotic resistance, antimicrobial resistance, superbugs, multidrug-resistant organisms, developing countries, developed countries. Publications from different countries were included to ensure generalizability. Publications were excluded if they didn't mention factors causing resistance, focused on the molecular basis of resistance, or if they were case reports. Publicly available reports from national and international health agencies were used. RESULTS: In developing countries, key contributors identified included: (1) Lack of surveillance of resistance development, (2) poor quality of available antibiotics, (3) clinical misuse, and (4) ease of availability of antibiotics. In developed countries, poor hospital-level regulation and excessive antibiotic use in food-producing animals play a major role in leading to antibiotic resistance. Finally, research on novel antibiotics is slow ing down due to the lack of economic incentives for antibiotic research. CONCLUSION: Overall, multiple factors, which are distinct for developing and developed countries, contribute to the increase in the prevalence of antibiotic resistance globally. The results highlight the need to improve the regulatory framework for antibiotic use and research globally.

A.baumannii is an opportunistic bacterium that has emerged in recent decades as a causative agent of potentially epidemic nosocomial infections. This bacterium has been able to develop an impressive resistance against the majority of antibiotics, which explains the therapeutic difficulties encountered. The objective of this work is to determine, through a retrospective study, the epidemiological profile, and the antibiotic resistance of A.baumannii strains isolated from diagnostic specimens made at Avicenne military hospital of Marrakech, and follow their evolution over 5 years (2012-2017). A.baumannii accounted for 3.75% of all isolated organisms during this period (n = 183). All hospital services were concerned, with a predominance of reanimation units (66% of isolates). The results obtained showed that these pathogens originate in 53% of the protected specimen brush and the main infectious sites were pneumopathies and urinary tract infections. An increase in the resistance of A.baumannii isolates for all antibiotics tested was observed (Ceftazidime 87%, Céfépime98%, Imipenem 84%, Ciprofloxacin 96% and Gentamicin 61%). However, all strains remained sensitive to Colistin. These results confirm the multidrug-resistant nature of A.baumannii and its nosocomial nature. This resistance represents a serious therapeutic and epidemiological problem, hence the need for the establishment of a system for monitoring the microbial environment of the hospital and the strict application of preventive measures.

1. Definitions and basic concepts -- 2. Have antibiotics and antibiotic resistance genes always been out there? -- 3. Human-related release of antibiotics into the environment -- 4. Spread of resistant organisms from human settlements into the environment -- 5. Impact of antibiotics and resistance in non-clinical settings.

Policy-makers play a key role in tackling the emerging public health problem of antibiotic resistance. Antibiotic resistance is a result of the misuse, and especially the overuse, of antibiotics. Antibiotic resistance leads to excess morbidity and deaths. The problem is urgent. In the European Union more than 25 000 people die each year from common resistant bacterial infections. Owing to variable diagnostic capacity and a lack of data in countries, including Albania the number for the whole Region is not known. Antibiotic resistance increases health care costs. The estimated total cost to society of antibiotic resistance in the European Union alone is estimated to be € 1.5 billion resistant bacteria or genes that carry this information can spread easily. The use of antibiotics in animals sometimes outweighs their use in humans. Antibiotic resistance could take us back to the pre-antibiotic era. The complexity of the problem and the large number of sectors involved require strong national coordination, surveillance systems, national guidelines and sector-wide action plans. Based on good practices of national coordination of several European countries in many countries serve as reference in the conclusions to develop strategic action plan by the Albanian health institutions that aim to: I. Strengthen national multi sectorial coordination for the containment of antibiotic resistance II. Strengthen national surveillance of antibiotic resistance III. Promote national strategies for the rational use of antibiotics and strengthen national surveillance of antibiotic consumption IV. Strengthen infection control and surveillance of antibiotic resistance in health care settings V. Prevent and control the development and spread of antibiotic resistance in the food chain VII. Improve awareness, patient safety and partnership The complex nature of antibiotic resistance and the use of antibiotics requires the involvement of a wide array of actors:

The antibiotic resistance (antimicrobial resistance – AMR) and the particular emergence of multi-resistant bacterial strains, is a problem of clinical relevance involving serious threats to public health worldwide. From early this decade, a lot of studies have demonstrated a significant increase in the rates of antibiotic resistance by bacterial pathogens responsible for nosocomial and community infections all over the world. The AMR leads to a reduced drug efficacy in the treatment options available and therefore, to an increase in mortality rates. The original causes of the phenomenon are: environmental factors which favor a mutation of the genetic bacterial inheritance, thereby inhibiting the active ingredient of the antibiotics; unsuitable administering of antibiotics in veterinary, incorrect taking both in hospitals and at home and, lately, lack of investments in the development of new drugs. The alarming epidemiological data prompted the World Health Organization (WHO) in 2011 to coin the slogan "No action today, no cure tomorrow" in order to immediately implement a new strategy to improve the use of available drugs and to accelerate the introduction of new ones through a new phase of research involving private and public institutions. The European Union has stressed that the surveillance is considered an essential factor for an effective response to this problem but it has also highlighted that the results produced have been lower than expectations because of serious shortcomings such as lack of methodological standards, insufficient data sharing and no coordination among European countries. In Italy the situation is much more troubling; in fact, according to the Ministry of Health, 5000-7000 yearly deaths are deemed due to nosocomial infections, with an annual cost of more than 100 million €.These figures explain how the fight against infections is far from being won. The purpose of this review is to analyze the basic causes of the recurrence of the phenomenon, to explain the steps taken by the most important international organizations to face AMR and finally to suggest a possible way to search for new classes of antibiotics.

The antibiotic resistance (antimicrobial resistance – AMR) and the particular emergence of multi-resistant bacterial strains, is a problem of clinical relevance involving serious threats to public health worldwide. From early this decade, a lot of studies have demonstrated a significant increase in the rates of antibiotic resistance by bacterial pathogens responsible for nosocomial and community infections all over the world. The AMR leads to a reduced drug efficacy in the treatment options available and therefore, to an increase in mortality rates. The original causes of the phenomenon are: environmental factors which favor a mutation of the genetic bacterial inheritance, thereby inhibiting the active ingredient of the antibiotics; unsuitable administering of antibiotics in veterinary, incorrect taking both in hospitals and at home and, lately, lack of investments in the development of new drugs. The alarming epidemiological data prompted the World Health Organization (WHO) in 2011 to coin the slogan "No action today, no cure tomorrow" in order to immediately implement a new strategy to improve the use of available drugs and to accelerate the introduction of new ones through a new phase of research involving private and public institutions. The European Union has stressed that the surveillance is considered an essential factor for an effective response to this problem but it has also highlighted that the results produced have been lower than expectations because of serious shortcomings such as lack of methodological standards, insufficient data sharing and no coordination among European countries. In Italy the situation is much more troubling; in fact, according to the Ministry of Health, 5000-7000 yearly deaths are deemed due to nosocomial infections, with an annual cost of more than 100 million €.These figures explain how the fight against infections is far from being won. The purpose of this review is to analyze the basic causes of the recurrence of the phenomenon, to explain the steps taken by the most important international organizations to face AMR and finally to suggest a possible way to search for new classes of antibiotics.

Antibiotic resistance in the environment: expert perspectives -- Antibiotic resistant bacteria in wildlife -- Genomic surveillance for One Health antimicrobial resistance: understanding human, animal, and environmental reservoirs and transmission -- Antibiotic resistance in pharmaceutical industry effluents and effluent-impacted environments -- Antibiotic resistance in municipal wastewater: A special focus on hospital effluents -- Control strategies to combat dissemination of antibiotic resistance in urban water systems -- Antibiotic resistance, sanitation and public health -- Antibiotic resistance and sanitation in India: current situation and future perspectives -- Mitigating antimicrobial resistance risks when using reclaimed municipal wastewater for agriculture -- Antibiotic resistance in soil -- Religious Mass Gathering (Hajj) and Antimicrobial Resistance: From Challenges to Opportunities -- Human movement and transmission of anti-microbial resistant bacteria.

Bacteria have an enormous genetic plasticity and adaptive potential that enables them toinhabit almost every ecological niche on this planet and respond to drastic environmental changes. While this bacterial diversity and flexibility is highly fascinating and provides us with immense resources, it can also put human health at risk, e.g. when pathogenic bacteria adapt to antibiotics and become resistant. As antibiotic resistant bacteria increase human morbidity and mortality it is crucial to take action. The antibiotic resistance crisis is addressed on multiple levels including governmental and non-governmental programs, education, public health campaigns as well as academic and industrial research in epidemiology, medicine, pharmacology,biology and chemistry. The work conductedin this thesis contributes to the antibiotic resistance research by providing novel tools to studyde novo antibiotic resistance evolution in a more systematic and high-throughput fashion. Moreover, these tools were utilized to characterize the genetic trajectories of de novo antibiotic resistance evolution,predominantly in the model organism Escherichiacoli. Genetic constrains were identified, like negative epistatic interactions between different resistance modes or collateral sensitivity, and subsequently exploited by creating a framework to rationally design drug combinations inorder to limit de novo resistance evolution. Finally, limitations in efficiency and geneticresponses to novel CRISPR-based antimicrobials were studied and based on the findings factors crucial to optimize killing efficiency were identified. In short, this thesis contributes to our understanding of antibiotic resistance evolution, providing suggestions for novel and improved treatment options that likely contribute to limiting resistance evolution and treatment of resistant bacteria