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A letter report issued by the General Accounting Office with an abstract that begins "Pursuant to a congressional request, GAO provided information on the potential threat to the public's health from antimicrobial resistant bacteria, focusing on: (1) what is known about the public health burden--in terms of illnesses, deaths and treatment costs--due to antimicrobial resistance; (2) potential future burden, given what is known about the development of resistance in microbes and usage of antimicrobials; and (3) federal efforts to gather and provide information about resistance."

To address the public health problem of antibiotic resistance, the European Union (EU) founded the European Antimicrobial Resistance Surveillance System. A network of 40 hospitals that serve approximately 30% of the Spanish population (about 12 million) participated. Each laboratory reported data on antimicrobial susceptibility testing using standard laboratory procedures that were evaluated by an external quality control program. The antibiotic consumption data were obtained from the National Health System. We compared the antibiotic susceptibility of Spanish isolates of invasive Streptococcus pneumoniae (2001 to 2003) with antibiotic consumption. Invasive S. pneumoniae was isolated from 1,968 patients, 20% of whom were children at or below the age of 14 years. Of non-penicillin-susceptible strains (35.6%; 95% confidence interval, 34 to 37.2), 26.4% were considered intermediate and 9.2% were considered resistant. Between 2001 and 2003, penicillin resistance decreased from 39.5 to 33% overall and from 60.4 to 41.2% in children at or below the age of 14 years (P = 0.002). Resistance to erythromycin was at 26.6%, and coresistance with penicillin was at 19.1%. Of total isolates, the ciprofloxacin MIC was >2 μg/ml for 2.1%, with numbers increasing from 0.4% (2001) to 3.9% (2003). Total antibiotic use decreased from 21.66 to 19.71 defined daily doses/1,000 inhabitants/day between 1998 and 2002. While consumption of broad-spectrum penicillins, cephalosporins, and erythromycin declined, use of amoxicillin-clavulanate and quinolones increased by 17.5 and 27%, respectively. The frequency of antibiotic resistance in invasive S. pneumoniae in Spain was among the highest in the EU. However, a significant decrease in penicillin resistance was observed in children. This decrease coincided with the introduction of a heptavalent conjugate pneumoccocal vaccine (June 2001) and with a global reduction in antibiotic consumption levels.

From 1995 to 2000, a total of 673 Enterococcus faecium and 1,088 Enterococcus faecalis isolates from pigs together with 856 E. faecium isolates from broilers were isolated and tested for susceptibility to four classes of antimicrobial agents used for growth promotion as part of the Danish program of monitoring for antimicrobial resistance. The four antimicrobials were avilamycin, erythromycin, vancomycin, and virginiamycin. Major changes in the use of antimicrobial agents for growth promotion have occurred during the last 6 years in Denmark. The government banned the use of avoparcin in 1995 and of virginiamycin in 1998. Furthermore, the producers have voluntarily stopped all use beginning in 1999. The avoparcin ban in 1995 was followed by a decrease in the occurrence of glycopeptide-resistant E. faecium (GRE) in broilers, from 72.7% in 1995 to 5.8% in 2000. The occurrence of glycopeptide resistance among isolates from pigs remained constant at around 20% from 1995 to 1997. It was shown that, in GRE from pigs, the genes encoding macrolide and glycopeptide resistance were genetically linked and that, following the decrease in the use of tylosin during 1998 and 1999, the occurrence of GRE in pigs decreased to 6.0% in 2000. From 1995 to 1997 the occurrence of erythromycin resistance among E. faecium and E. faecalis isolates from pigs was almost 90%. Use of tylosin decreased considerably during 1998 and 1999, and this decrease was followed by decreases in the occurrence of resistance to 46.7 and 28.1% among E. faecium and E. faecalis isolates from pigs, respectively. Erythromycin resistance among E. faecium isolates from broilers reached a maximum of 76.3% in 1997 but decreased to 12.7% in 2000 concomitantly with more limited use of virginiamycin. Use of virginiamycin increased from 1995 to 1997 and was followed by an increased occurrence of virginiamycin resistance among E. faecium isolates in broilers, from 27.3% in 1995 to 66.2% in 1997. In January 1998 the use of virginiamycin was banned in Denmark, and the ...

İnönü Üniversitesi Tıp Fakültesi Dergisi 10(4) 173-175 (2003) ; Çalışmamızın amacı antimikrobiyal ajanlara karşı stafilokokların direnç oranlarını incelemektir. Bu epidemiyolojik ve tedavi açısından faydalı olabilir. Yöntem: Farklı numunelerden izole edilen Stafilokok'lar geleneksel yöntemlerle tanımlandı. Antibiyotiklere duyarlılık testi NCCLS önerilerine göre disk diffüzyon yöntemi ile yapıldı. Sonuçlar: Koagulaz negatif stafilokok'larda antibiyotiklere (KNS) direnç oranı S. aureus'dan daha yüksek bulundu. Ellisekiz koagulaz negatif stafilokok suşunun 'u teikoplanine, 'i siprofloksasine, 'i gentamisine, 'ü ko-trimaksazol ve klindamisine, 'u eritromisine, 'sı penisiline, 'sı oksasiline dirençli bulundu. Bu suşların 'sı çoğul dirence sahipti, S. aureus'da da çoğul direnç gözlendi, ancak CNS'den daha düşüktü (). Otuziki S. aureus suşunun, 'si ko-trimaksazole, 'i teikoplanine, 'sı eritromisine, 'si klindamisine, 'i gentamisine, 'i siprofloksasine, 'i oksasiline ve tümü penisiline dirençli saptandı. Vankomisine direnç gözlenmedi. Tartışma: Antibiyotik kullanımının yaygın olduğu yoğun bakım ünitelerinde, dirençte ve çoğul dirençte artış vardır. Bu nedenle ihtiyatlı antibiyotik kullanım politikalarının uygulanması gereklidir. ; The aim of this study is to determine the resistance ratios of staphylococci to antimicrobial agents in intensive care units that might be useful from therapeutic and epidemiological points of view. Methods: Staphylococcus spp. were isolated from different specimens and identified according to conventional methods. Antimicrobial susceptibility test was performed by disk diffusion method according to proposals of NCCLS. Results: The incidence of resistance is higher among coagulase-negative staphylococcus (CNS) than Staphylococcus aureus. The antimicrobial resistance of 58 strains of CNS isolates was 29% teicoplanin, 51% ciprofloxacin, 58% gentamicin, 63% for each of co-trimoxazole and clindamycin, 79% erythromycin, 86% oxacillin and 96% penicillin. The multiple antimicrobial resistances were revealed by 96% of CNS isolates. The multiple antimicrobial resistance was also observed in S. aureus isolates but less than CNS (78%). Of 32 S. aureus isolates, 12% co-trimoxazole, 25% teicoplanin, 46% erythromycin, 50% clindamycin, 68% gentamicin, 71% ciprofloxacin, 81% oxacillin and 100% penicillin were resistant. No resistance to vancomycin was observed. Conclusion: The findings revealed an increase in incidence of resistance and multiple antimicrobial resistant strains to commonly used antimicrobials in intensive care units. Therefore, prudent policy in prescribing and using of antibiotics is indispensable.

Recent qualitative analyses warn of potential future human health risks from emergence of antibiotic resistance in food‐borne pathogens due to the use of similar antimicrobial drugs in both food animals and human medicine. While historical data suggest that human health risks from some animal antimicrobials, such as virginiamycin (VM), have remained low (McDonald et al., 2001), there is a widespread concern that "resistance epidemics" or endemics could arise in the future. How reassuring is the past about the future? This article applies quantitative risk assessment methods to help find out, using human health risks from VM and the nearly identical human antimicrobial quinupristin‐dalfopristin (QD) as a case study. A dynamic simulation model is used to predict the risks of emerging resistance to human antimicrobials in human populations from given input assumptions. Bayesian Monte Carlo uncertainty analysis allows past data to constrain and inform selection of input parameter values, and thus to predict the possible future resistance patterns that are consistent with historical data. The results show that health risks from VM use in food animals are highly sensitive to the human prescription rate of QD. For realistic prescription rates, quantitative risks are less than 1 × 10−6 even for members of the most‐threatened (ICU patient) population, while societal risks are <1 excess statistical death per year for the whole U.S. population. Such quantitative estimates complement more qualitative assessments that discuss the possibility of future "resistance epidemics" (or endemics) without quantifying their probabilities.

The intensive and inappropriate use of antibiotics in both medicine and agriculture has selected for antibiotic resistant bacteria that cause severe problems in antibiotic therapy. In animal husbandry, antibiotics are used for therapeutic and preventive treatments of infectious diseases and as growth promoters. In Europe, many antibiotics used as growth promoters were of the same classes as important antibiotics used in human medicine. The European Union withdrew the authorization for the use of the major antimicrobial growth promoters between 1996 and 1999. In 1999 Switzerland decided to ban the use of all antimicrobials as growthpromoting feed additives. The regulations concerning antibiotic use in animal husbandry and the chronological reasons for the ban of antimicrobial growth promoters are described. This ban led to a decrease of the antibiotic volume deployed in agriculture. This measure helps to reduce the amount of antibiotic resistant bacteria in food-producing animals. However, the use of medicated feed is still a common practice to prevent and to remedy bacterial infections and thus still leads to resistant pathogens. Surveillance programs, single animal treatment, good manufacturing practices and vaccinations are additional measures to be taken to keep the level of resistances in bacteria low.

Antibiotic resistance and emm gene types were examined from 692 Group A streptococci isolates from eight United States military basic training sites between 1998 and 2001. Macrolide resistance was associated with geographic sites and emm type. These data are useful for vaccine development initiatives and antimicrobial treatment considerations.

Although the acidic surface pH of the skin has been known for over a century, the stratum corneum (SC) pH gradient has been discovered only recently. After removal of SC layers with sequential tape strips, in humans, surface pH starts at 4.5–5.3, increasing by about 2–3 units until it reaches 6.8 in the lower SC. Both exogenous [free fatty acids (FFA) from sebaceous lipid, microbial metabolites, lactic acid from eccrine glands] and endogenous epidermal (enzymatic; membrane antiporters/pumps) mechanisms have been hypothesized to contribute to SC acidification. Three endogenous mechanisms have been identified to date that not only could influence SC pH, but also regulate one or more key SC functions: (1) the histidine-to-urocanic-acid pathway; (2) the phospholipid-to-FFA pathway, and (3) the sodium proton antiporter (NHE1). Additional factors that influence human surface pH have been detected. Endogenous factors, unrelated to pathological features, such as racial differences, topographical variation, gender differences, developmental and age-related changes have been reported. In contrast to adults, human newborn SC displays a near-neutral surface pH, which declines rapidly over the first postnatal month. Furthermore, endogenous factors have been described, as in atopic dermatitis, seborrheic dermatitis, diabetes, renal insufficiency and ichthyosis associated with an increased pH. Exogenous factors, like the use of detergents and cleansing products as well as SC hydration, can modify the surface pH. The consequences of SC acidification for several key SC functions are becoming clear, including (1) the role of an acidic pH for SC permeability barrier homeostasis, (2) the pH dependence of extracellular lipid processing and (3) SC integrity/cohesion. Integrity is defined as a measure of resistance to dissociation of adjacent corneocytes by tape stripping (cohesion is a related index defined as the amount of protein removed per stripping). (4) Proteolytic processes leading to desquamation are pH dependent, and (5) an acidic pH provides important antimicrobial resistance.

8 pages, 2 figures, 3 tables.-- PMID: 14623382 [PubMed].-- Printed version published Dec 31, 2003. ; In this study, we evaluated the activity of short antimicrobial peptides against different fungal isolates that cause postharvest decay of fresh fruits. The previously identified hexapeptides PAF19, PAF26 and LfcinB4-9 inhibited the in vitro growth of isolates from Penicillium digitatum and P. italicum, and from Alternaria and Geotrichum genera, being no active against Rhizopus, Mucor and Aspergillus. The results extend our previous observations on the specific and distinct activity profiles of PAFs. In addition, peptide activities were compared with that of two fungicides used for citrus fruit preservation, thiabendazol (TBZ) and imazalil (IMZ). We observed a lack of correlation between peptide and fungicide sensitivity among different species. Importantly, P. digitatum and P. italicum isolates resistant to fungicides were susceptible to peptides, and our data suggest that common multiple drug resistance mechanisms are not active against this class of peptides. The in vitro peptide inhibition was correlated with a retard of the decay caused by Penicillium on citrus fruits, and this effect was comparable for both fungicide-resistant and -sensitive isolates. Comparison of PAF26 and TBZ in vitro MIC values and their in vivo effect on citrus decay indicated that PAF26 performed in vivo better than TBZ. ; Belén López-García was recipient of a pre-doctoral fellowship from Generalitat Valenciana (Spain). This work was supported by grant BIO4-CT97-2086 from the European Union. ; Peer reviewed

From June to October 1995, the U.S. Army's 86th Combat Support Hospital was deployed in Haiti in support of the United Nations peacekeeping mission. The hospital's mission was to provide comprehensive health care to United Nations military and civilian personnel in Haiti. The hospital's laboratory, with microbiological and parasitological capability, was a critical asset in light of the infectious disease threats in Haiti. A total of 356 microbiological (5.4%) and 887 parasitological (13.4%) tests were performed, out of a total of 6628 laboratory tests. One finding was the discovery of antibiotic-resistant urinary isolates of Escherichia coli. These were from community-acquired infections and included strains resistant to ampicillin (6/15), trimethoprim+sulfamethoxazole (6/15), and ciprofloxacin (2/15). Ampicillin (8/15) and trimethoprim+sulfamethoxazole (3/15) resistance was also noted in Shigella spp. However, no chloroquine-resistant strains of malaria were encountered. Dengue virus, also mosquito borne, was a major pathogen. Antimicrobial-resistant nosocomial pathogens were also encountered. Deployed laboratories should be able to determine antimicrobial susceptibility and perform microbial identification to guide clinical management, conduct medical surveillance, and detect emerging resistance.

A letter report issued by the General Accounting Office with an abstract that begins "According to the World Health Organization, infectious diseases account for more than 13 million deaths every year, including nearly two-thirds of all deaths among children under age 5. Infectious diseases present a substantial threat to people in all parts of the world, and this threat has grown in volume and complexity. New diseases have emerged, others once viewed as declining in significance have resurged in importance, and many have developed substantial resistance to known antimicrobial drugs. Infectious disease surveillance provides national and international public health authorities with information that they need to plan and manage efforts to control these diseases. In the mid-1990s, public health experts in the United States and abroad determined that global infectious disease surveillance was inadequate, and both the World Health Assembly and the President of the United States called for the development of an effective global infectious disease surveillance and response system. The strongest influence on the evolution of the current global infectious disease surveillance framework has been the international community's focus on specific diseases or groups of diseases. The international community has created diverse surveillance programs to support global and regional efforts to control particular diseases. Surveillance systems in all countries suffer from a number of common constraints. However, these constraints have their greatest impact in the poorest countries, where per capita expenditure on all aspects of health care amounts to only about three percent of expenditures in high-income countries. Surveillance in developing countries is often impaired by shortages of human and material resources. The international community recently launched several initiatives that may improve global surveillance. The community has committed itself to reducing the global burdens imposed by three diseases--tuberculosis, human immunodeficiency virus/acquired immunodeficiency syndrome, and malaria. The community has also begun more broadly targeted initiatives to upgrade laboratories, strengthen epidemiological capacity, and otherwise improve surveillance for infectious diseases as a whole."