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"This book explores the role that environmental distribution of antimicrobial resistance genes and antibiotics plays in ecosystem and human health. The text features a multi-disciplinary framework that connects microbiology, environmental toxicology, and chemistry to assess human and ecological risk associated with exposure to antibiotics or antibiotic resistance genes as environmental contaminants. It also considers alternate uses and functions for antimicrobial compounds other than those intended for medicinal purposes in humans, animals, and fish. Recognizing the connectivity between overlapping complex systems, the book discusses the subject from the perspective of an ecosystem approach"--

National institutions/organisations participating in EARS-Net: Portugal - National Institute of Health Dr. Ricardo Jorge: Manuela Caniça; Vera Manageiro ; Antimicrobial resistance data reported to EARS-Net by 28 countries in 2010 and trend analyses including EARSS data from previous years, show that the Europewide increase of antimicrobial resistance observed in Escherichia coli during recent years is continuing unimpeded. The highest resistance proportions in E. coli were reported for aminopenicillins ranging up to 83 %. Despite the already high level of resistance the increase continues even in countries presenting resistance well above 50 %. The percentage of third-generation cephalosporin resistance reported among E. coli isolates has increased significantly over the last four years in half of the reporting countries, while a decreasing trend was observed in only one country. This resistance is directly linked to the high proportions (65–100 %) of ESBL-positives among cephalosporin-resistant E. coli isolates reported in 2010. A high frequency of multi-drug resistant Klebsiella pneumoniae was observed in southern, central and eastern Europe. In half of the reporting countries, the proportion of multiresistant K. pneumoniae isolates (combined resistance to third-generation cephalosporins, fluoroquinolones and aminoglycosides) was above 10 % and five countries show an increasing trend of carbapenem resistant K. pneumoniae. Carbapenems have been widely used in many countries due to the increasing rate of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae with a consequent impact on the emergence of carbapenemase production (VIM, KPC and NDM-1). Other trends in the occurrence of resistance reported to EARS-Net bring hope that national efforts on infection control and efforts targeted at containment of resistance may in some cases bring the development of resistance to a halt, or even reverse undesirable resistance trends, as exemplified by the development for meticillin-resistant Staphylococcus aureus (MRSA). Even though the proportion of MRSA among S. aureus is still above 25 % in eight out of 28 countries, the occurrence of MRSA is stabilising or decreasing in some countries and a sustained decrease has been observed in Austria, France, Ireland, Latvia, the UK and Cyprus. Furthermore, the United Kingdom has shown a consistent reduction of resistant proportions in K. pneumoniae for all antimicrobial classes under surveillance, and in a few countries (Germany, Greece, Italy and the UK) the efforts to control glycopeptide resistance in Enterococcus faecium seem to be successful and resulting in a continuous decrease of proportions of resistant isolates. Meanwhile, high-level aminoglycoside resistance in Enterococcus faecalis is stabilising in Europe at a level of 25–50%. For Streptococcus pneumoniae, non-susceptibility to penicillin remains generally stable in Europe and non-susceptibility to macrolides has declined in five countries while an increasing trend was observed in only one country. For Pseudomonas aeruginosa, high proportions of resistance to fluoroquinolones, carbapenems and combined resistance have been reported by many countries, especially in southern and eastern Europe. For several antimicrobial and pathogen combinations, e.g. fluoroquinolone resistance in E. coli, K. pneumoniae, P. aeruginosa and for MRSA, a north to south gradient is evident in Europe. In general, lower resistance proportions are reported in the north and higher proportions in the south of Europe. This is likely to be a reflection of differences in infection control practices, presence or absence of legislation regarding prescription of antimicrobial drugs. However, for K. pneumoniae, increasing trends of resistance to specific antimicrobial classes and of multiresistance have also been observed in northern European countries, like Denmark and Norway, which traditionally have a prudent approach to antimicrobial use. In addition to the regular trend analysis and situation overview, this 2010 EARS-Net report contains a focus chapter providing in-depth analysis for carbapenem resistant K. pneumoniae and P. aeruginosa. Results from susceptibility testing to carbapenems for these two pathogens reported since 2005, reveal a significant decrease of susceptibility to carbapenems in invasive K. pneumoniae over the period 2005–2010. Carbapenems are some of the few effective antimicrobials for the treatment of infections caused by bacteria that produce extended-spectrum beta-lactamases and thus resistance to carbapenems leaves very few therapeutic options available. Based on EARS-Net data, the antimicrobial resistance situation in Europe displays large variation depending on pathogen type, antimicrobial substance and geographical region. Besides evidence of stabilisation of the situation for some pathogens (e.g. MRSA) in a number of countries, the data show the unimpeded decline of antimicrobial susceptibility in other major pathogens (e.g. E. coli) and the alarming emergence of carbapenem resistance in K. pneumonia, leading to an unfortunate loss of antimicrobial treatment options.

Abstract International infectious disease surveillance has been conducted by the United States (U.S.) Department of Defense (DoD) for many years and has been consolidated within the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) since 1998. This includes activities that monitor the presence of antimicrobial resistance among pathogens. AFHSC-GEIS partners work within DoD military treatment facilities and collaborate with host-nation civilian and military clinics, hospitals and university systems. The goals of these activities are to foster military force health protection and medical diplomacy. Surveillance activities include both community-acquired and health care-associated infections and have promoted the development of surveillance networks, centers of excellence and referral laboratories. Information technology applications have been utilized increasingly to aid in DoD-wide global surveillance for diseases significant to force health protection and global public health. This section documents the accomplishments and activities of the network through AFHSC-GEIS partners in 2009.

In 2009, 1462 Escherichia coli isolates were collected in a systematic resistance monitoring approach from primary production, slaughterhouses and at retail and evaluated on the basis of epidemiological cut-off values. Besides resistance to antimicrobial classes that have been extensively used for a long time (e.g. sulphonamides and tetracyclines), resistance to (fluoro)quinolones and third-generation cephalosporins was observed. While in the poultry production chain the majority (60%) of isolates from laying hens was susceptible to all antimicrobials tested, most isolates from broilers, chicken meat and turkey meat showed resistance to at least one (85-93%) but frequently even to several antimicrobial classes (73-84%). In the cattle and pig production chain, the share of isolates showing resistance to at least one antimicrobial was lowest (16%) in dairy cows, whereas resistance to at least one antimicrobial ranged between 43% and 73% in veal calves, veal and pork. Resistance rates to ciprofloxacin and nalidixic acid in isolates from broilers were 41.1% and 43.1%, respectively. Likewise, high resistance rates to (fluoro)quinolones were observed in isolates from chicken meat and turkey meat. In contrast, ciprofloxacin resistance was less frequent in E. coli isolates from the cattle and pig production chain with highest rate in veal calves (13.3%). Highest resistance rates to cephalosporins were observed in broilers and chicken meat, with 5.9% and 6.2% of the isolates showing resistance. In dairy cattle and veal, no isolates with cephalosporin resistance were detected, whereas 3.3% of the isolates from veal calves showed resistance to ceftazidime. Resistance to (fluoro)quinolones and cephalosporins in E. coli isolates is of special concern because they are critically important antimicrobials in human antimicrobial therapy. The emergence of this resistance warrants increased monitoring. Together with continuous monitoring of antimicrobial usage, management strategies should be regularly assessed and adapted.

Not uploaded.Key words: Urinary tract infection; Multidrug-resistanceDOI: 10.3126/jnhrc.v5i2.2471Journal of Nepal Health Research Council (JNHRC) Vol. 5, No.2, October 2007 49-54

The new zoonoses Directive 2003/99/EC gives the opportunity for an improvement in the harmonization of antimicrobial resistance testing of zoonotic agents. The current reporting system under Council Directive 92/117/EEC was a voluntary approach leading to a limited comparability of the data. In the directive 2003/99/EC, inforced since June 2004, antimicrobial susceptibility testing is part of the legislation. The benchmarks, the zoonotic agents Salmonella spp. and Campylobacter spp., the animal species cattle, pigs and poultry, as well as products thereof are fixed. In this paper details for a harmonized monitoring scheme are proposed. The draft specifies in more detail the animal species, the production lines and the locations of the sampling. The sampling frame should ensure a representative number of isolates to meet the objectives, these are detection of occurrence of resistance patterns, estimation of the prevalence of resistance to an antimicrobial substance, and assessment of changes in the prevalence of antimicrobial resistance. Apart from isolates from monitoring schemes reflecting the healthy animal population, clinical isolates should be included to detect new emerging resistance genes. The comparability of the methods applied has to be ensured by an external quality assurance system. As the monitoring of antimicrobial resistance should be closely linked to the monitoring programs laid down in the directive 2003/99/EC to estimate the prevalence of zoonotic agents along the food chain. A stepwise implementation in accordance with the other monitoring programs is suggested. In order to support management decisions to limit the emergence and spread of resistance additional information has to be collected, i.e. resistance in animal pathogens, usage of antimicrobials, or the relevance of the import of animals or products of animal origin

The contribution of food-producing animals or foods to public health risks by ESBL and/or AmpC producing bacteria is related to specific plasmid-mediated ESBL and/or AmpC genes encoded by a number of organisms. The predominant ESBL families encountered are CTX-M, TEM, and SHV, the predominant AmpC family is CMY. The most common genes associated with this resistance in animals are bla CTX-M-1 (the most commonly identified ESBL), and bla CTX-M-14, followed by bla TEM-52 and bla SHV-12. The bacterial species most commonly identified with these genes are Escherichia coli and non-typhoidal Salmonella. ESBL/AmpC transmission is mainly driven by integrons, insertion sequences, transposons and plasmids, some of which are homologous in isolates from both food-production animals and humans. The use of antimicrobials is a risk factor for the selection and spread of resistant clones, resistance genes and plasmids. Since most ESBL- and AmpC-producing strains carry additional resistances to other commonly-used veterinary drugs and it is not restricted specifically to the use of cephalosporins. The present point of view presents some of the most important theoretical component of antimicrobial resistance and some of the current topics which are debated in EU. ; BG; bg; EFSAfocalpoint@mzh.government.bg