Journal of global antimicrobial resistance最新文献

Background: Antimicrobial resistance (AMR) is a major public health concern worldwide. International travel is a risk factor for acquiring antibiotic-resistant bacteria (ARB) and antibiotic-resistance genes (ARGs). Therefore, understanding the transmission of ARB and ARGs is instrumental in tackling AMR. This longitudinal study aimed to assess the benefit of wastewater monitoring in Guadeloupe to evaluate the role of tourism in the spread of AMR.

Methods: A wastewater-based surveillance (WBS) study was conducted to monitor AMR in Guadeloupe in 2022 during dry and wet seasons. We characterized the resistome, microbiome and exposome of water samples collected in wastewater treatment facilities of two cities with different levels of tourism activities, in the content of aircraft toilets, and the pumping station receiving effluents from hotels.

Results: The results show that the WBS approach facilitates the differentiation of various untreated effluents concerning exposome, microbiome, and resistome, offering insights into AMR dissemination. Additionally, the findings reveal that microbiome and exposome are comparable across sites and seasons, while resistome characterisation at specific locations may be pertinent for health surveillance. The microbiome of aircraft was predominantly composed of anaerobic bacteria from human intestinal microbiota, whereas the other locations exhibited a blend of human and environmental bacteria. Notably, individuals arriving by air have not introduced clinically significant resistance genes. Exposome compounds have been shown to influence the resistome's variance.

Conclusion: Clear differences were seen between the aircraft and the local sampling sites, indicating that the contribution of tourism to the observed resistance in Guadeloupe is not significant.

Objectives: Fecal microbiota transplantation (FMT) has shown promise as a treatment for recurrent or refractory Clostridioides difficile infections. This study aimed to evaluate the decolonization effects of FMT on vancomycin-resistant Enterococcus (VRE).

Methods: This feasibility trial prospectively recruited patients with more than three recurrent VRE infections. FMT was performed by infusing fecal microbiota solutions from healthy, unrelated donors into the participants' guts via colonoscopy. Fecal microbiota profiles before and after FMT were analyzed.

Results: Three of the six patients (50%) experienced VRE decolonization after FMT, lasting over six months. Baseline analysis revealed that patients who achieved decolonization had greater microbial diversity compared to those with persistent VRE colonization. Throughout the study, there were no adverse events observed in the patients after FMT. Elevated alpha diversity persisted in responders, while non-responders showed no significant changes. In responders, the abundance of genera within the phylum Firmicutes (Bacillota), including Anaerostipes, Blautia, Faecalibacterium, and Ruminococcus, and the genus Collinsella within the phylum Actinobacteriota increased steadily through 180 days post-FMT.

Conclusions: FMT may leverage bacterial strain competition to facilitate decolonization of drug-resistant organisms, with successful VRE decolonization potentially linked to increased abundance of phyla Firmicutes and Actinobacteriota over 6 months.

Objective: The standard antimicrobial therapy for Clostridioides difficile infections (CDIs) is limited to oral fidaxomicin or vancomycin, but these agents are associated with high treatment failure and recurrence rates. Clostridium butyricum had been proven effective in many kinds of gastrointestinal disease. With a less disturbed gut microbiota, we hypothesized that the properties of Clostridium butyricum Miyairi Bacteriocin (CBM-B) make it a potential therapeutic agent for treating patients with CDIs.

Methods: The inhibitory effects of CBM-B and vancomycin were compared using the kinetic time-kill assay, ex vivo co-culture model and mouse model.

Results: Among the clinical isolates of C. difficile, the minimal inhibitory concentration (MIC) of CBM-B ranged from 0.0625 to 8 µg/ml; the MIC₅₀ and MIC₉₀ were 1 µg/ml and 4 µg/ml, respectively. In the mouse model infected with a RT078 and receiving CBM-B intra-rectal enema therapy, mice infected with isolates with a relative low CBM-B MICs (2 µg/ml, abbreviated as M2) revealed significant better therapeutic effect, including less loss of body weight and cecum weight, compared with those infected with isolates of relative high CBM-B MICs (4 or 8 µg/ml, abbreviated as M4 or M8) . The relative C. difficile bacterial burden in stool of mice receiving CBM-B treatment were significantly lower among mice infected with M2, compared with that infected with M4 or M8. CBMB treatment, compared with vancomycin therapy revealed less disturbance in gut microbiota.

Conclusion: CBM-B could be effective in the treatment of CDIs that infected with a C. difficile isolate with relatively low MICs with less disturbance in gut microbiota.

Objectives: ;Antimicrobial stewardship programs (ASP) aim to improve the quality of medical prescribing and contain antimicrobial resistance (AMR). There is little information on the implementation of ASP in hospitals in Mexico. This study aimed to characterize ASP in a sample of hospitals in Mexico and to identify the facilitators and barriers perceived in their implementation, including the COVID-19 pandemic.

Methods: ;A self-assessment electronic survey was adapted from the CDC and WHO ASP's core elements, considering ASP organization, structure, education, guidelines, interventions, surveillance, monitoring, and reporting processes. The survey was addressed to ASP team leaders in a sample of public and private hospitals carrying out regular antimicrobial stewardship activities in Mexico in 2021 and 2022.

Results: ;Fifty hospitals participated: 32 (64%) public and 18 (36%) private. Fifty-two percent of hospitals had an official ASP document, 12% allocated protected time for ASP professionals, and 34% had an annual plan. Most hospitals had an ASP committee (68%); only 14% allocated funding. Most interventions were restrictive (68%). 61% percent of hospitals prepared cumulative antibiograms periodically, 54% monitored antimicrobial consumption (DDD/DOT), 44% monitored adherence to guidelines, and 24% monitored the implementation of interventions. The main barriers identified were work overload, insufficient human resources, and hospital reconversion due to COVID-19 (particularly in public hospitals), while the support of hospital authorities was the most important facilitator.

Conclusions: ;This diagnosis provides a baseline for strengthening ASP implementation in the country's hospitals. National and institutional policies should prioritize targeting ASP planning, monitoring, and human resources allocation.