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Health risk assessment of ciprofloxacin, tetracycline, and oxytetracycline residues in raw, frozen, and boiled broiler chicken available in a local area of Bangladesh 孟加拉国当地生鲜、冷冻和水煮肉鸡中环丙沙星、四环素和土霉素残留的健康风险评估
Pub Date : 2024-04-03 DOI: 10.3389/frabi.2024.1364946
Shaila Haque, Md. Yusuf Jamil, Md. Shahinul Haque Khan, Md. Sajib Al Reza, Md. Esrafil, M. Abedin, Md. Abu Zubair, Md. Asaduzzaman Sikder, L. Bari
The misuse of antibiotics in poultry farming is a global issue.The focus of this study was the health risk assessment of consumers from the determination of ciprofloxacin (CIP), tetracycline (TC), and oxytetracycline (OTC) in broiler chicken in the raw, frozen, and boiled stages using solid-phase extraction, high-performance liquid chromatography, and ultraviolet detection (SPE-HPLC-UV).Chromatographic separation was achieved using 0.3% metaphosphoric acid and acetonitrile (1:10, v/v) for CIP at 280 nm and oxalic acid (0.01 M) and acetonitrile (1:1, v/v) for TC and OTC at 355 nm with different retention times. The method had an acceptable precision with good linearity, specificity, limit of detection, limit of quantification, accuracy, and stability.Among a total of 252 raw samples, approximately 68.25%, 25.4%, and 7.54% contained CIP, TC, and OTC, respectively. Out of the positive raw samples, CIP exceeded the maximum residual limit (MRL) in 3.6% muscle, 14.3% liver and 17.9% skin samples, whereas TC and OTC were below the MRLs. The residual concentrations of these antibiotics were almost unchanged in frozen samples. After boiling the chicken samples, the TC and OTC residues were reduced significantly compared to CIP. Although the concentrations of CIP in boiled samples were above the MRL set by the European Union, these did not exceed the hazard index 1.Based on these results, the exposure levels to antibiotics in broiler chicken meats may be considered to have a low risk for human health.
本研究的重点是利用固相萃取、高效液相色谱和紫外检测(SPE-HPLC-UV)技术测定肉鸡生鲜、冷冻和水煮阶段中环丙沙星(CIP)、四环素(TC)和土霉素(OTC)的含量,从而对消费者的健康风险进行评估。使用 0.3% 偏磷酸和乙腈(1:10, v/v)在 280 nm 波长下对 CIP 进行色谱分离,使用草酸(0.01 M)和乙腈(1:1, v/v)在 355 nm 波长下对 TC 和 OTC 进行色谱分离,保留时间各不相同。该方法的精密度、线性、特异性、检出限、定量限、准确度和稳定性均良好。在总共 252 个原始样品中,分别有约 68.25%、25.4%和 7.54%含有 CIP、TC 和 OTC。在呈阳性的原料样品中,3.6%的肌肉、14.3%的肝脏和 17.9%的皮肤样品中的 CIP 超过了最高残留限量(MRL),而 TC 和 OTC 则低于最高残留限量。这些抗生素在冷冻样本中的残留浓度几乎没有变化。煮沸鸡肉样本后,TC 和 OTC 的残留量明显低于 CIP。虽然水煮样品中 CIP 的浓度高于欧盟规定的最高残留限量,但并未超过危害指数 1。
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引用次数: 0
Impact of acute and chronic exposure to sulfamethoxazole on the kinetics and microbial structure of an activated sludge community 急性和慢性接触磺胺甲噁唑对活性污泥群落动力学和微生物结构的影响
Pub Date : 2024-04-02 DOI: 10.3389/frabi.2024.1335654
I. Pala-Ozkok, Tugce Katipoglu-Yazan, T. Olmez-Hanci, Daniel Jonas, E. Ubay‐Cokgor, D. Orhon
The aim of this study was to reveal the microbial and kinetic impacts of acute and chronic exposure to one of the frequently administered antibiotics, i.e., sulfamethoxazole, on an activated sludge biomass. Respirometric analysis and model evaluation of the oxygen utilization rate profiles were the backbone of this study. The results showed that continuous exposure to sulfamethoxazole resulted in the inhibition of substrate storage and an increase in the endogenous decay rates by twofold, which was supported by analysis of the resistance genes. A mild inhibition on the growth and hydrolysis kinetics was also observed. Moreover, sulfamethoxazole had a binding impact with available organic carbon, resulting in a slightly less oxygen consumption. DNA sequencing and antibiotic resistance gene analyses showed that continuous exposure to sulfamethoxazole caused a change in the community structure at the species level. Resistant bacteria including Arthrobacter sp. and members of the Chitinophagaceae and Intrasporangiaceae families were found to have dominated the bacterial community. The impact of intermittent exposure was also investigated, and the results indicated a drop in the severity of the impact after 20 days of intermittence.
本研究旨在揭示急性和慢性接触一种常用抗生素(即磺胺甲噁唑)对活性污泥生物质的微生物和动力学影响。氧利用率曲线的呼吸测定分析和模型评估是这项研究的主要内容。研究结果表明,持续接触磺胺甲噁唑会抑制底物的储存,并使内源衰变速率增加两倍,这一点也得到了抗性基因分析的支持。此外,还观察到生长和水解动力学受到轻微抑制。此外,磺胺甲噁唑与可用的有机碳有结合作用,导致耗氧量略有减少。DNA 测序和抗生素耐药性基因分析表明,持续接触磺胺甲噁唑会在物种水平上改变群落结构。耐药细菌包括节杆菌、嗜甲壳素科和孢子内囊菌科的成员,它们在细菌群落中占主导地位。还调查了间歇接触的影响,结果表明,间歇接触 20 天后,影响的严重程度有所下降。
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引用次数: 0
Examining pharmacoepidemiology of antibiotic use and resistance in first-line antibiotics: a self-controlled case series study of Escherichia coli in small companion animals 一线抗生素使用和耐药性的药物流行病学研究:小型伴侣动物中大肠埃希菌的自控病例系列研究
Pub Date : 2024-02-27 DOI: 10.3389/frabi.2024.1321368
Olivia S. K. Chan, W. Lam, Tint Naing, Dorothy Yuen Ting Cheong, Elaine Lee, Ben Cowling, Matthew Low
Clinicians need to prescribe antibiotics in a way that adequately treats infections, while simultaneously limiting the development of antibiotic resistance (ABR). Although there are abundant guidelines on how to best treat infections, there is less understanding of how treatment durations and antibiotic types influence the development of ABR. This study adopts a self-controlled case study (SCCS) method to relate antibiotic exposure time to subsequent changes in resistance patterns. This SCCS approach uses antibiotic exposure as a risk factor, and the development of ABR as an incidence rate ratio (IRR), which can be considered as the multiplicative change in risk for bacteria to become or maintain resistance.To investigate the IRR of extensive (more than 7 antibiotic classes), revert, persistent, and directed antibiotic resistance according to the duration and type of antibiotic exposures in Escherichia coli (E. coli).We use anonymized veterinary clinical data from dog and cat patients older than 6 months between 2015 and 2020. Patients were considered suitable cases if they received antibiotics and had a minimum of two urinary antibiograms within a 12-month period (the first prior to antibiotics exposure and the second from 1 week to 6 months after exposure). The first antibiogram is conducted before antibiotic exposure (case n=20).From 20 individuals and 42 paired antibiograms we found that the IRR = 2 for extensive drug resistance in patients who received short-course antibiotic treatment compared to longer treatments. In contrast, multi-drug resistance IRR = 2.6 for long-course compared to short-course antibiotic treatment. The ratio of E. coli isolates that reverted from resistant to sensitive was 5.4 times more likely in patients who received antibiotics for longer than 10 days.
临床医生在开具抗生素处方时,既要充分治疗感染,又要限制抗生素耐药性(ABR)的产生。虽然有大量指南介绍了如何以最佳方式治疗感染,但人们对治疗时间和抗生素类型如何影响 ABR 的发展却知之甚少。本研究采用自控病例研究(SCCS)方法,将抗生素暴露时间与耐药性模式的后续变化联系起来。本研究采用匿名兽医临床数据,这些数据来自 2015 年至 2020 年间年龄超过 6 个月的猫狗患者。如果患者接受了抗生素治疗,并在 12 个月内至少进行了两次尿液抗生素检查(第一次在接触抗生素之前,第二次在接触抗生素后 1 周至 6 个月内),则被视为合适病例。第一次抗生素检查是在接触抗生素之前进行的(病例 n=20)。从 20 人和 42 份配对抗生素检查结果中,我们发现接受短程抗生素治疗的患者的广泛耐药性 IRR = 2,而接受长程治疗的患者的广泛耐药性 IRR = 2。相反,长疗程抗生素治疗与短疗程抗生素治疗相比,多重耐药性 IRR = 2.6。在接受抗生素治疗超过 10 天的患者中,大肠杆菌分离物从耐药转为敏感的几率要高出 5.4 倍。
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引用次数: 0
Editorial: Knowledge, attitude and practices of the public and healthcare-professionals towards sustainable use of antimicrobials: the intersection of pharmacology and social medicine 社论:公众和医疗保健专业人员对可持续使用抗菌药物的认识、态度和做法:药理学与社会医学的交汇点
Pub Date : 2024-02-21 DOI: 10.3389/frabi.2024.1374463
Márió Gajdács, Shazia Jamshed
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引用次数: 0
Mapping the scarcity of data on antibiotics in natural and engineered water environments across India 绘制印度各地自然水环境和工程水环境中抗生素数据稀缺图
Pub Date : 2024-02-12 DOI: 10.3389/frabi.2024.1337261
Sasikaladevi Rathinavelu, Cansu Uluseker, V. Sonkar, Shashidhar Thatikonda, I. Nambi, Jan-Ulrich Kreft
Antimicrobial resistance is a growing public health concern, increasingly recognized as a silent pandemic across the globe. Therefore, it is important to monitor all factors that could contribute to the emergence, maintenance and spread of antimicrobial resistance. Environmental antibiotic pollution is thought to be one of the contributing factors. India is one of the world’s largest consumers and producers of antibiotics. Hence, antibiotics have been detected in different environments across India, sometimes at very high concentrations due to their extensive use in humans and agriculture or due to manufacturing. We summarize the current state of knowledge on the occurrence and transport pathways of antibiotics in Indian water environments, including sewage or wastewater and treatment plants, surface waters such as rivers, lakes, and reservoirs as well as groundwater and drinking water. The factors influencing the distribution of antibiotics in the water environment, such as rainfall, population density and variations in sewage treatment are discussed, followed by existing regulations and policies aimed at the mitigation of environmental antimicrobial resistance in India, which will have global benefits. Then, we recommend directions for future research, development of standardized methods for monitoring antibiotics in water, ecological risk assessment, and exploration of strategies to prevent antibiotics from entering the environment. Finally, we provide an evaluation of how scarce the data is, and how a systematic understanding of the occurrence and concentrations of antibiotics in the water environment in India could be achieved. Overall, we highlight the urgent need for sustainable solutions to monitor and mitigate the impact of antibiotics on environmental, animal, and public health.
抗菌药耐药性是一个日益严重的公共卫生问题,越来越被认为是全球范围内一种无声的流行病。因此,监测可能导致抗菌药耐药性出现、维持和传播的所有因素非常重要。环境抗生素污染被认为是诱因之一。印度是世界上最大的抗生素消费国和生产国之一。因此,在印度各地的不同环境中都检测到了抗生素,有时由于抗生素在人类和农业中的广泛使用或生产原因,抗生素的浓度会非常高。我们总结了目前有关抗生素在印度水环境(包括污水或废水和处理厂、河流、湖泊和水库等地表水以及地下水和饮用水)中的出现和迁移途径的知识状况。我们讨论了影响抗生素在水环境中分布的因素,如降雨量、人口密度和污水处理的变化,随后讨论了旨在减轻印度环境抗菌药耐药性的现行法规和政策,这些法规和政策将惠及全球。然后,我们提出了未来的研究方向,包括开发监测水中抗生素的标准化方法、生态风险评估以及探索防止抗生素进入环境的策略。最后,我们评估了数据的稀缺程度,以及如何系统地了解印度水环境中抗生素的出现和浓度。总之,我们强调迫切需要可持续的解决方案来监测和减轻抗生素对环境、动物和公众健康的影响。
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引用次数: 0
Mapping the scarcity of data on antibiotics in natural and engineered water environments across India 绘制印度各地自然水环境和工程水环境中抗生素数据稀缺图
Pub Date : 2024-02-12 DOI: 10.3389/frabi.2024.1337261
Sasikaladevi Rathinavelu, Cansu Uluseker, V. Sonkar, Shashidhar Thatikonda, I. Nambi, Jan-Ulrich Kreft
Antimicrobial resistance is a growing public health concern, increasingly recognized as a silent pandemic across the globe. Therefore, it is important to monitor all factors that could contribute to the emergence, maintenance and spread of antimicrobial resistance. Environmental antibiotic pollution is thought to be one of the contributing factors. India is one of the world’s largest consumers and producers of antibiotics. Hence, antibiotics have been detected in different environments across India, sometimes at very high concentrations due to their extensive use in humans and agriculture or due to manufacturing. We summarize the current state of knowledge on the occurrence and transport pathways of antibiotics in Indian water environments, including sewage or wastewater and treatment plants, surface waters such as rivers, lakes, and reservoirs as well as groundwater and drinking water. The factors influencing the distribution of antibiotics in the water environment, such as rainfall, population density and variations in sewage treatment are discussed, followed by existing regulations and policies aimed at the mitigation of environmental antimicrobial resistance in India, which will have global benefits. Then, we recommend directions for future research, development of standardized methods for monitoring antibiotics in water, ecological risk assessment, and exploration of strategies to prevent antibiotics from entering the environment. Finally, we provide an evaluation of how scarce the data is, and how a systematic understanding of the occurrence and concentrations of antibiotics in the water environment in India could be achieved. Overall, we highlight the urgent need for sustainable solutions to monitor and mitigate the impact of antibiotics on environmental, animal, and public health.
抗菌药耐药性是一个日益严重的公共卫生问题,越来越被认为是全球范围内一种无声的流行病。因此,监测可能导致抗菌药耐药性出现、维持和传播的所有因素非常重要。环境抗生素污染被认为是诱因之一。印度是世界上最大的抗生素消费国和生产国之一。因此,在印度各地的不同环境中都检测到了抗生素,有时由于抗生素在人类和农业中的广泛使用或生产原因,抗生素的浓度会非常高。我们总结了目前有关抗生素在印度水环境(包括污水或废水和处理厂、河流、湖泊和水库等地表水以及地下水和饮用水)中的出现和迁移途径的知识状况。我们讨论了影响抗生素在水环境中分布的因素,如降雨量、人口密度和污水处理的变化,随后讨论了旨在减轻印度环境抗菌药耐药性的现行法规和政策,这些法规和政策将惠及全球。然后,我们提出了未来的研究方向,包括开发监测水中抗生素的标准化方法、生态风险评估以及探索防止抗生素进入环境的策略。最后,我们评估了数据的稀缺程度,以及如何系统地了解印度水环境中抗生素的出现和浓度。总之,我们强调迫切需要可持续的解决方案来监测和减轻抗生素对环境、动物和公众健康的影响。
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引用次数: 0
The presence of antibiotic-resistant bacteria at four Norwegian wastewater treatment plants: seasonal and wastewater-source effects 挪威四家污水处理厂存在的抗生素耐药菌:季节和污水来源的影响
Pub Date : 2024-02-07 DOI: 10.3389/frabi.2024.1351999
Daniel Basiry, R. Kommedal, K. Kaster
Wastewater treatment plants receive low concentrations of antibiotics. Residual concentrations of antibiotics in the effluent may accelerate the development of antibiotic resistance in the receiving environments. Monitoring of antimicrobial resistance genes (ARGs) in countries with strict regulation of antibiotic use is important in gaining knowledge of how effective these policies are in preventing the emergence of ARGs or whether other strategies are required, for example, at-source treatment of hospital effluents. This study evaluates the presence of certain common resistance genes (blaSHV-1, blaTEM-1, msrA, ermA, ermC, tetM, tetL, tetA, vanA, and vanC) in the influent, sludge, and effluent of four wastewater treatment plants (WWTPs) in the North Jæren region of Norway at two different sampling times (January and May). These WWTPs vary in drainage area and wastewater composition and were selected based on their differing wastewater characteristics. Randomly selected colonies from the activated sludge samples were used to determine the minimum inhibitory concentration (MIC) for ampicillin, vancomycin, and tetracycline. In addition, variations in the bacterial composition of the wastewater were characterized via 16S rRNA sequencing and were analyzed in terms of bacterial host taxa that explain the presence of the ARGs in wastewater. The MIC tests revealed MIC90 values of >128 µg/mL for ampicillin, ≥128 µg/mL for vancomycin, and 32 µg/mL for tetracycline. In addition, the three resistance genes, ermB, tetA, and tetM, that were present in the influent and activated sludge were still present in the effluent. These results indicate that WWTPs represent a direct route into the environment for resistance genes and do not significantly reduce their abundance. Hence, the development of treatment methods for the removal of these genes from WWTPs in the future is of utmost importance.
污水处理厂接收的抗生素浓度较低。污水中残留的抗生素浓度可能会加速接收环境中抗生素耐药性的产生。在严格管理抗生素使用的国家,对抗菌药耐药性基因(ARGs)进行监测,对于了解这些政策在防止 ARGs 出现方面的效果如何,或者是否需要采取其他策略(例如对医院污水进行源头处理)非常重要。本研究评估了挪威北耶伦地区四家污水处理厂(WWTP)在两个不同采样时间(1月和5月)的进水、污泥和出水中存在的某些常见耐药基因(blaSHV-1、blaTEM-1、msrA、ermA、ermC、tetM、tetL、tetA、vanA和vanC)。这些污水处理厂的排水面积和废水成分各不相同,因此根据其不同的废水特征进行了选择。从活性污泥样本中随机选择菌落,用于测定氨苄西林、万古霉素和四环素的最低抑菌浓度(MIC)。此外,还通过 16S rRNA 测序鉴定了废水中细菌组成的变化,并从细菌宿主类群的角度分析了废水中 ARGs 存在的原因。MIC 测试显示,氨苄西林的 MIC90 值大于 128 µg/mL,万古霉素的 MIC90 值≥128 µg/mL,四环素的 MIC90 值为 32 µg/mL。此外,进水和活性污泥中存在的三个抗性基因 ermB、tetA 和 tetM 在污水中仍然存在。这些结果表明,污水处理厂是抗性基因直接进入环境的途径,并不会显著降低抗性基因的丰度。因此,未来开发去除污水处理厂中这些基因的处理方法至关重要。
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引用次数: 0
The presence of antibiotic-resistant bacteria at four Norwegian wastewater treatment plants: seasonal and wastewater-source effects 挪威四家污水处理厂存在的抗生素耐药菌:季节和污水来源的影响
Pub Date : 2024-02-07 DOI: 10.3389/frabi.2024.1351999
Daniel Basiry, R. Kommedal, K. Kaster
Wastewater treatment plants receive low concentrations of antibiotics. Residual concentrations of antibiotics in the effluent may accelerate the development of antibiotic resistance in the receiving environments. Monitoring of antimicrobial resistance genes (ARGs) in countries with strict regulation of antibiotic use is important in gaining knowledge of how effective these policies are in preventing the emergence of ARGs or whether other strategies are required, for example, at-source treatment of hospital effluents. This study evaluates the presence of certain common resistance genes (blaSHV-1, blaTEM-1, msrA, ermA, ermC, tetM, tetL, tetA, vanA, and vanC) in the influent, sludge, and effluent of four wastewater treatment plants (WWTPs) in the North Jæren region of Norway at two different sampling times (January and May). These WWTPs vary in drainage area and wastewater composition and were selected based on their differing wastewater characteristics. Randomly selected colonies from the activated sludge samples were used to determine the minimum inhibitory concentration (MIC) for ampicillin, vancomycin, and tetracycline. In addition, variations in the bacterial composition of the wastewater were characterized via 16S rRNA sequencing and were analyzed in terms of bacterial host taxa that explain the presence of the ARGs in wastewater. The MIC tests revealed MIC90 values of >128 µg/mL for ampicillin, ≥128 µg/mL for vancomycin, and 32 µg/mL for tetracycline. In addition, the three resistance genes, ermB, tetA, and tetM, that were present in the influent and activated sludge were still present in the effluent. These results indicate that WWTPs represent a direct route into the environment for resistance genes and do not significantly reduce their abundance. Hence, the development of treatment methods for the removal of these genes from WWTPs in the future is of utmost importance.
污水处理厂接收的抗生素浓度较低。污水中残留的抗生素浓度可能会加速接收环境中抗生素耐药性的产生。在严格管理抗生素使用的国家,对抗菌药耐药性基因(ARGs)进行监测,对于了解这些政策在防止 ARGs 出现方面的效果如何,或者是否需要采取其他策略(例如对医院污水进行源头处理)非常重要。本研究评估了挪威北耶伦地区四家污水处理厂(WWTP)在两个不同采样时间(1月和5月)的进水、污泥和出水中存在的某些常见耐药基因(blaSHV-1、blaTEM-1、msrA、ermA、ermC、tetM、tetL、tetA、vanA和vanC)。这些污水处理厂的排水面积和废水成分各不相同,因此根据其不同的废水特征进行了选择。从活性污泥样本中随机选择菌落,用于测定氨苄西林、万古霉素和四环素的最低抑菌浓度(MIC)。此外,还通过 16S rRNA 测序鉴定了废水中细菌组成的变化,并从细菌宿主类群的角度分析了废水中 ARGs 存在的原因。MIC 测试显示,氨苄西林的 MIC90 值大于 128 µg/mL,万古霉素的 MIC90 值≥128 µg/mL,四环素的 MIC90 值为 32 µg/mL。此外,进水和活性污泥中存在的三个抗性基因 ermB、tetA 和 tetM 在污水中仍然存在。这些结果表明,污水处理厂是抗性基因直接进入环境的途径,并不会显著降低抗性基因的丰度。因此,未来开发去除污水处理厂中这些基因的处理方法至关重要。
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引用次数: 0
Transient comparison of techniques to counter multi-drug resistant bacteria: prime modules in curation of bacterial infections 应对多重耐药菌技术的瞬时比较:遏制细菌感染的主要模块
Pub Date : 2024-01-26 DOI: 10.3389/frabi.2023.1309107
M. Naveed, Muhammad Waseem, Izma Mahkdoom, Nouman Ali, Farrukh Asif, J. Hassan, Hamza Jamil
Multidrug-resistant organisms are bacteria that are no longer controlled or killed by specific drugs. One of two methods causes bacteria multidrug resistance (MDR); first, these bacteria may disguise multiple cell genes coding for drug resistance to a single treatment on resistance (R) plasmids. Second, increased expression of genes coding for multidrug efflux pumps, which extrude many drugs, can cause MDR. Antibiotic resistance is a big issue since some bacteria may withstand almost all antibiotics. These bacteria can cause serious sickness, making them a public health threat. Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), Multidrug resistant Mycobacterium tuberculosis (TB), and CRE are gut bacteria that resist antibiotics. Antimicrobial resistance is rising worldwide, increasing clinical and community morbidity and mortality. Superbugs have made antibiotic resistance in some environmental niches even harder to control. This study introduces new medicinal plants, gene-editing methods, nanomaterials, and bacterial vaccines that will fight MDR bacteria in the future.
耐多药生物是指不再被特定药物控制或杀死的细菌。导致细菌产生耐多药(MDR)的方法有两种:第一,这些细菌可能会将编码耐药的多个细胞基因伪装在耐药(R)质粒上,以抵抗单一疗法。其次,多药外排泵编码基因的表达量增加也会导致 MDR,这种多药外排泵可挤出多种药物。抗生素耐药性是一个大问题,因为有些细菌几乎可以耐受所有抗生素。这些细菌可导致严重疾病,对公共健康构成威胁。耐甲氧西林金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌(VRE)、耐多药结核分枝杆菌(TB)和 CRE 都是耐抗生素的肠道细菌。抗菌药耐药性在全球范围内不断上升,增加了临床和社区的发病率和死亡率。超级细菌使得某些环境中的抗生素耐药性更加难以控制。本研究介绍了新的药用植物、基因编辑方法、纳米材料和细菌疫苗,它们将在未来对抗 MDR 细菌。
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引用次数: 0
Focusing on antimicrobial resistant infections –are we missing the forest for the trees and the patients for pathogens? 关注抗菌药耐药性感染--我们是否只见树木不见森林,只见病原体不见患者?
Pub Date : 2023-12-19 DOI: 10.3389/frabi.2023.1329081
Alexander Lawandi, S. Kadri, John H. Powers
Antimicrobial resistance (AMR) is a challenge because it is associated with worse patient outcomes. To solve the problem will take development of interventions and policies which improve patient outcomes by prolonging survival, improving patient symptoms, function and quality of life. Logically, we should look to focusing resources in areas that would have the greatest impact on public health. AMR takes the approach of focusing on individual pathogens and “pathogen-focused” development. However, evaluating overall infections and their impact on patient outcomes reveals that 17 of 18 infection deaths are associated with susceptible pathogens. Here we discuss recentering on patients and patient outcomes instead of pathogens, and propose six suggestions on how a patient focus impacts areas and incentives for clinical research.
抗菌药耐药性(AMR)是一项挑战,因为它与患者的不良预后有关。要解决这一问题,就必须制定干预措施和政策,通过延长存活时间、改善患者症状、功能和生活质量来改善患者预后。从逻辑上讲,我们应该将资源集中用于对公共健康影响最大的领域。AMR 采取的方法是关注单个病原体和 "以病原体为重点 "的发展。然而,对整体感染及其对患者预后的影响进行评估后发现,18 例感染死亡病例中有 17 例与易感病原体有关。在此,我们讨论了重新关注患者和患者预后而非病原体的问题,并就关注患者如何影响临床研究的领域和激励机制提出了六点建议。
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引用次数: 0
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Frontiers in antibiotics
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