Antibiotics (Ab), antibiotic resistance genes (ARG) and bovine gastrointestinal and commensal bacteria (BGCB) have been detected and quantified in the airborne PM emitted from beef cattle feed yards (PM‐FY) (Environmental Health Perspectives. 123(4)337–343). Through the pathogenicity of BGCB detected in the PM‐FY, correlation of PM‐FY induced infectious diseases (morbidity/mortality data) across the globe (Clinical Infectious Diseases 33(3):364–9 September 2001; Environmental science & technology. 2014; 48(14):7825–32. Proc Natl Acad Sci U S A. 2015; 112(18):5649–54. PLoS Medicine13(3):e1001974 · March 2016; BMC Infectious Diseases 17(1):207 · March 2017; ) and central plains of the United States by CDC&P, are truant, a hypothetical scheme is presented to limit the impact of emerging PM‐FY mediated AR‐HuP induced ARP, is presented. Determine the pathogenicity of bacteria derive from PM‐FY, obtain the ARG sequence from PM‐FY derived pathogenic bacteria, determine the sequence similarity, define/refine the common ARG motif (CARGM) across the spectrum of AR‐HuP, with the antibiotic‐resistant human pathogens (AR‐HuP). Determine the culture sensitivity of the BGCB; generate the antibiogram, subsequently followed by the Antibiotic Time Out (ATO). Consequently, generate and implement an antibiotic treatment therapy plan minimizing the polypharmacy. Taken together, this approach shall eventually mitigate the PM‐FY derived BGCB –AR‐HuP induced ARP. For early detection of the ARP, CARGM could be utilized as a diagnostic instrument in the clinical screening across the globe. This would enable the timely detection of the spread of AR‐HuP in real time with reasonable specificity in terms of county, city, state and region, country, and continent, to determine the endemic, epidemic and pandemic patterns of emerging specific infectious diseases. Systematic universal implementation of the aforesaid protocol would plausibly minimize the horizontal/lateral transfer (Res Microbiol. 2015 Sep;166(7):594–600; Front Microbiol. 2016 Feb 19;7:173; Chemosphere. 2016 May;150:702–14 ; Crit Rev Microbiol. 2016;42(1):17–30; Front Microbiol. 2016 Dec 15;7:1983.) of ARG to nonpathogenic commensal microbes. Synchronizing the standards of antibiotics use in the food animal production in U.S along with the rest of the world where strict/limitation of antibiotics usage is successfully implemented would further enhance the chances of success in this endeavor (Global Health. 2013 Oct 16; 9:48; Kimberly Ann Elliott, Charles Kenny, and Janeen Madan. 2017. “A Global Treaty to Reduce Antimicrobial Use in Livestock.” http://www.cgdev.org/publication/global‐treaty‐reduce‐antimicrobial‐use‐livestock). Calves are imported from Mexico for food animal production in Texas (Parts) where the antibiotics used in food animal production remain a speculation. With a unifying universal regulatory guideline adopted on AB usage in food animal production, it is likely that interweaving ecological interactions that govern the spread of antibiotic resistance shall be eliminated or minimized. Furthermore, the spread of antibiotic resistance genes through human travel or trading of animal products between nations may make instituted regulatory policies of some countries less effective. Taken together, mitigation of impending AR‐HuP induced ARP is still a resounding goal before it floors a path for sixth mass extinction, provided it is a concerted global effort.Support or Funding InformationSupported by the Professional Development Funds by SWTJC to Subburaj KannanThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
Antibiotic prophylaxis (AP) for an inpatient surgical care unit (SCU) and also intensive care unit (ICU) remains a controversial treatment option. Though in a many instances AP is considered as an invaluable measure to minimize the mortality rate, in other instances AP has been shown to exacerbate the Antibiotic Resistance Pathogen (ARP) induced mortality rate in both SCU and ICU. A rationale is presented to purge the practice of AP in STBI/TBI admitted in ICU to Rout AR Induced Mortality. In a case report where the role of “Colonization Pressure” (CP) (i.e., the proportion of other patients colonized with ARP) analysis indicate, that in an ICU the average expected median time until the acquisition of Vancomycin‐Resistant Enterococci (VRE) ‐ is approximately 19 days when both antibiotic pressure and CP are 25% but 6 days when CP is 75% and antibiotic pressure is 25%. In an another case report, 250 trauma patients in a Surgical Intensive Care Unit (SICU) requiring an one or more surgical modality requiring a stay of 3 days or more received AP by 1 antibiotic (Cefoxitin sodium or ampicillin sodium/sulbactam sodium) for 24 hours (SHORT group or 1 or more antibiotics ( a combination of piperacillin sodium sterile and tazobactam sodium, or the combination of ampicillin, gentamicin sulfate, and metronidazole) prophylaxis administered longer than 24 hours with multiple antibiotics fail to improve morbidity. In a case report focused on patients admitted to the trauma intensive care unit (TICU) from January, 2001 through December, 2004 with blunt, non‐operative traumatic brain injury who is managed solely with an intracranial pressure (ICP) monitor, among those receiving no antibiotics prior to or during ICP monitoring ; and those already receiving antibiotics at the time of ICP monitor insertion were, n = 84. This study concluded that AP does not reduce the CNS infection rate and is associated with more MDR pathogens in any subsequent infectious complications. In a study aimed to determine the role of nosocomial transmission in both deployed hospitals and receiving military medical centers (MEDCENs) eighteen thousand five hundred sixty of 21,272 patients (2005 to 2009) were screened for Multidrug‐resistant organism (MDRO) colonization. Although colonization with Acinetobacter (ACB) declined during the following 5 years, an increase ARP including extended spectrum β‐lactamase (ESBL) ‐producing Enterobacteriaceae were shown to be increasing. However, the risk of ARP selection caused by the antibiotic administration for 48 hours or more, outweighed potential benefits. A study aimed to determine the impact of prolonged use of CNS device for dispensing AP as a factor in inducing the ARP and Clostridium difficile where, patient receiving AP, n = 116, and control group patients had mean APACHE II scores of 17.7 ± 9.2 and 15.1 ± 10.6 with 53.4 and 24.6 % receiving craniotomies. A higher incidence of ARP in patients receiving prolonged AP with a CNS device, but incidence of C. difficile were not significant compared to controls. Taken together, in the absence of Glasgow Coma Scale (GCS) rating upon admission of STBI/TBI patients in ICU, performing culture and sensitivity assay in CSF, implementing prudent antibiotic stewardship and implementing Antibiotic Time Out (ATO) followed by induction of “Trans” state possibly to make suggestions enabling a psychological propensity to sojourn the infectious state would limit the AR induced mortality.Support or Funding InformationSupported by Professional Development funds of SWTJC to Subburaj KannanThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
To determine the role of AR in irreversible coma subsequent to TBI, a case report has been critically appraised (J Neurosci Rural Pract. 2016 Jul–Sep; 7(3):450–2). Day 1: A 75‐year‐old patient with small right subdural hematoma with frontal contusion upon admission to Intensive Care Unit (ICU) had Glasgow Coma Scale (GCS) 7 (E1V1M5) with bilateral equal and reacting pupils treated with Colistin and tigecycline for management of external ventricular device (EVD)‐related ventriculitis. EVD was placed for monitoring of intracranial pressure (ICP). The patient was in treatment with ceftriaxone 1 g/12 hourly for aspiration pneumonia. Day 3: GCS drooped to 4 (E1M3Vt). Day 4: Patient developed a fever (up to 103°F) suspected to be of EVD associated ventriculitis. Antibiotics were empirically upgraded to vancomycin and ceftazidime. Cerebrospinal fluid (CSF) culture and sensitivity revealed A. baumannii sensitive only to colistin and tigecycline and resistant to all other antibiotics including carbapenems. Day 4: Intravenous colistin was started at the dose of 2 million International Units (IU) 8 hourly and 200,000 IU through intraventricular route daily. Tigecycline was administered intravenously at a loading dose of 100 mg followed by 50 mg twice daily. CSF culture after 3 days of starting colistin (7th day of treatment) and tigecycline was negative. On day 8th however, there was a progressive decline in GCS to 2 (E1M1Vt). Due to declining renal function, iv dose of colistin was decreased to 2 million IU 24 hourly on the 12th day of starting colistin. Intravenous colistin and tigecycline were continued for 14 days (Total period of treatment 21 days) subsequent to withdrawal of life support as poor neurological outcome anticipated. From the 12th day of treatment a. culture and sensitivity lab test on the patient's CSF, b. antibiogram, and c. information on the implementation of antibiotics timeout (ATO) was not presented in the case report. It is acknowledged that up until 8th‐day appropriate measures reflecting ATO was in practice. However, from 12th day onwards aforesaid factors reflecting the evolution of AR has not been attempted. Taken together, it is suggested that the factors that govern the AR, was inadequately monitored from day 12th to the time of withdrawal of life support. Contrary to the claim of, “successful microbiological cure”, it is suggested that progression of AR overwhelmed the lymphatic system with sepsis inducing neurotoxicity, nephrotoxicity and possibly antibiotics induced toxic shock syndrome, In the absence of acute physiology and chronic health evaluation II score, sequential organ failure assessment, systemic inflammatory response syndrome score, injury severity score, exclusively based GCS to 2 (E1M1Vt) the life support has been withdrawn. The profile of antibiotic resistance pathogenic microbes (ARP) and its role in septicemia leading up to multi organ system failure has not been addressed adequately. Considering the age as pivotal factor, administering the tigecycline as a component of multidrug and multi‐route therapy is a serious risk factor with potential site for colonization for ARP. Lack of adequately qualified Intensive Care Unit personnel, improper intraventricular catheter handling, and CSF sampling only when clinically necessary, and periodic replacement of drainage catheter with maximum care could have eliminated the plausible cause for the septicemia in addition to the parameters defining sepsis and septic shock(sepsis‐3).Support or Funding InformationSupported by the Professional Development Funds by SWTJC to Subburaj Kannan.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
To determine the probability and its impact of PM from coal mining industry on Commensal Microbial Genome consequential antibiotic resistance (AR), a guided field trip to the North American Coal Corporation – Camino Real Fuels, LLC, Eagle Pass (CRF‐EP), has been completed. The established and implemented BMP at CRF‐EP mitigate and/or minimize the PM and its role in sustainability of soil, water, air and biodiversity are presented here. Air Monitoring Stations are placed throughout the site to analyze the quality, wind flow direction, barometer pressure, also ambient temperature. The air monitors collect data for 24 hours, every 6 days. A meteorological station is set up to collect data every 15 minutes. First, they do the mining to rescue and relocate the wildlife to areas evaluated then approved as receptor sites. Secondly, they clear the area then remove the topsoil and the subsoil. Then the process of drilling and breaking the overburden. The overburden is loaded into haul trucks until the layers of coal are visible, clearing the overburden from the site using the dozer to move it to the old pit where it was. Once the topsoil is removed, then the subsoil, which is about four feet under, then the overburden to get to the surface of the coal scene. When all the layers of coal are loaded and are taken out, they take it through haul trucks so it can be transported to dump sites for final disposal. Next, they take it to the coal preparation plant which is a facility that washes coal of soil and rock. Once it is washed, they crush it into graded sized chunks so it can be easy to handle and prepared for proper discharge to transport to market. At last, the coal is loaded into train cranes to be sent back to Mexico, the staff members explained it takes about eight hours to load and it is done every 24 to 36 hours. After all that process is finished, they start by covering the area the way it was taken out. The environmental group goes and starts the seeding in order for the final stage, which is the reclamation plan, to take effect. The land is restored from the whole mining process for the vegetation to go back to its natural state. With the growth in depth of mines, the movement and the spreading of particulate matter (PM) are very difficult to see due to wrong ventilation. The water that is found near the coal mines, also known as surface water control, help in suppressing the dust. With the dust suppressed, it is no longer able to contaminate the atmosphere. By reclaiming the land used in the coal mining process, the landowners will be able to have their lands back just as if nothing ever happened. Just as important as the reclamation stage of the coal mining process, the mining company also has strict regulations in place in order to minimize the impact the operation has in the surrounding environment. In this site they use trucks using a water mister to control and minimize the dust so that no particulate matter is formed. Once the coal has been removed, a Reclamation Plan is then followed. This plan (or timeline) is used to set goals to accomplish final bond release. The post‐mine conditions are monitored over a period of 10 years and are compared with the baseline conditions. As pointed out by the professional representing the CRF, it has complied with all regulatory criteria. Taken together, CRF‐EP demonstrated that the probability of formation and dissemination of PM from the mining site is minimum as monitored by vigilant internal measures and as well the city, state, and federal agencies.Support or Funding InformationSupported by the Professional Development Funds to Subburaj KannanThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
YA are mountain people who were first contacted in the mid‐1960s, and who continue to live seminomadic hunter‐gatherer lifestyles in the Amazon jungle of Venezuela. YA harbor bacteria that carry FARG, including those that confer resistance to synthetic antibiotics and are syntenic with mobilization elements (verbatim) (Sci Adv. 2015 Apr 3; 1(3)). An effort has been made to provide the rationale for the presence of FRAG in YA genome even in the absence of exposure to commercial antibiotics. I. Acquiring the ARG from the soil commensal bacteria and activated upon exposure to Ab became FRAG, II. Having a diverse group of resident bacterial colonies with ARG upon exposure to Ab, the bacteria became adapted to form FRAG, III. Induction of ARG to FRAG by active metabolic compounds acquired from herbal remedies to the active form, IV. Horizontal Gene transfer mediated acquirement of ARG or FRAG from the gold miners referred as “Garimpeiros” through microevolution, V. Exposure/Inhalation of Particulate Matter (PM) (EHP. 2015 Apr;123(4):337–43.) induced “Cline” (cline is a steady change in certain characteristics present by members of the same population of the same species). During a cline, a species deals with mutations and variation, to be better adapted to the new environment, but their bacteria is also dealing with mutations and variations which will make it resistant to most forces. Yanomami's never actually knew they were having contact or taking antibiotics because they took them unknowingly. This could have also happened because the bacteria could have had silent antibiotics in them. So when the Yanomami's where exposed to bacteria, they were also being exposed to antibiotics, IV. Through “Persistence, V. Through intrinsic resistance is when the bacteria have the ability to protect it from the attacks of the antibiotics (Nature. 2016; 533:212–6. Hormesis ‐ Int J Mol Sci. 2017 Jan 15; 18(1). In essence, due to the fact that YA is nomadic (Hunter‐Gatherer) mode of life moving from one location to other location in the deep forest in groups are constantly exposed to low dose of the PM in the air. At the initial stage there may have been causality (Altruistic Death) conferring survival advantage to YA transforming a sensitive state to more tolerant to PM, through “Hormesis” enabling the inactive ARG to adapt and form FRAG by a process known as Collective Antibiotic Resistance (CAT) (Nat Chem Biol. 2015 Mar; 11:182–188). It is speculated that the resident bacteria in the gastrointestinal tract (GI) of YA may have evolved “swarming” state (surface growth) while initiating “quorum sensing (QS), forming a biofilm on the skin surface as well as GI. Swarming phenotype of bacteria has been shown to confer survival advantage via the altruistic death of initial population directly exposed to antibiotic and subsequent increase in the density of Ab tolerant and/or resistant pathogenic bacteria (J.Bac. 2003; 185:3111; PNAS. 2010; 107:3776). It is also a strong possibility that as inhabitants of the “Amazon River” basin, could have acquired water‐borne bacterial pathogen with FRAG in the form of consumption, irrigation and sewage disposal. Taken together, YA does not have to be consuming antibiotics or infected by AR pathogens to become resistant and engender FRAG. As per our hypothetical scheme, all of the above mechanisms could be contributing to the intrinsic AR. The degree of FARG in the genome of YA and resident commensal microbiome of YA directly proportional to extent of the exposure and tolerance to PM.Support or Funding InformationSupported by Professional Development funds to Subburaj KannanThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
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