Differential Drivers of Antimicrobial Resistance across the World

Abstract

Conspectus Antimicrobial resistance (AMR) is one of the greatest threats faced by humankind. The development of resistance in clinical and hospital settings has been well documented ever since the initial discovery of penicillin and the subsequent introduction of sulfonamides as clinical antibiotics. In contrast, the environmental (i.e., community-acquired) dimensions of resistance dissemination have been only more recently delineated. The global spread of antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) between air, water, soil, and food is now well documented, while the factors that affect ARB and ARG dissemination (e.g., water and air quality, antibiotic fluxes, urbanization, sanitation practices) in these and other environmental matrices are just now beginning to be more fully appreciated. In this Account, we discuss how the global perpetuation of resistance is dictated by highly interconnected socioeconomic risk factors and illustrate that development status should be more fully considered when developing global strategies to address AMR. We first differentiate low to middle income countries (LMICs) and high-income countries (HICs), then we summarize the modes of action of commercially available antibiotics, and then discuss the four primary mechanisms by which bacteria develop resistance to those antibiotics. Resistance is disseminated via both vertical gene transfer (VGT; parent to offspring) as well as by horizontal gene transfer (HGT; cell to cell transference of genetic material). A key challenge hindering attempts to control resistance dissemination is the presence of native, environmental bacteria that can harbor ARGs. Such environmental “resistomes” have potential to transfer resistance to pathogens via HGT. Of particular concern is the development of resistance to antibiotics of last-resort such as the cephalosporins, carbapenems, and polymyxins. We then illustrate how antibiotic use differs in LMICs relative to HICs in terms of the volumes of antibiotics used and their fate within local environments. Antibiotic use in HICs has remained flat over the past 15 years, while in LMICs use over the same period has increased substantially as a result of economic improvements and changes in diet. These use and fate differences impact local citizens and thus the local dissemination of AMR. Various physical, social, and economic circumstances within LMICs potentially favor AMR dissemination. We focus on three physical factors: changing population density, sanitation infrastructure, and solid-waste disposal. We show that high population densities in cities within LMICs that suffer from poor sanitation and solid-waste disposal can potentially impact the dissemination of resistance. In the final section, we discuss potential monitoring approaches to quantify the spread of resistance both within LMICs as well as in HICs. We posit that culture-based approaches, molecular approaches, and cutting-edge nanotechnology-based methods for monitoring ARB and ARGs should be considered both within ...

In vitro Antioxidant Activities and Effect of Hydroethanolic and Aqueous Extracts of Terminalia avicennioides (Combretaceae) on Salmonella

“…After malaria, typhoid fever is the second most commonly reported disease in Cameroon by health personnels [3]. But the situation is all the more worrying as batrerial strain have been developing resistance to antibiotics (ampicillin and phenicolates) present on the market in recent years [4]. In addition, during salmonella infection, or following exposure of the body to exogenous toxins, the production of free radicals such as superoxide anion and nitric oxide (O 2 -, NO.…”

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“…1.5x10 6 1.9x10 6 --3.5x10 6 3.0x10 6 --9 2.0x10 7 2.4x10 7 --8.0x10 6 7.4x10 6 4.0x10 6 4.3x10 6 10 1.0x10 3 1.6x10 3 --5.2x10 6 5.9x10 6 1.1x10 3 1.0x10 3 11 1.8x10 3 1.3x10 3 --3.2x10 4 2.9x10 4 1.1x10 2 1.0x10 2 12 2.4x10 3 2.8x10 3 --2.5x10 5 2.8x10 5 1.0x10 2 -13 3.1x10 3 2.7x10 3 --1.5x10 3 1.1x10 5 1.0x10 2 1.1x10 2 14 -->300 >300 ----15 -->300 >300 ----16 -->300 >300 ----17 -->300 >300 ----1: EMB agar-(absence of colonies) 2: MacConkey agar In this case, E. coli is the most abundant bacterium with a growth average of 7.7x10 6 CFU/g. Studies carry out by [23], in which analyzes the quantity of Enterobacteria present in waste water treatment plants of milk industry, show that the most abundant bacterium is also E. coli, with an average of 2.6x10 7 CFU/g.…”

“…Although bacterial resistance is attributed to purely natural processes due to the ability of bacteria to transfer their genes, it is also true that some inadequate procedures such as incomplete treatment, incorrect doses of antibiotic. Some studies reported that the emergence of resistance to third-generation cephalosporins and carbapenems in Gram-negative isolates might even appear due to the influence of adverse environmental conditions; promote morpho-physiological alterations and expression of genes to guarantee the survival of these microorganisms [3]. The survival of bacteria in other environments depend, however, on many parameters, such as temperature, humidity, pH, soil composition and the presence of the other microorganisms [3].…”

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“…Wastewater treatment plants (WWTPs) are also key hotspots a liated with the fecology of pathogens and the dissemination of emerging superbugs. These niches are considered as reservoirs of nutrients and/or abundance of elevated bacterial numbers as well as sub-toxic levels of antibiotics favorable for the survival of ARB [15,16]. Reports have revealed the implications of the reuse of treated wastewater nal e uent for irrigation purposes in farms, likewise, a rise of soil microbial biomass as a result of wastewater irrigation was observed in many studies [17][18][19].…”