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      Closing potential drivers of antimicrobial resistance: last-resort antimicrobials with the potential of being misused, the way forward – a short communication

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          Abstract

          Antimicrobial resistance (AMR) is still a formidable global public health challenge, as microorganisms, including bacteria, viruses, fungi, and parasites, evolve resistance to commonly used drugs, particularly antibiotics. The preservation of last-resort antimicrobials is critical for treating multi-drug-resistant infections; however, their indiscriminate use can exacerbate AMR crisis. This short communication delves into the multifaceted challenges, innovative strategies, and promising future directions to combat AMR effectively. Factors such as inappropriate prescription practices and the dearth of novel antibiotics contribute to the emergence of AMR. By implementing antimicrobial stewardship programs and fostering public education, we can mitigate the misuse of these vital drugs. Future research endeavors should concentrate on the development of cutting-edge drugs and diagnostic technologies to address AMR with enhanced precision and efficiency. Additionally, robust surveillance systems are crucial for monitoring antibiotic use and resistance patterns, providing valuable insights to inform policy decisions. A concerted, collaborative effort from governments, policymakers, healthcare providers, researchers, and other stakeholders is indispensable for overcoming the global health crisis posed by AMR.

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          Most cited references9

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          The antibiotic resistance crisis: part 1: causes and threats.

          Decades after the first patients were treated with antibiotics, bacterial infections have again become a threat because of the rapid emergence of resistant bacteria-a crisis attributed to abuse of these medications and a lack of new drug development.
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            Estimating the burden of antimicrobial resistance: a systematic literature review

            Background Accurate estimates of the burden of antimicrobial resistance (AMR) are needed to establish the magnitude of this global threat in terms of both health and cost, and to paramaterise cost-effectiveness evaluations of interventions aiming to tackle the problem. This review aimed to establish the alternative methodologies used in estimating AMR burden in order to appraise the current evidence base. Methods MEDLINE, EMBASE, Scopus, EconLit, PubMed and grey literature were searched. English language studies evaluating the impact of AMR (from any microbe) on patient, payer/provider and economic burden published between January 2013 and December 2015 were included. Independent screening of title/abstracts followed by full texts was performed using pre-specified criteria. A study quality score (from zero to one) was derived using Newcastle-Ottawa and Philips checklists. Extracted study data were used to compare study method and resulting burden estimate, according to perspective. Monetary costs were converted into 2013 USD. Results Out of 5187 unique retrievals, 214 studies were included. One hundred eighty-seven studies estimated patient health, 75 studies estimated payer/provider and 11 studies estimated economic burden. 64% of included studies were single centre. The majority of studies estimating patient or provider/payer burden used regression techniques. 48% of studies estimating mortality burden found a significant impact from resistance, excess healthcare system costs ranged from non-significance to $1 billion per year, whilst economic burden ranged from $21,832 per case to over $3 trillion in GDP loss. Median quality scores (interquartile range) for patient, payer/provider and economic burden studies were 0.67 (0.56-0.67), 0.56 (0.46-0.67) and 0.53 (0.44-0.60) respectively. Conclusions This study highlights what methodological assumptions and biases can occur dependent on chosen outcome and perspective. Currently, there is considerable variability in burden estimates, which can lead in-turn to inaccurate intervention evaluations and poor policy/investment decisions. Future research should utilise the recommendations presented in this review. Trial registration This systematic review is registered with PROSPERO (PROSPERO CRD42016037510). Electronic supplementary material The online version of this article (10.1186/s13756-018-0336-y) contains supplementary material, which is available to authorized users.
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              Enterohemorrhagic Escherichia coli O26:H11/H-: a new virulent clone emerges in Europe.

              Enterohemorrhagic Escherichia coli (EHEC) O26 causes diarrhea and hemolytic uremic syndrome (HUS). Strains harboring the stx1a gene prevail, but strains with stx2a as the sole Shiga toxin-encoding gene are now emerging. The traits and virulence of the latter set of strains are unknown. We correlated stx genotypes of 272 EHEC O26 strains isolated in 7 European countries between 1996 and 2012 with disease phenotypes. We determined phylogeny, clonal structure, and plasmid gene profiles of the isolates and portray geographic and temporal distribution of the different subgroups. The stx genotypes and plasmid genes were identified using polymerase chain reaction, phylogeny was assigned using multilocus sequence typing, and clonal relatedness was established using pulsed-field gel electrophoresis. Of the 272 EHEC O26 isolates, 107 (39.3%), 139 (51.1%), and 26 (9.6%) possessed stx1a, stx2a, or both genes, respectively. Strains harboring stx2a only were significantly associated with HUS (odds ratio, 14.2; 95% confidence interval, 7.9-25.6; P < .001) compared to other stx genotypes. The stx2a-harboring strains consist of 2 phylogenetically distinct groups defined by sequence type (ST) 21 and ST29. The ST29 strains are highly conserved and correspond by plasmid genes to the new virulent clone of EHEC O26 that emerged in Germany in the 1990s. This new clone occurred in 6 of the 7 countries and represented approximately 50% of all stx2a-harboring EHEC O26 strains isolated between 1996 and 2012. A new highly virulent clone of EHEC O26 has emerged in Europe. Its reservoirs and sources warrant identification.
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                Author and article information

                Contributors
                Journal
                Ann Med Surg (Lond)
                Ann Med Surg (Lond)
                MS9
                Annals of Medicine and Surgery
                Lippincott Williams & Wilkins (Hagerstown, MD )
                2049-0801
                June 2023
                3 May 2023
                : 85
                : 6
                : 3226-3231
                Affiliations
                [a ]School of Biosciences, Biotechnology, University of Nottingham, England, UK
                [b ]Department of Biochemistry, Caleb University, Imota, Lagos, Nigeria
                [c ]School of Chemical and Biotechnology, SASTRA Deemed University, Thanjavur, Tamil Nadu, India
                Author notes
                [* ]Corresponding author. Address: Caleb University, Imota, Lagos 104101, Nigeria.Tel.: 07025407045. E-mail: goshendavids@ 123456gmail.com (G.D. Miteu).
                Author information
                http://orcid.org/0000-0002-2117-4398
                Article
                AMSU-D-23-00470 00157
                10.1097/MS9.0000000000000760
                10289772
                889d45b5-29b6-48a2-a474-4e2b7c7b9dc2
                Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 7 March 2023
                : 15 April 2023
                Categories
                Short Communications
                Custom metadata
                TRUE

                antibiotics,antimicrobial resistance,last-resort drugs

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