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Molecular Surveillance of Antimicrobial Resistance of Mycobacterium leprae from Leprosy Patients in Zhejiang Province, China
Purpose: Reports on antimicrobial resistance (AMR) of Mycobacterium leprae (M. leprae) in Zhejiang Province are limited. Thus, this study aimed to investigate the drug resistance of new leprosy cases within several years and analyse the emergence of AMR mutations from Zhejiang Province. Methods: This study enrolled 34 leprosy cases in Zhejiang Province, China, from 2018 to 2021. Gene mutation of WHO- recommended DRDRs (folP1, tpoB and gvrA) and genes of compensatory AMR-associated DRDRs, including nth, rpoA, tpoC, gvrB and 23S rRNA, were detected by amplification. Clinical data analysis was performed to investigate the epidemiological association of leprosy. Results: Of the 34 samples, 2 (5.9%) strains showed drug resistance, which were mutated to dapsone and ofloxacin, separately. Two single mutations in gvrB were detected in different strains (5.9%), whereas one of the tpoC mutation was also detected in one strain each (2.9%), which were proved to be polymorphs. No correlation of drug resistance proportion was identified in male vs female, nerve vs no nerve involvement, deformity vs no deformity and reaction vs non-reaction cases. Conclusion: Results showed well control of leprosy patients in Zhejiang Province. Gene mutations of WHO-recommended DRDRs FolP1 and gvrA confirmed the resistance to dapsone and ofloxacin. Compensatory AMR-associated mutations confirmed to be polymorphs still require further study to determine their phenotypic outcomes in M. leprae. The results demonstrated that drug-resistant strains are not epidemic in this area. Given the few cases of leprosy, analysing the AMR of M. leprae in Zhejiang Province more comprehensively is difficult. However, regular MDT treatment and population management in the early stage may contribute to the low prevalence of leprosy. Keywords: M. leprae, antimicrobial resistance, gene mutation
Journal Article
Antimicrobial Resistance: Causes And Consequences
Antimicrobial resistance (AMR) is considered as one of the most important threats for public health with global dimensions. The aim of this paper is to analyze the causes and consequences of antimicrobial resistance and the actions which should be taken in order to reduce this threat. Overuse and misuse of antibiotics are believed to be responsible for the emergence of resistant pathogens. These occur not only in human medicine but also in veterinary medicine, animal husbandry and plant production. Another factor which contributes to the global spread of resistant pathogens is low sanitation, mainly encountered in low and middle income countries. However, low quality infection control programs and the lack of antibiotic stewardship programs also contribute to the dissemination of resistant strains. Other factors which were shown to have impact are population movement, medical tourism, intensive trade exchange and climate change. The consequences of increased resistance such as medical, microbiological, epidemiological, psychological and economic are also discussed. Finally, several documents of WHO and European Union underlying “One health” approach in the combat of resistance as well as international projects addressing problem of AMR are described. The importance of broad education campaigns targeting medical professionals, health care decision makers and general public in combat of AMR such as European Antibiotic Awareness Day (EU) and International Antibiotics Awareness Week (WHO) are also discussed.1. Introduction 2. The epidemiological situation of resistance in Poland in comparison with EU countries 3. Causes of the rise and dissemination of antibiotic resistance. 4. Consequences of increasing AMR. 5. What actions have been taken in the fight against antibiotic resistance and what are their results. 6. Summary
Journal Article
The theocrat
\"The Theocrat takes as its subject one of Arab and Islamic history's most perplexing figures, al-Hakim bi-Amr Illah (\"the ruler by order of God\"), the Fatimid caliph who ruled Egypt during the tenth century and whose career was a direct reflection of both the tensions within the Islamic dominions as a whole and of the conflicts within his own mind. In this remarkable novel Bensalem Himmich explores these tensions and conflicts and their disastrous consequences on an individual ruler and on his people. Himmich does not spare his readers the full horror and tragedy of al-Hakim's reign, but in employing a variety of textual styles-including quotations from some of the best known medieval Arab historians; vivid historical narratives; a series of extraordinary decrees issued by the caliph; and, most remarkably, the inspirational utterances of al-Hakim during his ecstatic visions, recorded by his devotees and subsequently a basis for the foundation of the Druze community-he succeeds brilliantly in painting a portrait of a character whose sheer unpredictability throws into relief the qualities of those who find themselves forced to cajole, confront, or oppose him.\"--Publisher description.
BOOK
Combating the menace of antimicrobial resistance in Africa: a review on stewardship, surveillance and diagnostic strategies
The emergence of antibiotic-resistant pathogens has threatened not only our ability to deal with common infectious diseases but also the management of life-threatening complications. Antimicrobial resistance (AMR) remains a significant threat in both industrialized and developing countries alike. In Africa, though, poor clinical care, indiscriminate antibiotic use, lack of robust AMR surveillance programs, lack of proper regulations and the burden of communicable diseases are factors aggravating the problem of AMR. In order to effectively address the challenge of AMR, antimicrobial stewardship programs, solid AMR surveillance systems to monitor the trend of resistance, as well as robust, affordable and rapid diagnostic tools which generate data that informs decision-making, have been demonstrated to be effective. However, we have identified a significant knowledge gap in the area of the application of fast and affordable diagnostic tools, surveillance, and stewardship programs in Africa. Therefore, we set out to provide up-to-date information in these areas. We discussed available hospital-based stewardship initiatives in addition to the role of governmental and non-governmental organizations. Finally, we have reviewed the application of various phenotypic and molecular AMR detection tools in both research and routine laboratory settings in Africa, deployment challenges and the efficiency of these methods.
Journal Article
Strengthening antimicrobial resistance surveillance systems: a scoping review
Background
Antimicrobial resistance (AMR) is an emerging global public health crisis. Surveillance is a fundamental component in the monitoring and evaluation of AMR mitigation endeavours. The primary aim of the scoping review is to identify successes, barriers, and gaps in implementing AMR surveillance systems and utilising data from them.
Methods
PubMed, Web of Science, SCOPUS, and EMBASE databases were searched systematically to identify literature pertaining to implementation, monitoring, and evaluation of AMR surveillance systems. A thematic analysis was conducted where themes within the literature were inductively grouped based on the described content.
Results
The systematic search yielded 639 journal articles for screening. Following deduplication and screening, 46 articles were determined to be appropriate for inclusion. Generally, most studies focused on human AMR surveillance (n = 38, 82.6%). Regionally, there was equal focus on low- and middle-income countries (n = 7, 15.2%) and trans-national contexts (n = 7, 14.5%). All included articles (n = 46, 100.0%) discussed barriers to either implementing or utilising AMR surveillance systems. From the scoping review, 6 themes emerged: capacity for surveillance, data infrastructure, policy, representativeness, stakeholder engagement, and sustainability. Data infrastructure was most frequently discussed as problematic in evaluation of surveillance systems (n = 36, 75.0%). The most frequent success to surveillance system implementation was stakeholder engagement (n = 30, 65.2%).
Conclusions
Experiences of AMR surveillance systems are diverse across contexts. There is a distinct separation of experiences between systems with emerging surveillance systems and those with established systems. Surveillance systems require extensive refinement to become representative and meet surveillance objectives.
Journal Article