Antimicrobial resistance is a global problem – a UK perspective

Hu, Xiao-Yang; Logue, Martin; Robinson, Nicola

doi:10.1016/j.eujim.2020.101136

Cited by 57 publications

(34 citation statements)

References 22 publications

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“…There have been several attempts over the last few decades to replenish the antibiotic discovery pipeline. This has become more urgent given the rise in reports of antimicrobial resistance [45]. Rather than repeat older methods of antibiotic discovery, researchers have tried new innovations.…”

Section: Discussionmentioning

confidence: 99%

The Isolation of a Novel Streptomyces sp. CJ13 from a Traditional Irish Folk Medicine Alkaline Grassland Soil that Inhibits Multiresistant Pathogens and Yeasts

et al. 2020

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The World Health Organization recently stated that new sources of antibiotics are urgently required to stem the global spread of antibiotic resistance, especially in multiresistant Gram-negative bacteria. Although it was thought that many of the original sources of antibiotics were exhausted, innovative research has revealed promising new sources of antibiotic discovery in traditional medicine associated with Streptomyces. In this work we investigated the potential of a specific limestone grassland soil, associated with Irish folk medicine, as a new source of antimicrobial discovery. Using selective enrichment and isolation techniques on a limestone grassland soil sample obtained from Boho, West Fermanagh, we isolated Streptomyces sp. CJ13. This bacterium inhibited the growth of a broad range of pathogens in vitro including Gram positive Staphylococcus aureus (MRSA 43300) and Gram negative multiresistant Pseudomonas aeruginosa (PA01), as well as the anaerobic bacteria Propionibacterium acnes and the yeast Starmerella bombicola. Genome sequencing and phylogenetic analysis revealed Streptomyces sp. CJ13 to be closely related to an unclassified Streptomyces sp. MJM1172, Streptomyces sp. Mg1 and two species known as Streptomyces sp. ICC1 and ICC4 from a karst region in British Columbia. The closest type species to Streptomyces sp. CJ13 was Streptomyces lavendulae subspecies lavendulae. Analysis of Streptomyces sp. CJ13 whole genome sequence using the secondary metabolite prediction tool antiSMASH revealed similarities to several antibiotic gene synthesis clusters including salinichelin, mediomycin A, weishanmycin, combamide, heat stable antifungal factor and SAL-2242. These results demonstrate the potential of this alkaline grassland soil as a new resource for the discovery of a broad range of antimicrobial compounds including those effective against multiresistant Gram negative bacteria.

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Section: Discussionmentioning

confidence: 99%

The Isolation of a Novel Streptomyces sp. CJ13 from a Traditional Irish Folk Medicine Alkaline Grassland Soil that Inhibits Multiresistant Pathogens and Yeasts

et al. 2020

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“…There is an urgent need for further research and guidance in this field, from producing evidence-based guidelines, 16 reassessing biomarkers for antimicrobial stewardship in COVID-19 patients, 22 understanding drivers, benefits and disbenefits of antibiotic use and assessing the wider impact of the pandemic on antimicrobial use (AMU) and AMR. In this scoping review, we aim to: add to the research evidence on prevalence and patterns of antimicrobial use in the treatment of COVID-19 patients; identify the most commonly used antibiotics in the treatment of hospitalised COVID-19 patients worldwide; identify the clinical scenarios associated with AMU; and to explore any impact on patient outcomes.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial use in COVID-19 patients in the first phase of the SARS-CoV-2 pandemic: Rapid review and evidence synthesis

Cong

Poudel

Alhusein

et al. 2021

Preprint

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Background: As the numbers of people with COVID-19 continue to increase globally, concerns have been raised regarding the widespread use of antibiotics for the treatment of COVID-19 patients and its consequences for antimicrobial resistance during the pandemic and beyond. The scale and determinants of antibiotic use in the early phase of the pandemic, and whether antibiotic prescribing is beneficial to treatment effectiveness in COVID-19 patients, are still unknown. Unwarranted treatment of this viral infection with antibiotics may exacerbate the problem of antibiotic resistance, while antibiotic resistance may render presumptive treatment of secondary infections in COVID-19 patients ineffective. Methods: This rapid review was undertaken to identify studies reporting antimicrobial use in the treatment of hospitalised COVID-19 patients. The review was conducted to comply with PRISMA guidelines for Scoping Reviews (http://www.prisma-statement.org/Extensions/ScopingReviews) and the protocol was registered with the Open Science Framework (OSF): http://osf.io/vp6t5. The following databases: Web of Science, EMBASE, PubMed, CNKI & VIP were searched to identify the relevant studies from 1 Dec 2019 up to 15 June 2020; no limits were set on the language or the country where studies were conducted. The search terms used were: ((Covid-19 or SARS-CoV-2 or Coronavirus disease 2019 or severe acute respiratory syndrome coronavirus-2) and ((antibiotic prescribing or antibiotic use or antibiotic*) or antimicrobial* or antimicrobial therapy or antimicrobial resistance or antimicrobial stewardship)). A total of 1216 records were identified through database searching and 118 clinical studies met the inclusion criteria and were taken into data extraction. A bespoke data extraction form was developed and validated through two independent, duplicate extraction of data from five Records. As all the included studies were descriptive in nature, we conducted descriptive synthesis of data and reported pooled estimates such as mean, percentage and frequency. We created a series of scenarios to capture the range of rationales for antibiotic prescribing presented in the included studies. Results: Our results show that during the early phase of the pandemic, 8501 out of 10 329 COVID-19 patients (82.3%) were prescribed antibiotics; antibiotics were prescribed for COVID-19 patients regardless of reported severity, with a similar mean antibiotic prescribing rate between patients with severe or critical illness (75.4%) and patients with mild or moderate illness (75.1%). The top five frequently prescribed antibiotics for hospitalised COVID-19 patients were azithromycin (28.0 % of studies), ceftriaxone (17.8%), moxifloxacin (14.4%), meropenem (14.4%) and piperacillin/tazobactam (12.7%). The proportion of patients prescribed antibiotics without clinical justification was 51.5% vs 41.9 % for patients with mild or moderate illness and those with severe or critical illness respectively. Comparison of patients who were provided antibiotics with a clinical justification with those who were given antibiotics without clinical justification showed lower mortality rates (9.5% vs 13.1%), higher discharge rates (80.9% vs 69.3%) and shorter length of hospital of stay (9.3 days vs 12.2 days). Only 9.7% of patients in our included studies were reported to have secondary infections. Conclusions: Antibiotics were prescribed indiscriminately for hospitalised COVID-19 patients regardless of severity of illness during the early phase of the pandemic. COVID-19 related concerns and lack of knowledge drove a large proportion of antibiotic use without specific clinical justification. Although we are still in the midst of the pandemic, the goals of antimicrobial stewardship should remain unchanged for the treatment of COVID-19 patients.

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“…3 Antibiotic misuse coupled with a growing AMR has led to ineffective treatment of common infections, a number of strategies are needed to tackle this growing problem. 4 For example, 81% of antibiotics in England are prescribed in a primary care setting and are more likely to progress during the COVID-19 pandemic as a result of remotely overprescribed broad-spectrum antibiotics. 5 The goal of the updated United Kingdom antibiotic stewardship policies was to significantly change the role of primary care dispensing.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial Resistance: Physicians' and Pharmacists' Perspective

Rušić

Božić

Bukic

et al. 2020

Microbial Drug Resistance

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The aim of this study was to evaluate pharmacists' and physicians' attitudes and knowledge about antimicrobial treatment and resistance and based on the results to identify possible gaps and suggest opportunities for collaboration between the two professions. Methods: The physician's questionnaire consisted of 47 items and the pharmacists' questionnaire consisted of 50 items. Participants were asked to identify situations in which they were more likely to prescribe/dispense an antimicrobial without a firm indication, to identify the greatest contributors to antimicrobial resistance (AMR) among health care workers, to rate statements related to AMR, how frequently they used different sources of information and to rate the possible causes of AMR. Furthermore, preparedness for specific actions in practice was self-rated and knowledge was evaluated. The questionnaires were anonymous and participation in the study was voluntary. Results: This research included 180 community pharmacists and 181 physicians. As many as 76 (42.0%) physicians stated they would prescribe an antimicrobial when unsure whether the infection was of viral or bacterial etiology. More than half of the participants considered family medicine doctors the greatest contributors to AMR (N = 216, 59.8%), followed by patients (N = 175, 48.5%). In questions focusing on knowledge, physicians scored significantly higher compared with pharmacists (4.06-1.01 vs. 3.71-1.08, p = 0.001). Conclusion: This research revealed practices among pharmacists and physicians that should be improved and it highlighted gaps in knowledge by both professions. More attention should be given to patient consultation when dispensing and prescribing an antimicrobial as this may reduce their contribution to AMR.

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Antimicrobial resistance is a global problem – a UK perspective

Cited by 57 publications

References 22 publications

The Isolation of a Novel Streptomyces sp. CJ13 from a Traditional Irish Folk Medicine Alkaline Grassland Soil that Inhibits Multiresistant Pathogens and Yeasts

The Isolation of a Novel Streptomyces sp. CJ13 from a Traditional Irish Folk Medicine Alkaline Grassland Soil that Inhibits Multiresistant Pathogens and Yeasts

Antimicrobial use in COVID-19 patients in the first phase of the SARS-CoV-2 pandemic: Rapid review and evidence synthesis

Antimicrobial Resistance: Physicians' and Pharmacists' Perspective

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