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Boccabella L, Palma EG, Abenavoli L, Scarlata GGM, Boni M, Ianiro G, Santori P, Tack JF, Scarpellini E. Post-Coronavirus Disease 2019 Pandemic Antimicrobial Resistance. Antibiotics (Basel) 2024; 13:233. [PMID: 38534668 DOI: 10.3390/antibiotics13030233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/04/2024] [Accepted: 02/28/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND AND AIM Antimicrobial resistance (AMR) is a chronic issue of our Westernized society, mainly because of the uncontrolled and improper use of antimicrobials. The coronavirus disease 2019 (COVID-19) pandemic has triggered and expanded AMR diffusion all over the world, and its clinical and therapeutic features have changed. Thus, we aimed to review evidence from the literature on the definition and causative agents of AMR in the frame of the COVID-19 post-pandemic era. METHODS We conducted a search on PubMed and Medline for original articles, reviews, meta-analyses, and case series using the following keywords, their acronyms, and their associations: antibiotics, antimicrobial resistance, severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), COVID-19 pandemic, personal protective equipment. RESULTS AMR had a significant rise in incidence both in in-hospital and outpatient populations (ranging from 5 up to 50%) worldwide, but with a variegated profile according to the germ and microorganism considered. Not only bacteria but also fungi have developed more frequent and diffuse AMR. These findings are explained by the increased use and misuse of antibiotics and preventive measures during the first waves of the SARS-CoV2 pandemic, especially in hospitalized patients. Subsequently, the reduction in and end of the lockdown and the use of personal protective equipment have allowed for the indiscriminate circulation of resistant microorganisms from low-income countries to the rest of the world with the emergence of new multi- and polyresistant organisms. However, there is not a clear association between COVID-19 and AMR changes in the post-pandemic period. CONCLUSIONS AMR in some microorganisms has significantly increased and changed its characteristics during and after the end of the pandemic phase of COVID-19. An integrated supranational monitoring approach to this challenge is warranted in the years to come. In detail, a rational, personalized, and regulated use of antibiotics and antimicrobials is needed.
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Affiliation(s)
- Lucia Boccabella
- Internal Medicine Unit, Madonna del Soccorso General Hospital, Via Luciano Manara 7, 63074 San Benedetto del Tronto, Italy
| | - Elena Gialluca Palma
- Internal Medicine Clinics, Riuniti University Hospital, Polytechnics University of Marche, 60121 Ancona, Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, University "Magna Graecia", 88100 Catanzaro, Italy
| | | | - Mariavirginia Boni
- Vascular Medicine Unit, "C. and G. Mazzoni" General Hospital, 63076 Ascoli Piceno, Italy
| | - Gianluca Ianiro
- Gastroenterology Unit, Fondazione Policlinico Gemelli, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Pierangelo Santori
- Internal Medicine Unit, Madonna del Soccorso General Hospital, Via Luciano Manara 7, 63074 San Benedetto del Tronto, Italy
| | - Jan F Tack
- Translational Research in GastroIntestinal Disorders (T.A.R.G.I.D.), Gasthuisberg University Hospital, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Emidio Scarpellini
- Internal Medicine Unit, Madonna del Soccorso General Hospital, Via Luciano Manara 7, 63074 San Benedetto del Tronto, Italy
- Translational Research in GastroIntestinal Disorders (T.A.R.G.I.D.), Gasthuisberg University Hospital, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
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Dhungel B, Thapa Shrestha U, Adhikari S, Adhikari N, Bhattarai A, Pokharel S, Karkey A, Limmathurotsakul D, Ghimire P, Rijal KR, Cheah PY, Pell C, Adhikari B. Use of antimicrobials during the COVID-19 pandemic: A qualitative study among stakeholders in Nepal. PLOS Glob Public Health 2023; 3:e0002166. [PMID: 37963156 PMCID: PMC10645294 DOI: 10.1371/journal.pgph.0002166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/05/2023] [Indexed: 11/16/2023]
Abstract
The COVID-19 pandemic was a major public health threat and the pressure to find curative therapies was tremendous. Particularly in the early critical phase of the pandemic, a lot of empirical treatments, including antimicrobials, were recommended. Drawing on interviews with patients, clinicians and drug dispensers, this article explores the use of antimicrobials for the management of COVID-19 in Nepal. A total of 30 stakeholders (10 clinicians, 10 dispensers and 10 COVID-19 patients) were identified purposively and were approached for an interview. Clinicians and dispensers in three tertiary hospitals in Kathmandu assisted in the recruitment of COVID-19 patients who were undergoing follow-up at an out-patient department. Interviews were audio recorded, translated and transcribed into English, and were analyzed thematically. The respondents report that over-the-counter (OTC) use of antibiotics was widespread during the COVID-19 pandemic in Nepal. This was mostly rooted in patients' attempts to mitigate the potential severity of respiratory illnesses, and the fear of the stigmatization and social isolation linked to being identified as a COVID-19 patient. Patients who visited drug shops and physicians reportedly requested specific medicines including antibiotics. Clinicians reported uncertainty when treating COVID-19 cases that added pressure to prescribe antimicrobials. Respondents from all stakeholder groups recognized the dangers of excessive use of antimicrobials, with some referring to the development of resistance. The COVID-19 pandemic added pressure to prescribe, dispense and overuse antimicrobials, accentuating the pre-existing OTC use of antimicrobials. Infectious disease outbreaks and epidemics warrant special caution regarding the use of antimicrobials and specific policy response.
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Affiliation(s)
- Binod Dhungel
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | | | - Sanjib Adhikari
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Nabaraj Adhikari
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Alisha Bhattarai
- Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Sunil Pokharel
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Abhilasha Karkey
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Direk Limmathurotsakul
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medical Research Unit, Faculty of tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Phaik Yeong Cheah
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medical Research Unit, Faculty of tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Christopher Pell
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Bipin Adhikari
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medical Research Unit, Faculty of tropical Medicine, Mahidol University, Bangkok, Thailand
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Gulumbe BH, Sahal MR, Abdulrahim A, Faggo AA, Yusuf ZM, Sambo KH, Usman NI, Bagwai MA, Muhammad WN, Adamu A, Aminu U, Abubakar MT, Lawan KA. Antibiotic resistance and the COVID-19 pandemic: A dual crisis with complex challenges in LMICs. Health Sci Rep 2023; 6:e1566. [PMID: 37711678 PMCID: PMC10498429 DOI: 10.1002/hsr2.1566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/17/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
Background and Aims Antimicrobial resistance (AMR), a global health crisis of mounting urgency, has been further complicated by the ongoing COVID-19 pandemic. The intricate relationship between these two phenomena is especially pronounced in low- and middle-income countries (LMICs) due to the distinct obstacles encountered by their healthcare systems and policy structures. This study aims to explore the complex challenges arising from the coexistence of these two crises in LMICs and proffer specific recommendations for holistic management. Methods An exhaustive bibliographic survey was executed, employing search queries in specialized databases such as PubMed, SCOPUS, and Web of Science's SCI-EXPANDED index. The timeframe for the literature search extended from January 2020 to January 2023. The search strategy employed key terms including antibiotic resistance, AMR, COVID-19 pandemic, low- and middle-income countries, SARS-CoV-2, and LMICs. Results The pandemic has aggravated various drivers of AMR in LMICs, including limited capabilities, weak frameworks, and socioeconomic factors. New challenges have emerged, such as disruptions in the antibiotic supply chain and an increased risk of healthcare-associated infections. The interaction between these drivers presents a complex problem that demands a coordinated response. Specific recommendations include strengthening health systems, funding research and innovation, and enhancing infection prevention control measures. Conclusion The coexistence of AMR and the COVID-19 pandemic in LMICs demands an integrated approach involving multiple stakeholders. Emphasis must be placed on constructing aligned regulatory frameworks, nurturing regional collaborations, and focusing on accessible therapeutic options. The study underscores the necessity for actionable strategies to achieve sustainable access to clean water and sanitation and also highlights the importance of long-term planning, funding, and specialized expertise in emerging modalities like phage therapy.
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Affiliation(s)
- Bashar Haruna Gulumbe
- Department of Microbiology, Faculty of ScienceFederal University Birnin KebbiBirninKebbiNigeria
| | - Muhammed Rabiu Sahal
- Department of Biological SciencesAbubakar Tafawa Balewa University BauchiBauchiBauchi StateNigeria
| | - Abdulrakib Abdulrahim
- Department of Microbiology, Faculty of ScienceFederal University Birnin KebbiBirninKebbiNigeria
| | | | | | - Kabir Hassan Sambo
- Department of MicrobiologyBauchi State UniversityGadauBauchi StateNigeria
| | - Nazeef Idris Usman
- Department of MicrobiologyBauchi State UniversityGadauBauchi StateNigeria
| | | | - Wada Nafiu Muhammad
- Department of Laboratory TechnologyFederal Polytechnic BauchiBauchiBauchi StateNigeria
| | - Aliyu Adamu
- Department of MicrobiologyBauchi State UniversityGadauBauchi StateNigeria
| | - Uzairu Aminu
- Department of Microbiology, Faculty of ScienceFederal University Birnin KebbiBirninKebbiNigeria
| | | | - Kadai Alhaji Lawan
- Department of Microbiology and Immunology, Faculty of Biomedical SciencesKampala International UniversityKampalaUganda
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Kokkini M, Oves-Costales D, Sánchez P, Melguizo Á, Mackenzie TA, Pérez-Bonilla M, Martín J, Giusti A, de Witte P, Vicente F, Genilloud O, Reyes F. New Phocoenamicin and Maklamicin Analogues from Cultures of Three Marine-Derived Micromonospora Strains. Mar Drugs 2023; 21:443. [PMID: 37623724 PMCID: PMC10455904 DOI: 10.3390/md21080443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
Antimicrobial resistance can be considered a hidden global pandemic and research must be reinforced for the discovery of new antibiotics. The spirotetronate class of polyketides, with more than 100 bioactive compounds described to date, has recently grown with the discovery of phocoenamicins, compounds displaying different antibiotic activities. Three marine Micromonospora strains (CA-214671, CA-214658 and CA-218877), identified as phocoenamicins producers, were chosen to scale up their production and LC/HRMS analyses proved that EtOAc extracts from their culture broths produce several structurally related compounds not disclosed before. Herein, we report the production, isolation and structural elucidation of two new phocoenamicins, phocoenamicins D and E (1-2), along with the known phocoenamicin, phocoenamicins B and C (3-5), as well as maklamicin (7) and maklamicin B (6), the latter being reported for the first time as a natural product. All the isolated compounds were tested against various human pathogens and revealed diverse strong to negligible activity against methicillin-resistant Staphylococcus aureus, Mycobacterium tuberculosis H37Ra, Enterococcus faecium and Enterococcus faecalis. Their cell viability was also evaluated against the human liver adenocarcinoma cell line (Hep G2), demonstrating weak or no cytotoxicity. Lastly, the safety of the major compounds obtained, phocoenamicin (3), phocoenamicin B (4) and maklamicin (7), was tested against zebrafish eleuthero embryos and all of them displayed no toxicity up to a concentration of 25 μM.
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Affiliation(s)
- Maria Kokkini
- Fundación MEDINA, Centro de Excelencia en Investigación de Medicamentos Innovadores en Andalucía, Parque Tecnológico Ciencias de la Salud, Avda. del Conocimiento 34, Armilla, 18016 Granada, Spain; (D.O.-C.); (P.S.); (Á.M.); (T.A.M.); (M.P.-B.); (J.M.); (F.V.); (O.G.)
| | - Daniel Oves-Costales
- Fundación MEDINA, Centro de Excelencia en Investigación de Medicamentos Innovadores en Andalucía, Parque Tecnológico Ciencias de la Salud, Avda. del Conocimiento 34, Armilla, 18016 Granada, Spain; (D.O.-C.); (P.S.); (Á.M.); (T.A.M.); (M.P.-B.); (J.M.); (F.V.); (O.G.)
| | - Pilar Sánchez
- Fundación MEDINA, Centro de Excelencia en Investigación de Medicamentos Innovadores en Andalucía, Parque Tecnológico Ciencias de la Salud, Avda. del Conocimiento 34, Armilla, 18016 Granada, Spain; (D.O.-C.); (P.S.); (Á.M.); (T.A.M.); (M.P.-B.); (J.M.); (F.V.); (O.G.)
| | - Ángeles Melguizo
- Fundación MEDINA, Centro de Excelencia en Investigación de Medicamentos Innovadores en Andalucía, Parque Tecnológico Ciencias de la Salud, Avda. del Conocimiento 34, Armilla, 18016 Granada, Spain; (D.O.-C.); (P.S.); (Á.M.); (T.A.M.); (M.P.-B.); (J.M.); (F.V.); (O.G.)
| | - Thomas A. Mackenzie
- Fundación MEDINA, Centro de Excelencia en Investigación de Medicamentos Innovadores en Andalucía, Parque Tecnológico Ciencias de la Salud, Avda. del Conocimiento 34, Armilla, 18016 Granada, Spain; (D.O.-C.); (P.S.); (Á.M.); (T.A.M.); (M.P.-B.); (J.M.); (F.V.); (O.G.)
| | - Mercedes Pérez-Bonilla
- Fundación MEDINA, Centro de Excelencia en Investigación de Medicamentos Innovadores en Andalucía, Parque Tecnológico Ciencias de la Salud, Avda. del Conocimiento 34, Armilla, 18016 Granada, Spain; (D.O.-C.); (P.S.); (Á.M.); (T.A.M.); (M.P.-B.); (J.M.); (F.V.); (O.G.)
| | - Jesús Martín
- Fundación MEDINA, Centro de Excelencia en Investigación de Medicamentos Innovadores en Andalucía, Parque Tecnológico Ciencias de la Salud, Avda. del Conocimiento 34, Armilla, 18016 Granada, Spain; (D.O.-C.); (P.S.); (Á.M.); (T.A.M.); (M.P.-B.); (J.M.); (F.V.); (O.G.)
| | - Arianna Giusti
- Laboratory for Molecular Biodiscovery, Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, O & N II Herestraat 49-box 824, 3000 Leuven, Belgium; (A.G.); (P.d.W.)
| | - Peter de Witte
- Laboratory for Molecular Biodiscovery, Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, O & N II Herestraat 49-box 824, 3000 Leuven, Belgium; (A.G.); (P.d.W.)
| | - Francisca Vicente
- Fundación MEDINA, Centro de Excelencia en Investigación de Medicamentos Innovadores en Andalucía, Parque Tecnológico Ciencias de la Salud, Avda. del Conocimiento 34, Armilla, 18016 Granada, Spain; (D.O.-C.); (P.S.); (Á.M.); (T.A.M.); (M.P.-B.); (J.M.); (F.V.); (O.G.)
| | - Olga Genilloud
- Fundación MEDINA, Centro de Excelencia en Investigación de Medicamentos Innovadores en Andalucía, Parque Tecnológico Ciencias de la Salud, Avda. del Conocimiento 34, Armilla, 18016 Granada, Spain; (D.O.-C.); (P.S.); (Á.M.); (T.A.M.); (M.P.-B.); (J.M.); (F.V.); (O.G.)
| | - Fernando Reyes
- Fundación MEDINA, Centro de Excelencia en Investigación de Medicamentos Innovadores en Andalucía, Parque Tecnológico Ciencias de la Salud, Avda. del Conocimiento 34, Armilla, 18016 Granada, Spain; (D.O.-C.); (P.S.); (Á.M.); (T.A.M.); (M.P.-B.); (J.M.); (F.V.); (O.G.)
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Bragagnolo N, Audette GF. Solution characterization of the dynamic conjugative entry exclusion protein TraG. Struct Dyn 2022; 9:064702. [PMID: 36590369 PMCID: PMC9797247 DOI: 10.1063/4.0000171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
The R100 plasmid and the secretion system it encodes are representative of F-like conjugative type IV secretion systems for the transmission of mobile DNA elements in gram-negative bacteria, serving as a major contributor to the spread of antibiotic resistance in bacterial pathogens. The TraG protein of F-like systems consists of a membrane-bound N-terminal domain and a periplasmic C-terminal domain, denoted TraG*. TraG* is essential in preventing redundant DNA transfer through a process termed entry exclusion. In the donor cell, it interacts with TraN to facilitate mating pair stabilization; however, if a mating pore forms between bacteria with identical plasmids, TraG* interacts with its cognate TraS in the inner membrane of the recipient bacterium to prevent redundant donor-donor conjugation. Structural studies of TraG* from the R100 plasmid have revealed the presence of a dynamic region between the N- and C-terminal domains of TraG. Thermofluor, circular dichroism, collision-induced unfolding-mass spectrometry, and size exclusion chromatography linked to multiangle light scattering and small angle x-ray scattering experiments indicated an N-terminal truncation mutant displayed higher stability and less disordered content relative to full-length TraG*. The 45 N-terminal residues of TraG* are hypothesized to serve as part of a flexible linker between the two independently functioning domains.
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Sulis G, Pai M, Gandra S. Comment on: Global consumption of antimicrobials: impact of the WHO Global Action Plan on Antimicrobial Resistance and 2019 coronavirus pandemic (COVID-19). J Antimicrob Chemother 2022; 77:2891-2892. [PMID: 35640655 PMCID: PMC9384159 DOI: 10.1093/jac/dkac180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Giorgia Sulis
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Canada
| | - Madhukar Pai
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Canada
| | - Sumanth Gandra
- Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis Missouri, USA
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Langford BJ, Matson KL, Eljaaly K, Apisarnthanarak A, Bailey PL, Macmurray L, Marra AR, Simonsen KA, Sreeramoju P, Nori P, Bearman GM. Ten ways to make the most of World Antimicrobial Awareness Week. ASHE 2022; 2:e187. [PMID: 36425221 PMCID: PMC9679734 DOI: 10.1017/ash.2022.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/19/2022]
Abstract
One fundamental strategy to address the public health threat of antimicrobial resistance (AMR) is improved awareness among the public, prescribers, and policy makers with the aim of engaging these groups to act. World Antimicrobial Awareness Week is an opportunity for concerted and consistent communication regarding practical strategies to prevent and mitigate AMR. We highlight 10 ways for antimicrobial stewards to make the most of World Antimicrobial Awareness Week.
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