Antibiotic Resistance Increases with Local Temperature

Redefining global health in the 21st century: Towards a more equitable global health agenda

Global health is at a critical juncture, with significant achievements in reducing deaths from HIV and under-five mortality since 2000. However, progress in other areas, such as maternal mortality and tuberculosis, remains uneven, and cardiovascular diseases continue to rise. Compounding these challenges is the emerging threat of climate change, which is predicted to cause millions of health-related deaths by the end of the century. This commentary proposes a new global health model inspired by Kate Raworth's 'doughnut' framework, which emphasizes maintaining ecological and social boundaries to foster sustainable health. The inner boundary focuses on ensuring equitable access to essential health services, particularly for underserved populations. The outer boundary addresses the health impacts of environmental degradation and climate change, advocating for adaptive and resilient health systems. This model calls for a reorientation of global health priorities to balance human well-being with environmental sustainability, urging international collective action at platforms like COP29. By addressing both health equity and ecological stability, this framework aims to guide the global health community towards a more equitable and sustainable future.

The potential impact of climate change on medication access and quality deserves far more attention

Notwithstanding the obvious interconnection between humans and the world that they share with non-human inhabitants, the impact of our changing climate on certain aspects of the public health ecosystem has been under-investigated. We briefly describe some of the possible climate-induced changes in the procurement, distribution, access and use of medications, including those for animals generally and livestock specifically. A fuller understanding of the effect of climate change on medicine supply, access, use and quality, including how these affect antimicrobial resistance, would contribute to the further development of the "One Health" and "One Health Systems" concepts. We suggest that this understanding is not yet available, even though the changing incidence of infectious diseases due to changing climate has been studied. There is a need for improved understanding of the impact of extremes of humidity and heat on medication quality and research into heat-stable medicines as well as strategies for the improving resilience of the pharmaceutical supply and distribution system in complex public health emergencies caused by aberrant weather patterns.

The effect of sample type and location on industrial workplace sink and hand dryer microbiomes

One major issue in tackling antimicrobial resistance (AMR) is the ability to effectively track resistance spread in environments where surveillance is limited. Such environments include those experiencing high volumes of hand washing and drying from multiple users. This study characterised the microbial populations and antimicrobial resistomes of two different sample types from a pharmaceutical industrial site as part of an AMR environmental surveillance programme. Paired samples were collected from hand dryers and adjacent sinks in distinct sampling locations: from toilets adjacent to 'wet' labs, and locations associated with 'dry' activities. Microbial populations in hand dryers were significantly different to those of sinks, whereas there was no significant difference based on sample location. The opposite effect was observed for resistomes, where profiles differed significantly based on sample location, but not sample type. When both sample type and location were considered together, differences in microbiomes were driven primarily by hand dryer profiles from different locations. Analysis of metagenomically-assembled genomes revealed the presence of many poorly characterised organisms, and suggested no specific families predominated in terms of ARG carriage. This study emphasises the impact of human activities in determining the resistome of commonly used appliances, and the need for continued AMR surveillance programmes.

Panel data analysis of the effect of ambient temperature on antimicrobial resistance in China

Antimicrobial resistance (AMR) has been causing tremendous loss of life, health and economic property, and WHO identified carbapenem-resistant gram-negative (CRGN) as the most urgent bacteria. The impact of climate change on AMR has received worldwide attention, but the evidence is insufficient. The prevalence of carbapenem-resistant antibiotic-resistant Klebsiella pneumoniae (CRKP), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPA) from the Chinese Antibiotic Resistance Surveillance System from 2014 to 2023 were used as the dependent variable, the average ambient temperature from the China Statistical Yearbook was used as the independent variable. After controlling factors from socio-economic, environmental and medical services, natural log-linear regression analysis was used and found that CRKP and CRAB increased 1.093-fold and 1.021-fold, respectively, for every 1˚C ambient temperature increase. And this effect was similarly validated in the subgroup models for seasons and regions. In addition, we determined that health facilities, hospital beds per capita, and PM2.5 had a significant effect on the AMR of different strains. Changes in ambient temperature have a cumulative effect, with the greatest cumulative four-year impact. The effects of ambient temperature and its changes on AMR and the identification of influencing factors in this study provide innovative insights and important evidence for combating AMR.

A global atlas and drivers of antimicrobial resistance in Salmonella during 1900-2023

Although previous studies using phenotypic or/and genomic approaches monitoring have revealed the spatiotemporal distribution of antimicrobial resistance (AMR) in Salmonella in local areas, their geographical patterns and driving factors remain largely unknown at a global scale. Here, we performed an analysis of publicly available data of 208,233 Salmonella genomes in 148 countries/regions between 1900 and 2023 and explored driving indicators of AMR. Overall, we found that the geographic distribution of AMR varied depending on the location, source, and serovar. The proportion of AMR levels increased across six continents, especially in serovars Agona, Dublin, I 1,4,[5],12:i:-, Muenchen, Senftenberg, Mbandaka mainly from chickens, food, wild animals, and the environment, while decreased in Schwarzengrund and Saintpaul mainly from cattle, pigs, and turkeys. We also found that S. Typhimurium exhibiting macro, red, dry, and rough was detected as early as 1992 in the USA, earlier than in China. Moreover, we identified that antibiotic consumption, agriculture, climate, urban, health, and socioeconomic factors contribute to the development of AMR in Salmonella. We present a globally high-resolution genetic atlas of Salmonella and also identify some factors driving the rise of AMR, which can provide valuable information for understanding the transmission dynamics and evolutionary trajectories of Salmonella.

Presence of high-risk ARGs with greater diversity and abundance in the rare resistome in wastewater across China

Antibiotic resistance genes (ARGs) are widely recognized as hazardous materials that pose risks to public health. The core resistome, with its low ARG diversity yet accounting for the majority of the total ARG abundance, dominating the profile of antibiotic resistance. In this study, nationwide wastewater surveillance in China using metagenomic sequencing also identified a core resistome of 117 ARGs that accounted for 69.6 % of the total abundance. The emphasis of the work was to examine the rare resistome that included 1503 ARGs outside the core resistome. The abundances of clinically relevant ARG types (e.g., β-lactams and quinolones) were significantly higher in the rare resistome compared to the core resistome. Human pathogen-related ARGs were much greater in subtype number (96 vs. 34) and significantly higher in abundance (67.0 % vs. 33.0 %) in the rare relative to the core resistome, indicating that the rare resistome was the major contributor to the human pathogen resistome. The majority of ARG types accounting for the highest proportions of the rare resistome were plasmid-originated (65.5 %-100 %). In addition, human pathogen-related ARGs also had a significantly higher proportion of plasmid sources than non-pathogen ARGs, further highlighting their importance in wastewater-based surveillance.

The global impact of industrialisation and climate change on antimicrobial resistance: assessing the role of Eco-AMR Zones

This study examines the relationship between industrialisation, climate change, and antimicrobial resistance (AMR) gene prevalence. Data analysis from the top 20 highly industrialised and the top 20 least industrialised nations revealed that industrial activities significantly contribute to global warming, with temperature increases of up to 2 °C observed in highly industrialised regions. These environmental changes influence the distribution and evolution of AMR genes, as rising temperatures can affect bacterial resistance in a manner similar to antibiotics. Through a bioinformatics approach, a marked disparity in AMR gene frequencies was observed between highly industrialised and less industrialised nations, with developed countries reporting higher frequencies due to extensive antibiotic use and advanced monitoring systems. 'Eco-AMR Zones' is proposed as a solution to specialised areas by promoting sustainable industrial practices, enforcing pollution controls, and regulating antibiotic use to mitigate AMR's environmental and public health impacts. These zones, supported by collaboration across various sectors, offer a promising approach to preserving antibiotic effectiveness and reducing environmental degradation. The study emphasises the importance of integrated global strategies that address both the ecological and public health challenges posed by AMR, advocating for sustainable practices, international collaboration, and ongoing research to combat the evolving threats of climate change and antimicrobial resistance.

Megatrends and emerging issues: Impacts on food safety

The world is changing at a pace, driven by global megatrends and their interactions. Megatrends, including climate change, the drive for sustainability, an aging population, urbanization, and geopolitical tensions, are producing an increasingly challenging environment for the provision of a safe and secure food supply. To ensure a robust, safe, and secure food supply for all, potential food safety impacts associated with these megatrends need to be understood, and mitigation and management plans must be implemented. This paper outlines the relevant megatrends, discusses their potential impact on food safety, and suggests steps to help ensure the production of safe food in the future. Megatrends are increasingly driving resource depletion, reducing the vitality of plants and animals, increasing the geographical spread of animal and plant pathogens, increasing the risk of mycotoxins, agrichemical residues, and antimicrobial-resistant pathogens contaminating foods, and threatening to destabilize food systems and the food regulatory network. Science-based actions, adopting continual and dynamic risk assessments, alongside the use of more sensitive and accurate methods for the detection of contaminants, may counter these challenges. The use of artificial intelligence, robotics and automation, the enhancement of food safety cultures, the continued education and training of workforces, and the implementation of risk-based food regulations will help ensure preventative controls are in place. As low-income countries and smallholder farmers are more likely to be exposed to the impact of these megatrends and less likely to have resources to counter them, geographical social inequality, unrest, and population migration are likely to be exacerbated unless urgent action is taken.

Designing pillar-layered metal-organic frameworks with photo-induced electron transfer interactions between ligands for enhanced photodynamic sterilization and photocatalytic degradation of dyes and antibiotics

Pollution caused by antibiotics, bacteria, and organic dyes presents global public health challenges, posing serious risks to human health. Consequently, new, efficient, fast, and simple photocatalytic systems are urgently required. To this end, 2,7-di(pyridin-4-yl)benzo[lmn][3,8]phenanthroline-1,3,6,8(2H,7H)-tetraone (NDI)-an electron acceptor-is introduced as a connecting column into a porphyrin-based metal-organic layer (2DTcpp) with excellent photocatalytic activity; this modification yields a three-dimensional pillar-layered metal-organic framework (MOF, 3DNDITcpp) with superior photocatalytic reactive oxygen species (ROS) generation capability. Introducing NDI enlarges the pore cavity of 3DNDITcpp creating active sites and boosting type II ROS production. The orderly arrangement of the electron donor (porphyrin layer) and acceptor (NDI) within 3DNDITcpp promotes photo-induced electron transfer (PET) interactions-as confirmed by density functional theory calculations-substantially boosting type I ROS production. Specifically, the energy levels of the lowest unoccupied molecular orbital (LUMO) and highest occupied molecular orbital (HOMO) of the porphyrin derivative ligand are -0.122252 and -0.185307 eV, respectively. The energy levels of the LUMO and HOMO of the NDI ligand are -0.15977 and -0.221199 eV, respectively. The HOMO energy level of the porphyrin ligand is between the HOMO and LUMO of NDI, and higher than the HOMO orbital energy level of NDI, proving that the porphyrin derivative ligand can act as an electron donor and carry out an efficient PET process with the electron acceptor NDI. Various ROS indicators demonstrate the superior ROS generation ability of 3DNDITcpp under light irradiation. Using activated 2,7-dichlorodihydrofluorescein diacetate (DCFH-DA) as an indicator of total ROS, the fluorescence enhancement factors of 2DTcpp, 3DPyTcpp, and 3DNDITcpp were 42.13, 48.24 and 94.21 times, respectively. Both the degradation curve and degradation rate of 9,10-anthracenediyl-bis(methylene)dimalonic acid (ABDA) demonstrated that the order of 1O2 production ability was 3DNDITcpp (rate up to 0.312 min-1) > 3DpyTcpp (0.158 min-1) ≈ 2DTcpp (0.155 min-1). In addition, dihydrorhodamine 123 (DHR 123) and hydroxyphenyl fluorescein (HPF) were used as specific indicators of O2- and OH to monitor the generation of type I ROS of 2DTcpp, 3DPyTcpp, and 3DNDITcpp, respectively. The fluorescence enhancement factors of DHR 123 and HPF aqueous solutions containing 3DNDITcpp were as high as 47.70 and 192.19 times, respectively. The fluorescence enhancement factors of DHR 123 and HPF containing 2DTcpp and 3DPyTcpp were 19.65/63.07 (2DTcpp) and 27.97/134.19 times (3DPyTcpp), respectively. Photocurrent response (3DNDITcpp is 1.2 and 2.7 times better than 3DPyTcpp and 2DTcpp, respectively) and electrochemical impedance (3DNDITcpp is 1.9 and 2.9 times smaller than 3DPyTcpp and 2DTcpp, respectively) measurements confirming its excellent type I ROS production capability. Under low-power light irradiation (60 mW·cm-2, 5 min), ROS generated by 3DNDITcpp effectively inactivates Escherichia coli and Staphylococcus aureus, with an inhibition zone diameter of approximately 4.00 cm. Furthermore, 3DNDITcpp rapidly degrades various colored dyes and antibiotics within 30 min, achieving degradation rates as high as 0.095 and 0.054 min-1, outperforming most traditional photosensitizers (PSs). To our knowledge, this is the first instance when differences in the electron clouds of mixed ligands are leveraged to induce PET interactions within pillar-layered MOFs, yielding excellent porous PSs. Overall, our study offers a new approach for developing porous PSs with enhanced ROS generation capacity and advances MOFs crystal engineering based on mixed ligands.

Healthcare-Associated Infections: The Role of Microbial and Environmental Factors in Infection Control-A Narrative Review

Healthcare-associated infections (HAIs), previously known as nosocomial infections, represent a significant threat to healthcare systems worldwide, prolonging patient hospital stays and the duration of antimicrobial therapy. One of the most serious consequences of HAIs is the increase in the rate of antibiotic resistance (AR) generated by the prolonged, frequent, and sometimes incorrect use of antibiotics, which leads to the selection of resistant bacteria, making treatment difficult and expensive, with direct consequences for the safety of patients and healthcare personnel. Therefore, timely and accurate diagnosis of HAIs is mandatory to develop appropriate infection prevention and control practices (IPC) and new therapeutic strategies. This review aimed to present the prevalence, risk factors, current diagnosis, including artificial intelligence (AI) and machine learning approaches, future perspectives in combating HAIs causative bacteria (phage therapy, microbiome-based interventions, and vaccination), and HAIs surveillance strategies. Also, we discussed the latest findings regarding the relationships of AR with climate change and environmental pollution in the context of the One Health approach. Phage therapy is an emerging option that can offer an alternative to ineffective antibiotic treatments for antibiotic-resistant bacteria causing HAIs. Clinical trials dealing with vaccine development for resistant bacteria have yielded conflicting results. Two promising strategies, fecal microbiota transplantation and probiotic therapy, proved highly effective against recurrent Clostridium difficile infections and have been shown to reduce HAI incidence in hospitalized patients undergoing antibiotic therapy. Artificial intelligence and machine learning systems offer promising predictive capabilities in processing large volumes of clinical, microbiological, and patient data but require robust data integration. Our paper argues that HAIs are still a global challenge, requiring stringent IPC policies, computer vision, and AI-powered tools. Despite promising avenues like integrated One Health approaches, optimized phage therapy, microbiome-based interventions, and targeted vaccine development, several knowledge gaps in clinical efficacy, standardization, and pathogen complexity remain to be answered.

Global diversity and distribution of antibiotic resistance genes in human wastewater treatment systems

Antibiotic resistance poses a significant threat to human health, and wastewater treatment plants (WWTPs) are important reservoirs of antibiotic resistance genes (ARGs). Here, we analyze the antibiotic resistomes of 226 activated sludge samples from 142 WWTPs across six continents, using a consistent pipeline for sample collection, DNA sequencing and analysis. We find that ARGs are diverse and similarly abundant, with a core set of 20 ARGs present in all WWTPs. ARG composition differs across continents and is distinct from that of the human gut and the oceans. ARG composition strongly correlates with bacterial taxonomic composition, with Chloroflexi, Acidobacteria and Deltaproteobacteria being the major carriers. ARG abundance positively correlates with the presence of mobile genetic elements, and 57% of the 1112 recovered high-quality genomes possess putatively mobile ARGs. Resistome variations appear to be driven by a complex combination of stochastic processes and deterministic abiotic factors.

Changing climate and socioeconomic factors contribute to global antimicrobial resistance

Climate change poses substantial challenges in containing antimicrobial resistance (AMR) from a One Health perspective. Using 4,502 AMR surveillance records involving 32 million tested isolates from 101 countries (1999-2022), we analyzed the impact of socioeconomic and environmental factors on AMR. We also established forecast models based on several scenarios, considering antimicrobial consumption reduction, sustainable development initiatives and different shared socioeconomic pathways under climate change. Our findings reveal growing AMR disparities between high-income countries and low- and middle-income countries under different shared socioeconomic pathway scenarios. By 2050, compared with the baseline, sustainable development efforts showed the most prominent effect by reducing AMR prevalence by 5.1% (95% confidence interval (CI): 0.0-26.6%), surpassing the effect of antimicrobial consumption reduction. Key contributors include reducing out-of-pocket health expenses (3.6% (95% CI: -0.5 to 21.4%)); comprehensive immunization coverage (1.2% (95% CI: -0.1% to 8.2%)); adequate health investments (0.2% (95% CI: 0.0-2.4%)) and universal access to water, sanitation and hygiene services (0.1% (95% CI: 0.0-0.4%)). These findings highlight the importance of sustainable development strategies as the most effective approach to help low- and middle-income countries address the dual challenges of climate change and AMR.

Distribution status and influencing factors of antibiotic resistance genes in the Chaohu Lake, China

Background

Chaohu Lake (CL) is one of the most polluted areas in China due to its high content of antibiotics. However, the distribution and influencing factors of antibiotic resistance genes (ARGs) in this lake are still controversial.

Methods

To solve this problem, we used metagenomic sequencing to investigate the distribution and in-fluencing factors of ARGs in CL.

Results

Our findings revealed the existence of nine kinds of ARGs, including 45 specific genes. The most abundant types were multidrug, bacitracin, polymyxin, macrolide lincosamide streptogramin, and aminoglycoside. Multiple microorganisms were undeniable ARG reservoirs, although they were not dominant species in the microbiota. Our results also showed that both the microbiota and physiochemical factors played important roles in shaping the distributions of ARGs in CL. Specifically, the levels of PO4-P (0.5927) and total phosphorus (0.4971) had a greater impact than total nitrogen (0.0515), NO3-N (0.0352), NO2-N (-0.1975), and NH3-N (-0.0952).

Conclusions

These findings provide valuable insights into the distribution and influencing factors of ARGs in lakes.

National-scale insights into AMR transmission along the wastewater-environment continuum

The circulation of antimicrobial resistance (AMR) bacteria between human populations and the environment is a key driver of the global AMR burden, with wastewater acting as a major route of transmission. In this nationwide study, influent and effluent samples were collected from 47 municipal wastewater treatment plants (WWTPs) across Wales, covering areas of varying sociodemographics and representing approximately 66 % of the population connected to the main sewer network. Additionally, 76 river and estuarine sediment samples were collected upstream and downstream of the WWTPs, as well as from nearby recreational beaches. High-throughput qPCR was used to quantify 76 antimicrobial resistance genes (ARGs), 10 mobile genetic elements and 5 pathogens. Our analyses revealed that the absolute abundance and composition of the influent resistome was influenced by increasing WWTP catchment population size and density. Significant shifts in the resistome were observed following the wastewater treatment process, with the biological treatment stage identified as a critical determinant of AMR removal efficiency. WWTPs using biological filter beds were found to be more effective in reducing ARG relative abundances compared to those employing activated sludge processes. Despite the presence of ARGs in the effluent, the abundance and diversity of the river sediment resistomes did not increase downstream of the WWTPs. However, the presence of a resistome was found in all sediment samples, with varying compositions influenced by WWTP size and sediment source. Altogether, these findings highlight the complex and interconnected factors that shape the resistome across the wastewater-environment continuum, highlighting the need for comprehensive, nationwide surveillance studies to inform targeted interventions and mitigate the spread of AMR.

Factors associated with clinical antimicrobial resistance in China: a nationwide analysis

BACKGROUND

Antimicrobial resistance (AMR) represents a critical global health threat, necessitating the identification of factors that contribute to its emergence and proliferation. We used a "One Health" perspective to evaluate the association of human and veterinary antibiotic usage, environmental factors, socio-economic factors, and health care factors with clinical AMR in China.

METHODS

We analyzed data from 31 provincial-level administrative divisions in China, encompassing 20,762,383 bacterial isolates sourced from the China Antimicrobial Resistance Surveillance System dataset between 2014 and 2022. A β regression model was used to explore the relationship of AMR with multiple variables. We also estimated the contribution of factors associated with AMR, and evaluated the avoidable risk of AMR under six different measures during 2019 according to available guidelines.

RESULTS

AMR had positive associations with human antibiotic usage, veterinary antibiotic usage, particulate matter smaller than 2.5 µm (PM2.5) level, population density, gross domestic product per capita, and length of hospital stay, and a 1 unit increase in the level of above independent variables were associated with a percentage change in the aggregate AMR of 1.8% (95% CI: 1.1, 2.5), 2.0% (95% CI: 0.6, 3.4), 0.9% (95% CI: 0.4, 1.4), 0.02% (95% CI: 0.01, 0.03), 0.5% (95% CI: 0.1, 0.8), and 8.0% (95% CI: 1.2, 15.3), respectively. AMR had negative associations with city water popularity, city greenery area per capita, and health expenditure per capita, and a 1 unit increase in the level of above independent variables were associated with a percentage change in the aggregate AMR of -4.2% (95% CI: -6.4, -1.9), -0.4% (95% CI: -0.8, -0.07), and -0.02% (95% CI: -0.04, -0.01), respectively. PM2.5 might be a major influencing factor of AMR, accounting for 13.7% of variation in aggregate AMR. During 2019, there was estimated 5.1% aggregate AMR could be attributed to PM2.5, corresponding to 25.7 thousand premature deaths, 691.8 thousand years of life lost, and 63.9 billion Chinese yuan in the whole country. Human antibiotic usage halved, veterinary antibiotic usage halved, city water popularity improved, city greenery area improved, and comprehensive measures could decrease nationwide aggregate AMR by 8.5, 0.5, 1.3, 4.4, and 17.2%, respectively.

CONCLUSIONS

The study highlights the complex and multi-dimensional nature of AMR in China and finds PM2.5 as a possible major influencing factor. Despite improvements in decreasing AMR, future initiatives should consider integrated strategies to control PM2.5 and other factors simultaneously to decrease AMR.

Expanding the focus of the One Health concept: links between the Earth-system processes of the planetary boundaries framework and antibiotic resistance

The scientific community warns that our impact on planet Earth is so acute that we are crossing several of the planetary boundaries that demarcate the safe operating space for humankind. Besides, there is mounting evidence of serious effects on people's health derived from the ongoing environmental degradation. Regarding human health, the spread of antibiotic resistant bacteria is one of the most critical public health issues worldwide. Relevantly, antibiotic resistance has been claimed to be the quintessential One Health issue. The One Health concept links human, animal, and environmental health, but it is frequently only focused on the risk of zoonotic pathogens to public health or, to a lesser extent, the impact of contaminants on human health, i.e., adverse effects on human health coming from the other two One Health "compartments". It is recurrently claimed that antibiotic resistance must be approached from a One Health perspective, but such statement often only refers to the connection between the use of antibiotics in veterinary practice and the antibiotic resistance crisis, or the impact of contaminants (antibiotics, heavy metals, disinfectants, etc.) on antibiotic resistance. Nonetheless, the nine Earth-system processes considered in the planetary boundaries framework can be directly or indirectly linked to antibiotic resistance. Here, some of the main links between those processes and the dissemination of antibiotic resistance are described. The ultimate goal is to expand the focus of the One Health concept by pointing out the links between critical Earth-system processes and the One Health quintessential issue, i.e., antibiotic resistance.

Understanding the impacts of temperature and precipitation on antimicrobial resistance in wastewater: theory, modeling, observation, and limitations

Changing climate may contribute to increased antimicrobial resistance (AMR), particularly in wastewater which acts as a reservoir for resistant bacteria. Here, we determined how applying climate dependencies to our previously published model, rooted in theory, impacts computational simulations of AMR in wastewater. We found AMR levels were reduced at lower temperatures but increased with lower precipitation. The impact of precipitation on AMR was more pronounced at higher temperatures compared to lower temperatures. To validate our model, we investigated associations between total AMR gene abundance in wastewater from the Global Sewage Surveillance project and mean temperature and rainfall values extracted from European Centre for Medium-Range Weather Forcasts Reanalysis v5 (ERA5) reanalysis. We observed similar trends between the simulations and observations. Observations and simulations from our study can inform experiments to determine causal relationships as well as help identify other key drivers. We also discuss study challenges given the complex nature of AMR in the environment.

Antibiotic Resistance Genes in Agricultural Soils: A Comprehensive Review of the Hidden Crisis and Exploring Control Strategies

This paper aims to review the sources, occurrence patterns, and potential risks of antibiotic resistance genes (ARGs) in agricultural soils and discuss strategies for their reduction. The pervasive utilization of antibiotics has led to the accumulation of ARGs in the soil. ARGs can be transferred among microorganisms via horizontal gene transfer, thereby increasing the likelihood of resistance dissemination and heightening the threat to public health. In this study, we propose that physical, chemical, and bioremediation approaches, namely electrokinetic remediation, advanced oxidation, and biochar application, can effectively decrease the abundance of ARGs in the soil. This study also highlights the significance of various control measures, such as establishing a strict regulatory mechanism for veterinary drugs, setting standards for the control of ARGs in organic fertilizers, and conducting technical guidance and on-farm soil monitoring to reduce the environmental spread of ARGs and protect public health.

Seasonal Change in Microbial Diversity: Bile Microbiota and Antibiotics Resistance in Patients with Bilio-Pancreatic Tumors: A Retrospective Monocentric Study (2010-2020)

Background: Bilio-pancreatic tumors are a severe form of cancer with a high rate of associated mortality. These patients showed the presence of bacteria such as Escherichia coli and Pseudomonas spp. in the bile-pancreatic tract. Therefore, efficient antibiotic therapy is essential to reduce bacterial resistance and adverse events in cancer patients. Recent studies on the seasonality of infectious diseases may aid in developing effective preventive measures. This study examines the seasonal impact on the bile microbiota composition and the antibiotic resistance of its microorganisms in patients with hepato-pancreatic-biliary cancer. Methods: We retrospectively evaluated the effect of the seasonally from 149 strains isolated by 90 Italian patients with a positive culture of bile samples collected through endoscopic retrograde cholangiopancreatography between 2010 and 2020. Results: Across all seasons, the most frequently found bacteria were E. coli, Pseudomonas spp., and Enterococcus spp. Regarding antibiotic resistance, bacteria showed the highest resistance to 3GC, fluoroquinolones, aminoglycosides, fosfomycin, and piperacillin-tazobactam in the summer and the lowest resistance in the spring, except for carbapenems and colistin. Conclusions: Antibiotic resistance has negative effects in cancer patients who rely on antibiotics to prevent and treat infections. Knowing whether bacterial and fungal resistance changes with the seasons is key information to define adequate and more effective antibiotic therapy.

Epigenetic modifications and metabolic gene mutations drive resistance evolution in response to stimulatory antibiotics

The antibiotic resistance crisis, fueled by misuse and bacterial evolution, is a major global health threat. Traditional perspectives tie resistance to drug target mechanisms, viewing antibiotics as mere growth inhibitors. New insights revealed that low-dose antibiotics may also serve as signals, unexpectedly promoting bacterial growth. Yet, the development of resistance under these conditions remains unknown. Our study investigated resistance evolution under stimulatory antibiotics and uncovered new genetic mechanisms of resistance linked to metabolic remodeling. We documented a shift from a fast, reversible mechanism driven by methylation in central metabolic pathways to a slower, stable mechanism involving mutations in key metabolic genes. Both mechanisms contribute to a metabolic profile transition from glycolysis to rapid gluconeogenesis. In addition, our findings demonstrated that rising environmental temperatures associated with metabolic evolution accelerated this process, increasing the prevalence of metabolic gene mutations, albeit with a trade-off in interspecific fitness. These findings expand beyond the conventional understanding of resistance mechanisms, proposing a broader metabolic mechanism within the selective window of stimulatory sub-MIC antibiotics, particularly in the context of climate change.

Prevalence of multidrug-resistant bacteria in healthcare and community settings in West Africa: systematic review and meta-analysis

BACKGROUND

Multidrug-resistant (MDR) bacteria are a global health threat, notably in low- and middle-income countries. The aim of this review was to estimate the prevalence of multidrug-resistant bacteria in healthcare and community settings in West Africa.

METHODS

In accordance with PRISMA guidelines, we searched PubMed, CINAHL, African Index Medicus, and other databases for studies published from 2010 onward. Data on MDR bacterial prevalence, study characteristics, and infection types were extracted and analyzed via R software. Subgroup analyses were performed to explore differences in prevalence across infection settings and sample types.

RESULTS

Out of the 5,320 articles identified, 50 studies from 13 West African countries met the inclusion criteria, with the majority from Nigeria (34%) and Ghana (22%). Among the 35,820 bacteria isolated in these studies, gram-negative bacteria (GNB), particularly Escherichia coli and Klebsiella sp., were the most frequently isolated species, accounting for 63.3% of the bacteria. The overall prevalence of MDR bacteria was 59% (95% CI: 48-69%), with significant heterogeneity between studies (I² = 98%, p < 0.001). Subgroup analysis revealed a 7% increase in MDR bacteria prevalence from the first five-year period to the last two five-year periods, and a greater prevalence of MDR bacteria in nosocomial infections (65%, 95% CI: 45-81%) than in community-acquired infections (53%, 95% CI: 31-74%). The prevalence of MDR bacteria in mixed infection settings was 58% (95% CI: 44-71%). The MDR prevalence was highest in the urine samples (72%, 95% CI: 57-84%) and superficial skin samples (69%, 95% CI: 29-92%), whereas it was lowest in the nasopharyngeal samples (26%, 95% CI: 21-33%).

CONCLUSION

The high prevalence of MDR bacteria in West Africa underscores the need for strengthened infection control measures, improved surveillance, and stricter antibiotic use policies. Enhanced regional collaboration is essential to mitigate the spread of AMR in both healthcare and community settings.

PROSPERO REGISTRATION NUMBER

CRD42023470363.

Soil warming increases the active antibiotic resistome in the gut of invasive giant African snails

BACKGROUND

Global warming is redrawing the map for invasive species, spotlighting the globally harmful giant African snail as a major ecological disruptor and public health threat. Known for harboring extensive antibiotic resistance genes (ARGs) and human pathogens, it remains uncertain whether global warming exacerbates these associated health risks.

METHODS

We use phenotype-based single-cell Raman with D2O labeling (Raman-D2O) and genotype-based metagenomic sequencing to investigate whether soil warming increases active antibiotic-resistant bacteria (ARBs) in the gut microbiome of giant African snails.

RESULTS

We show a significant increase in beta-lactam phenotypic resistance of active ARBs with rising soil temperatures, mirrored by a surge in beta-lactamase genes such as SHV, TEM, OCH, OKP, and LEN subtypes. Through a correlation analysis between the abundance of phenotypically active ARBs and genotypically ARG-carrying gut microbes, we identify species that contribute to the increased activity of antibiotic resistome under soil warming. Among 299 high-quality ARG-carrying metagenome-assembled genomes (MAGs), we further revealed that the soil warming enhances the abundance of "supercarriers" including human pathogens with multiple ARGs and virulence factors. Furthermore, we identified elevated biosynthetic gene clusters (BGCs) within these ARG-carrying MAGs, with a third encoding at least one BGC. This suggests a link between active ARBs and secondary metabolism, enhancing the environmental adaptability and competitive advantage of these organisms in warmer environments.

CONCLUSIONS

The study underscores the complex interactions between soil warming and antibiotic resistance in the gut microbiome of the giant African snail, highlighting a potential escalation in environmental health risks due to global warming. These findings emphasize the urgent need for integrated environmental and health strategies to manage the rising threat of antibiotic resistance in the context of global climate change. Video Abstract.

Insights into the ecological and climate crisis: Emerging infections threatening human health

The Anthropocene era is marked by unprecedented human-induced alterations to the environment, resulting in a climate emergency and widespread ecological deterioration. A staggering number of up to one million species of plants and animals are in danger of becoming extinct, which includes over 10 % of insect species and 40 % of plant species. Unrestrained release of greenhouse gases, widespread deforestation, intense agricultural practices, excessive fishing, and alterations in land use have exceeded the ecological boundaries that were once responsible for humanity's wellbeing. As per the Intergovernmental Panel on Climate Change (IPCC), existing policies are expected to result in a minimum rise in global temperature of +2 °C, with more recent assessments indicating a potential increase of up to +2.9 °C. The effects of climate change and ecological degradation on the formation of diseases are complex and have multiple aspects. Deforestation diminishes biodiversity and compels wildlife to come into greater proximity with humans, hence promoting the transmission of zoonotic diseases. Climate change intensifies these impacts by modifying the habitats of disease carrying organisms, resulting in the expansion of vector-borne diseases such as malaria, dengue, and Zika virus into previously unaffected areas. Furthermore, climate change amplifies the occurrence and severity of extreme weather phenomena, which undermines water, sanitation, and hygiene (WASH) practices. This creates an environment conducive to the transmission of waterborne diseases such as cholera in densely populated resettlement camps. Climate-induced disasters contribute to the complexity of epidemiological landscapes, exacerbating antimicrobial resistance and posing a threat to modern medical advancements. This narrative review investigates the complex connections between the ecological-climatic crises and emerging illnesses, offering an overview on how environmental changes contribute to outbreaks that pose a substantial threat to public health.

Human and Veterinary Medicine Collaboration: Synergistic Approach to Address Antimicrobial Resistance Through the Lens of Planetary Health

Antimicrobial resistance (AMR) represents a critical threat to human, animal, and environmental health, challenging global efforts to maintain sustainable ecosystems and public health systems. In this review, the complex, cross-disciplinary issues of AMR are explored within the framework of planetary health, emphasizing the interconnectedness of human and veterinary medicine with broader environmental and social systems. Specifically, it addresses the social, economic, environmental, and health dimensions of AMR under the planetary health framework. The social aspects consider how public awareness, education, and healthcare practices shape antimicrobial use (AMU) and resistance patterns. The economic impact evaluates the cost burdens of AMR, including healthcare costs, loss of productivity, and the implications for the livestock and food production industries. The environmental dimension highlights the role of pharmaceutical waste, agricultural runoff, and industrial pollution in contributing to the spread of antimicrobials and resistant pathogens in ecosystems. To illustrate these challenges, a comprehensive literature review using the PubMed and Web of Science databases was conducted, identifying 91 relevant articles on planetary health and AMR. In this review, the knowledge from these studies and additional references is integrated to provide a holistic overview of the AMR crisis. By applying the four pillars of planetary health-social, economic, environmental, and health knowledge-in this manuscript, the necessity is underscored of collaborative strategies across human and veterinary medicine to combat AMR. Ultimately, this synergistic approach aims to shape the policies and practices that safeguard public health, protect ecosystems, and promote a sustainable future by implementing antimicrobial stewardship programs and encouraging prudent AMU.

Prevalence and Antibiotic Susceptibility of Pathogenic Enterobacteria Strains from Three Biotopes in the City of Ouagadougou (Burkina Faso)

Purpose

The emergence of antibiotic resistance in pathogenic Enterobacteriaceae is a public health problem in tropical countries such as Burkina Faso. Antibiotic resistance could be identified using a variety of approaches. This study aimed to estimate the prevalence of pathogenic enterobacteria strains from three sources, as well as their antibiotic resistance profile to biotope and climatic season.

Material and Methods

The methodological approach consisted of identifying Enterobacteriaceae from human (urine, stool), animal (eggs, milk, fish), and environmental (soil, lettuce) samples, followed by assessing their antibiotic susceptibility. Samples were collected from February to December 2023. Bacterial species were isolated and phenotypically identified (morphologically, culturally, biochemically, and antigenically) using standard methods. The prevalence of bacterial susceptibility to ten antibiotics was determined using the agar disk diffusion method. The collected data were analyzed with IBM SPSS Statistics 25 software.

Results

A total of 615 Enterobacteriaceae isolates were collected, including 300, 168, and 147 samples from human, animal, and environmental sources respectively. Phenotypic characteristics allowed to partially identify 43 species, among these 29.76% belonged to Escherichia coli, 24.72% to Enterobacter cloacae, 13.82% to Klebsiella pneumoniae, 3.41% to Enterobacter sakazakii and 2.6% to Klebsiella oxytoca. Bacterial resistance rates were: aminopenicillins (54.8%), first-generation cephalosporins (35.3%), sulfonamides (33.3%), third-generation cephalosporins (30.7%), fourth-generation cephalosporins (22.5%), fluoroquinolones (21.8%), phenicols (16.8%), and carbapenems (16.2%). The distribution of antibiotic resistance was 45.3% from human sources, 19.3% from animal sources, and 13.8% from environmental sources.

Conclusion

The results indicate that resistant bacteria can come from any of the three biotopes, with human origin being the most frequent. The high prevalence of resistance to the antibiotics tested in isolated bacteria raises interest in investigating the genetic factors responsible.

Trends in Escherichia coli and Klebsiella pneumoniae Urinary Tract Infections and Antibiotic Resistance over a 5-Year Period in Southeastern Gabon

Background: Urinary tract infections (UTIs) are a substantial global health concern, exacerbated by the widespread use of antibiotics and leading to the development of multidrug-resistant strains. The aim of this study was to analyze the temporal patterns of Escherichia coli and Klebsiella pneumoniae UTIs and antibiotic resistance, taking into account various sociodemographic, clinical, and climatic factors within the study population. Methods: A total of 3026 urine samples from patients of all ages were analyzed over a period of five years by standard microbiological methods. Climatic data for the study area were also collected. Univariate and multivariate logistic regression analyses were performed to measure the impact of sociodemographic, clinical and climatic parameters on the occurrence of UTIs. Results: The study showed a 31.4% prevalence of UTIs among the population. Notably, there was a significant increase in pyelonephritis between 2019 and 2023 (p < 0.01). Furthermore, a significant association was found between cystitis and the long dry season, as well as the short rainy season. Furthermore, Escherichia coli and Klebsiella pneumoniae exhibited resistance to beta-lactams, quinolones, and co-trimoxazole. The resistance of Escherichia coli isolated from cystitis to nitrofurantoin showed a significant increase over the years (p < 0.04). Principal component analysis (PCA) suggested that humidity may play a role in the emergence of multidrug-resistant strains of Escherichia coli and Klebsiella pneumoniae. Conclusions: UTIs show variability according to various sociodemographic, clinical, and climatic factors, with a higher risk of complications seen in individuals aged ≤ 17 years. It is important to note that cases of pyelonephritis have been increasing over time, with a noticeable seasonal variation. This study suggests that humidity may play a role in promoting antibiotic multidrug resistance in Escherichia coli and Klebsiella pneumoniae.

Transmission and control strategies of antimicrobial resistance from the environment to the clinic: A holistic review

The environment serves as a significant reservoir of antimicrobial resistance (AMR) microbes and genes and is increasingly recognized as key source of clinical AMR. Modern human activities impose an additional burden on environmental AMR, promoting its transmission to clinical setting and posing a serious threat to human health and welfare. Therefore, a comprehensive review of AMR transmission from the environment to the clinic, along with proposed effective control strategies, is crucial. This review systematically summarized current research on the transmission of environmental AMR to clinical settings. Furthermore, the transmission pathways, horizontal gene transfer (HGT) mechanisms, as well as the influential drivers including triple planetary crisis that may facilitate AMR transfer from environmental species to clinical pathogens are highlighted. In response to the growing trend of AMR transmission, we propose insightful mitigation strategies under the One Health framework, integrating advanced surveillance and tracking technologies, interdisciplinary knowledge, multisectoral interventions, alongside multiple antimicrobial use and stewardship approaches to tacking development and spread of AMR.

Climate change as a challenge for pharmaceutical storage and tackling antimicrobial resistance

The rise of antimicrobial resistance (AMR) remains a pressing global health challenge. Infections that were once easily treatable with first-line antimicrobials are becoming increasingly difficult to manage. This shift directly threatens the wellness of humans, animals, plants, and the environment. While the AMR crisis can be attributed to a myriad of factors, including lack of infection prevention and control measures, over-prescription of antimicrobials, patient non-compliance, and the misuse of antimicrobials, one aspect that has garnered less attention is the role of storage conditions of these medicines. The way medications, particularly antimicrobials, are transported and stored until the point of use can influence their efficacy and, subsequently, may impact the development of resistant microbial strains. This review delves deeper into the often-overlooked domain of climate change (CC) and antimicrobial storage practices and the potential effects. Inappropriate storage conditions, such as exposure to extreme temperatures, humidity or light, can degrade the potency of antimicrobials. When these compromised medicines are administered to patients or animals alike, they may not effectively eradicate the targeted pathogens, leading to partial survival of the pathogens. These surviving pathogens, having been exposed to sub-lethal doses, are more likely to evolve and develop resistance mechanisms. The review discusses the mechanism underlying this and underscores the implications of antimicrobial storage practices in relation to two of the most pressing global health challenges: AMR and CC. The review also presents specific case studies and highlights the importance of monitoring storage practices and supply chain surveillance. Furthermore, the importance of deploying genomic tools to understand the potential impact of storage conditions on the development of AMR is discussed, and antimicrobial storage highlighted as a crucial part of comprehensive strategies in the fight against AMR.

Increased risk of antibiotic resistance in surface water due to global warming

As the pace of global warming accelerates, so do the threats to human health, urgent priority among them being antibiotic-resistant infections. In the context of global warming, this review summarises the direct and indirect effects of rising surface water temperatures on the development of bacterial antibiotic resistance. First, the resistance of typical pathogens such as E. coli increased with average temperature. This is not only related to increased bacterial growth rate and horizontal gene transfer frequency at high temperatures but also heat shock responses and cumulative effects. Secondly, the acceleration of bacterial growth indirectly promotes antibiotic residues in surface water, which is conducive to the growth and spread of resistant bacteria. Furthermore, the cascading effects of global warming, including the release of nutrients into the water and the resulting increase of bacteria and algae, indirectly promote the improvement of resistance. Water treatment processes exposed to high temperatures also increase the risk of resistance in surface water. The fitness costs of antibiotic resistance under these dynamic conditions are also discussed, concluding the relationship between various factors and resistance persistence. It was expected to provide a comprehensive basis for mitigating antibiotic resistance in the face of global warming.

Imperative for a health-centred focus on climate change in radiology

Climate change negatively impacts individual and population-level health through multiple pathways, including poor air quality, extreme heat and changes in infectious disease. These health effects will lead to higher health system and medical imaging utilisation. At the same time, the delivery of radiology services generates substantial greenhouse gas emissions. Mitigation strategies to reduce the environmental impact of medical imaging and adaptation strategies to build resiliency to current and future impacts of climate change in radiology should be centred on human health. A health-centred response in radiology reinforces the role of radiologists as physicians and emphasises the opportunity for medical imaging to promote health and advance our understanding of climate-related health effects. This review discusses the need for a health-centred focus on climate change in radiology, including the effects of climate change on human health and health systems, intersection of climate change with health equity, health benefits of climate action and opportunities to leverage medical imaging to improve human health.

Using digital health technologies to optimise antimicrobial use globally

Digital health technology (DHT) describes tools and devices that generate or process health data. The application of DHTs could improve the diagnosis, treatment, and surveillance of bacterial infection and the prevention of antimicrobial resistance (AMR). DHTs to optimise antimicrobial use are rapidly being developed. To support the global adoption of DHTs and the opportunities offered to optimise antimicrobial use consensus is needed on what data are required to support antimicrobial decision making. This Series paper will explore bacterial AMR in humans and the need to optimise antimicrobial use in response to this global threat. It will also describe state-of-the-art DHTs to optimise antimicrobial prescribing in high-income and low-income and middle-income countries, and consider what fundamental data are ideally required for and from such technologies to support optimised antimicrobial use.

The One Health aspect of climate events with impact on foodborne pathogens transmission

The ongoing effects of climate change have exacerbated two significant challenges to global populations: the transmission of foodborne pathogens and antimicrobial resistance (AMR) through the food chain. Using the latest available scientific information this review explores how climate-related factors such as rainfall, floods, storms, hurricanes, cyclones, dust, temperature and humidity impact the spread of the foodborne pathogens Salmonella, E. coli, Campylobacter, Vibrio, Listeria, and Staphylococcus aureus. We explore the complex dynamics between environmental changes and the heightened risk of foodborne diseases, analysing the contribution of wildlife, insects and contaminated environments in the proliferation of AMR and climate change. This review paper combines a thorough analysis of current literature with a discussion on findings from a wide variety of studies to provide a comprehensive overview of how climatic factors contribute to the survival, persistence and transmission of bacterial pathogens in the food chain. In addition, we discuss the necessity for effective mitigation strategies and policies. By providing insights into the interrelationships between climate change and food safety, this review hopes to inform future research and policy development to promote safer and more sustainable food systems and further integration within the One Health approach.

Desiccation tolerance and reduced antibiotic resistance: Key drivers in ST239-III to ST22-IV MRSA clonal replacement at a Malaysian teaching hospital

Molecular surveillance of methicillin-resistant Staphylococcus aureus (MRSA) isolated from Hospital Canselor Tuanku Muhriz (HCTM), a Malaysian teaching hospital revealed clonal replacement events of SCCmec type III-SCCmercury to SCCmec type IV strains before the year 2017; however, the reasons behind this phenomenon are still unclear. This study aimed to identify factors associated with the clonal replacement using genomic sequencing and phenotypic investigations (antibiogram profiling, growth rate and desiccation tolerance determination, survival in vancomycin sub-minimum inhibitory concentration (MIC) determination) of representative HCTM MRSA strains isolated in four-year intervals from 2005 - 2017 (n = 16). HCTM Antimicrobial Stewardship (AMS) and Infection Prevention and Control (IPC) policies were also reviewed. Phylogenetic analyses revealed the presence of 3 major MRSA lineages: ST239-III, ST22-IV and ST6-IV; MRSAs with the same STs shared similar core and accessory genomes. Majority of the ST239-III strains isolated in earlier years of the surveillance (2005, 2009 and 2013) were resistant to many antibiotics and harboured multiple AMR and virulence genes compared to ST22-IV and ST6-IV strains (isolated in 2013 and 2017). Interestingly, ST22-IV and ST6-IV MRSAs grew significantly faster and were more resistant to desiccation than ST239-III (p < 0.05), even though the later clone survived better post-vancomycin exposure. Intriguingly, ST22-IV was outcompeted by ST239-III in broth co-cultures; though it survived better when desiccated together with ST239-III. Higher desiccation tolerance and fewer carriage of AMR genes by ST22-IV, together with reduction of antibiotic selection pressure in HCTM (due to AMS and IPC policies) during 2005 - 2017 may have provided the clone a competitive edge in replacing the previously dominant ST239-III in HCTM. This study highlights the importance of MRSA surveillance for a clearer picture of circulating clones and clonal changes. To our knowledge, this is the first genomic epidemiology study of MRSA in Malaysia, which will serve as baseline genomic data for future surveillance.

Intersections between climate change and antimicrobial resistance: a systematic scoping review

Climate change and antimicrobial resistance (AMR) present crucial challenges for the health and wellbeing of people, animals, plants, and ecosystems worldwide, yet the two are largely treated as separate and unrelated challenges. The aim of this systematic scoping Review is to understand the nature of the growing evidence base linking AMR and climate change and to identify knowledge gaps and areas for further research. We conducted a systematic search of the peer-reviewed literature in Scopus, Web of Science, and PubMed on 27 June, 2022. Our search strategy identified and screened 1687 unique results. Data were extracted and analysed from 574 records meeting our inclusion criteria. 222 (39%) of these reviewed articles discussed harmful synergies in which both climate change and AMR exist independently and can interact synergistically, resulting in negative outcomes. Just over a quarter (n=163; 28%) of the literature contained general or broad references to AMR and climate change, whereas a fifth (n=111; 19%) of articles referred to climate change influencing the emergence and evolution of AMR. 12% of articles (n=70) presented positive synergies between approaches aimed at addressing climate change and interventions targeting the management and control of AMR. The remaining literature focused on the shared drivers of AMR and climate change, the trade-offs between climate actions that have unanticipated negative outcomes for AMR (or vice versa), and, finally, the pathways through which AMR can negatively influence climate change. Our findings indicate multiple intersections through which climate change and AMR can and do connect. Research in this area is still nascent, disciplinarily isolated, and only beginning to converge, with few documents primarily focused on the equal intersection of both topics. Greater empirical and evidence-based attention is needed to investigate knowledge gaps related to specific climate change hazards and antimicrobial resistant fungi, helminths, protists, and viruses.

Synergizing Ecotoxicology and Microbiome Data Is Key for Developing Global Indicators of Environmental Antimicrobial Resistance

The One Health concept recognises the interconnectedness of humans, plants, animals and the environment. Recent research strongly supports the idea that the environment serves as a significant reservoir for antimicrobial resistance (AMR). However, the complexity of natural environments makes efforts at AMR public health risk assessment difficult. We lack sufficient data on key ecological parameters that influence AMR, as well as the primary proxies necessary for evaluating risks to human health. Developing environmental AMR 'early warning systems' requires models with well-defined parameters. This is necessary to support the implementation of clear and targeted interventions. In this review, we provide a comprehensive overview of the current tools used globally for environmental AMR human health risk assessment and the underlying knowledge gaps. We highlight the urgent need for standardised, cost-effective risk assessment frameworks that are adaptable across different environments and regions to enhance comparability and reliability. These frameworks must also account for previously understudied AMR sources, such as horticulture, and emerging threats like climate change. In addition, integrating traditional ecotoxicology with modern 'omics' approaches will be essential for developing more comprehensive risk models and informing targeted AMR mitigation strategies.

Antimicrobial Activity of Cold Atmospheric Plasma on Bacterial Strains Derived from Patients with Diabetic Foot Ulcers

Bacterial infections or their biofilms in diabetic foot ulcer (DFU) are a key cause of drug-resistant wounds and amputations. Cold atmospheric plasma (CAP) is well documented for its antibacterial effect and promoting wound healing. In the current study, we built an argon-based, custom CAP device and investigated its potential in eliminating laboratory and clinical bacterial strains derived from DFU. The CAP device performed as expected with generation of hydroxyl, reactive nitrogen species, and argon species as determined by optical emission spectroscopy. A dose-dependent increase in oxidation reduction potential (ORP) and nitrites in the liquid phase was observed. The CAP treatment eliminated both gram-positive (Staphylococcus aureus, Entrococcus faecalis) and negative bacteria (Pseudomonas aeruginosa, Proteus mirabilis) laboratory strains. Clinical samples collected from DFU patients exhibited a significant decrease in both types of bacteria, with gram-positive strains showing higher susceptibility to the CAP treatment in an ex vivo setting. Moreover, exposure to CAP of polymicrobial biofilms from DFU led to a notable disruption in biofilm and an increase in free bacterial DNA. The duration of CAP exposure used in the current study did not induce DNA damage in peripheral blood lymphocytes. These results suggest that CAP could serve as an excellent tool in treating patients with DFUs.

Assessment of Spillover of Antimicrobial Resistance to Untreated Children 7-12 Years Old After Mass Drug Administration of Azithromycin for Child Survival in Niger: A Secondary Analysis of the MORDOR Cluster-Randomized Trial

BACKGROUND

The risk of antibiotic resistance is complicated by the potential for spillover effects from one treated population to another. Azithromycin mass drug administration programs report higher rates of antibiotic resistance among treatment arms in targeted groups. This study aimed to understand the risk of spillover of antibiotic resistance to nontarget groups in these programs.

METHODS

Data were used from a cluster-randomized trial comparing the effects of biannual azithromycin and placebo distribution to children 1-59 months old on child mortality rates. Nasopharyngeal samples from untreated children 7-12 years old were tested for genetic determinants of macrolide resistance (primary outcome) and resistance to other antibiotic classes (secondary outcomes). Linear regression was used to compare the community-level mean difference in prevalence by arm at the 24-month time point, adjusting for baseline prevalence.

RESULTS

A total of 1103 children 7-12 years old in 30 communities were included in the analysis (15 azithromycin, 15 placebo). The adjusted mean differences in the prevalence of resistance determinants for macrolides, β-lactams, and tetracyclines were 3.4% (95% confidence interval, -4.1% to 10.8%; P = .37), -1.2% (-7.9% to 5.5%; P = .72), and -3.3% (-9.5% to 2.8%; P = .61), respectively.

CONCLUSIONS

We were unable to demonstrate a statistically significant increase in macrolide resistance determinants in untreated groups in an azithromycin mass drug administration program. While the result might be consistent with a small spillover effect, this study was not powered to detect such a small difference. Larger studies are warranted to better quantify the potential for spillover effects within these programs.

A Comprehensive Review on Bioactive Molecules and Advanced Microorganism Management Technologies

The advent of new strains of resistant microbes and the concomitant growth in multidrug resistance have made antimicrobial resistance an urgent public health concern. New antimicrobials are desperately needed to boost the success rates of treating infectious diseases and save lives. There are many intriguing biomolecules with antibacterial action, which are mostly unexplored in microorganisms. This review article describes the importance of natural compounds against microorganisms using advanced techniques to protect individuals from diseases. We have conducted an extensive literature review using databases such as SCOPUS, SCI, PUBMED, ScienceDirect, and Medline to gather relevant information. Our review covers various microorganism sources for antimicrobials, antifungal drugs, micro-culturing techniques, and microbial-based microsystems' applications. Every kind of higher trophic life depends on microorganisms for sustenance. The unseen majority is essential to understanding how humans and other living forms can survive anthropogenic climate change. The article discusses antimicrobial substances and the latest techniques and strategies for developing effective treatments. Novel model systems and cutting-edge biomolecular and computational methodologies could help researchers enhance antimicrobial resistance by completely capitalizing on lead antimicrobials.

Comprehensive analysis and risk assessment of Antibiotic contaminants, antibiotic-resistant bacteria, and resistance genes: Patterns, drivers, and implications in the Songliao Basin

The pervasive use of antibiotics has raised substantial environmental concerns, especially regarding their temporal and spatial distribution across diverse water systems. This study addressed the gap in comprehensive research on antibiotic contamination during different hydrological periods, focusing on the Jilin section of the Songliao Basin in Northeast China, an area with severe winter ice cover. The study examined the occurrence, distribution, influencing factors, and potential ecological risks of prevalent antibiotic contaminants. Findings revealed antibiotic concentrations ranging from 239.64 to 965.81 ng/L, with antibiotic resistance genes (ARGs) at 5.22 × 10-2 16S rRNA-1 and antibiotic-resistant bacteria (ARB) up to 5.76 log10 CFU/mL. Ecological risk assessments identified significant risks to algae from oxytetracycline, erythromycin, and amoxicillin. Redundancy analysis and co-occurrence networks with ordinary least squares (OLS) demonstrated that the dispersion of ARGs and ARB is significantly influenced by environmental factors such as total organic carbon (TOC), total phosphorus (TP), total nitrogen (TN), fluoride (F⁻), and nitrate (NO₃⁻). These elements, along with mobile genetic elements (MGEs), play crucial roles in ARG patterns (R2 = 0.94, p ≤ 0.01). This investigation offers foundational insights into antibiotic pollution dynamics in cold climates, supporting the development of targeted mitigation strategies for aquatic systems.

Effects of sulfamethoxazole and copper on the natural microbial community from a fertilized soil

Cattle manure or its digestate, which often contains antibiotic residues, can be used as an organic fertilizer and copper (Cu) as a fungicide in agriculture. Consequently, both antibiotics and Cu are considered soil contaminants. In this work, microcosms were performed with soil amended with either manure or digestate with Cu and an antibiotic (sulfamethoxazole, SMX) co-presence and the planting of Lactuca sativa. After the addition of the organic amendments, a prompt increase in the microbial activity and at the same time of the sul1 and intI1 genes was observed, although ARGs generally decreased over time. In the amended and spiked microcosms, the microbial community was able to remove more than 99% of SMX in 36 days and the antibiotic did not bioaccumulate in the lettuce. Interestingly, where Cu and SMX were co-present, ARGs (particularly sul2) increased, showing how copper had a strong effect on resistance persistence in the soil. Copper also had a detrimental effect on the plant-microbiome system, affecting plant biomass and microbial activity in all conditions except in a digestate presence. When adding digestate microbial activity, biodiversity and lettuce biomass increased, with or without copper present. Not only did the microbial community favour plant growth, but lettuce also positively influenced its composition by increasing bacterial diversity and classes (e.g., Alphaproteobacteria) and genera (e.g., Bacillus), thus indicating a good-quality soil. KEY POINTS: • Cattle digestate promoted the highest microbial activity, diversity, and plant growth • Cattle digestate counteracted detrimental contaminant effects • Cu presence promoted antibiotic cross-resistance in soil.

The longitudinal trend and influential factors exploring of global antimicrobial resistance in Klebsiella pneumoniae

Klebsiella pneumoniae (Kp) is a human symbiotic opportunistic pathogen capable of causing severe hospital-based infections and community-acquired infections. The problem of antimicrobial resistance (AMR) has become increasing serious over time, posing a major threat to socio-economic and human development. In this study, we explored the global trend of AMR in 1786 strains of Kp isolated between 1982 and 2023. The number of antibiotic resistance genes (ARGs) in Kp increased significantly from 24.29 ± 5.44 to 32.42 ± 8.52 over time. Mobile genetic elements (MGEs) were responsible for the ARGs horizontal transfer of Kp strains. The results of structural equation modeling (SEM) indicated a strong association between the human development index and the increase of antibiotic consumption, which indirectly affected the occurrence and development of antibiotic resistance in Kp. The results of Generalized Linear Models (GLM) indicated that the influence of environmental factors such as temperature on the development of Kp resistance could not be ignored. Overall, this study monitored the longitudinal trend of antimicrobial resistance in Kp, explored the factors influencing antibiotic resistance, and provided insights for mitigating the threat of antimicrobial resistance.

Bacterial isolates and antibiotic sensitivity in canine bacterial keratitis in Korea

OBJECTIVE

To analyze bacterial isolates associated with canine bacterial keratitis and their antibiotic susceptibility patterns in Korea, focusing on multidrug resistance (MDR) and identifying effective antibiotic combinations for clinical treatment.

ANIMAL STUDIED

A total of 146 dogs diagnosed with suspected bacterial keratitis between October 2022 and October 2023 in Korea, with 157 eye samples collected for analysis.

PROCEDURE

Eye samples were cultured to isolate bacteria, and antibiotic susceptibility testing was performed using the minimum inhibitory concentration (MIC) method. Bacterial identification was conducted using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF). The study assessed the efficacy of individual antibiotics and combination therapies.

RESULTS

Bacteria were isolated in 55.4% of the samples. The most common genera were Staphylococcus species (48.5%, 48/99), Streptococcus species (13.1%, 13/99), Pseudomonas species (9.1%, 9/99), and Escherichia coli (9.1%, 9/99). Amikacin (84.8%) showed the highest antibiotic susceptibility, while doxycycline exhibited the lowest (17.2%). The most effective antibiotic combinations were amikacin-moxifloxacin (93%). MDR isolates accounted for 52.5% (52/99) of the total bacterial samples.

CONCLUSIONS

Staphylococcus species were the most common isolates, with 52.5% showing MDR, underscoring the need to curb antibiotic misuse. While antibiotics like amikacin demonstrated high susceptibility rates, their use should be reserved for resistant infections to prevent further resistance development. Rather than focusing solely on finding effective combinations of antibiotics, it is crucial to consider alternative treatment strategies that offer more sustainable solutions. Rather than relying on antibiotic combinations, attention should shift to sustainable alternatives to treat bacterial keratitis and reduce antibiotic dependence in clinical practice.

Diagnostic Excellence in the Context of Climate Change: A Review

Climate change is leading to a rise in heat-related illnesses, vector-borne diseases, and numerous negative impacts on patients' physical and mental health outcomes. Concurrently, healthcare contributes about 4.6% of global greenhouse gas emissions. Low-value care, such as overtesting and overdiagnosis, contributes to unnecessary emissions. In this review, we describe diagnostic excellence in the context of climate change and focus on two topics. First, climate change is affecting health, leading to the emergence of certain diseases, some of which are new, while others are increasing in prevalence and/or becoming more widespread. These conditions will require timely and accurate diagnosis by clinicians who may not be used to diagnosing them. Second, diagnostic quality issues, such as overtesting and overdiagnosis, contribute to climate change through unnecessary emissions and waste and should be targeted for interventions. We also highlight implications for clinical practice, research, and policy. Our findings call for efforts to engage healthcare professionals and policymakers in understanding the urgent implications for diagnosis in the context of climate change and reducing global greenhouse gas emissions to enhance both patient and planetary outcomes.

Nonlinear impacts of temperature on antibiotic resistance in Escherichia coli

The increase in bacterial antibiotic resistance poses a significant threat to the effectiveness of antibiotics, and there is growing evidence suggesting that global warming may speed up this process. However, the direct influence of temperature on the development of antibiotic resistance and the underlying mechanisms is not yet fully understood. Here we show that antibiotic resistance exhibits a nonlinear response to elevated temperatures under the combined stress of temperatures and antibiotics. We find that the effectiveness of gatifloxacin against Escherichia coli significantly diminishes at 42 °C, while resistance increases 256-fold at 27 °C. Additionally, the increased transcription levels of genes such as marA, ygfA, and ibpB with rising temperatures, along with gene mutations at different sites, explain the observed variability in resistance patterns. These findings highlight the complexity of antibiotic resistance evolution and the urgent need for comprehensive studies to understand and mitigate the effects of global warming on antibiotic resistance.

Beyond the incubator: applying a "one health" approach in the NICU

A "one health" approach recognises that human health, animal health and planetary health are closely interlinked and that a transdisciplinary approach is required to fully understand and maintain global health. While, by necessity, Neonatal Intensive Care has traditionally focused on the acutely unwell newborn, the avoidance of long-term harm is core to many management decisions. The COVID 19 pandemic and climate crisis have brought into sharp relief the importance of a "one health" approach as part of long-term health promotion in the holistic care of neonates, who may survive to experience the burden of future environmental crises. This narrative review seeks to integrate what we know about "one health" issues in the neonatal intensive care unit, notably antimicrobial resistance and climate change, and suggest "everyday changes" which can be utilised by practitioners to minimise the impact of neonatal intensive care on these global health issues. Many of the changes suggested not only represent important improvements for planetary health but are also core to good neonatal practice. IMPACT: Neonatal patients are likely to bear the burden of future environmental crises including pandemics and climate related disasters. While the focus of intensive care practitioners is acute illness, awareness of "one health" problems are important for our smallest patients as part of preventing long-term harm. High quality neonatal care can benefit both the planet and our patients.

AMR and Sustainable Development Goals: at a crossroads

Antimicrobial resistance (AMR) poses a significant global health threat, primarily stemming from its misuse and overuse in both veterinary and public healthcare systems. The consequences of AMR are severe, leading to more severe infections, increased health protection costs, prolonged hospital stays, unresponsive treatments, and elevated fatality rates. The impact of AMR is direct and far-reaching, particularly affecting the Sustainable Development Goals (SDGs), underscoring the urgency for concerted global actions to achieve these objectives. Disproportionately affecting underprivileged populations, AMR compounds their vulnerabilities, pushing them further into poverty. Moreover, AMR has ramifications for food production, jeopardizing sustainable agriculture and diminishing the livelihoods of farmers. The emergence of antibiotic-resistant bacteria in underprivileged areas heightens the risk of complications and mortality. Climate change further contributes to AMR, as evidenced by increased instances of foodborne salmonellosis and the development of antibiotic resistance, resulting in substantial healthcare costs. Effectively addressing AMR demands collaboration among governments, entrepreneurs, and the public sector to establish institutions and policies across all regulatory levels. Expanding SDG 17, which focuses on partnerships for sustainable development, would facilitate global antimicrobial stewardship initiatives, technology transfer, surveillance systems, and investment in vaccine and drug research. The World Bank's SDG database, tracking progress towards sustainable development, reveals a concerning picture with only a 15% success rate till 2023 and 48% showing deviation, underscoring a global gap exacerbated by the COVID-19 pandemic. Tackling AMR's global impact necessitates international cooperation, robust monitoring, and evaluation methods. The five priorities outlined guide SDG implementation, while impoverished countries must address specific challenges in their implementation efforts. Addressing AMR and its impact on the SDGs is a multifaceted challenge that demands comprehensive and collaborative solutions on a global scale.

Climate change and antibiotic resistance: A scoping review

This scoping review aimed to investigate the potential association between climate change and the rise of antibiotic resistance while also exploring the elements of climate change that may be involved. A scoping review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, comprehensively searching scientific literature up to 31 January 2024. Multiple databases were utilized, including MEDLINE, Web of Science and SCOPUS. Various search strategies were employed, and selection criteria were established to include articles relevant to antibiotic resistance and climate change. The review included 30 selected articles published predominantly after 2019. Findings from these studies collectively suggest that rising temperatures associated with climate change can contribute to the proliferation of antibiotic resistance, affecting diverse ecosystems. This phenomenon is observed in soil, glaciers, rivers and clinical settings. Rising temperatures are associated with a rise in the prevalence of antibiotic resistance across various environments, raising concerns for global health. However, these studies provide valuable insights but do not establish a definitive causal link between environmental temperature and antibiotic resistance. The selective pressure exerted by antibiotics and their residues in ecosystems further complicates the issue.