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Seghers F, Taylor MM, Storey A, Dong J, Wi TC, Wyber R, Ralston K, Nguimfack BD. Securing the supply of benzathine penicillin: a global perspective on risks and mitigation strategies to prevent future shortages. Int Health 2024; 16:279-282. [PMID: 37787149 PMCID: PMC10987389 DOI: 10.1093/inthealth/ihad087] [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: 05/31/2023] [Accepted: 09/05/2023] [Indexed: 10/04/2023] Open
Abstract
Benzathine benzylpenicillin is a globally indispensable medicine. As a long-lasting injectable penicillin, it serves as the primary treatment for syphilis, group A streptococcal infections, rheumatic fever and rheumatic heart disease. A competitive market and low profit margins, compounded by limited visibility of demand, have resulted in a decreased number of active pharmaceutical ingredient (API) manufacturers. By 2016, only three Chinese API manufacturers remained, continuing to supply to the global market today. Recurring global shortages, a consequence of supply and demand imbalances, indicate underlying market risks. Therefore, the need for mitigation strategies is imperative.
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Affiliation(s)
- Frederic Seghers
- Clinton Health Access Initiative, 383 Dorchester Avenue, Boston, MA 02127, USA
| | - Melanie M. Taylor
- U.S. Centers for Disease Control and Prevention, Division of HIV Prevention 1600, Clifton Road, Atlanta, GA 30333, USA
| | - Andrew Storey
- Clinton Health Access Initiative, 383 Dorchester Avenue, Boston, MA 02127, USA
| | - Jicui Dong
- World Health Organization, Regulation and Prequalification Department, Access to Medicines and Health Products Division. Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Teodora C. Wi
- World Health Organization, Communicable and Noncommunicable Diseases Division, Department of Global HIV, Hepatitis and STIs Programmes Avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Rosemary Wyber
- Telethon Kids Institute, END RHD program, 15 Hospital Avenue, Nedlands, Western Australia 6009, Australia
| | - Kate Ralston
- World Heart Federation, 32 Rue de Malatrex, Geneva 1201, Switzerland
| | - Boniface Dongmo Nguimfack
- World Health Organization, Communicable and Noncommunicable Diseases Division, Department of Global HIV, Hepatitis and STIs Programmes Avenue Appia 20, 1211 Geneva 27, Switzerland
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2
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Håkonsen H, Hedenrud T. Would Pharmacy Students Advocate Green Pharmacy Given Their Preference for Medicines With Environmental Impact? Am J Pharm Educ 2024; 88:100694. [PMID: 38574996 DOI: 10.1016/j.ajpe.2024.100694] [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] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/07/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE To investigate the preferences among university students in Gothenburg, Sweden for medicines that have a different environmental impact with respect to effect and explore to what extent having received information about pharmaceuticals' potential harm to the environment is associated with the stated preferences. METHODS A survey was conducted among students in different study programs at the University of Gothenburg, Sweden. In all, 704 students received oral and written information about the study at the end of a lecture and were invited to take part (response rate: 83.5%). The questionnaire contained items about medicinal environmental information and 2 scenarios with fictious medicines as options for the treatment or symptom relief of minor ailments in humans. RESULTS Overall, 53.3% of the students (pharmacy students: 57.8%) had received information about the environmental impact of medicines, and 79.6% (pharmacy students: 80.6%) reported that they had concerns about the consequences. Twenty percent (pharmacy students: 9.0%) named the university as an information source. The students were most satisfied overall with the least effective and most environmentally friendly medicines. Consistently, pharmacy students gave higher scores to the most environmentally harmful medicines, especially compared with medical and health care students. Pharmacy students, who, to the same extent as medical and health care students had received information about medicines' environmental impact, were less likely to state environmentally friendly options with an inferior effect as their preferred choice. CONCLUSION Pharmacy students generally rated the medicines higher than other student groups, despite being aware of the harmful effects on the environment.
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Affiliation(s)
- Helle Håkonsen
- University of Gothenburg, Institute of Medicine, School of Public Health and Community Medicine, Gothenburg, Sweden.
| | - Tove Hedenrud
- University of Gothenburg, Institute of Medicine, School of Public Health and Community Medicine, Gothenburg, Sweden
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3
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Gama GSP, Pimenta AS, Feijó FMC, de Azevedo TKB, de Melo RR, de Andrade GS. The Potential of Wood Vinegar to Replace Antimicrobials Used in Animal Husbandry-A Review. Animals (Basel) 2024; 14:381. [PMID: 38338024 PMCID: PMC10854697 DOI: 10.3390/ani14030381] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/16/2023] [Accepted: 12/27/2023] [Indexed: 02/12/2024] Open
Abstract
The indiscriminate use of antimicrobials in animal husbandry can result in various types of environmental contamination. Part of the dose of these products is excreted, still active, in the animals' feces and urine. These excreta are widely used as organic fertilizers, which results in contamination with antimicrobial molecules. The impacts can occur in several compartments, such as soil, groundwater, and surface watercourses. Also, contamination by antimicrobials fed or administrated to pigs, chickens, and cattle can reach the meat, milk, and other animal products, which calls into question the sustainability of using these products as part of eco-friendly practices. Therefore, a search for alternative natural products is required to replace the conventional antimicrobials currently used in animal husbandry, aiming to mitigate environmental contamination. We thus carried out a review addressing this issue, highlighting wood vinegar (WV), also known as pyroligneous acid, as an alternative antimicrobial with good potential to replace conventional products. In this regard, many studies have demonstrated that WV is a promising product. WV is a nontoxic additive widely employed in the food industry to impart a smoked flavor to foods. Studies have shown that, depending on the WV concentration, good results can be achieved using it as an antimicrobial against pathogenic bacteria and fungi and a valuable growth promoter for poultry and pigs.
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Affiliation(s)
- Gil Sander Próspero Gama
- Graduate Program in Forest Sciences, Forest Engineering, Universidade Federal do Rio Grande do Norte, Rodovia RN 160, km 03 s/n, Distrito de Jundiaí, Macaíba CEP 59.280-000, Brazil; (G.S.P.G.); (A.S.P.); (T.K.B.d.A.); (G.S.d.A.)
| | - Alexandre Santos Pimenta
- Graduate Program in Forest Sciences, Forest Engineering, Universidade Federal do Rio Grande do Norte, Rodovia RN 160, km 03 s/n, Distrito de Jundiaí, Macaíba CEP 59.280-000, Brazil; (G.S.P.G.); (A.S.P.); (T.K.B.d.A.); (G.S.d.A.)
| | - Francisco Marlon Carneiro Feijó
- Graduate Program in Environment, Technology, and Society—PPGATS, Laboratory of Veterinary Microbiology and Laboratory of Wood Technology, Universidade Federal Rural do Semiárido—UFERSA, Av. Francisco Mota, 572—Bairro Costa e Silva, Mossoró CEP 59.625-900, Brazil;
| | - Tatiane Kelly Barbosa de Azevedo
- Graduate Program in Forest Sciences, Forest Engineering, Universidade Federal do Rio Grande do Norte, Rodovia RN 160, km 03 s/n, Distrito de Jundiaí, Macaíba CEP 59.280-000, Brazil; (G.S.P.G.); (A.S.P.); (T.K.B.d.A.); (G.S.d.A.)
| | - Rafael Rodolfo de Melo
- Graduate Program in Environment, Technology, and Society—PPGATS, Laboratory of Veterinary Microbiology and Laboratory of Wood Technology, Universidade Federal Rural do Semiárido—UFERSA, Av. Francisco Mota, 572—Bairro Costa e Silva, Mossoró CEP 59.625-900, Brazil;
| | - Gabriel Siqueira de Andrade
- Graduate Program in Forest Sciences, Forest Engineering, Universidade Federal do Rio Grande do Norte, Rodovia RN 160, km 03 s/n, Distrito de Jundiaí, Macaíba CEP 59.280-000, Brazil; (G.S.P.G.); (A.S.P.); (T.K.B.d.A.); (G.S.d.A.)
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4
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Malmqvist E, Fumagalli D, Munthe C, Larsson DGJ. Pharmaceutical Pollution from Human Use and the Polluter Pays Principle. Public Health Ethics 2023; 16:152-164. [PMID: 37547912 PMCID: PMC10401492 DOI: 10.1093/phe/phad012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Indexed: 08/08/2023] Open
Abstract
Human consumption of pharmaceuticals often leads to environmental release of residues via urine and faeces, creating environmental and public health risks. Policy responses must consider the normative question how responsibilities for managing such risks, and costs and burdens associated with that management, should be distributed between actors. Recently, the Polluter Pays Principle (PPP) has been advanced as rationale for such distribution. While recognizing some advantages of PPP, we highlight important ethical and practical limitations with applying it in this context: PPP gives ambiguous and arbitrary guidance due to difficulties in identifying the salient polluter. Moreover, when PPP does identify responsible actors, these may be unable to avoid or mitigate their contribution to the pollution, only able to avoid/mitigate it at excessive cost to themselves or others, or excusably ignorant of contributing. These limitations motivate a hybrid framework where PPP, which emphasizes holding those causing large-scale problems accountable, is balanced by the Ability to Pay Principle (APP), which emphasizes efficiently managing such problems. In this framework, improving wastewater treatment and distributing associated financial costs across water consumers or taxpayers stand out as promising responses to pharmaceutical pollution from human use. However, sound policy depends on empirical considerations requiring further study.
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Affiliation(s)
- Erik Malmqvist
- Corresponding author: Erik Malmqvist, Department of Philosophy, Linguistics & Theory of Science and Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Box 200, 405 30 Gothenburg, Sweden. Tel.: +46-31 786 56 52;
| | - Davide Fumagalli
- Department of Philosophy, Linguistics & Theory of Science and Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Christian Munthe
- Department of Philosophy, Linguistics & Theory of Science and Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
| | - D G Joakim Larsson
- Department of Infectious Diseases, Institute of Biomedicine and Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
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5
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Pillay S, Calderón-Franco D, Urhan A, Abeel T. Metagenomic-based surveillance systems for antibiotic resistance in non-clinical settings. Front Microbiol 2022; 13:1066995. [PMID: 36532424 PMCID: PMC9755710 DOI: 10.3389/fmicb.2022.1066995] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 10/11/2022] [Accepted: 11/09/2022] [Indexed: 08/12/2023] Open
Abstract
The success of antibiotics as a therapeutic agent has led to their ineffectiveness. The continuous use and misuse in clinical and non-clinical areas have led to the emergence and spread of antibiotic-resistant bacteria and its genetic determinants. This is a multi-dimensional problem that has now become a global health crisis. Antibiotic resistance research has primarily focused on the clinical healthcare sectors while overlooking the non-clinical sectors. The increasing antibiotic usage in the environment - including animals, plants, soil, and water - are drivers of antibiotic resistance and function as a transmission route for antibiotic resistant pathogens and is a source for resistance genes. These natural compartments are interconnected with each other and humans, allowing the spread of antibiotic resistance via horizontal gene transfer between commensal and pathogenic bacteria. Identifying and understanding genetic exchange within and between natural compartments can provide insight into the transmission, dissemination, and emergence mechanisms. The development of high-throughput DNA sequencing technologies has made antibiotic resistance research more accessible and feasible. In particular, the combination of metagenomics and powerful bioinformatic tools and platforms have facilitated the identification of microbial communities and has allowed access to genomic data by bypassing the need for isolating and culturing microorganisms. This review aimed to reflect on the different sequencing techniques, metagenomic approaches, and bioinformatics tools and pipelines with their respective advantages and limitations for antibiotic resistance research. These approaches can provide insight into resistance mechanisms, the microbial population, emerging pathogens, resistance genes, and their dissemination. This information can influence policies, develop preventative measures and alleviate the burden caused by antibiotic resistance.
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Affiliation(s)
- Stephanie Pillay
- Delft Bioinformatics Lab, Delft University of Technology, Delft, Netherlands
| | | | - Aysun Urhan
- Delft Bioinformatics Lab, Delft University of Technology, Delft, Netherlands
- Infectious Disease and Microbiome Program, Broad Institute of MIT and Harvard, Cambridge, MA, United States
| | - Thomas Abeel
- Delft Bioinformatics Lab, Delft University of Technology, Delft, Netherlands
- Infectious Disease and Microbiome Program, Broad Institute of MIT and Harvard, Cambridge, MA, United States
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6
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Camargo A, Guerrero-Araya E, Castañeda S, Vega L, Cardenas-Alvarez MX, Rodríguez C, Paredes-Sabja D, Ramírez JD, Muñoz M. Intra-species diversity of Clostridium perfringens: A diverse genetic repertoire reveals its pathogenic potential. Front Microbiol 2022; 13:952081. [PMID: 35935202 PMCID: PMC9354469 DOI: 10.3389/fmicb.2022.952081] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/28/2022] [Indexed: 11/23/2022] Open
Abstract
Clostridium perfringens is the causative agent of many enterotoxic diseases in humans and animals, and it is present in diverse environments (soil, food, sewage, and water). Multilocus Sequence Typing (MLST) and Whole Genome Sequencing (WGS) have provided a general approach about genetic diversity of C. perfringens; however, those studies are limited to specific locations and often include a reduced number of genomes. In this study, 372 C. perfringens genomes from multiple locations and sources were used to assess the genetic diversity and phylogenetic relatedness of this pathogen. In silico MLST was used for typing the isolates, and the resulting sequence types (ST) were assigned to clonal complexes (CC) based on allelic profiles that differ from its founder by up to double-locus variants. A pangenome analysis was conducted, and a core genome-based phylogenetic tree was created to define phylogenetic groups. Additionally, key virulence factors, toxinotypes, and antibiotic resistance genes were identified using ABRicate against Virulence Factor Database (VFDB), TOXiper, and Resfinder, respectively. The majority of the C. perfringens genomes found in publicly available databases were derived from food (n = 85) and bird (n = 85) isolates. A total of 195 STs, some of them shared between sources such as food and human, horses and dogs, and environment and birds, were grouped in 25 CC and distributed along five phylogenetic groups. Fifty-three percent of the genomes were allocated to toxinotype A, followed by F (32%) and G (7%). The most frequently found virulence factors based on > 70% coverage and 99.95% identity were plc (100%), nanH (99%), ccp (99%), and colA (98%), which encode an alpha-toxin, a sialidase, an alpha-clostripain, and a collagenase, respectively, while tetA (39.5%) and tetB (36.2%), which mediate tetracycline resistance determinants, were the most common antibiotic resistance genes detected. The analyses conducted here showed a better view of the presence of this pathogen across several host species. They also confirm that the genetic diversity of C. perfringens is based on a large number of virulence factors that vary among phylogroups, and antibiotic resistance markers, especially to tetracyclines, aminoglycosides, and macrolides. Those characteristics highlight the importance of C. perfringens as a one of the most common causes of foodborne illness.
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Affiliation(s)
- Anny Camargo
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
- Faculty of Health Sciences, Universidad de Boyacá, Tunja, Colombia
| | - Enzo Guerrero-Araya
- ANID, Millennium Science Initiative Program, Millennium Nucleus in the Biology of the Intestinal Microbiota, Santiago, Chile
| | - Sergio Castañeda
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - Laura Vega
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
| | - María X. Cardenas-Alvarez
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
- Department of Pharmacology, University of North Carolina, Chapel Hill, NC, United States
| | - César Rodríguez
- Laboratorio de Investigación en Bacteriología Anaerobia, Facultad de Microbiología, Centro de Investigación en Enfermedades Tropicales, Universidad de Costa Rica, San José, Costa Rica
| | - Daniel Paredes-Sabja
- ANID, Millennium Science Initiative Program, Millennium Nucleus in the Biology of the Intestinal Microbiota, Santiago, Chile
- Department of Biology, Texas A&M University, College Station, TX, United States
| | - Juan David Ramírez
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
- Molecular Microbiology Laboratory, Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Marina Muñoz
- Centro de Investigaciones en Microbiología y Biotecnología-UR (CIMBIUR), Facultad de Ciencias Naturales, Universidad del Rosario, Bogotá, Colombia
- ANID, Millennium Science Initiative Program, Millennium Nucleus in the Biology of the Intestinal Microbiota, Santiago, Chile
- *Correspondence: Marina Muñoz,
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Mondain V, Retur N, Bertrand B, Lieutier-Colas F, Carenco P, Diamantis S. Advocacy for Responsible Antibiotic Production and Use. Antibiotics (Basel) 2022; 11:antibiotics11070980. [PMID: 35884234 PMCID: PMC9311909 DOI: 10.3390/antibiotics11070980] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022] Open
Abstract
Antibiotic-resistant bacteria have become one of humankind’s major challenges, as testified by the UN’s Call to Action on Antimicrobial Resistance in 2021. Our knowledge of the underlying processes of antibiotic resistance is steadily improving. Beyond the inappropriate use of antimicrobials in human medicine, other causes have been identified, raising ethical issues and requiring an approach to the problem from a “One Health” perspective. Indeed, it is now clear that the two main issues regarding the subject of antibiotics are their misuse in the global food industry and their method of production, both leading to the emergence and spread of bacterial resistance.
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Affiliation(s)
- Véronique Mondain
- Centre Hospitalo-Universitaire de Nice, Service des Maladies Infectieuses et Tropicales, Hôpital Archet 1, 06202 Nice, France
- Correspondence:
| | - Nicolas Retur
- Centre Hospitalo-Universitaire de Nice, Pharmacie, Hôpital Archet 1, 06202 Nice, France;
| | | | - Florence Lieutier-Colas
- AntibioEst, Regional Antibiotic Therapy Centre, Nancy University Hospital, Brabois Hospital, 54511 Vandoeuvre-les-Nancy, France;
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8
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Liguori K, Keenum I, Davis BC, Calarco J, Milligan E, Harwood VJ, Pruden A. Antimicrobial Resistance Monitoring of Water Environments: A Framework for Standardized Methods and Quality Control. Environ Sci Technol 2022; 56:9149-9160. [PMID: 35732277 DOI: 10.1080/10643389.2021.2024739] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Antimicrobial resistance (AMR) is a grand societal challenge with important dimensions in the water environment that contribute to its evolution and spread. Environmental monitoring could provide vital information for mitigating the spread of AMR; this includes assessing antibiotic resistance genes (ARGs) circulating among human populations, identifying key hotspots for evolution and dissemination of resistance, informing epidemiological and human health risk assessment models, and quantifying removal efficiencies by domestic wastewater infrastructure. However, standardized methods for monitoring AMR in the water environment will be vital to producing the comparable data sets needed to address such questions. Here we sought to establish scientific consensus on a framework for such standardization, evaluating the state of the science and practice of AMR monitoring of wastewater, recycled water, and surface water, through a literature review, survey, and workshop leveraging the expertise of academic, governmental, consulting, and water utility professionals.
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Affiliation(s)
- Krista Liguori
- The Charles Edward Via, Jr., Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, Virginia 24060, United States
| | - Ishi Keenum
- The Charles Edward Via, Jr., Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, Virginia 24060, United States
| | - Benjamin C Davis
- The Charles Edward Via, Jr., Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, Virginia 24060, United States
| | - Jeanette Calarco
- Department of Integrative Biology, University of South Florida, Tampa, Florida 33620, United States
| | - Erin Milligan
- The Charles Edward Via, Jr., Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, Virginia 24060, United States
| | - Valerie J Harwood
- Department of Integrative Biology, University of South Florida, Tampa, Florida 33620, United States
| | - Amy Pruden
- The Charles Edward Via, Jr., Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, Virginia 24060, United States
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9
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Liguori K, Keenum I, Davis BC, Calarco J, Milligan E, Harwood VJ, Pruden A. Antimicrobial Resistance Monitoring of Water Environments: A Framework for Standardized Methods and Quality Control. Environ Sci Technol 2022; 56:9149-9160. [PMID: 35732277 PMCID: PMC9261269 DOI: 10.1021/acs.est.1c08918] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Antimicrobial resistance (AMR) is a grand societal challenge with important dimensions in the water environment that contribute to its evolution and spread. Environmental monitoring could provide vital information for mitigating the spread of AMR; this includes assessing antibiotic resistance genes (ARGs) circulating among human populations, identifying key hotspots for evolution and dissemination of resistance, informing epidemiological and human health risk assessment models, and quantifying removal efficiencies by domestic wastewater infrastructure. However, standardized methods for monitoring AMR in the water environment will be vital to producing the comparable data sets needed to address such questions. Here we sought to establish scientific consensus on a framework for such standardization, evaluating the state of the science and practice of AMR monitoring of wastewater, recycled water, and surface water, through a literature review, survey, and workshop leveraging the expertise of academic, governmental, consulting, and water utility professionals.
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Affiliation(s)
- Krista Liguori
- The
Charles Edward Via, Jr., Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, Virginia 24060, United States
| | - Ishi Keenum
- The
Charles Edward Via, Jr., Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, Virginia 24060, United States
| | - Benjamin C. Davis
- The
Charles Edward Via, Jr., Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, Virginia 24060, United States
| | - Jeanette Calarco
- Department
of Integrative Biology, University of South
Florida, Tampa, Florida 33620, United States
| | - Erin Milligan
- The
Charles Edward Via, Jr., Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, Virginia 24060, United States
| | - Valerie J. Harwood
- Department
of Integrative Biology, University of South
Florida, Tampa, Florida 33620, United States
| | - Amy Pruden
- The
Charles Edward Via, Jr., Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, Virginia 24060, United States
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10
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Boudreau LeBlanc A, Williams-Jones B, Aenishaenslin C. Bio-Ethics and One Health: A Case Study Approach to Building Reflexive Governance. Front Public Health 2022; 10:648593. [PMID: 35372246 PMCID: PMC8971560 DOI: 10.3389/fpubh.2022.648593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Surveillance programs supporting the management of One Health issues such as antibiotic resistance are complex systems in themselves. Designing ethical surveillance systems is thus a complex task (retroactive and iterative), yet one that is also complicated to implement and evaluate (e.g., sharing, collaboration, and governance). The governance of health surveillance requires attention to ethical concerns about data and knowledge (e.g., performance, trust, accountability, and transparency) and empowerment ethics, also referred to as a form of responsible self-governance. Ethics in reflexive governance operates as a systematic critical-thinking procedure that aims to define its value: What are the “right” criteria to justify how to govern “good” actions for a “better” future? The objective is to lay the foundations for a methodological framework in empirical bioethics, the rudiments of which have been applied to a case study to building reflexive governance in One Health. This ongoing critical thinking process involves “mapping, framing, and shaping” the dynamics of interests and perspectives that could jeopardize a “better” future. This paper proposes to hybridize methods to combine insights from collective deliberation and expert evaluation through a reflexive governance functioning as a community-based action-ethics methodology. The intention is to empower individuals and associations in a dialogue with society, which operation is carried out using a case study approach on data sharing systems. We based our reasoning on a feasibility study conducted in Québec, Canada (2018–2021), envisioning an antibiotic use surveillance program in animal health for 2023. Using the adaptive cycle and governance techniques and perspectives, we synthesize an alternative governance model rooted in the value of empowerment. The framework, depicted as a new “research and design (R&D)” practice, is linking operation and innovation by bridging the gap between Reflexive, Evaluative, and Deliberative reasonings and by intellectualizing the management of democratizing critical thinking locally (collective ethics) by recognizing its context (social ethics). Drawing on the literature in One Health and sustainable development studies, this article describes how a communitarian and pragmatic approach can broaden the vision of feasibility studies to ease collaboration through public-private-academic partnerships. The result is a process that “reassembles” the One Health paradigm under the perspective of global bioethics to create bridges between the person and the ecosystem through pragmatic ethics.
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Affiliation(s)
- Antoine Boudreau LeBlanc
- Bioethics Programs, Department of Social and Preventive Medicine, Public Health School, Université de Montréal, Montréal, QC, Canada
- *Correspondence: Antoine Boudreau LeBlanc
| | - Bryn Williams-Jones
- Bioethics Programs, Department of Social and Preventive Medicine, Public Health School, Université de Montréal, Montréal, QC, Canada
| | - Cécile Aenishaenslin
- Department of Pathology and Microbiology, Faculty of Veterinary Medicine, Université de Montréal, Montréal, QC, Canada
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11
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Abstract
Antibiotic resistance is a global health challenge, involving the transfer of bacteria and genes between humans, animals and the environment. Although multiple barriers restrict the flow of both bacteria and genes, pathogens recurrently acquire new resistance factors from other species, thereby reducing our ability to prevent and treat bacterial infections. Evolutionary events that lead to the emergence of new resistance factors in pathogens are rare and challenging to predict, but may be associated with vast ramifications. Transmission events of already widespread resistant strains are, on the other hand, common, quantifiable and more predictable, but the consequences of each event are limited. Quantifying the pathways and identifying the drivers of and bottlenecks for environmental evolution and transmission of antibiotic resistance are key components to understand and manage the resistance crisis as a whole. In this Review, we present our current understanding of the roles of the environment, including antibiotic pollution, in resistance evolution, in transmission and as a mere reflection of the regional antibiotic resistance situation in the clinic. We provide a perspective on current evidence, describe risk scenarios, discuss methods for surveillance and the assessment of potential drivers, and finally identify some actions to mitigate risks.
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Affiliation(s)
- D. G. Joakim Larsson
- grid.8761.80000 0000 9919 9582Centre for Antibiotic Resistance Research at University of Gothenburg, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl-Fredrik Flach
- grid.8761.80000 0000 9919 9582Centre for Antibiotic Resistance Research at University of Gothenburg, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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12
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Abstract
Introduction: Rising rates of antimicrobial resistance (AMR) globally continue to pose agrave threat to human health. Low- and middle-income countries (LMICs) are disproportionately affected, partly due to the high burden of communicable diseases.Areas covered: We reviewed current trends in AMR in LMICs and examined the forces driving AMR in those regions. The state of interventions being undertaken to curb AMR across the developing world are discussed, and the impact of the current COVID-19 pandemic on those efforts is explored.Expert opinion: The dynamics that drive AMR in LMICs are inseparable from the political, economic, socio-cultural, and environmental forces that shape these nations. The COVID-19 pandemic has further exacerbated underlying factors that increase AMR. Some progress is being made in implementing surveillance measures in LMICs, but implementation of concrete measures to meaningfully impact AMR rates must address the underlying structural issues that generate and promote AMR. This, in turn, will require large infrastructural investments and significant political will.
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Affiliation(s)
- Giorgia Sulis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Sena Sayood
- Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St Louis
| | - Sumanth Gandra
- Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, St Louis
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13
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Monahan C, Nag R, Morris D, Cummins E. Antibiotic residues in the aquatic environment - current perspective and risk considerations. J Environ Sci Health A Tox Hazard Subst Environ Eng 2021; 56:733-751. [PMID: 33979269 DOI: 10.1080/10934529.2021.1923311] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
Antimicrobial resistance is a major concern for human and animal health, projected to deteriorate with time and given current trends of antimicrobial usage. Antimicrobial use, particularly in healthcare and agriculture, can result in the release of antimicrobials into surface waters, promoting the development of antibiotic resistance in the environment, and potentially leading to human health risks. This study reviews relevant literature, and investigates current European and Irish antimicrobial usage trends in humans and animals, as well as potential pathways that antibiotics can take into surface waters following use. Reported levels in the aquatic environment are summarized, with particular focus on Ireland. There are relatively few studies examining Irish water bodies or sewage effluent for antibiotic residues, however, five antibiotics, namely azithromycin, ciprofloxacin, clarithromycin, metronidazole, and trimethoprim, have been measured in Irish waters, in concentrations predicted to select for resistance. Numerous isolates of multi-drug resistant bacteria have also been found in water bodies throughout Ireland and Europe. The value of risk assessment methodologies in understanding risks posed by antibiotic residues is reviewed including the advantages and disadvantages of specific approaches. Hazard quotient and bespoke Monte Carlo approaches are predominant risk assessment tools used to examine antimicrobial release and their complex pathways. This study highlights the need for monitoring of antimicrobial releases and the potential for resistance development, persistence and transmission while highlighting the role of risk assessment methodologies in assessing potential human and environmental health impacts.
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Affiliation(s)
- Ciaran Monahan
- School of Biosystems and Food Engineering, University College Dublin, Dublin, Ireland
| | - Rajat Nag
- School of Biosystems and Food Engineering, University College Dublin, Dublin, Ireland
| | - Dearbháile Morris
- Galway School of Medicine, National University of Ireland, Galway, Ireland
| | - Enda Cummins
- School of Biosystems and Food Engineering, University College Dublin, Dublin, Ireland
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14
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Barretto C, Rincón C, Portmann AC, Ngom-Bru C. Whole Genome Sequencing Applied to Pathogen Source Tracking in Food Industry: Key Considerations for Robust Bioinformatics Data Analysis and Reliable Results Interpretation. Genes (Basel) 2021; 12:275. [PMID: 33671973 PMCID: PMC7919020 DOI: 10.3390/genes12020275] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 12/31/2022] Open
Abstract
Whole genome sequencing (WGS) has arisen as a powerful tool to perform pathogen source tracking in the food industry thanks to several developments in recent years. However, the cost associated to this technology and the degree of expertise required to accurately process and understand the data has limited its adoption at a wider scale. Additionally, the time needed to obtain actionable information is often seen as an impairment for the application and use of the information generated via WGS. Ongoing work towards standardization of wet lab including sequencing protocols, following guidelines from the regulatory authorities and international standardization efforts make the technology more and more accessible. However, data analysis and results interpretation guidelines are still subject to initiatives coming from distinct groups and institutions. There are multiple bioinformatics software and pipelines developed to handle such information. Nevertheless, little consensus exists on a standard way to process the data and interpret the results. Here, we want to present the constraints we face in an industrial setting and the steps we consider necessary to obtain high quality data, reproducible results and a robust interpretation of the obtained information. All of this, in a time frame allowing for data-driven actions supporting factories and their needs.
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Affiliation(s)
- Caroline Barretto
- Institute of Food Safety and Analytical Sciences, Nestlé Research, 1000 Lausanne 26, Switzerland; (C.R.); (A.-C.P.); (C.N.-B.)
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15
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Munthe C, Fumagalli D, Malmqvist E. Sustainability principle for the ethics of healthcare resource allocation. J Med Ethics 2021; 47:90-97. [PMID: 33154090 PMCID: PMC7848061 DOI: 10.1136/medethics-2020-106644] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/21/2020] [Accepted: 10/14/2020] [Indexed: 06/11/2023]
Abstract
We propose a principle of sustainability to complement established principles used for justifying healthcare resource allocation. We argue that the application of established principles of equal treatment, need, prognosis and cost-effectiveness gives rise to what we call negative dynamics: a gradual depletion of the value possible to generate through healthcare. These principles should therefore be complemented by a sustainability principle, making the prospect of negative dynamics a further factor to consider, and possibly outweigh considerations highlighted by the other principles. We demonstrate how this principle may take different forms, and show that a commitment to sustainability is supported by considerations internal to the ethical principles already guiding healthcare resource allocation. We also consider two objections. The first of these, we argue, is either based on implausible assumptions or begs the question, whereas the second can be adequately accommodated by the principle we propose.
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Affiliation(s)
- Christian Munthe
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Goteborg, Sweden
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Goteborg, Sweden
| | - Davide Fumagalli
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Goteborg, Sweden
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Goteborg, Sweden
| | - Erik Malmqvist
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Goteborg, Sweden
- Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Goteborg, Sweden
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16
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Abstract
Antibiotic resistance is widely recognized as a major threat to public health and healthcare systems worldwide. Recent research suggests that pollution from antibiotics manufacturing is an important driver of resistance development. Using Sweden as an example, this article considers how industrial antibiotic pollution might be addressed by public actors who are in a position to influence the distribution and use of antibiotics in high-income countries with publicly funded health systems. We identify a number of opportunities for these actors to incentivize industry to increase sustainability in antibiotics production. However, we also show that each alternative would create tensions with other significant policy goals, necessitating trade-offs. Since justifiable trade-offs require ethical consideration, we identify and explore the main underlying normative issues, namely, the weighing of local versus global health interests, the weighing of present versus future health interests, and the role of individualistic constraints on the pursuit of collective goals. Based on this analysis, we conclude that the actors have weighty principled reasons for prioritizing the goal of addressing pollution, but that translating this stance into concrete policy requires accommodating significant pragmatic challenges.
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17
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Arora A. Moving towards sustainable dermatological practice. Int J Dermatol 2020; 59:e343-e345. [DOI: 10.1111/ijd.15017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/17/2020] [Accepted: 05/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Anmol Arora
- School of Clinical MedicineUniversity of Cambridge Cambridge UK
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18
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Nijsingh N, Munthe C, Larsson DGJ. Correction to: Managing pollution from antibiotics manufacturing: charting actors, incentives and disincentives. Environ Health 2019; 18:108. [PMID: 31830999 PMCID: PMC6907334 DOI: 10.1186/s12940-019-0545-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Following publication of the original article [1], the author explained that there are multiple errors in the original article.
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Affiliation(s)
- Niels Nijsingh
- Centre for Antibiotic Resistance Research (CARe), at University of Gothenburg, Gothenburg, Sweden
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Gothenburg, Sweden
- Institute of Ethics, History and Theory of Medicine, Ludwig Maximilian University, Munich, Germany
| | - Christian Munthe
- Centre for Antibiotic Resistance Research (CARe), at University of Gothenburg, Gothenburg, Sweden
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Gothenburg, Sweden
| | - D G Joakim Larsson
- Centre for Antibiotic Resistance Research (CARe), at University of Gothenburg, Gothenburg, Sweden.
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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