Antimicrobial resistance transmission

P. L. Geenen, M. G. J. Koene, H. Blaak, A. Havelaar and A. W. Van De Giessen, National Institute for Pubhc Health and the Environment, 2011, Risk profile on antimicrobial resistance transmissible from food animals to humans, Bilthoven, the Netherlands, 2011, available at www.rivm.nl/ bibliotheek/rapporten/330334001. pdf. 

Holmberg, S. D., J. G. Wells, M, L. Cohen, 1984, Animal-to-Man Transmission of Antimicrobial-Resistant Salmonella ... 

Lack of access to medicines and inappropriate doses result in serious morbidity and mortality, particularly for childhood infections and chronic diseases, such as hypertension, diabetes, epilepsy and mental disorders. Inappropriate use and over-use of medicines waste resources - often out-of-pocket payments by patients - and result in significant patient harm in terms of poor patient outcomes and adverse drug reactions. Furthermore, over-use of antimicrobials is leading to increased antimicrobial resistance and non-sterile injections to the transmission of hepatitis, HIV/AIDS and other blood-borne diseases. Finally, irrational over-use of medicines can stimulate inappropriate patient demand, and lead to reduced access and attendance rates due to medicine stock-outs and loss of patient confidence in the health system. 

Multiresistant Escherichia coli have been selected by the use of broad-spectrum antimicrobials in both livestock and humans (36). The development of antimicrobial resistance in Escherichia coli creates problems due to the high propensity of these bacteria to disseminate antimicrobial resistance genes. Resistance genes have been traced from Escherichia coli in animals to Escherichia coli in humans. Escherichia coli 0157 H7 has been recently recognized as an important human pathogen (37). lire mode of its transmission is primarily through the food, but person-to-person transmission has been also identified in some day-care center and nursing home outbreaks (38). 

Numerous other surveillance systems track disease transmission and antimicrobial resistance both nationally and internationally (Appendix B), but there are few meaningful links among them. Mechanisms to integrate and link these systems should be developed. 

Microbial resistance can occur by the gradual selection of resistant mutants or more usually by R-factor j transmission between bacteria, Table V-l-2 summarizes the common modes of resistance exhibited by microorganisms against the various classes of antimicrobial agents. 

Microorganisms are frequently transferred by cross-infection due to hand contact between hospital staff and patients. Cross-infection has been estimated to account for 10-20% of hospital-acquired infections [5]. Hand-body contact, or contact spread, is a mode of nosocomial transmission that is particularly hard to control because the pathogens are environmentally robust and generally more resistant to antimicrobials. 

Compound 4 was also found efficient against a completely antibiotic resistant strain of Burkholderia, specifically Burkholderia dolosa, which is resistant to clinical antibiotics in concentrations up to 5mgmL However, B. dolosa was found to be susceptible to 4 at significantly lower concentrations. Transmission electronic microscopy (TEM) photos of B. dolosa obtained after a 1 h treatment of 5 pgmL of 4 showed the powerful antimicrobial properties of the NHC-Ag. Figure 4.1 shows the morphology of the cell before and after treatment, when the cell was annihilated. 

---