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- Kesarimangalam, Sriram, 1983, et al.
(author)
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Identification and characterization of plasmids carrying the mobile colistin resistance gene mcr-1 using optical DNA mapping
- 2023
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In: JAC-Antimicrobial Resistance. - : Oxford University Press (OUP). - 2632-1823. ; 5:1
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Journal article (peer-reviewed)abstract
- Objectives Colistin is a last-resort antibiotic, but there has been a rapid increase in colistin resistance, threatening its use in the treatment of infections with carbapenem-resistant Enterobacterales (CRE). Plasmid-mediated colistin resistance, in particular the mcr-1 gene, has been identified and WGS is the go-to method in identifying plasmids carrying mcr-1 genes. The goal of this study is to demonstrate the use of optical DNA mapping (ODM), a fast, efficient and amplification-free technique, to characterize plasmids carrying mcr-1. Methods ODM is a single-molecule technique, which we have demonstrated can be used for identifying plasmids harbouring antibiotic resistance genes. We here applied the technique to plasmids isolated from 12 clinical Enterobacterales isolates from patients at a major hospital in Thailand and verified our results using Nanopore long-read sequencing. Results We successfully identified plasmids encoding the mcr-1 gene and, for the first time, demonstrated the ability of ODM to identify resistance gene sites in small (similar to 30 kb) plasmids. We further identified bla(CTX-M) genes in different plasmids than the ones encoding mcr-1 in three of the isolates studied. Finally, we propose a cut-and-stretch assay, based on similar principles, but performed using surface-functionalized cover slips for DNA immobilization and an inexpensive microscope with basic functionalities, to identify the mcr-1 gene in a plasmid sample. Conclusions Both ODM and the cut-and-stretch assay developed could be very useful in identifying plasmids encoding antibiotic resistance in hospitals and healthcare facilities. The cut-and-stretch assay is particularly useful in low- and middle-income countries, where existing techniques are limited.
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| 2. |
- Kittiyaowamarn, Rossaphorn, et al.
(author)
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Neisseria gonorrhoeae antimicrobial susceptibility trends in Bangkok, Thailand, 2015-21 : Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP)
- 2023
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In: JAC - Antimicrobial Resistance. - : Oxford University Press. - 2632-1823. ; 5:6
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Journal article (peer-reviewed)abstract
- OBJECTIVES: Rising antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global public health concern. Many ceftriaxone-resistant cases have been linked to Asia. In the WHO/CDC global Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP), we conducted AMR surveillance at two clinical sites in Bangkok, Thailand, 2015-21.METHODS: Urethral discharge samples, from males with urethral discharge and/or dysuria, were Gram-stained and cultured. ETEST was performed to determine AMR. EGASP MIC alert values, CLSI and EUCAST breakpoints were used.RESULTS: In 2015-21, gonococcal isolates were cultured from 1928 cases; most (64.1%) were males reporting having sex with females. The sensitivity and specificity of Gram-stained microscopy compared with culture for detection of gonococci were 97.5% and 96.6%, respectively. From 2015 to 2021, the azithromycin MIC90 increased from 0.125 to 1 mg/L, and the MIC90 of ceftriaxone and cefixime increased from 0.008 and ≤0.016 mg/L to 0.032 and 0.064 mg/L, respectively. Eight EGASP MIC alert values (in seven isolates) were identified. Five alert values were for cefixime (all resistant according to EUCAST breakpoints) and three for azithromycin (all resistant according to EUCAST breakpoints). The average annual resistance to ciprofloxacin during 2015-21 was 92%.CONCLUSIONS: A continuous high susceptibility to ceftriaxone, Thailand's first-line gonorrhoea treatment, was found. However, the increasing MICs of ceftriaxone, cefixime and azithromycin are a substantial threat, especially considering these are the last remaining options for the treatment of gonorrhoea. To monitor AMR, continuous and quality-assured gonococcal AMR surveillance such as the Thai WHO/CDC EGASP, ideally including WGS, is imperative globally.
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| 3. |
- Michalsen, B. O., et al.
(author)
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Regional and national antimicrobial stewardship activities: a survey from the Joint Programming Initiative on Antimicrobial Resistance-Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN)
- 2023
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In: Jac-Antimicrobial Resistance. - 2632-1823. ; 5:2
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Journal article (peer-reviewed)abstract
- Background Antibiotic overuse and misuse in primary care are common, highlighting the importance of antimicrobial stewardship (AMS) efforts in this setting. Audit and feedback (A&F) interventions can improve professional practice and performance in some settings. Objectives and methods To leverage the expertise from international members of the Joint Programming Initiative on Antimicrobial Resistance - Primary care Antibiotic Audit and feedback Network (JPIAMR-PAAN). Network members all have experience of designing and delivering A&F interventions to reduce inappropriate antibiotic prescribing in primary care settings. We aim to introduce the network and explore ongoing A&F activities in member regions. An online survey was administered to all network members to collect regional information. Results Fifteen respondents from 11 countries provided information on A&F activities in their country, and national/regional antibiotic stewardship programmes or policies. Most countries use electronic medical records as the primary data source, antibiotic appropriateness as the main outcome of feedback, and target GPs as the prescribers of interest. Funding sources varied across countries, which could influence the frequency and quality of A&F interventions. Nine out of 11 countries reported having a national antibiotic stewardship programme or policy, which aim to provide systematic support to ongoing AMS efforts and aid sustainability. Conclusions The survey identified gaps and opportunities for AMS efforts that include A&F across member countries in Europe, Canada and Australia. JPIAMR-PAAN will continue to leverage its members to produce best practice resources and toolkits for antibiotic A&F interventions in primary care settings and identify research priorities.
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| 4. |
- Mickelsson, Martin, 1983-, et al.
(author)
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Health communication for AMR behaviour change : Zimbabwean students' relationships with the microbial world
- 2023
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In: JAC - Antimicrobial Resistance. - : Oxford University Press. - 2632-1823. ; 5:6
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Journal article (peer-reviewed)abstract
- BackgroundMicrobes have a global impact on health; microbial relationships benefit and impair quality of life. Negative health impacts of antimicrobial resistance (AMR) in our relationships with the microbial world are primarily borne by the Global South.ObjectivesTo study experiences, understandings and practices of Zimbabwean students regarding health, food and microbes.MethodsUsing purposive sampling, Zimbabwean school students were recruited as participants in group interviews supported by participant observation, exploring the relationships between health, food and microbes.ResultsThe study included 120 students from six upper secondary schools in the Midland Region and Gweru District. Findings identify two categories: microbial relationships and microbial encounters, each with three subcategories. Food emerged as both mediating artefacts and mediating experiences, enabling the students to link biomedical explanations of AMR and their everyday lives with friends and family. The necessity for health communication to explore and engage with participants’ contextual preferences and motivations is highlighted. When discussing food choices and practices, students considered the beneficial relationships with the microbial world.ConclusionsA contextually relevant approach is outlined, where food mediates the relationship between student health and the microbial world, supporting health communication for AMR behaviour change. Expanding AMR education to include the everyday experiences of food enables students to link the pressing sustainability challenge of AMR to their health goals. The study showcases how the exploration of microbial relationships and food practices as a ubiquitous feature of community life can form a basis for AMR prevention and control.
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| 5. |
- Smith, Michael, et al.
(author)
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Environmental stressors, sleep, and a visit from St. Nicholas
- 2023
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In: SLEEP Advances. - 2632-5012. ; 4:1
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Research review (peer-reviewed)abstract
- The importance of adequate quantity and quality of sleep is increasingly recognized by clinicians, policy makers, and the public as a critical cornerstone of good physical and mental health. Although progress is being made, the crucial role of sleep disturbance by environmental stressors is often neglected in public health discourse, as was highlighted recently by Lim et al. [1] To further stimulate this discussion, we here highlight the major clinical and public health issues of adequate quantity and quality of sleep via a narrative review on the effects of environmental stressors on sleep, framed within the context of the 1823 poem A Visit From St. Nicholas by Clement Clarke Moore [2].
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