900 resultados para Resistance of last-resort antibiotics


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Last-resort antibiotics are the final line of action for treating serious infections caused by multiresistant strains. Over the years the prevalence of resistant bacteria has been increasing. Natural environments are reservoirs of antibiotic resistance, highly influenced by human-driven activities. The importance of aquatic systems on the evolution of antibiotic resistance is highlighted from the assumption that clinically-relevant resistance genes have originated in strains ubiquitous in these environments. We hypothesize that: a) rivers are reservoirs and disseminators of antibiotic resistance; b) anthropogenic activities potentiate dissemination of resistance to last-resort antibiotics. Hence, the main goal of the work is to compare the last-resort antibiotics resistome, in polluted and unpolluted water. Rivers from the Vouga basin, exposed to different anthropogenic impacts, were sampled. Water quality parameters were determined to classify rivers as unpolluted or polluted. Two bacterial collections were established enclosing bacteria resistant to cefotaxime (3rd generation cephalosporin) and to imipenem (carbapenem). Each collection was characterized regarding: phylogenetic diversity, antibiotic susceptibility, resistance mechanisms and mobile genetic elements. The prevalence of cefotaxime- and imipenem-resistant bacteria was higher in polluted water. Results suggested an important role in the dissemination of antibiotic resistance for Enterobacteriaceae, Pseudomonas and Aeromonas. The occurrence of bacteria resistant to non-beta-lactams was higher among isolates from polluted water as also the number of multiresistant strains. Among strains resistant to cefotaxime, extended-spectrum beta-lactamase (ESBL) genes were detected (predominantly blaCTX-M-like) associated to mobile genetic elements previously described in clinical strains. ESBL-producers were often multiresistant as a result of co-selection mechanisms. Culture-independent methods showed clear differences between blaCTX-M-like sequences found in unpolluted water (similar to ancestral genes) and polluted water (sequences identical to those reported in clinical settings). Carbapenem resistance was mostly related to the presence of intrinsically resistant bacteria. Yet, relevant carbapenemase genes were detected as blaOXA-48-like in Shewanella spp. (the putative origin of these genes), and blaVIM-2 in Pseudomonas spp. isolated from polluted rivers. Culture-independent methods showed an higher than the previously reported diversity of blaOXA-48-like genes in rivers. Overall, clear differences between polluted and unpolluted systems were observed, regarding prevalence, phylogenetic diversity and susceptibility profiles of resistant bacteria and occurrence of clinically relevant antibiotic resistance genes, thus validating our hypotheses. In this way, rivers act as disseminators of resistance genes, and anthropogenic activities potentiate horizontal gene transfer and promote the constitution of genetic platforms that combine several resistance determinants, leading to multiresistance phenotypes that may persist even in the absence of antibiotics.

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The discovery of antibiotics was a major breakthrough in medicine. However, short after their introduction in clinical practice resistant bacteria were detected. Nowadays, antibiotic resistance constitutes a serious public health problem. In hospital settings, with high resistance levels, reducing drastically the therapeutic options. Carbapenems are last-resort antibiotics used in Portugal, only in hospitals, to treat serious infections. Bacterial resistance towards this class of antibiotics has increased during last years. In Gram-negative bacteria the production of carbapenemases is a common resistance mechanism. OXA-48 is a carbapenemase of Ambler class D and represents a major concern for human health. It is frequently detected in clinical isolates of Enterobacteriaceae. There are few studies suggesting that genes encoding for OXA-48 variants originated from genes present in the chromosome of members of genus Shewanella, and have disseminated to Enterobacteriaceae members, associated with mobile genetic elements. The aim of this study was to characterize strains from different sources of Shewanella to confirm its role as OXA-48 progenitor. For this, the phylogenetic affiliation of 33 strains of Shewanella was performed by 16SrDNA and gyrB sequencing. The most common species were S. hafniensis and S. xiamenensis, but also S. aestuarii, S. baltica, S. indica, S. haliotis, S. putrefaciens, S. algidipiscicola, S. irciniae, S. algae and S. fodinae were identified. blaOXA-48-like genes were detected in 21 isolates: S. hafniensis (8/8), S. xiamenensis (5/5), S. baltica (4/4), S. algae (1/1), S. fodinae (1/1), S. putrefaciens (1/2) and S. algidipiscicola (1/2). Sequence analysis revealed that genes encoded enzymes identical to OXA-48, OXA-181 and OXA-204 but also new variants differing from OXA-48 from 2 to 81 aminoacids. Genetic context analysis revealed the C15 gene upstream and lysR gene downstream, identical to what has been identified so far flanking blaOXA-48-like genes in Shewanella spp. The assessment of antibiotic susceptibility was performed for all isolates using the disk diffusion method. In general, it was observed a great sensitivity for all antibiotics except to amoxicillin and aztreonam. Multidrug resistance was detected in only 1 isolate. Other resistance genes and the presence of integrons were not identified. Plasmids were detected in 30.3% isolates (10/ 33). These results reinforce the role of Shewanella spp. as origin of blaOXA-48-like genes.

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Vol. 15, 560 p., without t.p. or index. In the L.C. copy, only the first number has cover title

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Vol. 13, Index to the twelve volumes of Notes on United States reports, embracing all propositions of law laid down in Supreme Court decisions, 2 Dallas to 172 United States, by Walter Malins Rose and W. A. Sutherland

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"New York. Court of Appeals; New Jersey. Supreme Court. Court of Errors and Appeals, Court of Chancery and Prerogative Court; Pennsylvania. Supreme Court; Delaware. Superior Court, Court of Errors and Appeals and Court of Chancery; Maryland. Court of Appeals; District of Columbia. Supreme Court. From September, 1885."

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Editors : Vols. 1-8, L. Lewis, jr., and J. H. Merrill.--v. 9-16, A. Hamilton.--v. 17-18, J. H. Merrill.--v. 19-20, 31-48, W. M. McKinney.--v. 21-23, J. M. Kerr and W. M. McKinney.--v. 24-30, J. C. Thomson and W. M. McKinney

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In the original edition, published in 1871-88, the notes and references for v. 1-27 were I. G. Thompson, and for v. 28-60 by Irving Browne.

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Existing literature has examined the predictions and proscriptions of Karl Marx in response to the 2008 global financial crisis. However, the suggestions put forth by the Marxist-leaning literature never took hold and state-level banking and finance policies have remained largely unchanged. While many criticisms of Marxism exist, this paper examines Belarus, a ‘neo-communist’ or ‘market-socialist’ state, to provide a new perspective on the continuation of capitalism in the United States and Europe. In the case of Belarus, the International Monetary Fund and the Eurasian Economic Community's Anti-Crisis Fund provided both the critical liquidity needed to temporarily quell the effects of the financial crisis. Their demands meant that Belarus agreed to speed its move away from the Soviet-era finance and banking policies and more towards its western capitalist neighbors. Its failure to implement these policies further hurt its recovery. Examining Belarus' path to and out of its financial crisis makes apparent that the role of the international lender of last resort (LOLR). The LOLR acts as a key element in protecting states embroiled in the financial crisis from facing the possibility of making the difficult policy changes put forth by the Marxist literature. By ignoring its promises under the loan conditions from its LOLRs, Belarus moved further from the recovery promised by the Marxist suggestions.

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The use of antibiotics in birds and animals intended for human consumption within the European Union (EU) and elsewhere has been subject to regulation prohibiting the use of antimicrobials as growth promoters and the use of last resort antibiotics in an attempt to reduce the spread of multi-resistant Gram negative bacteria. Given the inexorable spread of antibiotic resistance there is an increasing need for improved monitoring of our food. Using selective media, Gram negative bacteria were isolated from retail chicken of UK-Intensively reared (n = 27), Irish-Intensively reared (n = 19) and UK-Free range (n = 30) origin and subjected to an oligonucleotide based array system for the detection of 47 clinically relevant antibiotic resistance genes (ARGs) and two integrase genes. High incidences of β-lactamase genes were noted in all sample types, acc (67%), cmy (80%), fox (55%) and tem (40%) while chloramphenicol resistant determinants were detected in bacteria from the UK poultry portions and were absent in bacteria from the Irish samples. Denaturing Gradient Gel Electrophoresis (DGGE) was used to qualitatively analyse the Gram negative population in the samples and showed the expected diversity based on band stabbing and DNA sequencing. The array system proved to be a quick method for the detection of antibiotic resistance gene (ARG) burden within a mixed Gram negative bacterial population.