Antimicrobial resistance

The etiological spectrum of bloodstream infections is variable between industrialized and developing countries and even within a defined location over time. We investigated trends in bloodstream infections at an infectious disease hospital in Ho Chi Minh City, Vietnam, from 1994-2008. Amongst 66 111 blood cultures performed, a clinically relevant pathogen was isolated in 7645 episodes (positivity rate; 116/1000 cultures). Salmonella Typhi was the predominant pathogen until 2002; however, a considerable annual decline in the proportion of S. Typhi was observed (OR 0.6993, 95% CI [0.6885, 0.7103], p < 0.0001). Conversely, there was a significant increase in the proportions of non-typhoidal Salmonella (NTS), Cryptococcus neoformans and Penicillium marneffei, concurrent with increasing HIV prevalence. These data document a substantial longitudinal shift in bloodstream infection etiology in southern Vietnam. We propose such changes are related to increasing economic prosperity and HIV prevalence, and this pattern marks a substantial change in the epidemiology of invasive salmonellosis in Southeast Asia. (S. Baker). diversity in etiology and the proportions of isolated bacteria that exhibit resistance to antimicrobials. 1,2 An understanding of the epidemiology of bloodstream infections in different locations is crucial in the development of rational management and treatment guidelines. In many developing countries in Asia, Salmonella Typhi is the predominant organism isolated from the blood of febrile patients, and isolates that are multidrug resistant (MDR) or exhibit decreased susceptibility to fluoroquinolones 0035-9203/$ -see front matter

Meeting consumer concerns and preferences for fresh and safely processed fisheries products free of chemical and synthetic preservatives is a challenge for the aqua-food industry. As such, natural preservatives from plant and animal origin including chitosan, essential oils (EOs), plant extracts and lactic acid bacteria have attracted considerable interest recently. These preservatives have antimicrobial and antioxidant properties that can retard spoilage, uphold product quality and safety as well as extend the storage shelf-life of fish and seafood. Chitosan and EOs have been successfully used in edible coatings, film wrapping and dipping solutions. The present review focuses on the effectiveness of chitosan, EOs and other natural preservatives intended for prolonging the shelf-life of fisheries products, and maintaining their freshness and quality. Moreover, the mechanisms of action of natural additives, harmful impacts of chemical preservatives and status of aquatic food preserva...

Campylobacter fetus subspecies are mostly characterized by reproductions problems in cattle and sheep. This study aimed to study the genetic profile and assess the genes mechanism of resistance and their virulence factors using genome sequence analysis. A total of 59 confirmed Campylobacter fetus subspecies based on molecular assays and DNA sequencing were subjected to antimicrobial susceptibility test against 14 antibiotic agents representing the five classes of antibiotics using the disc diffusion method. In addition, sequencing the genome of all strains induced complete resistance against all tested antibiotics. The results of the antimicrobial test indicated that 54.4% had a resistance profile, 26.3% were intermediate, while 19.3% were observed to be susceptible. The Whole Genome Sequencing (WGS) result revealed the presence of different genes, such as Broad-specificity multidrug efflux pump and 16S rRNA (guanine 527-N 7)-methyltransferase (gidB), efflux pump conferring antibiotic resistance (MacA and MacB), protein-altering cell wall charge conferring antibiotic resistance (PgsA), which have never been reported in Campylobacter fetus subspecies. The WGS also revealed the presence of genes that involved in colonization, adhesion, motility, and invasion, such as type IV secretion system protein (VirD4), S-Layer, cytolethal distending toxin (A, B, and C), Campylobacter invasion antigen (CiaB), and fic domain protein (fic) were among important CDS. The presence of these uncommon genes explains the resistance of Campylobacter fetus subspecies against different tested antibiotics. The results of this study can be used to implement molecular surveillance of Campylobacter fetus subspecies and conduct further studies on the resistance mechanism in these subspecies.

En este documento se elaboraron una serie de recomendaciones para el ensayo, lectura, interpretación e informe de las pruebas de sensibilidad a los antimicrobianos para las enterobacterias aisladas con mayor frecuencia de especímenes clínicos. Se adoptaron como base las recomendaciones del National Committee for

Streptococcus pneumoniae is one of the leading bacterial pathogens causing invasive disease and noninvasive infections at both extremes of life: in children younger than 5 years and in elderly persons of 65 years or more. Pneumococcal infections result in substantial morbidity and mortality among children under 5 years of age; it is estimated that 1,600,000 deaths occur per year in that age range alone, mostly in developing countries, thus representing a serious public health problem around the globe. Infections caused by S. pneumoniae are considered by the World Health Organization (WHO) as the number one vaccine-preventable cause of death in children younger than 5 years of age. In 2000, the first heptavalent conjugated pneumococcal vaccine (PCV7) was licensed in the United States, differing from the already available non-conjugated polysaccharide pneumococcal vaccine in its ability to induce a protective immune response in children under 2 years of age. Initial efficacy studies in the United States with PCV7 revealed a 97.4% efficacy against invasive pneumococcal disease (IPD) caused by vaccine serotypes (4, 9V, 14, 19F, 23F, 18C and 6B). PCV7 was introduced into the National Immunization Program (NIP) of various countries starting in year 2000 and, after 11 years of use, the data confirm that PCV7 introduction resulted in a major reduction of S. pneumoniae IPD, non-bacteremic pneumonia, otitis media medical visits, the need for tympanic tubes, the number of cases of otorrhea and of various antimicrobial resistant strains in children <5 years of age. Additionally, reductions in S. pneumoniae infections have been observed in unvaccinated children above 5 years of age and adults including individuals older than 65 years of age (herd effect). Effectiveness has been observed in countries using a 4-dose regimen (3 infant doses followed by a booster during the second year of life) but also in countries with modified reduced doses (2 infant doses and a booster during the second year of life or after 3 infant doses with no booster).

Objective Antibiotics may frequently be prescribed on the basis of vague diagnoses, possibly resulting in unnecessary antimicrobial resistance. Our aim is to map general practitioners' (GPs') decision-making for common infections, exploring their diagnostic basis for antibiotic prescriptions. Setting General practice in Iceland. Method Ten in-depth qualitative interviews with, and three observations of, GPs in 1995. Diagnostic issues extracted and analysed. In 2006, eight GPs commented on analysis and updated (email/telephone). Main outcome measure Diagnostic variability and reasons for prescribing antibiotics, consistency or changes over time. Results Wide variations were uncovered in diagnostic procedures, although each GP remained consistent through time. Some GPs had developed ''rules-of-thumb''. They often balanced risks against issues like money, time, need for the workforce (perceived importance of the patient's job), client's need for job/earnings (perceived ability to afford a sick day) and doctor-patient relationship (risk of refusal adversely affecting the relationship). Perceptions of risk varied from focusing on resistance development to focusing on possible harm from untreated infections, also ranging between considering both to worrying about neither. Changes over time were not prominent but included increased point-ofcare testing and the perception by GPs that patients were increasingly willing to ''wait and see''. Conclusions Large variability and individuality characterized the GPs' diagnostic procedures, contrasted by consistency through time. If modification of diagnostic routines is needed, provision of ''scientific facts'' and technological aids is insufficient. A prerequisite for changing practice is GPs' acceptance of accuracy of information and of reliability, applicability, and relevance of technology, for physician and/or patient. Keywords Anti-bacterial agents Á Diagnosis Á Evidencebased medicine Á Iceland Á Infection Á Physician's practice patterns Impact of findings on practice • GPs' diagnostic procedures vary between individuals and between infections. • GPs' diagnostic procedures are relatively resistant to changes over time. • GPs only change diagnostic procedures if they consider themselves to have adequate information, indicating that change is beneficial.

Background: We conducted a retrospective analysis on the identification and antibiogram of all bacteria isolated from urine samples with microbiological confirmation of urinary tract infection (UTI) in a Spanish reference hospital over a 7-year period. Methods: A retrospective analysis was performed of the identification and antibiogram data. Results: A total of 31,758 uropathogens were isolated. Escherichia coli accounted for the majority (55.2%) of these, followed by Enterococcus faecalis (18.0%) and Klebsiella spp (10.3%). The highest E coli susceptibility rates were to imipenem (93.0%-99.8%), amikacin (97.3%-99.5%), nitrofurantoin (96.7%-98.9%), and fosfomycin (95.3%-100%), and the lowest were to cefuroxime (67.8%-86.4%), ciprofloxacin (61.2%-69.8%), and co-trimoxazole (55.0%-65.5%). We highlight the overall high activity of imipenem, piperacillintazobactam, nitrofurantoin, and fosfomycin on isolates versus the low activity of fluoroquinolones, co-trimoxazole, or cephalosporins. The activity of amoxicillin-clavulanic acid and fosfomycin decreased significantly over the 7-year study period. Conclusions: Imipenem and piperacillin-tazobactam appear to be good options for the empiric treatment of UTI acquired in hospital or requiring hospitalization, whereas nitrofurantoin and fosfomycin can be first-choice antibiotics for the treatment of uncomplicated community-acquired cystitis. However, surveillance studies are required to detect resistance to these antibiotics, given that an increase in uropathogen resistance rates may contraindicate its future use in empiric UTI therapy.

Resistance to fluoroquinolones was evaluated in 17 nalidixic acid-resistant Escherichia coli strains isolated from animal faeces. Polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP), hybridisation and sequencing were used to reveal point mutations in DNA gyrase subunits A and B and the presence of the qnr gene as evidence of plasmid resistance. Chromosomal resistance and class 1 integrons were found in 10 of the 17 E. coli strains examined, while the qnr gene was not found in any of these. Mutation Ser83-Leu was found in six strains and in one strain mutation Ser83-Ala was found in gyrA. Mutations in gyrA Asp87 codons and in gyrB Asp426 or Lys 447 codons were not identified. Sequencing of the E. coli strain ATCC 25922 subjected to resistance induction revealed a gyrB mutation of the Lys 447 residue which had been replaced by arginine.

This is the first report of isolation and identification of five strains of Enterococcus from honey stomach of the Giant honeybee Apis dorsata. Samples of honeybee were collected from Apis dorsata colonies in different bee trees and Enterococcus isolated fiom honey stomach tising selective media. The forty-three isolates were Gram-stained and tested for Catatase reaction. The 16S rRNA genes from extracted DNA of bacterial colonies were amplified with polymerase chain reaction (PCR) using universal primers. All bacterial 16S rRNA genes were sequenced and the distant bacteria deposited in GenBank. The Enterococcus strains were identified as Enterococcus sp. named However, it appears that honey stomach of honeybee could be a source of new lactic acid bacteria.

The 23S rRNA gene in clinical isolates of Helicobacter pylori isolated between 1995 and 2004 from Japan was investigated and the relationship between mutations in this gene and clarithromycin susceptibility was studied. Among nine mutations that have previously been reported to confer clarithromycin resistance, an adenine → guanine transition at position 2142 (A2142G) or 2143 (A2143G) was detected in all clarithromycin-resistant strains (n = 67) but not in any clarithromycin-susceptible strains (n = 17). Mutations at positions 2182, 2223, 2244 and 2288 have previously been reported to confer clarithromycin resistance in H. pylori isolates from Bangladesh, China and Brazil. However, these mutations were not associated with clarithromycin resistance in H. pylori isolates from Japan in this study. Other mutations at positions 2115, 2144 and 2711, which have also been reported to confer clarithromycin resistance in H. pylori from Sweden and Italy, were not detected in the strains in this study. Our results suggest that susceptibility to clarithromycin is predicted by detection of mutations at positions 2142 and 2143 of the 23S rRNA gene in H. pylori isolates in Japan.

A total of 210 food samples originating from milk products, ready-to-eat salads, raw meat and raw meat products purchased in ten open-air market places in Thessaloniki, Greece, were analyzed for the presence of Listeria monocytogenes. Thirty (14.3%) contained L. monocytogenes with the highest prevalence in raw meat (27.5%), raw meat products (18%) and cheese (8%). The strains were susceptible to 16 antimicrobials as determined by microbroth dilution, except one strain which displayed resistance to tetracycline (MIC > 32 lg/ml). This strain carried the tetracycline resistance gene tet(M). Pulsed-field gel electrophoresis (PFGE) revealed a low genetic diversity among the isolates, irrespective of their origin. This suggests that dominant L. monocytogenes clones are widespread in different food product types in open-air food markets in Greece. The high prevalence of L. monocytogenes in these products indicates that appropriate hygienic measures and periodic bacteriological controls are also necessary in open-air food markets to reduce contamination with food-borne pathogens. Greek specialties made with raw meat and raw milk may contain L. monocytogenes and should not be consumed by persons at risk.

The use of antibiotics for growth promotion and disease treatment by the commercial swine industry has led to high proportions of multiple antibiotic-resistant enteric bacteria being shed by these animals and concerns about the environmental spread of these bacteria. A study was conducted to quantify the extent of release of antibiotic-resistant E. coli from swine farms into groundwater. Four study sites, two swine farms and two reference sites (crop farms), with known groundwater flow paths were screened for E. coli four times over the course of one and a half years. A total of 100 biochemically-confirmed E. coli were collected from the four sites. There were statistically significantly higher E. coli levels at the two swine farm sites than at the reference sites. The bacterial isolates were tested for antibiotic resistance using a panel of 17 drugs that are typical of human and veterinary use. There were 19 and 71 E. coli isolates from swine farms #1 and #2, respectively, with mos...

Brazilian shrimp culture industry has a great economic importance mainly to the northeast region. However, the accelerated development of this activity has resulted in the emergency of outbreaks of diseases from farming shrimp, and as a consequence the use of antimicrobial drugs to minimize the potential adverse effect under the shrimp production. The inappropriate use of antibiotics in aquaculture is one of the causes for the high incidence of antimicrobial resistant bacteria isolated from aquatic environments that represent a danger for aquatic organisms and human health. There is little information available on the level of antimicrobial resistance in pathogenic bacteria from shrimp farming environment. Therefore, this study aimed to evaluate the phenotypic resistance profile among Vibrio isolates from hatcheries water samples and from cultivated marine shrimp hepatopancreas (L. vannamei). Antimicrobial susceptibility testing was carried out by a standard disc diffusion method and the minimum inhibitory concentration (MIC) of oxytetracycline (OTC) for resistant Vibrio isolates was determinate by broth dilution method. The results showed a high incidence of resistance to ampicillin (45.2%) and to the tetracycline class (38.7%). Florfenicol and nitrofurantoin were 100% effective against Vibrio isolates. In this study, the OTC-resistant Vibrio spp. showed MIC values of more than 400 mg/L and the presence of seawater did not influence the oxytetracycline bioactivity. The occurrence of antimicrobial multiresistance patterns was observed in 29% of Vibrio isolates. Fifty-five percent of multiresistant isolates of Vibrio lost one or more antibiotic resistance phenotype after procedure to curing of resistance plasmids. The oxytetracycline resistance was the phenotype most often lost among plasmid-cured isolates.

A global or European strategy should be developed to deal with increasing antimicrobial resistance. This strategy includes surveillance of antimicrobial resistance and monitoring of the use of antimicrobial agents in animals and humans. In animals, surveillance should be focussed on potential transfer of resistant, zoonotic, food-born pathogens and resistance genes to humans. In humans the surveillance should be clinically relevant. Guidelines for rational therapy should be implemented and 'antibiotic teams' should be installed in each hospital to evaluate the prescription of antibiotics and its compliance with guidelines. Keeping animals for food production involves the responsibility for their well being. This includes treatment of infections. However, the use of feed additive, growth-promoting antimicrobials related to therapeutics in human medicine, should be banned immediately. Research aimed at intervention strategies for antimicrobial resistance should be given a high priority with adequate financing both nationally and in Europe. Well co-ordinated European research programmes should have priority; this includes the need to install a European multidisciplinary scientific advisory group.

Hospital acquired infection (HAI) comprises a considerable burden to patients and healthcare delivery globally. Antimicrobial resistant organisms pose an increasing threat, although multiple resistant pathogens are still in the minority. Many global networks and initiatives are addressing this threat with variable degrees of success. Antibiotic resistance control has a high profile but the same is not true for biocide resistance. The many issues relating to biocide resistance are examined, the paradigm with antiseptic use are explored and ways in which biocide resistance could threaten the prevention and control of HAIs are described. Several proposals to inform the need and nature of surveillance, prevention and control measures are made. 1. Summary, 989 2. Introduction, 989 3. The context of hospital infection, 990 4. Clinical significance of antibiotic resistance, 990 5. Issues of-Biocide Resistance, 991 6. HAI: type, prevention and possible implications of biocide resistance, 991 6.1 Auto-infection, 991 6.2 Cross-infection from other patients or staff, 992 6.3 HAI from the environment, 992 7. The paradigm of biocide resistance: an illustration, 993 8. Prevention and control of antimicrobial resistance, 994 9. Acknowledgements, 995 10. References, 995

The presence of broad-spectrum-cephalosporin-resistant Escherichia coli isolates and the implicated mechanisms of resistance were investigated in 79 food samples of animal origin obtained in different supermarkets and local butcheries in Tunisia. Ten of these samples (12.6%) harbored extended-spectrum beta-lactamase (ESBL) producing E. coli isolates and 13 ESBL-positive isolates were recovered (one or two/sample), which exhibited nine different Pulsed-Field-Gel-Electrophoresis (PFGE) patterns. ESBLs detected were the following: CTX-M-1 (10 strains), CTX-M-1+ TEM-1b (2 strains) and CTX-M-1 +TEM-20 (1 strain). The orf477 sequence was identified downstream of bla CTX-M-1 gene in all 13 strains and ISEcp1 upstream in 9 strains. All ESBL-positive strains were included into phylogenetic group A or B1 (4 and 9 strains, respectively). Three of the 79 food samples (3.8%) contained broadspectrum-cephalosporin-resistant and ESBL-negative E. coli isolates with AmpC phenotype. One isolate per sample was studied, and they showed unrelated PFGE patterns. The CMY-2 type beta-lactamase was identified in one of these 3 strains and specific point mutations in the promoter/attenuator region of ampC gene (at positions −42, −18, −1 and +58) were detected in the remaining two strains. Twelve ESBL-positive and one ESBL-negative E. coli strains contained class 1 integrons with the following gene cassette arrangements: dfrA1+aadA (6 strains) and dfrA17+aadA5 (7 strains). E. coli strains from food samples could represent a reservoir of ESBL-encoding genes and integrons that could be transmitted to humans through the food chain.

Objectives
Multidrug-resistant (MDR) superbugs, including Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus (MRSA), are a challenge for healthcare professionals. In this study, the synergistic activity of vitamins with antibiotics against resistant bacterial strains was evaluated.

Methods
Synergistic effects between antibiotics and stock solutions of vitamins were evaluated by the Kirby–Bauer disk diffusion assay. Distilled water and propylene glycol were used as solvent for water-soluble and fat-soluble vitamins, respectively. Final concentrations of 10 mg/mL for each water-soluble vitamin [B1 (thiamine), B2 (riboflavin), B6 (pyridoxine), B12 (methylcobalamin) and C (ascorbic acid)] and 0.1 mg/mL for each fat-soluble vitamin [A (retinol), D (cholecalciferol), E (α-tocopherol) and K (menadione)] were used in combination with the antibiotics.

Results
The results demonstrated that vitamins K and E had good synergistic activity with piperacillin/tazobactam, imipenem and doripenem against A. baumannii, whilst vitamins B1, B2 and B12 showed remarkable synergistic activity with linezolid against MRSA. Vitamin B1 was further shown to have better synergism with oxacillin, tetracycline, rifampicin and linezolid against MRSA. The fat-soluble vitamins E and K showed good synergism against Gram-negative A. baumannii, whilst the water-soluble vitamins B1, B2 and B12 were effective against MRSA but not against A. baumannii.

Conclusions
This synergistic action of vitamins with antibiotics may be used as a tool to treat MDR superbugs, with further evaluation required at a molecular level.

Objectives: This study aimed to assess the knowledge of the residents in Greater Lagro, Quezon City, Philippines on antimicrobials and the development of antimicrobial resistance. Methodology: A questionnaire-based survey was conducted on 340 residents in Greater Lagro, Quezon City, Philippines, whereby their knowledge regarding antimicrobial use and the development of antimicrobial resistance was assessed by using a five point Likert scale, whose responses ranged from " no knowledge " to " very knowledgeable. " Findings: The study showed that the community residents were partly knowledgeable on antimicrobials and antimicrobial resistance. Conclusion: The lack of knowledge on antimicrobials and the development of antimicrobial resistance is a fundamental public health problem that could lead to ineffective treatment as well as antimicrobial resistance.

Background and Aim: The increasing antimicrobial resistance with reduced susceptibility to antimicrobial drugs is becoming a major concern for both human and animal, which raises health morbidity and mortality rate of cases that cannot be treated by antibiotics. Nowadays, there are many efforts to minimize the misuse of antibiotics. This study evaluated the antimicrobial activity of the crude ethanolic extracts of three Thai herbs divided in four groups; petals of marigold (Tagetes erecta), mulberry leaves and root barks (Morus indica), and whole onions of red shallot (Allium ascalonicum) against Streptococcus agalactiae.

Materials and Methods: The antimicrobial activity of four groups of the crude extracts using absolute ethanol from three Thai herbs was tested against standard strains of S. agalactiae using the agar well diffusion method. The commercial antibiotics ceftriaxone and erythromycin were used as positive control standards to determine the sensitivity of S. agalactiae.

Results: The result showed that all four groups of Thai herbal extract had inhibitory activity against standard strains of S. agalactiae. The inhibitory concentration test values were obtained using the dilution test at 25, 50, and 75 mg/ml. The maximum antimicrobial activity against S. agalactiae was observed in the ethanolic extracts from red shallot extract, followed by leaves of mulberry, petals of marigold, and root barks of mulberry, respectively.

Conclusion: The results demonstrated that the crude extract of three Thai herbs had antimicrobial activity inhibiting the growth of S. agalactiae and suggesting that they may be useful in the treatment of S. agalactiae infections in humans and animals.

Clean intermittent catheterisation (CIC) of the bladder is used to imitate normal bladder emptying in patients with bladder dysfunction. CIC is associated with urinary tract infection (UTI) that may be difficult to treat in the case of antimicrobial resistance. The aim of this study was to establish the effect and safety of intravesical

The metallo beta-lactamase (MBL) mediated resistance patterns remain unknown in most countries. We aimed to investigate the existence and antimicrobial resistance of MBL-producing strains among carbapenemresistant Gram-negative bacteria that were isolated from nosocomial infections in patients in an university hospital in Turkey. Fifteen of 52 Pseudomonas aeruginosa strains (29%), 5 of 24 Acinetobacter baumanii strains (21%), and 2 of 2 Klebsiella pneumoniae strains (100%) were found to be metallo enzyme producers, with the Etest MBL technique. The in vitro antibiotic susceptibility of the MBL-positive organisms was investigated by the Etest method. Of the ten drugs tested, isepamicin was the most active agent against the MBL-producing strains. Overall, the rank order of activity of the ten antibiotics, in terms of the percentages of susceptible strains, was: isepamicin, 73%; ciprofloxacin, 64%; amikacin, 59%; aztreonam, 18%; tobramycin, 18%; meropenem, 14%; cefoperazone-sulbactam, 5%; piperacillin-tazobactam, 0%; ticarcillin-clavulanate, 0%; and cefepim, 0%. The meropenem minimum inhibitory concentrations (MICs) of the metallo enzyme-producing and nonproducing carbapenem-resistant strains were compared, and the MBL-producers were found to have higher meropenem MICs than the nonMBL-producing carbapenem-resistant strains. Early preventive measures should be taken against MBL-producing nosocomial pathogens that are associated with wide spread and high antimicrobial resistance.

There is a lack of efficient and safe preservatives in the food industry. Massive use of some common food preservation methods has led, over the years, to development of a resistance to different treatments by various food pathogens. Enteric bacteria are especially tolerant to adverse environmental conditions-such as low pH and high salt concentrations-which limits efficiency of some preservation methods. Consumers demand for natural, preservative-free, and minimally processed foods and worldwide concern regarding disease outbreaks caused by food-related pathogens have created a need for development of new classes of antimicrobial (AM) agents. The twentieth century revealed a massive array of new peptide-based antimicrobials. Small ribosomally made compounds are found in practically all living species where they act as important component of host defense. Certain indubitable advantages of peptides-pertaining to simplicity, activity spectra, and bacterial resistance-over known preservative agents advocate their potential for food preservation. Nisin, an AM compound originating from bacteria, is so far the only FDA-approved peptide. However, a growing number of reports describe the potential of animal-derived antimicrobial peptides as food preservatives. These studies have yielded various native compounds and/or derivatives that possess markedly improved antimicrobial properties under a broad range of incubation conditions. The present work reviews the most investigated peptides and accounts for their potential use as alternatives to the preservatives used today. The focus is on research aspects aiming at understanding the mechanism of action of these peptides at extreme environments of various food systems. Collectively, the data accumulated are convincingly indicative of potential applications of these peptides in food safety, namely, with respect to fighting multidrug-resistant pathogens.

India show various trends in different parts of the country. However, there are limited data on the changing profile of laboratory proven STIs in the same clinic over the years. The present study was thus aimed to determine the changing trends of the profile of STIs and HIV seropositivity in STD clinic attendees over a 15 yr period, and also to detect change, if any, in the antimicrobial resistance pattern of Neisseria gonorrhoeae.

Background and Aim: Pigeon rearing has been gaining popularity for recent years. They are reared remarkably very close to the house of the owner. This activity, therefore, may pose potential threats for humans as well as other animals as pigeons may carry and spread different pathogens including drug-resistant bacteria. This study was conducted to explore the prevalence of Escherichia coli and Salmonella spp. as well as their antibiogram profile along with an association analysis. Materials and Methods: Forty swab samples were collected from 20 pigeons during the study. E. coli and Salmonella spp. were isolated and identified on various types of agars, including MacConkey, Eosin methylene blue, Brilliant green, and Salmonella-Shigella agar. Biochemical tests such as the carbohydrate fermentation test, the triple sugar iron agar slant reaction, the indole test, the methyl red test, the catalase test, as well as the Voges–Proskauer test were also performed. Besides, the presence of E....

Antimicrobial resistance (AMR), a central health challenge of the twenty first century,
poses substantial population health risks, with deaths currently estimated to
be around 700,000 per year globally. The international community has signaled its
commitment to exploring and implementing effective policy responses to AMR,
with a Global Action Plan on AMR approved by the World Health Assembly in
2015. Major governance challenges could thwart collective efforts to address AMR,
along with limited knowledge about how to design effective global governance
mechanisms. To identify common ground for more coordinated global actions we
conducted a narrative review to map dominant ideas and academic debates about
AMR governance. We found two categories of global governance mechanisms:
binding and non-binding and discuss advantages and drawbacks of each. We suggest
that a combination of non-binding and binding governance mechanisms supported
by leading antimicrobial use countries and important AMR stakeholders, and
informed by One Health principles, may be best suited to tackle AMR.

The antimicrobial activity of different solvent extracts (hydro alcoholic extracts of methanol) of different parts of Lagenaria siceraria (Molina) Standl was evaluated for its antimicrobial potential.  The in vitro antimicrobial activity was evaluated by agar well diffusion method. Extraction was done by individual cold percolation method. The antimicrobial activity was tested against five Gram positive bacteria, five Gram negative bacteria and four fungi.  The MIC and MBC was also determined, including five antibiotics. All the parts possessed antimicrobial activity but to a different level.  The extracts showed better antifungal activity than antibacterial activity and Gram negative bacteria were more susceptible than Gram positive bacteria. The peel showed lowest MIC and MBC values indicating the therapeutic value of agro waste material.

INTRODUCTION:
Tertiary Institutions' Social Health Insurance Programme (TISHIP) is an arm of the National Health Insurance Scheme (NHIS), which provides quality healthcare to students in Nigerian higher institutions. The success of this scheme depends on the students' knowledge and awareness of its existence as well as the level of its implementation by healthcare providers. This study was therefore designed to assess students' knowledge and attitude towards TISHIP and its implementation level among health workers in Nnamdi Azikiwe University Medical Centre.

METHODS:
Using a stratified random sampling technique, 420 undergraduate students of Nnamdi Azikiwe University, Awka were assessed on their level of awareness and general assessment of TISHIP through an adapted and validated questionnaire instrument. The level of implementation of the scheme was then assessed among 50 randomly selected staff of the University Medical Center. Data collected were analyzed using Statistical Package for Social Sciences (SPSS) version 20 software.

RESULTS:
Whereas the students in general, showed a high level of TISHIP awareness, more than half of them (56.3%) have never benefited from the scheme with 52.8% showing dissatisfaction with the quality of care offered with the scheme. However, an overwhelming number of the students (87.9%) opined that the scheme should continue. On the other hand, the University Medical Centre staff responses showed a satisfactory scheme implementation.

CONCLUSION:
The study found satisfactory TISHIP awareness with poor attitude among Nnamdi Azikiwe University students. Furthermore, the University Medical Centre health workers showed a strong commitment to the objectives of the scheme.

KEYWORDS:
Patient satisfaction; Professional practice; Students attitudes; health promotion

Diarrhea remains one of the principle causes of morbidity and mortality in children in the world. Although studies on causative agents of children diarrhea in Libya are few, the available data shows that rotavirus is the major cause of diarrhea in Libyan children. However, bacterial and parasitic pathogens also play an important role in the etiology of diarrhea in children in Libya with salmonellae and Cryptosporidium as major agents, respectively. Fever and severe dehydration are common clinical features among diarrheic children particularly those affected by rotavirus. The emergence of antimicrobial-resistant enteric bacterial pathogens in this population has been noted and may complicate treatment options. The ease by which antimicrobial agents can be obtained over the counter in Libya may play a role in the emergence of this problem. A serious educational program in the country on the benefits of breast feeding is needed. Also, the introduction of a rotavirus vaccine into the vaccination program in Libya to protect the pediatric population should be taken into consideration.

Turkey is a home country for a good number of fermented beverages derived from milk, cereals, fruits and vegetables, and several studies have reported the probiotic potentiality of these beverages. Probiotics, otherwise known as beneficial microorganisms possess the ability to exert antimicrobial effects, which is one of the most important selection criteria for their use in commercial products. In the current study, the antimicrobial activities of potential probiotic bacteria isolated from five fermented traditional Turkish beverages (boza, kefir, ayran, shalgam juice and hardaliye) were evaluated. The bacterial isolates were morphologically characterized and genotypically identified by 16S rRNA gene sequence analysis. The antimicrobial effects of the isolates against selected human pathogens were assessed using spot-on-the-lawn and agar well diffusion assays. Eighteen of the twenty-two strains displayed varying degrees of antagonism against the tested pathogens. Amongst the isolat...

Resumo: As plantas medicinais constituem uma alternativa no tratamento primário da saúde, através de seus
compostos bioativos vegetais e óleos essenciais que apresentam potencial multifuncional contra microrganismos
patogênicos. O uso conjugado com drogas sintéticas pode resultar em interações indesejáveisprejudiciais ao
organismo, através de mudanças no mecanismo de ação, que além de promover reações adversas às respostas
farmacológicas esperadas, tem como principal consequência a multirresistência dos microorganismos. Este
trabalho teve como objetivo verificar na literatura científica relatos sobre os principais produtos naturais mais
comumente utilizados que possuem atividade antimicrobiana, que podem ser aplicados na substituição de
fármacos sintéticos, frente à patógenos de interesse humano. Realizou-se um levantamento bibliográfico em
diversas bases de dados, na busca de testes clínicos, in vitro e in vivo e relatos de casos que demonstrassem a
ação antimicrobiana de produtos naturais. Relacionada às doenças infecciosas de fator preocupante a saúde
pública, as espécies patogênicas mais citadas na literatura foram a E. coli, P. aeruginosa, S. aureus e C. albicans.
Das espécies de plantas frequentes no consumo da população, foram selecionadas seis (Matricaria
chamomomilla, Ocimum gratissimum, Punica granatum L., Rosmarinus officinalis, Syzygium aromaticum e
Uncaria tumentosa) das mais utilizadas, além da Própolis, ambas apresentaram atividade antimicrobiana positiva,
com ação inibitória similar ou superior aos antibióticos. Nesta perspectiva, estudos detalhados sobre o
mecanismo de ação dos produtos naturais sob o organismo humano, visam avanços na prevenção e tratamento de
diversas doenças. Palavras-chave: Antibióticos. Fitoterapia. Interação medicamentosa.
Abstract: Medicinal plants are an alternative in the primary health treatment, through its bioactive plant
compounds and essential oils that have multifunctional potential against pathogenic microorganisms. The
combined use of natural and synthetic drugs can result in undesirable interactions that are detrimental to the
organism, through changes in the mechanism of action, which in addition to promoting adverse reactions to the
expected pharmacological responses, has as main consequence the multiresistance of microorganisms. This work
aimed to verify in the scientific literature reports on the main natural products most commonly used that have
antimicrobial activity, which can be applied in the substitution of synthetic drugs, against pathogens of human
interest. A bibliographic survey was carried out in several databases, searching for clinical, in vitro and in vivo
tests and case reports that demonstrated the antimicrobial action of natural products. Related to infectious
diseases of concern to public health, the pathogenic species most cited in the literature were E. coli, P.
aeruginosa, S. aureus and C. albicans. Of the plant species that were common to the population, six (Matricaria
chamomomilla, Ocimum gratissimum, Punica granatum L., Rosmarinus officinalis, Syzygium aromaticum and
Uncaria tumentosa) were selected from the most used, besides Propolis, both showed positive antimicrobial
activity similar to or higher than antibiotics. In this perspective, detailed studies on the mechanism of action of
natural products under the human body, aim at advances in the prevention and treatment of various diseases.
Keywords: Antibiotics. Phytotherapy. Drug interaction.