Search Results (319)

Background/Objectives: Patient-level factors strongly influence antimicrobial resistance (AMR) through the pressure applied to healthcare professionals to prescribe antibiotics even for self-limiting viral infections, enhanced by knowledge and attitude concerns. This includes Africa, with high levels of AMR. However, validated measurement tools for African primary healthcare (PHC) are scarce. This study evaluated the reliability, structural validity, and interpretability of the Community Antimicrobial Use Scale (CAMUS) in South Africa. Methods: A cross-sectional survey was conducted with 1283 adults across 25 diverse public PHC facilities across two provinces. The 30-item theory-based tool underwent exploratory and confirmatory factor analysis (EFA/CFA), reliability, and validity testing. Results: EFA identified a coherent five-factor structure: (F1) Understanding antibiotics; (F2) Social and behavioural norms; (F3) Non-prescribed use; (F4) Understanding of AMR; and (F5) Attitudes. Internal consistency was strongest for knowledge and misuse domains (alpha approximation 0.80). Test–retest reliability was good-to-excellent (ICC: 0.72–0.89). CFA confirmed acceptable composite reliability (CR ≥ 0.63). Although average variance extracted (AVE) was low for broader behavioural constructs, indicating conceptual breadth, it was high for AMR knowledge (0.737). Construct validity was supported by positive correlations with health literacy (r = 0.48) and appropriate use intentions (r = 0.42). Measurement error metrics (SEM = 1.59; SDC = 4.40) indicated good precision for group-level comparisons. Conclusions: CAMUS demonstrated a theoretically grounded structure with robust performance in knowledge and misuse domains. While social and attitudinal domains require refinement, we believe the tool is psychometrically suitable for group-level antimicrobial use surveillance and programme evaluation in South African PHC settings and wider to help with targeting future educational programmes among patients. Full article

This study analyzes the competitive asymmetries and trade effects of the proposed EU–Mercosur Trade Agreement on the European Union’s (EU) and Polish agri-food sectors. The comparative analysis reveals that Mercosur holds a significant structural advantage driven by substantially lower labor costs, cheaper agricultural land, and a climate permitting multiple harvests. This cost advantage is further compounded by weaker regulatory standards (e.g., on pesticides and antibiotics). This structural edge is most pronounced in high-volume commodities, leading to Mercosur trade surpluses in products such as soybeans, sugar cane, and wheat, which pose the primary competitive threats to the EU market. Conversely, the EU maintains an intensive advantage through superior yields in intensive farming (e.g., maize) and specialization in high-value, processed products. This creates quantifiable export opportunities for EU/Polish producers in sectors where Mercosur is a consistent net importer, notably other frozen vegetables, preserved tomatoes, and apples. The findings confirm an asymmetric effect of liberalization, which necessitates a dual strategy of internal structural reform (e.g., the EU Protein Strategy) and the implementation of external protective mechanisms, including strategic Common Agricultural Policy (CAP) adaptations and safeguard clauses, to maintain the long-term competitiveness and Supply Chain Resilience of European agriculture. Full article

Coral reef ecosystems represent one of the most biodiverse and productive marine habitats, yet they are increasingly threatened by a range of anthropogenic stressors. Among these, emerging contaminants including pharmaceutical and personal care products (PPCPs) have started to feature as contaminants of concern due to their persistence, bioaccumulation potential, and complex interactions within reef environments. This review synthesizes current research on the occurrence, transport pathways, and ecological impacts of emerging contaminants, specifically focusing on PPCPs on coral reef systems. Evidence indicates that compounds such as UV filters, antibiotics, and endocrine-disrupting chemicals can impair coral physiology, disrupt symbiotic relationships with zooxanthellae, and contribute to bleaching events. The review further highlights the variability in coral species’ sensitivity to these contaminants, with documented effects ranging from oxidative stress to reduced growth and reproductive capacity. Despite advances in detection and risk assessment, significant knowledge gaps remain regarding long-term exposure, mixture effects, and the influence of local environmental conditions on contaminant toxicity. By consolidating recent findings, this review underscores the urgent need for targeted research and policy action to mitigate the threat of emerging contaminants to coral reef ecosystems. Full article

Background/Objectives: The increasing trend of foodborne zoonotic pathogens exhibiting antimicrobial resistance (AMR) represents a growing threat to food safety and public health in sub-Saharan Africa (SSA). Resistant strains of foodborne zoonotic pathogens compromise treatment efficacy, raise illness, and threaten sustainable food systems in human and animal health. However, regional understanding and policy response are limited due to the fragmentation of data and the inadequacy of surveillance. This systematic review and meta-analysis aimed to achieve the following: (1) estimate the pooled prevalence of AMR, including multidrug resistance (MDR) in selected foodborne pathogens; (2) compare subgroup variations across countries, pathogen species, and antibiotic classes; and (3) evaluate temporal trends. Methods: Following PRISMA 2020 guidelines, studies published between 2010 and June 2025 reporting AMR and MDR in Salmonella, Campylobacter, or E. coli from food or animal sources in SSA were systematically reviewed. Data on pathogen prevalence, AMR profile, and MDR were extracted. Random-effects meta-analysis using R software was implemented to estimate the pooled prevalence and the 95% confidence intervals (95% CI). Subgroup analyses were performed to explore heterogeneity across countries, antibiotic class, and bacterial species. Results: Ninety studies from 16 sub-Saharan African countries were included, encompassing 104,086 positive isolates. The pooled foodborne pathogen prevalence was 53.1% (95% CI: 51.5–54.7), AMR prevalence was 61.6% (95% CI: 59.4–63.9), and MDR prevalence was 9.1% (95% CI: 8.3–10.0). The highest resistance was reported in Campylobacter spp. (43.6%), followed by Salmonella spp. (29.1%) and E. coli (22.8%). High heterogeneity was observed across studies (I² = 95–99%, p < 0.001). Conclusions: It is concluded that substantial AMR burden exists in food systems, highlighting an urgent need for integrated One Health surveillance, antimicrobial stewardship, and policy harmonization in SSA. Strengthening laboratory capacity, enforcing prudent antimicrobial use, and promoting regional data sharing are critical for the management of antimicrobial resistance in sub-Saharan Africa. Full article

Klebsiella pneumoniae is increasingly reported in canine medicine, with growing attention to multidrug-resistant (MDR) and hypervirulent strains. Although its overall prevalence in dogs appears relatively low, published studies indicate that affected animals may harbor clinically important resistance determinants, including extended-spectrum β-lactamases and, less frequently, carbapenemases. Canine isolates described in the literature also carry virulence-associated traits such as hypermucoviscosity and enhanced iron-acquisition systems, which overlap with features of high-risk human lineages and suggest potential, but largely inferred, interspecies links. These observations highlight the relevance of a One Health perspective and the importance of coordinated surveillance that includes companion animals. This narrative review synthesizes available literature on the epidemiology, clinical presentations, antimicrobial resistance, virulence traits, and molecular characteristics of K. pneumoniae in dogs. We critically evaluate evidence suggesting that dogs may function as reservoirs, sentinels, or amplifiers of MDR strains, particularly in clinical settings or following antimicrobial exposure. In addition, we summarize emerging alternative and adjunctive strategies—such as bacteriophage therapy, antimicrobial peptides, anti-virulence approaches, microbiome-based interventions, as well as strengthened antimicrobial stewardship and infection-control practices—that are under investigation as complements to conventional antibiotics. Overall, published evidence indicates that K. pneumoniae infections in dogs represent an under recognized but potentially important clinical and One Health concern. Continued surveillance, responsible antimicrobial use, and rigorous evaluation of non-antibiotic strategies will be essential to inform future veterinary practice and public health policy. Full article

Background/Objectives: Antimicrobial resistance (AMR) among Enterobacterales poses a major threat to public health in Southern Africa and has led to limited treatment options and increased mortality. Despite Africa bearing the brunt, there is limited data on the epidemiology and molecular epidemiology of the genetic determinants of β-lactam and/or carbapenem resistance. This narrative literature review summarizes the epidemiology and molecular characteristics of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE), carbapenem-resistant Enterobacterales (CRE), and carbapenemase-producing Enterobacterales (CPE) in Southern Africa, while identifying data gaps and surveillance challenges. Methods: A comprehensive literature review was conducted using peer-reviewed articles from ten Southern African countries, including South Africa, Lesotho, Eswatini, Botswana, Namibia, Angola, Zambia, Zimbabwe, Mozambique, and Malawi, reporting the epidemiology and/or molecular characterization of ESBL-PE, CRE, and CPE. Results: ESBL-PE, CRE, and CPE pose an increasing healthcare threat in Southern Africa, with prevalence varying widely by source. Klebsiella pneumoniae and E. coli are the predominant ESBL-PE, CRE, and CPE species. The most frequent resistance genes are bla_CTX-M among ESBLs and bla_NDM and bla_OXA among carbapenemases, reflecting global patterns. However, molecular characterization across the region remains limited, with countries such as Botswana, Lesotho, Eswatini, Zambia, and Zimbabwe lacking sufficient data on the prevalence and diversity of these resistance determinants. Conclusions: Despite the paucity of genomic and epidemiological data, Southern Africa faces an urgent AMR challenge. Strengthening laboratory infrastructure, genomic surveillance, and regional coordination is crucial to mitigate AMR and guide antibiotic stewardship policies. Full article

Raw meat can act as a reservoir and vehicle for antimicrobial-resistant foodborne Escherichia coli, particularly when sold under poor hygienic conditions, as is often the case in informal markets in many developing countries, thereby representing a significant public health risk. This study aimed to characterize the antibiotic resistance patterns and virulence of E. coli isolated from raw meat sold in informal markets in Luanda, Angola. A total of 99 E. coli isolates were recovered from fresh beef, pork and goat meat in five informal markets. DNA macrorestriction analysis by Pulsed-Field Gel Electrophoresis (PFGE) was used to evaluate the genetic diversity of isolates. Multiplex PCR was performed to detect virulent and antibiotic resistance genes. Antibiotic susceptibility was tested using the disk diffusion method. PFGE analysis showed high genotypic diversity. Virulence genes were found in 46% of the isolates, with astA (32.3%) being the most frequent. The results also showed high resistance to cefotaxime (67.7%), ampicillin (56.7%) and amoxicillin/clavulanic acid (56.6%). Resistance to imipenem, a last-resort antibiotic, was observed in 30.3% of the isolates. The most prevalent resistance genes were CTX-M group 1 (10.1%) and FOX variants (27.3%). The presence of multidrug-resistant and potentially pathogenic E. coli strains in raw meat sold in informal markets in Luanda represents a significant threat to public health. These findings underscore the urgent need to improve surveillance, hygiene practices, and antimicrobial use regulation policies in animal production in Angola. Full article

Background: Antimicrobial resistance (AMR) is a major global health threat, and Cyprus reports one of the highest levels of community antibiotic consumption in the EU. Despite their central role in antibiotic access and counselling, the stewardship practices and perspectives of community pharmacists in this regulated setting are not well documented. Methods: We conducted semi-structured qualitative interviews with 20 community pharmacists to explore their perspectives on antibiotic use and AMR. Results: We analysed the data using reflexive thematic analysis, revealing five key themes: regulation and control of dispensing; pharmacist–patient interaction and misuse; antimicrobial stewardship and public education; safety and professional responsibility; and systemic barriers. Pharmacists reported strict adherence to prescription-only rules, and described regulation and e-prescribing as a practical ‘shield’ that legitimised refusals and redirected some misuse from overt non-prescription requests towards attempts to reuse, extend, or ‘top up’ prior prescriptions and household leftovers. They described managing frequent patient demands for antibiotics for self-limiting conditions and using brief counselling scripts, written aids, and symptomatic alternatives to promote appropriate use. Participants emphasised the risks of antibiotic-related harms, including AMR and other health consequences, while also highlighting workload, access constraints, and communication difficulties as barriers to effective counselling. Overall, the findings indicate that community pharmacists in Cyprus function as front-line antimicrobial stewards. Conclusions: These accounts position community pharmacists in Cyprus as front-line antimicrobial stewards. Policy should consider supporting this function by providing enhanced communication tools, improving access pathways for timely prescriber review (including outside routine hours), and strengthening links between community pharmacy and national AMR action plans. Full article

Pharmaceuticals are increasingly recognized as contaminants of emerging concern, yet monitoring strategies often do not reflect actual consumption patterns or ecological risk. Greece presents a particularly relevant case due to high pharmaceutical use and fragmented monitoring data. In the present study, 359 pharmaceuticals, metabolites, and transformation products were reviewed, as reported in monitoring studies in Greek wastewater, surface waters, and drinking water. Consumption data (from the Organization for Economic Co-operation and Development, OECD), environmental occurrence (from 55 studies), and ecotoxicity thresholds (i.e., from the NORMAN Database) were integrated to calculate risk quotients (RQs) and assess monitoring gaps. RQ values were derived for 241 compounds: 38 (16%) high-risk, 60 (25%) medium-risk, and 143 (59%) low-risk. High-risk substances included several NSAIDs, macrolide and fluoroquinolone antibiotics, synthetic hormones, contrast agents, and triclosan. Major under-monitoring was observed for widely consumed classes A and B, while antibiotics, NSAIDs, antidepressants, and analgesics were disproportionately targeted. Several metabolites showed higher RQs than their parent compounds but were rarely analyzed. These findings reveal significant mismatches between pharmaceutical use, environmental occurrence, and ecological risk in Greece. Results support adopting risk-based prioritization for environmental monitoring and align with ongoing updates to EU water policy. Full article

Bacteriophages, often referred to as “bacteria eaters,” have gained renewed interest as a powerful alternative to traditional antibiotics, particularly in addressing antibiotic-resistant bacterial infections. The present review summarizes data collected in Bulgaria during the 1960s, 1970s, and 1980s, drawing connections between past findings and present-day understanding of cytotoxicity and the clinical validation of bacteriophage applications. Its sections describe phage structure, mechanisms of action, and historical findings both globally and within the Bulgarian context, while also highlighting emerging trends and applications. The cited studies delve into the past through contemporary research contributions related to “Bulgarian phages”, a topic that remains underexplored in existing literature. The role of phages in medical microbiology is discussed alongside the challenges of therapeutic implementation, with particular focus on insights gained from the Bulgarian experience. In conclusion, by fostering international collaborations, investing in infrastructure, and establishing supportive policies, bacteriophage therapy can emerge as a critical tool for managing bacterial infections and reducing the global burden of antibiotic resistance in the future. Full article

Background: Antimicrobial resistance (AMR) is accelerating globally, driven by widespread inappropriate antibiotic use and diagnostic uncertainty in primary care. Pharmcist-led point-of-care testing (POCTs) has emerged as a promising model to optimize antibiotic prescribing, improve triage, and strengthen antimicrobial stewardship (AMS). Methods: This scoping review synthesizes current evidence, regulatory models, and implementation data on pharmacist-led diagnostics and antibiotic management across multiple countries. Results: Despite strong policy interest, clinical trial evidence remains limited. Existing studies—primarily pilots, feasibility work, and service evaluations—suggest that POCTs combined with structured pathways reduces inappropriate antibiotic use. Conclusions: Regulatory fragmentation, workforce limitations, and insufficient monitoring systems constrain widespread implementation. Larger, well-designed trials are needed to establish long-term safety, clinical outcomes, and AMS impact. Full article

Bacterial contaminants in ambulances could have a major impact on morbidities, mortalities, and healthcare resources, especially if these bacteria are antimicrobial-resistant. As far as we know, this is the first study in Al-Qassim region to evaluate the prevalence of bacterial contaminants in swab samples obtained from ambulances from Alqwarah General Hospital, Al-Qassim region, Saudi Arabia as an indicator for evaluation of the implemented infection control measures, and screen the antibiotics profiles of the isolates against the most regularly used antimicrobials. In total, 204 samples were collected from the ambulances following patient transport. To evaluate the effect of vehicle decontamination, 204 swabs were collected from the same sites of the ambulances immediately after cleaning and disinfection. The isolates were identified using standard bacteriological and biochemical methods, as recommended by the Clinical Laboratory Standard Institute (CLSI). The antibiotic susceptibility patterns were assessed using the Kirby–Bauer disc diffusion method. The prevalence of bacterial contamination in the samples collected following patient transport was 46.08%. In total, 83.33%, 75.00%, and 66.66% of the samples collected from DC shock apparatuses, ceilings, and emergency personnel seats, respectively, were contaminated. Furthermore, ceilings, DC shock apparatuses, emergency personnel seats, cervical collars, and monitors were found to harbor 10.8%, 9.8%, 7.8%, 6.8%, and 6.8% of the 102 bacterial isolates, respectively. Gram-positive organisms represented 96.1% of all bacterial isolates. Bacillus spp. was the most common isolate, accounting for 60.8% of all bacterial isolates. Although Pseudomonas aeruginosa and Proteus spp. isolates were sensitive to all the tested antimicrobials, many Gram-positive bacterial isolates were resistant to some antibiotics in variable frequencies. After 48 h of aerobic incubation (with or without 5–10% CO₂) on nutrient, blood, chocolate, and MacConkey agar plates at 37 °C, no bacterial growth was detected in the samples collected immediately following cleaning and disinfection. This is the second Saudi study to evaluate the prevalence of bacterial contaminants in Saudi Arabian ambulances, and it could help health policy makers in improving the implemented infection prevention and control measures in Saudi Arabian ambulances. The samples taken after patient transport revealed bacterial contaminants with varying rates of antimicrobial resistance. Policies ensuring the optimal cleaning and disinfection of ambulances can minimize the potential of bacterial infection for high-risk patients, their relatives, and healthcare providers. Full article

Background: Antimicrobial resistance (AMR) is now a critical issue in South Africa, enhanced by considerable inappropriate prescribing of antibiotics. There is currently variable dispensing of antibiotics without a prescription. Where this occurs, it is principally for urinary tract infections (UTIs) and sexually transmitted infections (STIs). Consequently, there is a need to comprehensively evaluate antibiotic dispensing patterns and factors influencing this to reduce AMR. Methods: A previously piloted questionnaire was administered to patients exiting three different categories of community pharmacies in a rural province. The questionnaire included data on the prevalence of antibiotics dispensed, whether without a prescription, and the rationale for this. Results: A total of 465 patients leaving community pharmacies with a medicine were interviewed. 54.4% of interviewed patients were dispensed at least one antibiotic, with 78.7% dispensed these without a prescription from either independent or franchise pharmacies. Metronidazole (36.1%) and azithromycin (32.7%) were the most dispensed antibiotics. STIs were the most common infectious disease for which an antibiotic was dispensed (60.1%), with 99.6% dispensed without a prescription. Upper respiratory tract infections (URTIs) were the most common infection where antibiotics were dispensed with a prescription (60.0%), with little dispensing without a prescription (7.1%). The most frequently cited reasons for obtaining antibiotics without a prescription were prior use (56.8%), long waiting times at PHC clinics (15.6%), and financial constraints (6.0%). Conclusions: There is an urgent need to review community pharmacists’ scope of practice, including allowing them to prescribe antibiotics for infectious diseases such as UTIs, similar to other countries. Concomitantly, utilise trained community pharmacists to engage with prescribers to improve future antibiotic use, especially for URTIs. Full article

Romania faces a double challenge in the swine production sector. On one hand, the European Union’s environmental agenda demands that member states drastically reduce both the carbon footprint and the use of antibiotics in animal husbandry by 2030. On the other hand, the Romanian swine industry still grapples with long-standing internal issues such as excessive fragmentation, a strong dependence on imported piglets and feed materials, and a clear shortage of modern management experience. This study set out to explore how the ADKAR model can serve as a structured approach to help commercial swine farms in Romania transition toward sustainability. To gather relevant data, researchers distributed a five-point Likert-scale questionnaire to 83 farm managers, out of the 361 officially registered commercial swine farms. The instrument was designed to assess how each farm positioned itself across the five ADKAR dimensions. The results revealed that most Romanian farm managers are highly aware of the need for change and show a generally positive attitude toward adopting sustainable practices. However, there remain considerable knowledge gaps and practical limitations, which continue to act as major barriers to effective implementation. The composite ADKAR-S Index, which measures the “sustainability maturity” of each farm, displayed a strong positive correlation with economic performance, particularly the profit margin (r ≈ 0.45, p < 0.001), and a significant negative correlation with antimicrobial use (r ≈ −0.50, p < 0.001). Simply put, farms that are better prepared for organizational transformation tend to perform better financially while also reducing their environmental footprint. The findings suggest that policy efforts should prioritize human capital development, especially through training programs and reinforcement systems such as continuous monitoring and staff incentives, to ensure that sustainable practices are not only adopted but also maintained in the long run. Full article

The widespread use of antibiotics in livestock farming has led to the persistent issue of antibiotic residues in meat products, raising significant concerns for food safety and public health. These residues can contribute to the emergence and spread of antimicrobial resistance (AMR), a growing global health threat recognized by the World Health Organization. While some regulatory bodies have imposed restrictions on non-therapeutic antibiotic use in animal agriculture, inconsistent global policies continue to hinder unified efforts to reduce AMR risks. This review explores the role of biotechnology in addressing this challenge by offering innovative tools for the detection, degradation, and removal of antibiotic residues from meat. Biotechnological approaches include the use of biosensors, high-throughput screening, enzymatic degradation, microbial bioremediation, genetically engineered bacteria, phage therapy, and phytoremediation. In addition, enabling technologies such as genomics, metagenomics, bioinformatics, and computational modeling support the rational design of targeted interventions. We further examine the integration of these biotechnological strategies within the broader “One Health” framework, which emphasizes the interconnectedness of human, animal, and environmental health. Case studies and recent applications demonstrate the potential of these methods to ensure safer meat production, reduce public health risks, and enhance consumer trust. By focusing on scalable, science-driven solutions, biotechnology offers a promising path toward mitigating antibiotic residues in the food supply and combating the long-term threat of AMR. Full article