Antibiotics have always been considered one of the wonder discoveries of the 20th century. This is true, but the real wonder is the rise of antibiotic resistance in hospitals, communities, and the environment concomitant with their use. The extraordinary genetic capacities of microbes have benefitted from man's overuse of antibiotics to exploit every source of resistance genes and every means of horizontal gene transmission to develop multiple mechanisms of resistance for each and every antibiotic introduced into practice clinically, agriculturally, or otherwise. This review presents the salient aspects of antibiotic resistance development over the past half-century, with the oft-restated conclusion that it is time to act. To achieve complete restitution of therapeutic applications of antibiotics, there is a need for more information on the role of environmental microbiomes in the rise of antibiotic resistance. In particular, creative approaches to the discovery of novel antibiotics and their expedited and controlled introduction to therapy are obligatory.

Origins and Evolution of Antibiotic Resistance

The causes of antibiotic resistance are complex and include human behaviour at many levels of society; the consequences affect everybody in the world. Similarities with climate change are evident. Many efforts have been made to describe the many different facets of antibiotic resistance and the interventions needed to meet the challenge. However, coordinated action is largely absent, especially at the political level, both nationally and internationally. Antibiotics paved the way for unprecedented medical and societal developments, and are today indispensible in all health systems. Achievements in modern medicine, such as major surgery, organ transplantation, treatment of preterm babies, and cancer chemotherapy, which we today take for granted, would not be possible without access to effective treatment for bacterial infections. Within just a few years, we might be faced with dire setbacks, medically, socially, and economically, unless real and unprecedented global coordinated actions are immediately taken. Here, we describe the global situation of antibiotic resistance, its major causes and consequences, and identify key areas in which action is urgently needed.

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Antibiotic resistance—the need for global solutions

Antibiotics are widely used in humans and animals, but there is a big concern about their negative impacts on ecosystem and human health after use. So far there is a lack of information on emission inventory and environmental fate of antibiotics in China. We studied national consumption, emissions, and multimedia fate of 36 frequently detected antibiotics in China by market survey, data analysis, and level III fugacity modeling tools. Based on our survey, the total usage for the 36 chemicals was 92700 tons in 2013, an estimated 54000 tons of the antibiotics was excreted by human and animals, and eventually 53800 tons of them entered into the receiving environment following various wastewater treatments. The fugacity model successfully predicted environmental concentrations (PECs) in all 58 river basins of China, which are comparable to the reported measured environmental concentrations (MECs) available in some basins. The bacterial resistance rates in the hospitals and aquatic environments were found to b...

Comprehensive evaluation of antibiotics emission and fate in the river basins of China: source analysis, multimedia modeling, and linkage to bacterial resistance.

Antibiotic resistance genes (ARGs) are emerging contaminants posing a potential worldwide human health risk. Intensive animal husbandry is believed to be a major contributor to the increased environmental burden of ARGs. Despite the volume of antibiotics used in China, little information is available regarding the corresponding ARGs associated with animal farms. We assessed type and concentrations of ARGs at three stages of manure processing to land disposal at three large-scale (10,000 animals per year) commercial swine farms in China. In-feed or therapeutic antibiotics used on these farms include all major classes of antibiotics except vancomycins. High-capacity quantitative PCR arrays detected 149 unique resistance genes among all of the farm samples, the top 63 ARGs being enriched 192-fold (median) up to 28,000-fold (maximum) compared with their respective antibiotic-free manure or soil controls. Antibiotics and heavy metals used as feed supplements were elevated in the manures, suggesting the potential for coselection of resistance traits. The potential for horizontal transfer of ARGs because of transposon-specific ARGs is implicated by the enrichment of transposases—the top six alleles being enriched 189-fold (median) up to 90,000-fold in manure—as well as the high correlation (r2 = 0.96) between ARG and transposase abundance. In addition, abundance of ARGs correlated directly with antibiotic and metal concentrations, indicating their importance in selection of resistance genes. Diverse, abundant, and potentially mobile ARGs in farm samples suggest that unmonitored use of antibiotics and metals is causing the emergence and release of ARGs to the environment.

https://www.pnas.org/content/pnas/110/9/3435.full.pdf

Diverse and abundant antibiotic resistance genes in Chinese swine farms.

This article gives a very brief overview of the antibiotic era, beginning from the discovery of first antibiotics until the present day situation, which is marred by the emergence of hard-to-treat multiple antibiotic-resistant infections. The ways of responding to the antibiotic resistance challenges such as the development of novel strategies in the search for new antimicrobials, designing more effective preventive measures and, importantly, better understanding the ecology of antibiotics and antibiotic resistance are discussed. The expansion of conceptual frameworks based on recent developments in the field of antimicrobials, antibiotic resistance, and chemotherapy is also discussed.

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A brief history of the antibiotic era: lessons learned and challenges for the future.

Antibiotics are used in animal livestock production for therapeutic treatment of disease and at subtherapeutic levels for growth promotion and improvement of feed efficiency. It is estimated that approximately 75% of antibiotics are not absorbed by animals and are excreted in waste. Antibiotic resistance selection occurs among gastrointestinal bacteria, which are also excreted in manure and stored in waste holding systems. Land application of animal waste is a common disposal method used in the United States and is a means for environmental entry of both antibiotics and genetic resistance determinants. Concerns for bacterial resistance gene selection and dissemination of resistance genes have prompted interest about the concentrations and biological activity of drug residues and break-down metabolites, and their fate and transport. Fecal bacteria can survive for weeks to months in the environment, depending on species and temperature, however, genetic elements can persist regardless of cell viability. Phylogenetic analyses indicate antibiotic resistance genes have evolved, although some genes have been maintained in bacteria before the modern antibiotic era. Quantitative measurements of drug residues and levels of resistance genes are needed, in addition to understanding the environmental mechanisms of genetic selection, gene acquisition, and the spatiotemporal dynamics of these resistance genes and their bacterial hosts. This review article discusses an accumulation of findings that address aspects of the fate, transport, and persistence of antibiotics and antibiotic resistance genes in natural environments, with emphasis on mechanisms pertaining to soil environments following land application of animal waste effluent.

https://crashrecovery.org/zika/02-14MAR2008-Antibiotic-Resistance-Genes-J.Environ.Qual.May-June2009.pdf

Fate and transport of antibiotic residues and antibiotic resistance genes following land application of manure waste.

The adsorption and desorption of atrazine (2-chloro-4-ethylamino-6- isopropylamino-s-triazine) and a primary metabolite, deethylatrazine (2-amino-4-chloro-6-isopropylamino-s-triazine; DEA), by low organic C ({le} 3.3 g kg{sup -1}) materials were measured by batch-equilibrium techniques. The adsorbents were samples of glacial outwash sand, till, and stream sediments. The adsorption of both atrazine and DEA conformed to linear isotherms. The adsorption of atrazine by most of the absorbents yielded apparent K, values that were in excess of those based on surface agricultural soils. Adsorption correlated with only the pH of the sand-water suspensions. The desorption of atrazine was hysteretic under the conditions of the measurement. DEA had a lower affinity for the same adsorbents; the mean ratio of Kd values of DEA to those of atrazine was 0.37 {+-} 0.20. DEA adsorption did not correlate with organic C, surface area, clay content of the adsorbents, or with the pH of the suspensions. DEA adsorption, unlike atrazine, tended to be reversible. There was a linear relationship between the adsorption constants of atrazine and those of DEA. 40 refs., 8 figs., 3 tabs.

Adsorption and desorption of atrazine and deethylatrazine by low organic carbon geologic materials

RNA methylase genes are common antibiotic resistance determinants for multiple drugs of the macrolide, lincosamide, and streptogramin B (MLSB) families. We used molecular methods to investigate the diversity, distribution, and abundance of MLSB methylases in waste lagoons and groundwater wells at two swine farms with a history of tylosin (a macrolide antibiotic structurally related to erythromycin) and tetracycline usage. Phylogenetic analysis guided primer design for quantification of MLSB resistance genes found in tylosin-producing Streptomyces (tlr(B), tlr(D)) and commensal/pathogenic bacteria (erm(A), erm(B), erm(C), erm(F), erm(G), erm(Q)). The near absence of tlr genes at these sites suggested a lack of native antibiotic-producing organisms. The gene combination erm(ABCF) was found in all lagoon samples analyzed. These four genes were also detected with high frequency in wells previously found to be contaminated by lagoon leakage. A weak correlation was found between the distribution of erm genes and previously reported patterns of tetracycline resistance determinants, suggesting that dissemination of these genes into the environment is not necessarily linked. Considerations of gene origins in history (i.e., phylogeny) and gene distributions in the landscape provide a useful “molecular ecology” framework for studying environmental spread of antibiotic resistance.

Molecular Ecology Of Macrolide–Lincosamide–Streptogramin B Methylases in Waste Lagoons and Subsurface Waters Associated with Swine Production

The feasibility of applying immature yard-waste compost to remove nitrate from agricultural drainage effluents: a preliminary assessment.

The effect of Cl complexation in extracts of a flue gas-scrubber incinerator fly ash sample on the sorption of Cd and Ph by kaolinite and illite was investigated using batch-sorption methods. In the pH range of 5 to 9, Cl complexation may reduce sorption and thus increase the mobility of these metals. When an ash-water suspension was acidified to pH 6.85, the dissolution of Cl and Ca essentially eliminated Cd sorption because of complexation and cationic competition. Cadmium would be considered as either mobile or very mobile under these conditions. Lead was not soluble in the pH-6.85 suspension. At pH 12, the approximate pH of water in contact with flue gas-scrubber fly ash, Cd was essentially insoluble and Ph occurred as anionic Ph hydroxide. Anionic Ph was sorbed by the two clays, and the extent of sorption was not influenced by Cl or carbonate complexation. Sorption constants, derived from isotherms, suggested that Ph would be relatively immobile in saturated soil-water systems. The recent concern that highly alkaline, flue gas-scrubber fly ash may release environmentally significant concentrations of mobile Ph when placed in an ash-disposal site with a soil liner should be reevaluated in light of this study. 37 refs., 6more » figs., 3 tabs.« less

Ivan G. Krapac

Papers

Fate and transport of antibiotic residues and antibiotic resistance genes following land application of manure waste.

Adsorption and desorption of atrazine and deethylatrazine by low organic carbon geologic materials

Molecular Ecology Of Macrolide–Lincosamide–Streptogramin B Methylases in Waste Lagoons and Subsurface Waters Associated with Swine Production

The feasibility of applying immature yard-waste compost to remove nitrate from agricultural drainage effluents: a preliminary assessment.

Sorption of Cadmium and Lead by Clays from Municipal Incinerator Ash—Water Suspensions