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What are the mechanisms through which Microbes resistant to antimicrobial or antibiotics arise?

Discuss About The Evaluation Of Prevalence Of Antibiotic Resistant.

Supposing the very same formula and substances that were used approximately 90 years ago to develop antibiotics are still the same techniques used even today, and the components of the drugs are still the same. So, do we blame the drug for not for not destroying the bacteria of the 21st century? Or do we blame the physicians of these days for not being accurate? Or do we blame we blame everybody using these antibiotics for not adhering to the proper discourse when administering it? I don’t think so. One fact remains constant: in our fast moving world, far faster than any period in human resource management history, and so do these bacteria mutate and develop adaptive features that can withstand the antibiotics (Gullberg et al. 2011). This paper will examine the antimicrobial resistant bacteria through evaluating a research question from the very same thematic concern and also give critical appraisal for five different articles addressing the very same topic. What are the mechanisms through which Microbes resistant to antimicrobial or antibiotics arise?

Although we may note some predictions of experts, I would like to categorically point out that, human knowledge of the future is extremely limited and sometimes farcical. In 1928, Alexander Fleming, an expert and a professor of bacteriology discovered penicillin, the very first true antibiotic. Following his breakthrough in the field of medicine, a lot more such discoveries were made until microbial infections were never a threat to both animals and human lives. But no expert by that time predicted or considered the fact that these bacteria would evolve or mutate to develop resistance to these drugs (Derde et al. 2014). In a nutshell, resistance emanates majorly from one of the many mechanisms: for instance, natural resistance in some bacteria, a certain species obtaining resistance from another species, or through genetic mutation. In fungi they have antifungal resistance, in viruses, it is called antiviral resistance, in protozoa, they develop antiprotozoal resistance, and in this context, the bacteria or microbes develop antibiotic or antimicrobial resistance respectively (Galvin et al. 2010). So, the article https://www.bbc.co.uk/guides/z8kccdm on how the microbes resistant to antimicrobials, it states that antibiotics function through disruption of the survival mechanisms of the microbes or through simply making them extinct by preventing them from reproducing (Rai et al. 2013).

The fact is that when a lot of these antibiotics are used on the microbes, they develop resistance and in places where there are more human or animal hosts, they spread very fast either directly or indirectly to other hosts. They always degenerate or replicate very fast at the molecular stages hence outsmarting the antimicrobials (Hammerum and Heuer 2009). They mutate to become superbugs that don't just survive but thrive over time. The resistant microbes have got several mechanisms for spreading to a larger area either directly or indirectly. They are both water or airborne hence can spread via water, human beings can pass the bacteria to others by coughing, or when they get into contact especially with unclean hands (Derde et al. 2012). From my point, though not having the entire expertise regarding the field, a lot of emphases should be not only be put in diagnosing microbial infections,  but also in looking for the alternative ways by which the mutated microbes-the ‘superbugs’ could be manipulated to offset further potential damages.

Five articles

  • Mechanisms of antibiotic resistance. Microbiology spectrum, 2016. 4(2). By Munita, J.M., and Arias, C.A.
  • The complex relationship between virulence and antibiotic resistance. Genes, 8(1), 2017. P.39. by Schroeder, M., Brooks, B.D. and Brooks, A.E.
  • An Evaluation of the Prevalence of Antibiotic Resistant among Salmonella and Staphylococcus Aureus Isolated from Various Food Animals. by Torres, M.A.
  • High levels of macrolide resistance-associated mutations in Mycoplasma genitalium warrant antibiotic susceptibility-guided treatment. Journal of Antimicrobial Chemotherapy, 2015. 70(9), pp.2515-2518. By Nijhuis, R.H.T., Severs, T.T., Van der Vegt, D.S.J.M., Van Zwet, A.A. and Kusters, J.G.
  • Antibiotic Resistance: Associations and Implications for Antibiotic Usage Strategies to Control Multiresistant Bacteria. Antimicrobial Stewardship: Principles and Practice, 2016 80. By Rice, L.B.

The first article, Mechanisms of antibiotic resistance. Microbiology spectrum co-authored by Munita J.M and Arias C.A. I found this article from the National Library of Australia science section of the library database. I used the keywords like antimicrobial resistance, antibiotic resistant, superbugs and mechanism of antimicrobial resistant bacteria (Magiorakos et al. 2012). Because I had a randomized controlled trial in testing the article, I used the CASP checklist in critical appraisal of the article (Munita and Arias 2016).

 The second article, the complex relationship between virulence and antibiotic resistance. Genes by Brooks is also another remarkable article from the National Library of Australia section of epidemiology library database. The keywords I used here are antifungal, antibiotics, antimicrobial, et cetera. Basing on RCT, I used CASP method to critically appraise the article (Schroeder et al. 2017).

The third auditing, An Evaluation of the Prevalence of Antibiotic Resistance among Salmonella and Staphylococcus Aureus Isolated from Various Food Animals, by Torres was also found in the National Library of Australia science section of the library database. I searched the article using keywords like antimicrobial-resistant bacteria, antibiotics, and mechanisms used by bacteria in resisting antibiotics. I used the CASP checklist framework to appraise the article (Torres 2016) critically.

The fourth article, which I also found from the National Library of Australia, is known as High levels of macrolide resistance-associated mutations in Mycoplasma genitalium warrant antibiotic susceptibility-guided treatment. Journal of Antimicrobial Chemotherapy In this regard I used keywords like a genetic mutation of microbial, and how the microbial evolved. Similarly, I used CASP checklist as a model for critically appraising the article (Nijhuis et al. 2015).

The last article also came from the National Library of Australia database. The article is known as Antibiotic Resistance: Associations and Implications for Antibiotic Usage Strategies to Control Multiresistant Bacteria. Antimicrobial Stewardship: Principles and Practice, by Rice L.B. the keywords I used to Search this article were:  superbugs, antimicrobial, implications associated with antibiotics. I used CASP checklist in critically evaluating the article (Rice 2016).

GRADE level of evidence is to develop the recommendation on h the periodic health exams and put or base the recommendation by the medical literature (Young and Solomon 2009). Through this study resource, a system of rating evidence was established when assessing or determining the effectiveness of various research articles.  The evidence is considered when grading based on recommendations. For instance, a Grade A recommendation is given based on the good evidence to support a recommendation that a condition is in the periodic research article regarding the health exam.  The level of evidence is further described and expanded in five articles on the level of evidence for antimicrobial resistant bacteria. Both articles place the randomized contrail trials (RCT) at the apex or the top level and case series or expert opinions at the lowest level.  The hierarchies' ranks these studies based on the probability of bias (LoBiondo-Wood and Haber 2017). RCT are given the top priority because they are modeled to be unbiased, and they contain fewer risks of the systematic errors. For instance, by randomly distribution of the topics or the subject to very many groups, the type of study also randomizes confounding elements that may make the results biased. A case series of experts or the studies based on the expert's opinions are always biased by the authors own understanding or experience about that particular case study, and usually, it lacks control of confounding factors.

Methods

Level

Type of evidence

I

At least a single RCT having proper randomization

II.1

Well framed cohort or case-control study

II.2

Dramatic outcomes from uncontrolled studies or time series comparison

III

Subjective expert opinions

The complex relationship between virulence and antibiotic resistance, Genes by Brooks

Level

 Type of evidence

I

Wider RCTs with very clear-cut results

II

Unclear results based from small RCTs

III

Case-control studies and cohorts

IV

The historical cohorts and case-control studies

V

Studies with no limits, case series

An Evaluation of the Prevalence of Antibiotic Resistance among Salmonella and Staphylococcus Aureus Isolated from Various Food Animals, by Torres. Basing on level of evidence from the CASP checklist

Level

Type of evidence

I

A systematic review of the studies, adequate power with high quality prospective cohort study

II

Retrospective cohort study, with the less quality prospective cohorts, the unframed controls from an RCT and finally the systemic review of the studies

III

Systematic review and the case-control study

IV

Case series

V

Clinical opinion or case report or the evidence-based study and the expert opinion

High levels of macrolide resistance-associated mutations in Mycoplasma genitalium warrant antibiotic susceptibility-guided treatment. Journal of Antimicrobial Chemotherapy. Basing level of evidence from (Bonita et al. 2006)

Level

Type of evidence

I

A systematic review of the studies, adequate power with high quality prospective cohort study

II

Retrospective cohort study, with the less quality prospective cohorts, the unframed controls from an RCT and finally the systemic review of the studies

III

Systematic review and the case-control study

IV

Case series

V

Clinical opinion or case report or the evidence-based study and the expert opinion

Antibiotic Resistance: Associations and Implications for Antibiotic Usage Strategies to Control Multiresistant Bacteria. Antimicrobial Stewardship: Principles and Practice, by Rice

Level

 Type of evidence

I

Wider RCTs with very clear-cut results

II

Unclear results based from small RCTs

III

Case-control studies and cohorts

IV

The historical cohorts and case-control studies

V

Studies with no limits, case series

 

Most of the articles disseminate the level of the papers they produce and the author usually assigns a level introducing the article or the abstract to conference convening.  This usually makes the reader to understand or to have full insights about the level of evidence of the article or the research; however, the presented level of evidence does not always guarantee the quality of the research (Ruiz-Aragon and Márquez 2010). It is therefore, very critical for the readers not to assume the level 1 evidence is always the best quality one or the relevant choice for the research question. This very concept will be very critical for most of us if not all of us, as we evolve into the field of microbiology in epidemiology (Cairo et al,.2012). By design or through the framework of the field, our designated epidemiological specialty will always contain very significant articles that may be based on the lower level of evidence perhaps, because of the level of creativity or innovation and the technique of the articles expected to move this particular specialty forward.

Despite the fact that RCTs are usually assigned highest level of evidence, not all or the entire lot of RCTs are carried out properly and the results properly scrutinized. (Bonita et al. 2006) Stressed the critical aspects of estimation of errors and the power of studies when interpreting the outcomes from the RCTs. For instance, a poorly done RCT may record a negative outcome due to low power despite the fact that in this real regard difference is seen between the antibiotic administrations. Scales, for example, the Jadad scale have been established to show the quality of RCTs. Though the physicians may be deprived of the time or inclination to utilize the scale in assessing the quality there are some fundamental aspects that should be taken into consideration.

The items known for evaluating the RCTs include the following: randomization, blinding, blinding technique and a description of the randomization, description of the number of subjects which pulled off analysis. For example, Munita and Arias (2016) published a paper assessing the mechanisms of antibiotic resistance. Microbiology spectrum. The authors evaluated the quality of RCTs and the papers with a score of seventy-nine percent were recognized to be high quality, and sixty percent of the papers had a score less than seventy-nine percent. The authors established the RCTs during the period and the estimated mean score was seventy percent. The major reason for the low-quality outcome was inappropriate randomization, binding and the description of the microbes’ antibiotic exclusion criteria. In fact, almost three-quarter of the studies involves double binding, but the majority does not always randomize the subjects, describe the randomization procedures or execute a power analysis. Power analysis is also another area worth noting in this context (Panesar et al. 2013). A review of various articles concerning antibiotic resistance revealed literature revealed that the majority of published articles have less power to realize medium to large differences between the microbial groups. Regardless of what the level of evidence for study, if it is not powered enough, the interpretation of the outcome is questionable. In spite the fact that the ultimate goal of all these is to improve the entire level of evidence in antimicrobial resistance, the fact remains that all the lower level evidence should also be considered because they are equally important.  Case series and case reports are very critical for the generation of hypothesis and can also entirely end up in becoming more controlled studies. Also, in the sight of remarkable evidence to support an aspect of treatment, such as the use of antimicrobials for wound infections, there is sometimes a little need for RCT. We have entirely shown the need for RCTs to improve evidence in microbiology. management, we must also have to recognize the fact that there are a lot of challenges associated, specifically with randomization and blinding. And even though RCTs may not seem much effective in this context, but well framed, modeled and conducted case-control studies and cohort may improve the level of evidence (Wu et al. 2009).  Otherwise many contemporary studies tend to be descriptive and miss a control group. But in some very fundamental cases, observation and RCTs have found remarkable results regarding this field. The application of these alternative checklists would generally improve the prospects of the critical appraisal of the articles which ultimately will increase the entire evidence levels in epidemiology.

Results

Conclusion

In summary, the level of evidence is a critical aspect of appraisals in the field of epidemiology. Having full comprehension of the levels and why they are assigned to different articles and abstracts would help the reader to make his or her priorities right concerning the type of information they want to have.  But this is not simply saying that you ignore all the level 4 evidence and use only the level one pieces of evidence, rather all the levels of evidence provide a framework the reader needs and the reader needs to take a lot of cautionary measures when scrutinizing and interpreting the evidence. The report also highlights the inherent biases present in various publications, and throughout its course, the paper emphatically and coherently examines the research question about antimicrobial resistant bacteria.

References

Cairo, F., Sanz, I., Matesanz, P., Nieri, M. and Pagliaro, U., 2012. Quality of reporting of randomized clinical trials in implant dentistry. A systematic review of critical aspects of design, outcome assessment and clinical relevance. Journal of clinical periodontology, 39(s12), pp.81-107.

Derde, L.P., Cooper, B.S., Goossens, H., Malhotra-Kumar, S., Willems, R.J., Gniadkowski, M., Hryniewicz, W., Empel, J., Dautzenberg, M.J., Annane, D. and Aragão, I., 2014. Interventions to reduce colonization and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomized trial. The Lancet infectious diseases, 14(1), pp.31-39.

Derde, L.P., Dautzenberg, M.J., and Bonten, M.J., 2012. Chlorhexidine body washing to control antimicrobial-resistant bacteria in intensive care units: a systematic review. Intensive care medicine, 38(6), pp.931-939.

Galvin, S., Boyle, F., Hickey, P., Vellinga, A., Morris, D. and Cormican, M., 2010. Enumeration and characterization of antimicrobial-resistant Escherichia coli bacteria in effluent from municipal, hospital, and secondary treatment facility sources. Applied and environmental microbiology, 76(14), pp.4772-4779.

Gullberg, E., Cao, S., Berg, O.G., Ilbäck, C., Sandegren, L., Hughes, D. and Andersson, D.I., 2011. Selection of resistant bacteria at low antibiotic concentrations. PLoS Pathogens, 7(7), p.e1002158.

Hammerum, A.M. and Heuer, O.E., 2009. Human health hazards from antimicrobial-resistant Escherichia coli of animal origin. Clinical Infectious Diseases, 48(7), pp.916-921.

LoBiondo-Wood, G. and Haber, J., 2017. Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.

Magiorakos, A.P., Srinivasan, A., Carey, R.B., Carmeli, Y., Falagas, M.E., Giske, C.G., Harbarth, S., Hindler, J.F., Kahlmeter, G., Olsson?Liljequist, B. and Paterson, D.L., 2012. Multidrug?resistant, extensively drug?resistant and pandrug?resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clinical microbiology and infection, 18(3), pp.268-281.

Munita, J.M. and Arias, C.A. 2016. Mechanisms of antibiotic resistance. Microbiology spectrum,  4(2).

 Nijhuis, R.H.T., Severs, T.T., Van der Vegt, D.S.J.M., Van Zwet, A.A. and Kusters, J.G. 2015.  High levels of macrolide resistance-associated mutations in Mycoplasma genitalium warrant antibiotic susceptibility-guided treatment. Journal of Antimicrobial Chemotherapy, 70(9), pp.2515-2518.

Panesar, S.S., Javad, S., Silva, D.D., Nwaru, B.I., Hickstein, L., Muraro, A., Roberts, G., Worm, M., Bilo, M.B., Cardona, V. and Dubois, A.E.J., 2013. The epidemiology of anaphylaxis in Europe: a systematic review. Allergy, 68(11), pp.1353-1361.

Panesar, S.S., Nwaru, B.I., Hickstein, L., Rader, T., Hamadah, H., Ali, D.F.I., Patel, B., Muraro, A., Roberts, G., Worm, M. and Sheikh, A., 2013. The epidemiology of anaphylaxis in Europe: protocol for a systematic review. Clinical and translational allergy, 3(1), p.9.

Rai, M.K., Deshmukh, S.D., Ingle, A.P. and Gade, A.K., 2012. Silver nanoparticles: the powerful nano-weapon against multidrug?resistant bacteria. Journal of applied microbiology, 112(5), pp.841-852.

Rice, L.B. 2016. Antibiotic Resistance: Associations and Implications for Antibiotic Usage Strategies to Control Multiresistant Bacteria. Antimicrobial Stewardship: Principles and Practice, 80.

Ruiz-Aragon, J. and Márquez, S.C., 2010. The effectiveness of lumbar sympathectomy in the treatment of occlusive peripheral vascular disease in lower limbs: the systematic review. Medicine clinic, 134(11), operations.477-482.

Schroeder, M., Brooks, B.D., and Brooks, A.E.2017. The complex relationship between virulence and antibiotic resistance. Genes, 8(1),  p.39.

Sievert, D.M., Ricks, P., Edwards, J.R., Schneider, A., Patel, J., Srinivasan, A., Kallen, A., Limbago, B. and Fridkin, S., 2013. Antimicrobial-resistant pathogen-associated with healthcare-associated infection summary of data reported to the National Healthcare Network at the Centers for Disease Control and Prevention, 2009–2010. Infection Control & Hospital Epidemiology, 34(1), pp.1-14.

Simoes, M., Bennett, R.N., and Rosa, E.A., 2009. Understanding antimicrobial activities of phytochemicals against multidrug resistant bacteria and biofilms. Natural product reports, 26(6), pp.746-757.

Torres, M.A. 2016. An Evaluation of the Prevalence of Antibiotic Resistant among Salmonella and Staphylococcus Aureus Isolated from Various Food Animals.

Wu, T., Li, Y., Bian, Z., Liu, G. and Moher, D., 2009. Randomized trials published in some Chinese journals: how many are randomized?. Trials, 10(1), p.46.

Young, J.M. and Solomon, M.J., 2009. How to critically appraise an article. Nature Reviews Gastroenterology and Hepatology, 6(2), p.82.

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