THE UNSEEN CRISIS: A COMPREHENSIVE REVIEW OF BACTERIAL ANTIMICROBIAL RESISTANCE AND ITS GLOBAL RAMIFICATIONS

• Dr. Gabriela S. Paredes

  Department of Clinical Microbiology, National Autonomous University of Mexico, Mexico

  Author

• Dr. Ibrahim A. Idris

  Department of Infectious Disease Control, University of Khartoum, Sudan

  Author

Antimicrobial resistance (AMR) in bacteria is one of the most pressing global health threats we face today, often quietly referred to as a "silent pandemic." This comprehensive review brings together our current understanding of bacterial AMR, covering how bacteria become resistant, how these resistant germs spread, and the huge impact they have on human, animal, and environmental health. Drawing from recent scientific papers, this article highlights the complex web of factors driving AMR, from the overuse and misuse of antibiotics in hospitals and farms to poor sanitation and the spread of resistant strains in our environment. We'll see how resistance is everywhere, affecting important germs like Staphylococcus aureus (including MRSA and VRSA), Neisseria gonorrhoea, Enterococcus faecalis (including VRE), Pseudomonas aeruginosa, Escherichia coli, Mycobacterium tuberculosis (including MDR-TB and XDR-TB), Acinetobacter baumannii, and Clostridioides difficile. The review underscores the critical need for a united 'One Health' approach, which means combining strong surveillance, new treatment ideas, strict infection control, and better public awareness. Our goal is to slow down this growing crisis and protect the effectiveness of antibiotics for future generations. The deep impact on global illness, deaths, and economic stability means we need immediate international teamwork and strong policies.

1. Abdrabou, A.M.M., Bischoff, M., Mellmann, A., von Müller, L., Margardt, L., Gärtner, B.C., Berger, F.K. and German C. difficile surveillance group. 2022. Implementation of a Clostridioides difficile sentinel surveillance system in Germany: first insights for 2019–2021. Anaerobe 77, 102548; doi:10.1016/J.ANAEROBE.2022.102548.

2. Aires, J.R., Köhler, T., Nikaido, H. and Plésiat, P. 1999. Involvement of an active efflux system in the natural resistance of Pseudomonas aeruginosa to aminoglycosides. Antimicrob. Agents Chemother. 43(11), 2624–2628; doi:10.1128/aac.43.11.2624

3. Alam, M., Saleem, Z., Haseeb, A., Qamar, M.U., Sheikh, A., Almarzoky Abuhussain, S.S., Iqbal, M.S., Raees, F., Chigome, A., Cook, A., Moore, C.E., Mustafa, Z.U., Salman, M., Saleh, U., Shabbir, S. and Godman, B. 2023. Tackling antimicrobial resistance in primary care facilities across Pakistan: current challenges and implications for the future. J. Infect. Public Health 16, 97–110; doi:10.1016/j.jiph.2023.10.046

4. Alduina, R., Gambino, D., Presentato, A., Gentile, A., Sucato, A., Savoca, D., Filippello, S., Visconti, G., Caracappa, G., Vicari, D. and Arculeo, M. 2020. Is caretta caretta a carrier of antibiotic resistance in the mediterranean sea? Antibiotics 9(3), 116; doi:10.3390/antibiotics9030116

5. Almaghrabi, R.S., Macori, G., Sheridan, F., McCarthy, S.C., Floss-Jones, A., Fanning, S., Althawadi, S., Mutabagani, M., Binsaslloum, A., Alrasheed, M., Almohaizeie, A., Allehyani, B., Alghofaili, A., Bohol, M.F. and Al-Qahtani, A.A. 2024. Wholgenomee sequencing of resistance and virulence genes in multidrug resistant Pseudomonas aeruginosa. J. Infect. Public Health 17(2), 299–307; doi:10.1016/J.JIPH.2023.12.012

6. Bereket, W., Hemalatha, K., Getenet, B., Wondwossen, T., Ali, S., Zeynudin, A. and Kannan, S. 2012. Update on bacterial nosocomial infections. Eur. Rev. Med. Pharmacol. Sci. 16(8), 1039–1044. Available via https://europepmc.org/article/med/22913154

7. Bhattacharya, R., Bose, D., Gulia, K. and Jaiswal, A. 2024. Impact of AMR on sustainable development goals and integrated strategies for meeting environmental and socio-economic targets. Environ. Prog. Sustain. 43(1), e14320; doi: 10.1002/EP.14320

8. Boral, B., Unaldi, Ö., Ergin, A., Durmaz, R., Eser, Ö.K. and Acinetobacter Study Group. 2019. A prospective multicenter study on the evaluation of antimicrobial resistance and molecular epidemiology of multidrug-resistant Acinetobacter baumannii infections in intensive care units with clinical and environmental features. Ann. Clin. Microbiol. Antimicrob. 18(1), 1–9; doi:10.1186/S12941-019-0319-8/FIGURES/3

9. Breijyeh, Z., Jubeh, B. and Karaman, R. 2020. Resistance of gram-negative bacteria to current antibacterial agents and approaches to resolve it. Molecules 25(6), 1340; doi:10.3390/MOLECULES25061340

10. Callaway, R., Johura, F.-T., Sultana, M., Sadique, A., Monira, S., Sack, D.A., Sack, R.B., Alam, M. and Chakraborty, S. 2024. Antimicrobial resistance of enterotoxigenic Escherichia coli from diarrheal patients and the environment in two geographically distinct rural areas in Bangladesh over the years. Microorganisms 12(2), 301; doi:10.3390/MICROORGANISMS12020301

11. Chizimu, J.Y., Solo, E.S., Bwalya, P., Kapalamula, T.F., Mwale, K.K., Squarre, D., Shawa, M., Lungu, P., Barnes, D.A., Yamba, K. and Mufune, T. 2023. Genomic analysis of Mycobacterium tuberculosis strains resistant to second-line anti-tuberculosis drugs in Lusaka, Zambia. Antibiotics 12(7), 1126; doi:10.3390/ANTIBIOTICS12071126/S1

12. Coll, F., Gouliouris, T., Blane, B., Yeats, C.A., Raven, K.E., Ludden, C., Khokhar, F.A., Wilson, H.J., Roberts, L.W., Harrison, E.M., Horner, C.S., Le, T.H., Nguyen, T.H., Nguyen, V.T., Brown, N.M., Holmes, M.A., Parkhill, J., Estee Török, M and Peacock, S.J. 2024. Antibiotic resistance using Enterococcus faecium whole-genome sequences: a diagnostic accuracy study using genotypic and phenotypic data. Lancet Microb 5(2), e151–e163; doi:10.1016/S2666-5247(23)00297-5

13. Demissie, E., Amare, A., Birhanu, M. and Gizachew, M. 2024. Neisseria gonorrhea antimicrobial resistance patterns and associated risk factors in women of childbearing potential in northwestern Ethiopia. BMC Women’s Health 24(1), 1–11; doi:10.1186/S12905-024-02898-3/TABLES/5

14. Despotovic, M., de Nies, L., Busi, S.B. and Wilmes, P. 2023. Reservoirs of antimicrobial resistance in the context of One Health. Curr. Opin. Microbiol. 73; doi:10.1016/J.MIB.2023.102291

15. Dorji, T., Horan, K., Sherry, N.L., Tay, E.L., Globan, M., Viberg, L., Bond, K., Denholm, J.T., Howden, B.P. and Andersson, P. 2024. Whole-genome sequencing of drug-resistant Mycobacterium tuberculosis isolates from Victoria, Australia. Int. J. Infect. Dis. 138, 46–53; doi:10.1016/J.IJID.2023.11.010

16. Edwards, J.L., Shao, J.Q., Ault, K.A. and Apicella, M.A. 2000. Neisseria gonorrhea elicits membrane ruffling and cytoskeletal rearrangements upon infection of primary human endocervical and ectocervical cells. Infect Immun. 68(9), 5354–5363; doi:10.1128/iai.68.9.5354-5363.2000

17. Francis, S.C., Mthiyane, T.N., Baisley, K., Mchunu, S.L., Ferguson, J.B., Smit, T., Crucitti, T., Gareta, D., Dlamini, S., Mutevedzi, T., Seeley, J., Pillay, D., McGrath, N. and Shahmanesh, M. 2018. Prevalence of sexually transmitted infections among young people in South Africa: a nested survey of a health and demographic surveillance site. PLoS Med. 15(2), e1002512; doi:10.1371/journal.pmed.1002512

18. Ghimpețeanu, O.M., Pogurschi, E.N., Popa, D.C., Dragomir, N., Drăgotoiu, T., Mihai, O.D. and Petcu, C.D. 2022. Antibiotic use in livestock and residues in food—a public health threat: a review. Foods 11(10), 1430; doi:10.3390/FOODS11101430

19. Ginindza, T.G., Stefan, C.D., Tsoka-Gwegweni, J.M., Dlamini, X., Jolly, P.E., Weiderpass, E., Broutet, N. and Sartorius, B. 2017. Prevalence and risk factors of sexually transmitted infections (STIs) among women of reproductive age in Swaziland. Infect. Agents Cancer. 12(1), 1–12; doi:10.1186/s13027-017-0140-y

20. Godijk, N.G., Bootsma, M.C.J. and Bonten, M.J.M. 2022. Transmission routes of antibiotic resistant bacteria: a systematic review. BMC Infect. Dis. 22(1), 482; doi: 10.1186/S12879-022-07360-Z

21. Gomi, R., Matsumura, Y., Yamamoto, M., Tanaka, M., Komakech, A.J., Matsuda, T. and Harada, H. 2024. Genomic surveillance of antimicrobial-resistant Escherichia coli in fecal sludge and sewage in Uganda. Water Res. 248, 120830; doi:10.1016/J.WATRES.2023.120830

22. Guh, A.Y., Mu, Y., Winston, L.G., Johnston, H., Olson, D., Farley, M.M., Wilson, L.E., Holzbauer, S.M., Phipps, E.C., Dumyati, G.K., Beldavs, Z.G., Kainer, M.A., Karlsson, M., Gerding, D.N. and McDonald, L.C. 2020. Trends in U.S. burden of Clostridioides difficile infection and outcomes. N. Engl. J. Med. 382(14), 1320–1330; doi:10.1056/NEJMOA1910215

23. Hashemzadeh, M., Dezfuli, A.A.Z., Khosravi, A.D., Khosravi, N.A. and Saki, M. 2024. Antibiotic resistance and genomic characterization of Mycobacterium abscessus complex isolates from patients with pulmonary tuberculosis in Iran: a multicenter study (2010–2021). Acta. Microbiol. Imm. H. 1(aop), 82–88; doi:10.1556/030.2024.02169

24. Hazra, D., Lam, C., Chawla, K., Sintchenko, V., Dhyani, V.S. and Venkatesh, B.T. 2023. Impact of whole-genome sequencing of Mycobacterium tuberculosis on treatment outcomes for MDR-TB/XDR-TB: a systematic review. Pharmaceutics 15(12), 2782; doi:10.3390/PHARMACEUTICS15122782/S1

25. Ikhimiukor, O.O., Odih, E.E., Donado-Godoy, P. and Okeke, I.N. 2022. A bottom-up view of antimicrobial resistance transmission in . Nat. Microbiol. 7(6), 757–765; doi:10.1038/S41564-022-01124-W

26. Iskandar, K., Murugaiyan, J., Hammoudi Halat, D., Hage, S.E., Chibabhai, V., Adukkadukkam, S., Roques, C., Molinier, L., Salameh, P. and Van Dongen, M. 2022. Antibiotic discovery and resistance: the chase and the race. Antibiotics 11(2), 182; doi:10.3390/ANTIBIOTICS11020182

27. Jin, C., Jia, C., Hu, T., Xu, H., Shen, Y. and Yue, M. 2024. Predicting antimicrobial resistance in E. coli using discriminative position-fused deep learning classifier. Comput. Struct. Biotechnol. J. 23, 559–565; doi:10.1016/J.CSBJ.2023.12.041

28. Knight, G.M., Glover, R.E., McQuaid, C.F., Olaru, I.D., Gallandat, K., Leclerc, Q.J., Fuller, N.M., Willcocks, S.J., Hasan, R., van Kleef, E. and Chandler, C.I. 2021. Antimicrobial resistance and COVID-19: Intersections and implications. Elife 10, e64139.

29. Koch, N., Islam, N.F., Sonowal, S., Prasad, R. and Sarma, H. 2021. Environmental antibiotics and resistance genes as emerging contaminants: methods of detection and bioremediation. Curr. Res. Microb. Sci. 2(11), 100027; doi:10.1016/j.crmicr.2021.100027

30. Kwon, J., Pelletiers, W., Galloway Peña, J., van Duin, D., Ledbetter, L., Baum, K., Ruffin, F., Knisely, J.M., Bizzell, E., Fowler, V.G., Chambers, H.F., Pettigrew, M.M. and Group for the A. R. L. (2024). Participant diversity in United States randomized controlled trials of antibacterials for Staphylococcus aureus infections, 2000–2021. Clin. Infect. Dis. 79(1), 141–147; doi:10.1093/CID/CIAE049

31. Lappin, M.R., Blondeau, J., Boothe, D., Breitschwerdt, E.B., Guardabassi, L., Lloyd, D.H., Papich, M.G., Rankin, S.C., Sykes, J.E., Turnidge, J. and Weese, J.S. 2017. Antimicrobial use guidelines for the treatment of respiratory tract disease in dogs and cats: antimicrobial guidelines working group of the International Society for Companion Animal Infectious Diseases. J. Vet. Intern. Med. 31(2), 279–294; doi:10.1111/JVIM.14627

32. Lee, J.H., Kim, N.H., Jang, K.M., Jin, H., Shin, K., Jeong, B. C., Kim, D.W. and Lee, S.H. 2023. Prioritization of critical factors for surveillance of the dissemination of antibiotic resistance in Pseudomonas aeruginosa: a systematic review. Int. J. Mol. Sci. 24(20), 15209; doi:10.3390/IJMS242015209/S1

33. Liang, Z., Yu, Y., Ye, Z., Li, G., Wang, W. and An, T. 2020. Pollution profiles of antibiotic resistance genes associated with airborne opportunistic pathogens in Pearl River Estuary and their exposure risk to human beings. Environ. Int. 143, 105934; doi:10.1016/j.envint.2020.105934

34. Liu, C., Monaghan, T., Yadegar, A., Louie, T. and Kao, D. 2023. Insights into the epidemiology of Clostridioides difficile infection and treatment: a global perspective. Antibiotics 12(7), 1141; doi:10.3390/ANTIBIOTICS12071141

35. Liu, B., Su, P., Hu, P., Yan, M., Li, W., Yi, S., Chen, Z., Zhang, X., Guo, J., Wan, X., Wang, J., Gong, D., Bai, H., Wan, K., Liu, H., Li, G. and Tan, Y. 2024. Prevalence, transmission, and genetic diversity of pyrazinamide resistance among multidrugresistant Mycobacterium tuberculosis Isolates in Hunan, China. Infect. Drug Resist. 17, 403–416; doi:10.2147/IDR.S436161

36. Mączyńska, B., Jama-Kmiecik, A., Sarowska, J., Woronowicz, K., Choroszy-Król, I., Piątek, D. and Frej-Mądrzak, M. 2023. Changes in the antibiotic resistance of Acinetobacter baumannii and Pseudomonas aeruginosa clinical isolates in a multi-profile hospital in years 2017–2022 in Wroclaw, Poland. J. Clin. Med. 12(15), 5020; doi:10.3390/JCM12155020

37. Maddock, K.J., Burbick, C.R., Cole, S.D., Daniels, J.B., LeCuyer, T.E., Li, X.-Z., Loy, J.D., Sanchez, S., Stenger, B.L.S. and Diaz-Campos, D. 2024. A One Health perspective on the use of genotypic methods for antimicrobial resistance prediction. J. Am. Vet. Med. Assoc. 262(3), 303–312; doi:10.2460/JAVMA.23.12.0687

38. Mastrantonio, P. and Rupnik, M. (eds.). 2024. Updates on Clostridioides difficile in Europe, vol. 1435. Cham, Switzerland: Springer; doi:10.1007/978-3-031-42108-2

39. McCowan, C., Bakhshi, A., McConnachie, A., Malcolm, W., Sje, B., Santiago, V.H. and Leanord, A. 2022. E. coli bacteremia and antimicrobial resistance following antimicrobial prescription for urinary tract infection in: the community. BMC Infect. Dis. 22(1), 1–10; doi10.1186/S12879-022-07768-7/TABLES/7

40. McHugh, M.P., Parcell, B.J., Pettigrew, K.A., Toner, G., Khatamzas, E., El Sakka, N., Karcher, A.M., Walker, J., Weir, R., Meunier, D., Hopkins, KL., Woodford, N., Templeton, K.E., Gillespie, S.H. and Holden, M.T.G. 2022. Presence of optrA-mediated linezolid resistance in multiple E. faecalis lineages and plasmids revealed by long read sequencing. Microbiology (United Kingdom) 168(2), 001137; doi:10.1099/MIC.0.001137

41. Medrano, H., Lee, L., Young, V., Janecko, N., Deckert, A.E., Gow, S.P., Reid-Smith, R.J. and Agunos, A. 2024. Surveillance of antimicrobial resistance in Escherichia coli, Salmonella, and Campylobacter recovered from laying hens, their environment, and products in Canada indicated a stable level of resistance to critically important antimicrobials over varying time periods between 2007 and 2021. Int. J. Food Microbiol. 412, 110541; doi:10.1016/J.IJFOODMICRO.2023.110541

42. Murray, C.J., Ikuta, K.S., Sharara, F., Swetschinski, L., Robles Aguilar, G., Gray, A., Han, C., Bisignano, C., Rao, P., Wool, E., Johnson, S.C., Browne, A.J., Chipeta, M.G., Fell, F., Hackett, S., HainesWoodhouse, G., Kashef Hamadani, B.H., Kumaran, E.A.P., McManigal, B., … Naghavi, M. (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet, 399(10325), 629–655; doi:10.1016/S0140-6736(21)02724-0.

43. Oliveira, R., Tavares de Sousa, H. and Roseira, J. 2024. P1239 characterization of Clostridioides strains and antibiotic resistance profile in Inflammatory Bowel Disease patients with Clostridioides infection. J Crohns Colitis 18(Supplement_1), i2192–i2192; doi:10.1093/ECCO-JCC/JJAD212.1369

44. Omar, S.V., Louw, G., Ismail, F., Liu, X., Ngcamu, D., Gwala, T., van der Meulen, M. and Joseph, L. (2024). Performance evaluation of the Xpert MTB/XDR test for the detection of drug resistance to Mycobacterium tuberculosis among people diagnosed with tuberculosis in South Africa. MedRxiv 2024.02.16.24302824; doi:10.1101/2024.02.16.24302824

45. Orcid, R. 2019. Tackling antimicrobial resistance 2019-2024 – The UK’s five-year national action plan. J. Hosp. Infect. 101(4), 426–427; doi:10.1016/j.jhin.2019.02.019

46. Pan, F., Altenried, S., Scheibler, S. and Ren, Q. 2024. A rapid and specific antimicrobial resistance detection of Escherichia coli via magnetic nanoclusters. Nanoscale 16(6), 3011–3023; doi:10.1039/D3NR05463B

47. Papadimitriou-Olivgeris, M., Fligou, F., Spiliopoulou, A., Koutsileou, K., Kolonitsiou, F., Spyropoulou, A., Zotou, A., Marangos, M., Anastassiou, E.D., Christofidou, M. and Spiliopoulou, I. 2017. Risk factors and predictors of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii mortality in critically ill bacteraemic patients over a 6-year period (2010–15): antibiotics do matter. J. Med. Microbiol. 66(8), 1092–1101; doi:10.1099/jmm.0.000538

48. Parmanik, A., Das, S., Kar, B., Bose, A., Dwivedi, G.R. and Pandey, M.M. 2022. Current treatment strategies against multidrug-resistant bacteria: a review. Curr. Microbiol. 79(12), 388; doi:10.1007/s00284-022-03061-7

49. Pereira, A., Sidjabat, H.E., Davis, S., Vong da Silva, P.G., Alves, A., Dos Santos, C., Jong, J.B.D.C., da Conceição, F., Felipe, N.J., Ximenes, A., Nunes, J., Fária, I.D.R., Lopes, I., Barnes, T.S., McKenzie, J., Oakley, T., Francis, J.R., Yan, J. and Ting, S. 2024. Prevalence of antimicrobial resistance in Escherichia coli and Salmonella species isolates from chickens in live bird markets and boot swabs from layer farms in Timor-Leste. Antibiotics 13(2), 120; doi:10.3390/ANTIBIOTICS13020120

50. Pulingam, T., Parumasivam, T., Gazzali, A.M., Sulaiman, A.M., Chee, J.Y., Lakshmanan, M., Chin, C.F. and Sudesh, K. 2022. Antimicrobial resistance: prevalence, economic burden, mechanisms of resistance, and strategies to overcome. Eur. J. Pharm. Sci. 170(1), 106103; doi:10.1016/J.EJPS.2021.106103

51. Quillin, S.J. and Seifert, H.S. 2018. Neisseria gonorrhea host adaptation and pathogenesis. Nat. Rev. Microbiol. 16(4), 226–240; doi:10.1038/nrmicro.2017.169

52. Sartorius, B., Gray, A.P., Davis Weaver, N., Robles Aguilar, G., Swetschinski, L.R., Ikuta, K.S., Mestrovic, T., Chung, E., Wool, E.E., Han, C., Gershberg Hayoon, A., Araki, D.T., Abd-Elsalam, S., Aboagye, R.G., Adamu, L.H., Adepoju, A.V., Ahmed, A., Akalu, G.T., Akande-Sholabi, W., … Naghavi, M. (2024). The burden of bacterial antimicrobial resistance in the WHO African region in 2019: a cross-country systematic analysis. Lancet Glob. Health 12(2), e201–e216; doi:10.1016/S2214-109X(23)00539-9.

53. Seekatz, A.M., Safdar, N. and Khanna, S. 2022. The role of the gut microbiome in colonization resistance and recurrent Clostridioides difficile infection. Therap. Adv. Gastroenterol. 15, 17562848221134396; doi:10.1177/17562848221134396

54. Serretiello, E., Manente, R., Dell’Annunziata, F., Folliero, V., Iervolino, D., Casolaro, V., Perrella, A., Santoro, E., Galdiero, M., Capunzo, M., Franci, G. and Boccia, G. 2023. Antimicrobial Resistance in Pseudomonas aeruginosa before and during the COVID-19 Pandemic. Microorganisms 11(8), 1918; doi:10.3390/MICROORGANISMS11081918

55. Singha, B., Murmu, S., Nair, T., Rawat, R.S., Sharma, A.K. and Soni, V. 2024. Metabolic rewiring of Mycobacterium tuberculosis in response to drug treatment and antibiotics resistance. Metabolites 14(1), 63; doi:10.3390/METABO14010063

56. Spigaglia, P., Mastrantonio, P. and Barbanti, F. 2024. Antibiotic resistance of Clostridioides difficile. Adv. Exp. Med. Biol. 1435, 169–198; doi:10.1007/978-3-031-42108-2_9/COVER

57. Torres Ortiz, A., Coronel, J., Vidal, J.R., Bonilla, C., Moore, D.A.J., Gilman, R.H., Balloux, F., Kon, O.M., Didelot, X. and Grandjean, L. 2021. Genomic signatures of preresistance in Mycobacterium tuberculosis. Nat. Commun. 12(1), 7312; doi:10.1038/S41467-021-27616-7

58. Townsend, L., Hughes, G., Kerr, C., Kelly, M., O’Connor, R., Sweeney, E., Doyle, C., O’Riordan, R., Martin-Loeches, I., Bergin, C. and Bannan, C. 2020. Bacterial pneumonia co-infection and antimicrobial therapy duration in SARS-CoV-2 (COVID-19) infection. JAC Antimicrob Resist. 2(3), dlaa071; doi: 10.1093/jacamr/dlaa071

59. Tsai, C.S., Lu, P.L., Lu, M.C., Hsieh, T.C., Chen, W.T., Wang, J.T. and Ko, W.C. 2023. Ribotypes and antimicrobial susceptibility profiles of clinical Clostridioides difficile isolates: a multicenter, laboratory-based surveillance in Taiwan, 2019–2021. J. Microbiol. Immunol. Infect. 57(2), 320–327; doi:10.1016/J.JMII.2023.12.004

60. Uddin, T.M., Chakraborty, A.J., Khusro, A., Zidan, B.R.M., Mitra, S., Emran, T.B., Dhama, K., Ripon, M.K.H., Gajdács, M., Sahibzada, M.U.K., Hossain, M.J. and Koirala, N. 2021. Antibiotic resistance in microbes: history, mechanisms, therapeutic strategies and future prospects. J. Infect. Public Health 14(12), 1750–1766; doi:10.1016/J.JIPH.2021.10.020

61. Unemo, M., Seifert, H.S., Hook, E.W., Hawkes, S., Ndowa, F. and Dillon, J.A.R. 2019. Gonorrhea. Nat. Rev. Dis. Primers 5(1), 79; doi:10.1038/s41572-019-0128-6

62. Velazquez-Meza, M. East, Galarde-López, M., Carrillo-Quiróz, B. and Alpuche-Aranda, C.M. 2022. Antimicrobial resistance: one Health approach. Vet. World 15(3), 743–749; doi:10.14202/vetworld.2022.743-749

63. Vendrik, K.E.W., Baktash, A., Goeman, JJ., Harmanus, C., Notermans, D. W., de Greeff, S.C. and Kuijper, E.J. 2022. Comparison of the trends of Clostridioides difficile infections in hospitalized patients during the first and second waves of the COVID-19 pandemic: a retrospective sentinel surveillance study. Lancet Reg. Health 19, 100424; doi:10.1016/J.LANEPE.2022.100424

64. Woodford, N., Turton, J.F. and Livermore, D.M. 2011. Multiresistant Gram-negative bacteria: the role of high-risk clones in the dissemination of antibiotic resistance. FEMS Microbiol. Rev. 35(5),736–755; doi:10.1111/j.1574-6976.2011.00268.x

65. Xu, Y., Zhang, Y., Zheng, X., Yu, K., Sun, Y., Liao, W., Jia, H., Xu, C., Zhou, T. and Shen, M. 2021. Prevalence and functional characteristics of CrpP-like in Pseudomonas aeruginosa isolates from China. Eur. J. Clin. Microbiol. Infect. Dis. 40(12), 2651–2656; doi:10.1007/s10096-021-04287-2

66. Zbylicki, B.R., Murphy, C.E., Petsche, J.A., Müh, U., Dobrila, H.A., Ho, T.D., Daum, M.N., Pannullo, A.G., Weiss, D.S. and Ellermeier, C.D. 2024. Identification of Clostridioides difficile mutants with increased daptomycin resistance. J. Bacteriol. 206(3), e0036823; doi:10.1128/JB.00368-23

67. Zhang, X.X., Zhang, T. and Fang, H.H.P. 2009. Antibiotic resistance genes in water environment. Appl. Microbiol. Biotechnol. 82(3), 397–414; doi:10.1007/s00253-008-1829-z

68. Zhou, N., Cheng, Z., Zhang, X., Lv, C., Guo, C., Liu, H., Dong, K., Zhang, Y., Liu, C., Chang, Y., Chen, S., Guo, X., Zhou, X. N., Li, M. and Zhu, Y. 2022. Global antimicrobial resistance: a system-wide comprehensive investigation using the Global One Health Index. Infect. Dis. Poverty 11(1), 92; doi:10.1186/S40249-022-01016-5

• pdf

All articles published by The Parthenon Frontiers and its associated journals are distributed under the terms of the Creative Commons Attribution (CC BY 4.0) International License unless otherwise stated. 

Authors retain full copyright of their published work. By submitting their manuscript, authors agree to grant The Parthenon Frontiers a non-exclusive license to publish, archive, and distribute the article worldwide. Authors are free to:

• Share their article on personal websites, institutional repositories, or social media platforms.

• Reuse their content in future works, presentations, or educational materials, provided proper citation of the original publication.