14
vicinity of animal farms, manure storage sites, landfill leachate, wastewater treatment plants, septic tanks, drug manufacturing plants, etc. can increase coliform
count and also drive the groundwater microflora towards antibiotic resistance
(Kümmerer 2009). Many reports have shown the presence of multi drug resistant
antibiotic resistant bacteria such as Vibrio cholerae, Shigella sonnei, Salmonella
enterica, etc. from taps, wells and fresh-water streams (Akoachere et al. 2013; Ma
et al. 2017). Majority (75%) of the enteric bacteria isolated from a river in South
Africa has been reported to show multi drug resistance (Mulamattathil et al. 2014).
This study also showed a trend of lower resistance in the regions upstream of the
city and higher resistance within and downstream of the city (Lin et al. 2004). In
Kenya, ground water was found to be contaminated with enteric pathogens such as
E. coli, P. aeruginosa, Salmonella, etc., which also showed high antibiotic resistance in the range of 87–98% out of total isolates (Wahome 2013).
1.2.6 Antimicrobial Resistance and Humans
The consumption pattern of antibiotics varies between countries across the world
and depends on various factors including the hygiene, living conditions, frequency
of infectious diseases, antibiotic stewardship in health professionals and general
awareness about antibiotic usage in the public. A primary concern for public health
is the high rate of prescription of broad spectrum antibiotics, even for general low
level infectious diseases. Many surveys have also shown that broad spectrum antibiotics are being prescribed even for viral diseases such as sore throat. Another
aspect is the antibiotics dose regimen, which could be personalized and shortened
based on individual patients and biological markers to precisely determine the presence of infection (ECDC (European Centre for Disease Prevention and Control),
EFSA (European Food Safety Authority), EMA (European Medicines Agency)
Joint report 2015). This leads to exhaustion of the arsenal of antibiotics which could
be used in humans, in case of serious multi drug resistant infections. This calls for
serious training of antibiotic stewardship among health professionals themselves,
augmented by awareness drive amongst the public for evidence based usage of antibiotics during patient admissions. Creating awareness in public could include examples such as for Triclosan – a common ingredient in antimicrobial cleaning agents,
which was later found out to assist in development of antibiotic resistance. Owing
to mass awareness programs against it, many manufacturers have stopped or reduced
its use in their products and its use has been restricted in many countries since 2014
(Laurie McGinley 2016).
Humans can also act as vectors for transmission of antibiotic resistance in food
animals and facilitate unintended re-circulation of antibiotic resistant strains in the
food web. This includes animal farm workers, and their families who harbor high
number of antibiotic resistant pathogens such as Staphylococcus aureus in their
digestive tract and over their skin (Lozano et al. 2016). In many of the developing
world settings, this is due to close contact between the workers and the animals
K. S. Singh et al.
vicinity of animal farms, manure storage sites, landfill leachate, wastewater treatment plants, septic tanks, drug manufacturing plants, etc. can increase coliform
count and also drive the groundwater microflora towards antibiotic resistance
(Kümmerer 2009). Many reports have shown the presence of multi drug resistant
antibiotic resistant bacteria such as Vibrio cholerae, Shigella sonnei, Salmonella
enterica, etc. from taps, wells and fresh-water streams (Akoachere et al. 2013; Ma
et al. 2017). Majority (75%) of the enteric bacteria isolated from a river in South
Africa has been reported to show multi drug resistance (Mulamattathil et al. 2014).
This study also showed a trend of lower resistance in the regions upstream of the
city and higher resistance within and downstream of the city (Lin et al. 2004). In
Kenya, ground water was found to be contaminated with enteric pathogens such as
E. coli, P. aeruginosa, Salmonella, etc., which also showed high antibiotic resistance in the range of 87–98% out of total isolates (Wahome 2013).
1.2.6 Antimicrobial Resistance and Humans
The consumption pattern of antibiotics varies between countries across the world
and depends on various factors including the hygiene, living conditions, frequency
of infectious diseases, antibiotic stewardship in health professionals and general
awareness about antibiotic usage in the public. A primary concern for public health
is the high rate of prescription of broad spectrum antibiotics, even for general low
level infectious diseases. Many surveys have also shown that broad spectrum antibiotics are being prescribed even for viral diseases such as sore throat. Another
aspect is the antibiotics dose regimen, which could be personalized and shortened
based on individual patients and biological markers to precisely determine the presence of infection (ECDC (European Centre for Disease Prevention and Control),
EFSA (European Food Safety Authority), EMA (European Medicines Agency)
Joint report 2015). This leads to exhaustion of the arsenal of antibiotics which could
be used in humans, in case of serious multi drug resistant infections. This calls for
serious training of antibiotic stewardship among health professionals themselves,
augmented by awareness drive amongst the public for evidence based usage of antibiotics during patient admissions. Creating awareness in public could include examples such as for Triclosan – a common ingredient in antimicrobial cleaning agents,
which was later found out to assist in development of antibiotic resistance. Owing
to mass awareness programs against it, many manufacturers have stopped or reduced
its use in their products and its use has been restricted in many countries since 2014
(Laurie McGinley 2016).
Humans can also act as vectors for transmission of antibiotic resistance in food
animals and facilitate unintended re-circulation of antibiotic resistant strains in the
food web. This includes animal farm workers, and their families who harbor high
number of antibiotic resistant pathogens such as Staphylococcus aureus in their
digestive tract and over their skin (Lozano et al. 2016). In many of the developing
world settings, this is due to close contact between the workers and the animals
K. S. Singh et al.