title: Antibiotic Resistant Superbugs: Assessment of the Interrelationship of Occurrence in Clinical Settings and Environmental Niches.
abstract: The increasing threat to global health posed by antibiotic resistance remains of serious concern. Human health remains at higher risk due to several reported therapeutic failures to many life threatening drug resistant microbial infections. The resultant effects have been prolonged hospital stay, higher cost of alternative therapy, increased mortality, etc. This opinionated review considers the two main concerns in integrated human health risk assessment (i.e., residual antibiotics and antibiotic resistant genes) in various compartments of human environment, as well as clinical dynamics associated with the development and transfer of antibiotic resistance (AR). Contributions of quorum sensing, biofilms, enzyme production, and small colony variants in bacteria, among other factors in soil, water, animal farm and clinical settings were also considered. Every potential factor in environmental and clinical settings that brings about AR needs to be identified for the summative effects in overall resistance. There is a need to embrace coordinated multi-locational approaches and interrelationships to track the emergence of resistance in different niches in soil and water versus the hospital environment. The further integration with advocacy, legislation, enforcement, technological innovations and further research input and recourse to WHO guidelines on antibiotic policy would be advantageous towards addressing the emergence of antibiotic resistant superbugs.
authors.affiliation: SARChI, Institute for Water and Wastewater Technology, Durban University of Technology, Durban 4000, South Africa. anthonya1@dut.ac.za.|Department of Microbiology, University of Uyo, 520211 Uyo, Akwa Ibom State, Nigeria. anthonya1@dut.ac.za.|Department of Biochemistry and Microbiology, University of Fort Hare, Alice 5700, Eastern Cape, South Africa. anthonya1@dut.ac.za.
authors.forename: Anthony Ayodeji
authors.initials: AA
authors.lastname: Adegoke
authors.affiliation: SARChI, Institute for Water and Wastewater Technology, Durban University of Technology, Durban 4000, South Africa. kunle_faleye@yahoo.co.uk.
authors.forename: Adekunle Christopher
authors.initials: AC
authors.lastname: Faleye
authors.affiliation: SARChI, Institute for Water and Wastewater Technology, Durban University of Technology, Durban 4000, South Africa. gsingh.gulshan@gmail.com.
authors.forename: Gulshan
authors.initials: G
authors.lastname: Singh
authors.affiliation: SARChI, Institute for Water and Wastewater Technology, Durban University of Technology, Durban 4000, South Africa. thors@dut.ac.za.
authors.forename: Thor Axel
authors.initials: TA
authors.lastname: Stenström
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects* / Q000472:pathogenicity*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics* / Q000502:physiology*; D004777:Environment; D006801:Humans; D008826:Microbial Sensitivity Tests; D012988:Soil Microbiology; D014871:Water Microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: antimicrobial resistance; critical control point; exposure; health risk assessment; residual antibiotics; superbug; total antibiotic resistance