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Antibiotic Drug Resistance 2019 Edition by Jose-Luis Capelo-Martinez, Gilberto Igrejas , John Wiley

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    Author(s)Jose-Luis Capelo-Martinez, Gilberto Igrejas
    PublisherJohn Wiley
    ISBN9781119282525
    Pages720
    BindingHardback
    LanguageEnglish
    Publish YearOctober 2019

    Description

    John Wiley Antibiotic Drug Resistance 2019 Edition by Jose-Luis Capelo-Martinez, Gilberto Igrejas

    This book presents a thorough and authoritative overview of the multifaceted field of antibiotic science - offering guidance to translate research into tools for prevention, diagnosis, and treatment of infectious diseases.

    Provides readers with knowledge about the broad field of drug resistance

    Offers guidance to translate research into tools for prevention, diagnosis, and treatment of infectious diseases

    Links strategies to analyze microbes to the development of new drugs, socioeconomic impacts to therapeutic strategies, and public policies to antibiotic-resistance-prevention strategies


    Table of contents
    List of Contributors xix


    Preface xxv


    About the Editors xxvii


    Part I Current Antibiotics and Their Mechanism of Action 1


    1 Resistance to Aminoglycosides: Glycomics and the Link to the Human Gut Microbiome 3
    Viviana G. Correia, Benedita A. Pinheiro, Ana Luisa Carvalho, and Angelina S. Palma


    1.1 Aminoglycosides as Antimicrobial Drugs 3


    1.1.1 The Structure of Aminoglycosides 5


    1.1.2 Mechanisms of Action 8


    1.2 Mechanisms of Resistance 10


    1.2.1 Aminoglycoside?Modifying Enzymes 10


    1.2.2 Mutation or Modification of Ribosomal Target Sequences 13


    1.2.3 Changes in Uptake and Efflux 14


    1.3 Development of New AGAs: The Potential of Glycomics 16


    1.3.1 Exploitation of Carbohydrate Chemistry to Study Structure-Activity Relationship of Aminoglycoside Derivatives 17


    1.3.2 Aminoglycoside Microarrays to Screen Interactions of Antibiotics with RNAs and Proteins 18


    1.4 Influence of the Human Microbiome in Aminoglycoside Resistance 20


    1.4.1 The Effect of Antibiotic?Induced Alterations 21


    1.4.2 A Reservoir of Antibiotic Resistance 24


    1.4.3 Strategies to Modulate the Human Microbiome 25


    1.5 Conclusions and Outlook 26


    Acknowledgments 27


    References 28


    2 Mechanisms of Action and of Resistance to Quinolones 39
    Jose L. Martinez


    2.1 Introduction 39


    2.2 Mechanism of Action of Quinolones 40


    2.3 Mutations in the Genes Encoding the Targets of Quinolones 41


    2.4 Multidrug Efflux Pumps and Quinolone Resistance 42


    2.5 Transferable Quinolone Resistance 43


    2.6 Stenotrophomonas maltophilia and Its Uncommon Mechanisms of Resistance to Quinolones 46


    Acknowledgments 47


    References 47


    3 Beta?Lactams 57
    Luz Balsalobre, Ana Blanco, and Teresa Alarcon


    3.1 Introduction 57


    3.2 Chemical Structure 58


    3.3 Classification and Spectrum of Activity 59


    3.3.1 Penicillins 59


    3.3.2 Cephalosporins 61


    3.3.3 Monobactams 63


    3.3.4 Carbapenems 64


    3.3.5 Beta?Lactam Associated with Beta?Lactamase Inhibitors 64


    3.4 Mechanism of Action 66


    3.5 Activity of Beta?Lactams Against Multiresistant Bacteria 68


    3.6 Conclusions 70


    References 70


    4 Glycopeptide Antibiotics: Mechanism of Action and Recent Developments 73
    Paramita Sarkar and Jayanta Haldar


    4.1 Introduction 73


    4.2 Naturally Occurring Glycopeptide Antibiotics 75


    4.3 Mechanism of Action of Glycopeptide Antibiotics 76


    4.4 Resistance to Glycopeptides 78


    4.5 Second?Generation Glycopeptides 79


    4.5.1 Telavancin 79


    4.5.2 Dalbavancin 80


    4.5.3 Oritavancin 80


    4.6 Strategies to Overcome Resistance to Glycopeptides 81


    4.6.1 Modifications That Enhance the Binding Affinity to Target Pentapeptide 81


    4.6.2 Incorporation of Lipophilicity 85


    4.6.3 Incorporation of Lipophilic Cationic Moieties to Impart Membrane Disruption Properties 86


    4.6.4 Incorporation of Metal Chelating Moiety to Vancomycin to Impart New Mechanism of Action 88


    4.7 Glycopeptides Under Clinical Trials 88


    4.8 Glycopeptide Antibiotics: The Challenges 90


    References 91


    5 Current Macrolide Antibiotics and Their Mechanisms of Action 97
    S. Lohsen and D.S. Stephens


    5.1 Introduction 97


    5.2 Structure of Macrolides 99


    5.3 Macrolide Mechanisms of Action 101


    5.4 Clinical Use of Macrolides 104


    5.5 Next?Generation Macrolides and Future Use 107


    References 109


    Part II Mechanism of Antibiotic Resistance 119


    6 Impact of Key and Secondary Drug Resistance Mutations on Structure and Activity of ?Lactamases 121
    Egorov Alexey, Ulyashova Mariya, and Rubtsova Maya


    6.1 Introduction 121


    6.2 Structure of the Protein Globule of TEM?Type ?Lactamases: Catalytic and Mutated Residues 122


    6.2.1 Catalytic Site of ?Lactamase TEM?1 124


    6.2.2 Mutations Causing Phenotypes of TEM?Type ?Lactamases 125


    6.3 Effect of the Key Mutations on Activity of TEM?Type ?Lactamases 127


    6.3.1 Single Key Mutations in TEM?Type ESBLs (2be) 128


    6.3.2 Combinations of Key Mutations in TEM?Type ESBLs (2be) 130


    6.3.3 Key Mutations in IRT TEM?Type ?Lactamases (2br) 131


    6.3.4 Single Key Mutations in IRT TEM?Type ?Lactamases (2br) 131


    6.3.5 Combinations of Key Mutations in IRT TEM?Type ?Lactamases (2br) 133


    6.3.6 Combinations of Key ESBL and IRT Mutations in CMT TEM?Type ?Lactamases (2ber) 133


    6.4 Effect of Secondary Mutations on the Stability of TEM?Type ?Lactamases 134


    6.5 Conclusions 135


    Abbreviations 136


    References 137


    7 Acquired Resistance from Gene Transfer 141
    Elisabeth Grohmann, Verena Kohler, and Ankita Vaishampayan


    7.1 Introduction 141


    7.2 Horizonal Gene Transfer: A Brief Overview 143


    7.2.1 Transformation 144


    7.2.2 Transduction 144


    7.2.3 Conjugation 145


    7.3 Conjugative Transfer Mechanisms 145


    7.3.1 Conjugative Transfer of Plasmids 146


    7.3.2 Conjugative Transfer of Integrative Conjugative Elements 148


    7.3.3 Conjugative Transfer of Other Integrative Elements 150


    7.4 Antibiotic Resistances and Their Transfer 151


    7.4.1 Dissemination of Carbapenem Resistance Among Bacterial Pathogens 151


    7.4.2 Dissemination of Cephalosporin Resistance Among Bacterial Pathogens 153


    7.4.3 Dissemination of Methicillin Resistance Among Bacterial Pathogens 153


    7.4.4 Dissemination of Vancomycin Resistance Among Bacterial Pathogens 154


    7.4.5 Dissemination of Fluoroquinolone Resistance Among Bacterial Pathogens 154


    7.4.6 Dissemination of Penicillin and Ampicillin Resistance Among Bacterial Pathogens 155


    7.5 Nanotubes Involved in Acquisition of Antibiotic Resistances 155


    7.6 Conclusions and Outlook 156


    Abbreviations 156


    References 157


    8 Antimicrobial Efflux Pumps 167
    Manuel F. Varela


    8.1 Bacterial Antimicrobial Efflux Pumps 167


    8.1.1 Active Drug Efflux Systems 167


    8.1.2 Secondary Active Drug Transporters 169


    References 173


    9 Bacterial Persistence in Biofilms and Antibiotics: Mechanisms Involved 181
    Anne Jolivet?Gougeon and Martine Bonnaure?Mallet


    9.1 Introduction 181


    9.2 Reasons for Failure of Antibiotics in Biofilms 182


    9.2.1 Failure of Antibiotics to Penetrate Biofilm: Active Antibiotics on the Biofilm 182


    9.2.2 Outer Membrane Vesicles (OMVs) 183


    9.2.3 Horizontal Transfer of Encoding ?Lactamase Genes 184


    9.2.4 Influence of Subinhibitory Concentrations of Antibiotics on Biofilm 184


    9.2.5 Small Colony Variants (SCVs), Persistence (Persisters), and Toxin-Antitoxin (TA) Systems 186


    9.2.6 Quorum Sensing: Bacterial Metabolites 191


    9.2.7 Extracellular DNA 191


    9.2.8 Nutrient Limitation 192


    9.2.9 SOS Inducers (Antibiotics and Others) 192


    9.2.10 Hypermutator Phenotype 192


    9.2.11 Multidrug Efflux Pumps 193


    9.3 Usual and Innovative Means to Overcome Biofilm Resistance in Biofilms 193


    9.3.1 Antibiotics (Bacteriocins) Natural and Synthetic Molecules: Phages 194


    9.3.2 Efflux Pump Inhibitors 195


    9.3.3 Anti?Persisters: Quorum?Sensing Inhibitors 195


    9.3.4 Enzymes 196


    9.3.5 Electrical Methods 196


    9.3.6 Photodynamic Therapy 196


    9.4 Conclusion 197


    Acknowledgments 197


    Conflict of Interest 197


    References 197


    Part III Socio-Economical Perspectives and Impact of AR 211


    10 Sources of Antibiotic Resistance: Zoonotic, Human, Environment 213
    Ivone Vaz?Moreira, Catarina Ferreira, Olga C. Nunes, and Celia M. Manaia


    10.1 The Antibiotic Era 213


    10.2 Intrinsic and Acquired Antibiotic Resistance 214


    10.3 The Natural Antibiotic Resistome 215


    10.4 The Contaminant Resistome 215


    10.5 Evolution of Antibiotics Usage 216


    10.6 Antibiotic Resistance Evolution 219


    10.7 Stressors for Antibiotic Resistance 219


    10.8 Paths of Antibiotic Resistance Dissemination 221


    10.9 Antibiotic Resistance in Humans and Animals 224


    10.10 Final Considerations 227


    References 228


    11 Antibiotic Resistance: Immunity?Acquired Resistance: Evolution of Antimicrobial Resistance Among Extended?Spectrum ?Lactamases and Carbapenemases in Klebsiella pneumonia and Escherichia coli 239
    Isabel Carvalho, Nuno Silva, Joao Carrola, Vanessa Silva, Carol Currie, Gilberto Igrejas, and Patricia Poeta


    11.1 Overview of Antibiotic Resistance as a Worldwide Health Problem 239


    11.2 Objectives 241


    11.3 Causes of Antimicrobial Resistance 242


    11.4 Enterobacteriaceae: General Characterization 243


    11.4.1 Escherichia coli 243


    11.4.2 Klebsiella pneumoniae 244


    11.5 Current Antibiotic Resistance Threats 245


    11.5.1 Carbapenem?Resistant Enterobacteriaceae 245


    11.5.2 Extended?Spectrum ?Lactamase 247


    11.6 Consequences and Future Strategies to Brace the Antibiotic Backbone 250


    11.7 Concluding Remarks and Future Perspectives 251


    Acknowledgments 252


    References 252


    12 Extended?Spectrum? ?Lactamase and Carbapenemase?Producing Enterobacteriaceae in Food?Producing Animals in Europe: An Impact on Public Health? 261
    Nuno Silva, Isabel Carvalho, Carol Currie, Margarida Sousa, Gilberto Igrejas, and Patricia Poeta


    12.1 Extended?Spectrum ?Lactamase 261


    12.1.1 ESBL?Producing Enterobacteriaceae in Food Animals 262


    12.2 Carbapenemases 265


    12.3 Concluding Remarks 267


    References 268


    Part IV Therapeutic Strategy for Overcoming AR 275


    13 AR Mechanism?Based Drug Design 277
    Mire Zloh


    13.1 Introduction 277


    13.2 Drug Design Principles 279


    13.3 Identification of Novel Targets and Novel Mechanisms of Action 282


    13.4 Efflux Pump Inhibitors 286


    13.5 Design of Inhibitors of Drug?Modifying Enzymes 294


    13.6 Antimicrobial Peptides 297


    13.7 Other Approaches to Overcome Bacterial Resistance 299


    13.8 Conclusion 300


    References 300


    14 Antibiotics from Natural Sources 311
    David J. Newman


    14.1 Introduction 311


    14.1.1 The Origin of Microbial Resistance Gene Products 311


    14.2 Organization of the Following Sections 312


    14.3 Peptidic Antibiotics (Both Cyclic and Acyclic) 312


    14.3.1 Tyrocidines, Gramacidins, and Derivatives 312


    14.3.2 Streptogramins and Derivatives: Cyclic Peptides 313


    14.3.3 Arylomycins (Lipopeptide and Modification, Preclinical) 313


    14.3.4 Daptomycin (Cyclic Depsilipopeptide) 314


    14.3.5 Colistins (Cyclic Peptides with a Lipid Tail) 315


    14.3.6 Glycopeptides 317


    14.3.7 Host Defense Peptides 319


    14.4 ?Lactams: Development, Activities, and Chemistry 321


    14.4.1 Combinations with ?Lactamase Inhibitors 322


    14.5 Aminoglycosides 323


    14.5.1 Streptomycin 323


    14.5.2 Plazomicin 323


    14.6 Early Tetracyclines: Aureomycin and Terramycin 324


    14.6.1 Semisynthetic Tetracyclines from 2005 324


    14.7 Erythromycin Macrolides 326


    14.7.1 Recent Semisynthetic Macrolides 326


    14.8 Current Methods of "Discovering Novel Antibiotics" 328


    14.8.1 Introduction 328


    14.8.2 Initial Rate?Limiting Step (Irrespective of Methods) 328


    14.8.3 Genomic Analyses of Whole Microbes 329


    14.8.4 Isolated Genomics 329


    14.8.5 New Sources (and Old Ones?) for Investigation 331


    14.8.6 "Baiting" for Microbes 331


    14.8.7 Use of Elicitors 333


    14.9 Conclusions 333


    14.9.1 Funding? 334


    14.9.2 The "Take?Home Lesson" 334


    References 334


    15 Bacteriophage Proteins as Antimicrobials to Combat Antibiotic Resistance 343
    Hugo Oliveira, Luis D. R. Melo, and Silvio B. Santos


    15.1 Introduction 343


    15.2 Polysaccharide Depolymerases 346


    15.2.1 Depolymerase Structure 348


    15.2.2 Depolymerase Classification 349


    15.2.3 Depolymerase Activity Assessment 350


    15.2.4 Depolymerases as Antimicrobials 351


    15.2.5 Remarks on Depolymerases 355


    15.3 Peptidoglycan?Degrading Enzymes 356


    15.3.1 Virion?Associated Lysins (VALs) 358


    15.3.2 Gram?Positive Targeting Endolysins 365


    15.3.3 Gram?Negative Targeting Endolysins 374


    15.4 Holins 388


    15.4.1 Holin Structure 388


    15.4.2 Holins as Antimicrobials 389


    15.4.3 Remarks on Holins 390


    15.5 Final Considerations 390


    References 392


    16 Antibiotic Modification Addressing Resistance 407
    Haotian Bai and Shu Wang


    16.1 Chemical Synthesis of New Antibiotics 407


    16.2 Antibiotic Modification with Targeted Groups 413


    16.3 Antibiotic Modification with Photo?Switching Units 417


    16.4 Antibiotic Modification by Supramolecular Chemistry 420


    16.5 Antibiotic Modification by Complexed with Other Materials 423


    16.6 Conclusion 425


    References 425


    17 Sensitizing Agents to Restore Antibiotic Resistance 429
    Anton Gadelii, Karl?Omar Hassan, and Anders P. Hakansson


    17.1 Introduction 429


    17.2 Sensitizing Strategies Directly Targeting Resistance Mechanisms 430


    17.2.1 Inhibition of ?Lactamases 430


    17.2.2 Drug Efflux Pump Inhibitors (EPIs) 433


    17.3 Sensitizing Strategies Circumventing Resistance Mechanisms 435


    17.3.1 Manipulating Bacterial Homeostasis 435


    17.3.2 Cell Wall/Membrane Proteins 437


    17.3.3 Biofilms and Quorum Sensing 438


    17.3.4 Persister Cells 440


    17.3.5 Targeting Nonessential Genes/Proteins 441


    17.3.6 Bacteriophages 441


    17.4 Using and Strengthening the Human Immune System Against Resistant Bacteria 441


    17.4.1 Strengthening Host Immune System Function 441


    17.4.2 Antimicrobial Peptides (AMPs) 443


    17.5 Conclusion 443


    References 444


    18 Repurposing Antibiotics to Treat Resistant Gram?Negative Pathogens 453
    Frank Schweizer


    18.1 Introduction 453


    18.2 Anti?Virulence Strategy 454


    18.3 Antibiotic Combination Strategy 454


    18.4 Antibiotic-Antibiotic Combination Approach 455


    18.5 Antibiotic-Adjuvant Combination Approach 456


    18.6 ?Lactam and ?Lactamase Inhibitor Combination 456


    18.7 Imipenem-Cilastatin/Relebactam Triple Combination 457


    18.8 Aspergillomarasmine A 458


    18.9 Intrinsic Resistance Challenges and Strategies to Overcome Them 458


    18.10 Repurposing of Hydrophobic Antibiotics with High Molecular Weight by Enhancing Outer Membrane Permeability Using Polybasic Adjuvants 461


    18.11 Repurposing of Hydrophobic Antibiotics with Large Molecular Weight and Other Antibacterials as Antipseudomonal Agents Using Polybasic Adjuvants 464


    18.12 Repurposing of Antibiotics as Potent Agents Against MDR GNB 467


    18.13 Outlook and Conclusions 468


    References 468


    19 Nontraditional Medicines for Treatment of Antibiotic Resistance 477
    Ana Paula Guedes Frazzon, Michele Bertoni Mann, and Jeverson Frazzon


    19.1 Introduction 477


    19.2 Antibodies 478


    19.2.1 Raxibacumab Versus Bacillus anthracis 478


    19.2.2 Bezlotoxumab Versus Clostridium difficile 479


    19.2.3 Panobacumab Versus Pseudomonas aeruginosa 479


    19.2.4 LC10 Versus Staphylococcus aureus 480


    19.3 Immunomodulators 481


    19.3.1 Antibodies plus Polymyxins 481


    19.3.2 Antibodies plus Vitamin D 482


    19.3.3 Antibodies plus Clavanin 482


    19.3.4 Antibodies plus Reltecimod 483


    19.4 Potentiators of Antibiotic Activity 483


    19.4.1 Antibiotic-Antibiotic Combinations 484


    19.4.2 Pairing of Antibiotic with Nonantibiotic 485


    19.5 Bacteriophages 488


    19.5.1 Life Cycles of Bacteriophages 488


    19.5.2 Bacteriophage Therapy 489


    19.5.3 Phage Enzymes 490


    19.5.4 Concerns About the Application of Phage to Treat Bacteria 491


    19.6 Therapy with Essential Oils 491


    19.7 Microbiota?Based Therapy 495


    19.7.1 Microbiota Modulation 495


    19.7.1.1 Probiotics 496


    19.7.1.2 Prebiotics 496


    19.7.2 Stool Microbiota Transplant 496


    Further Reading 497


    20 Therapeutic Options for Treatment of Infections by Pathogenic Biofilms 503
    Bruna de Oliveira Costa, Osmar Nascimento Silva, and Octavio Luiz Franco


    20.1 Introduction 503


    20.2 Antibiotic Therapy for the Treatment of Pathogenic Biofilms 504


    20.2.1 Monotherapy 504


    20.2.2 Antibiotic Combination Therapy 505


    20.3 New Findings for the Treatment of Pathogenic Biofilms 507


    20.3.1 AMPs Applied to Treatment Pathogenic Biofilms 507


    20.3.2 Bacteriophage Therapy Anti?Biofilm 514


    20.3.3 Nanotechnology Applied to the Treatment of Pathogenic Biofilms 517


    20.4 Conclusion and Future Directions 519


    References 520


    Part V Strategies to Prevent the Spread of AR 533


    21 Rapid Analytical Methods to Identify Antibiotic?Resistant Bacteria 535
    John B. Sutherland, Fatemeh Rafii, Jackson O. Lay, Jr., and Anna J. Williams


    21.1 Introduction 535


    21.2 Standard Methods for Antibiotic Sensitivity Testing 536


    21.3 Rapid Cultural Methods 537


    21.4 Rapid Serological Methods 540


    21.5 Rapid Molecular (Genetic) Methods 540


    21.6 Mass Spectrometric Methods 545


    21.7 Flow Cytometric Methods 549


    21.8 Conclusions 550


    Acknowledgments 553


    References 553


    22 Effective Methods for Disinfection and Sterilization 567
    Lucia Fernandez, Diana Gutierrez, Beatriz Martinez, Ana Rodriguez, and Pilar Garcia


    22.1 Introduction 567


    22.2 Disinfection and Sterilization: Methods and Factors Involved in Their Efficacy 569


    22.2.1 Methods of Sterilization and Disinfection 570


    22.2.2 Factors Influencing Disinfection and Sterilization Efficacy 570


    22.3 Resistance to Disinfectants 571


    22.3.1 Molecular Mechanisms of Biocide Resistance 571


    22.3.2 Biofilms 572


    22.3.3 Cross?Resistance Between Antibiotics and Disinfectants 574


    22.4 New Technologies as Alternatives to Classical Disinfectants 575


    22.4.1 Chemical and Physical Disinfectants 575


    22.4.2 Antimicrobial Surfaces 578


    22.4.3 Biological Disinfectants 578


    22.5 Current Legislation 579


    22.6 Conclusions 581


    References 582


    23 Strategies to Prevent the Spread of Antibiotic Resistance: Understanding the Role of Antibiotics in Nature and Their Rational Use 589
    Rustam Aminov


    23.1 Introduction 589


    23.2 Agriculture as the Largest Consumer of Antimicrobials 590


    23.3 Antimicrobials and Antimicrobial Resistance 591


    23.4 First?Generation Tetracyclines: Discovery and Usage 592


    23.5 Tetracycline Resistance Mechanisms 593


    23.6 Phylogeny of Tetracycline Resistance Genes 593


    23.7 Second?Generation Tetracyclines 595


    23.8 Third?Generation Tetracyclines 595


    23.9 Resistance to Third?Generation Tetracyclines 596


    23.10 Other Potential Resistance Mechanisms Toward Third?Generation Tetracyclines 597


    23.11 Evolutionary Aspect of tet(X) 598


    23.12 Ecological Aspects of tet(X) 599


    23.13 Antibiotics and Antibiotic Resistance as Integral Parts of Microbial Diversity 602


    23.14 The Role of Antibiotics in Natural Ecosystems 604


    23.15 Low?Dose Antibiotics: Phenotypic Effects 605


    23.16 Low?Dose Antibiotics: Genetic Effects 606


    23.17 Regulation of Antibiotic Synthesis in Antibiotic Producers 608


    23.18 Convergent Evolution of Antibiotics as Signaling Molecules 610


    23.19 Carbapenems: Convergent Evolution and Regulation in Different Bacteria 611


    23.20 Antibiotics and Antibiotic Resistance: Environmental and Anthropogenic Contexts 614


    23.21 Conclusions 615


    Conflict of Interest 616


    References 616


    Part VI Public Policy 637


    24 Strategies to Reduce or Eliminate Resistant Pathogens in the Environment 639
    Johan Bengtsson?Palme and Stefanie Hess


    24.1 Introduction 639


    24.2 Sources of Resistant Bacteria in the Environment 640


    24.3 Sewage and Wastewater 641


    24.3.1 Sewage Treatment Plants 641


    24.3.2 Non?Treated Sewage 643


    24.3.3 Industrial Wastewater Effluents 643


    24.3.4 Environmental Antibiotic Resistance is a Poverty Problem 644


    24.4 Agriculture 646


    24.4.1 Intensive, Large?Scale Animal Husbandry 646


    24.4.2 Manure Application 647


    24.4.3 Agriculture in Developing Countries 647


    24.4.4 Aquaculture 648


    24.5 De Novo Resistance Selection 649


    24.6 Relevant Risk Scenarios 649


    24.7 Management Options 653


    24.7.1 Possible Interventions on the Level of Releases of Resistant Bacteria 653


    24.7.2 Restricting Transmission of Resistant Bacteria from the Environment 657


    24.7.3 Better Agriculture Practices to Sustain the Lifespans of Antibiotics 658


    24.7.4 Limiting Selection for Resistance in the Environment 659


    24.8 Final Remarks 661


    Acknowledgments 662


    Conflict of Interest 662


    References 662


    Index 675



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