Antibiotics are the most magnificent discovery of 20th century that have saved millions of lives from infectious diseases. Microbes have developed acquired antimicrobial resistance (AMR) to many drugs due to high selection pressure from increasing use and misuse of antibiotics over the years. The transmission and acquisition of AMR occur primarily via human–human interface both within and outside of the healthcare facilities. A huge number of interdependent factors related to healthcare and agriculture govern the development of AMR through various drug resistance mechanisms. The emergence and spread of AMR from the unrestricted use of antimicrobials in livestock feed has been a major contributing factor. The prevalence of AMR bacteria has attained its incongruous level worldwide and threatening global public health as silent pandemic, necessitating urgent intervention. Therapeutic options of AMR bacterial infections are limited resulting in significant morbidity and mortality with high financial impact. The paucity in discovery and supply of new novel antimicrobials to treat life-threatening AMR infections stands in sharp contrast to demand. Immediate interventions to contain AMR include surveillance and monitoring, minimizing over the counter antibiotics and antibiotics in food animals, access to quality and affordable medicines, vaccines and diagnostics, and enforcement of legislation. An orchestral collaborative action within and between multiple national and international organizations are required urgently, otherwise, a post-antibiotic era can be a real possibility than an apocalyptic fantasy for the 21st century. This narrative review highlights on the basis, mechanisms and factors in microbial resistance and key strategies to combat antimicrobial resistance.

BACKGROUND AND OBJECTIVES: Papio hamadryas baboons, known reservoirs of several infectious diseases, roam and deposit their excreta indiscriminately on footpaths, parks, and streets of the city peripheries of Taif, Baha, and Abha in southwestern Saudi Arabia. Nonetheless, city centers of these places are free of baboons. This study aims to determine the impact of baboons on human gastrointestinal health. DESIGN AND SETTINGS: This is a descriptive cross-sectional analytical ecological study conducted in 3 cities located in southwestern Saudi Arabia between July 2011 and July 2012. MATERIALS AND METHODS: We investigated the impact of these baboons on the human health through a coprological survey of infectious agents of baboons and humans in these 3 cities using macroscopic and micro.scopic analyses, before and after parasite concentration, and culturing of bacteria on selective and differential media, which were then identified by 16S rDNA gene sequencing. Baboon fecal samples (n=823) were collected from city peripheries. Two groups of human fecal samples, each consisting of 795 samples were collected, one from city centers and the second from city peripheries where baboons intermingle with the human population. RESULTS: Baboon fecal samples were the most contaminated with infectious agents, except for Staphylococcus aureus, which was more commonly present in human fecal samples collected from city peripheries. Human fecal samples collected form city peripheries showed higher rates of most infective agents than those collected from city centers. CONCLUSION: This indicates that baboons are medically important reservoirs of infectious agents associated with higher human coproprevalence of gastrointestinal infectious agents.

OBJECTIVES: To determine Clostridium difficile (C. difficile) prevalence on retail surfaces and shoppers plastic bags. METHODS: From 20 June to 10 August 2011, in a cross-sectional epidemiological study, 17 supermarkets from 2 cities, Albaha and Altaif, Saudi Arabia were sampled. A total of 800 samples, which comprised 200 samples per surveyed surface, were studied. These included baskets, trolleys, conveyer belts, and outgoing shoppers’ plastic bags. Clostridium difficile strains were isolated. The isolates were characterized using ribotyping and polymerase chain reaction for the detection of toxin A (tcdA), toxin B (tcdB), binary toxin (cdtB), and toxin C (tcdC) genes. Susceptibility to antibiotics was determined on a Muller-Hinton agar with 5% sheep blood agar using E-tests. RESULTS: Overall, the C. difficile prevalence on sampled surfaces was 0.75%. The highest prevalence was found on retail baskets and trolleys, followed by plastic bags. A total of 5 different ribotypes were identified. Alterations in tcdC were detected in ribotype 027 and BT1. All the identified isolates were susceptible to vancomycin, but resistant to levofloxacin. CONCLUSION: In this study, C. difficile was present at a rate of 0.75% on supermarket surfaces. Spore disinfection of implicated surfaces may be necessary to control any community-acquired infections caused by this pathogen.

OBJECTIVE: To investigate for the presence of mycobacteria at water dams of Albaha, Saudi Arabia. METHODS: An epidemiological study was conducted between 20 - 30 June 2013 in the Albaha region, Kingdom of Saudi Arabia. Five hundred and twenty samples (sand, wet stones, clay, and decayed vegetation) were collected from 13 dams in the region. These locations were: 3 dams from Alaqiq city (Thrad, Alaqiq, and Almshereq); 4 dams from Almandaq city (Almudlamat, Alkhrar, Alsader, and Medhas); one dam from Albaha city (Shehba9a); and 5 dams from Baljerashi city (Alzarawah, Alareshaen, Almatwah, Alheajh, and Almarbah). Samples from these locations (n=520) were inoculated on Lowenstein-Jensen media. The isolated Mycobacterium (M.) obtained were identified by standard culture, enzymatic tests, biochemical characteristics, comparison of mycolic acid profiles, 16S rRNA gene sequencing, and restriction fragment patterns of the hsp65 gene polymerase chain reaction product. RESULTS: Mycobacterium isolates were recovered from 79% of the samples obtained from all types of samples and locations. A total of 145 of the isolates were found to belong to the 11 Mycobacterium species: 5 M. intracellulare, 8 M. abscessus, 9 M. szulgai, 12 M. fortuitum, 12 M. avium, 14 M. kansasii, 15 M. simiae, 15 M. gordonae, 16 M. terrae complex, 18 M. chelonae, and 21 M. malmoense. CONCLUSION: Mycobacterium species is present at high percentages in Albaha dams. The findings support a nationwide study to understand the clinical importance of environmental Mycobacterium in Saudi Arabia.

OBJECTIVES: To determine whether site-specific mouth rinsing with oral disinfectants can improve oral odor beyond the traditional panoral mouth disinfection with mouth rinses by targeting specifically oral malodor implicated anaerobic bacteria. METHODS: Twenty healthy fasting subjects volunteered for a blinded prospective, descriptive correlational crossover cross-section clinical trial conducted during the month of Ramadan between July and August 2013 in Albaha province in Saudi Arabia involving the application of Listerine® Cool Mint® mouth rinse by either the traditional panoral rinsing method, or a site-specific disinfection method targeting the subgingival and supragingival plaque and the posterior third of the tongue dorsum, while avoiding the remaining locations within the oral cavity. The viable anaerobic and aerobic bacterial counts, volatile sulfur compounds (VSCs) levels, organoleptic assessment of oral odor, and the tongue-coating index were compared at baseline, one, 5, and 9 hours after the treatment. RESULTS: The site-specific disinfection method reduced the VSCs and anaerobic bacterial loads while keeping the aerobic bacterial numbers higher than the traditional panoral rinsing method. CONCLUSION: Site-specific disinfection can more effectively maintain a healthy oral cavity by predominantly disinfecting the niches of anaerobic bacteria within the oral cavity.