In a recent study, 25% of bacterial pneumonia cases were shown to be resistant to penicillin, and an . United Nations Environment Programme. (p. 314) Which of the following is one of the ABCDs of STD prevention? B. Bacteria can only pass resistant genes on to their progeny. 5, 431441 (2021). Hence, any actions to reduce selection pressures to mitigate the risk of emergence of new forms of resistance, whether in humans, animals or the environment, are based on the precautionary principle. Government of Sweden. Treatment of micropollutants in municipal wastewater: ozone or powdered activated carbon? Many pharmaceutical companies also acknowledge the need for change and have collectively endorsed voluntary emission targets63,152. 35, 901911 (2011). More studies of this type, in both high-income and low-income settings, are needed to estimate the role of contaminated water in the transmission of resistant bacteria. Antimicrobialsare critical tools in helping to fight diseases in humans, animals and plants. A critical bottleneck is likely to be the selection of the rare genotypes with acquired resistance that result from mobilization and/or HGT, genotypes that otherwise would disappear46. Gone are the days, it seems at times, when bel J. Antimicrob. Adv. Long-read sequencing of DNA from bacterial communities might overcome some challenges in placing ARGs into context135, as short-read assemblies of ARG-containing contigs from complex metagenomes are notoriously uncertain. Environ. Pneumonia Hepatitis C A. Carcinogen Owing to low production costs, China and India have become the worlds largest producers of antibiotics. Google Scholar. Google Scholar. The slogan has previously been, Antibiotics: Handle with Care but changed to Antimicrobials: Handle with Care in 2020 to reflect the broadening scope of drug resistant infections. Genomics https://doi.org/10.1099/mgen.0.000455 (2020). Women in the United States and Canada are not routinely offered HIV testing during pregnancy, but they should request it if they feel they are at risk. https://doi.org/10.1038/s42003-020-01176-w (2020). J. Environ. (p. 362) Approximately how many people living in the United States have had cancer? D. headaches, 74. Ballast water is a mobile carrier for the global transfer of bacteria and genes, thus posing a certain risk of ARGs spreading into the global ocean. Sivalingam, P., Pot, J. Knppel, A., Nsvall, J. Review on Antimicrobial Resistance. B. C. P cell B. half C. Resistant genes arise naturally in bacteria. Potential ecological footprints of active pharmaceutical ingredients: an examination of risk factors in low-, middle- and high-income countries. Only prescribe and dispense antibiotics when they are needed, according to current guidelines. Environ. 2 Infections caused by microorganisms are one of the leading causes of death worldwide. D. radon. as well as FORMAS (2018-00833) to C.-F.F. He went to the hospital and, several hours later, his speech was back to normal. A. squamous cell and basal cell Future genome sequencing of many more environmental species is likely to provide a much better foundation for such investigations. 22. New environmental criteria for the procurement of pharmaceuticals, https://sykehusinnkjop.no/nyheter/new-environmental-criteria-for-the-procurement-of-pharmaceuticals (2019). An infected person remains symptomatic after the viral load set point is established. Yang, Y., Li, B., Zou, S., Fang, H. H. P. & Zhang, T. Fate of antibiotic resistance genes in sewage treatment plant revealed by metagenomic approach. Technol. Numerous studies have shown that the abundance of resistant bacteria and/or ARGs increase after manure from antibiotic-treated animals is added as a fertilizer to farmland. While the introduction of new ARGs to pathogens is worrying, changes in the genetic context around ARGs that affect the level of resistance, co-selection opportunities, or virulence or transmission potential can also add to the resistance challenge. Therefore, analyses of selection pressures, being the most well recognized driver of resistance development, are commonly used as surrogates for risk. https://doi.org/10.3389/fmicb.2019.02892 (2019). Although this must be seen as a positive initiative, the near-complete lack of disclosure of both production sites for active ingredients and emission levels18 makes it difficult to judge progress, reinforcing that industrial pollution is rarely resolved without active interference from public institutions. Environmental release of faecal bacteria may also boost the evolutionary process by providing genetic elements that are adapted to capture and transfer ARGs. Environ. Promote and apply good practices at all steps of production and processing of foods from animal and plant sources. Non-resistant bacteria receive the new DNA and become resistant to drugs. Air pollution could drive global dissemination of antibiotic resistance genes. Kim, C., Ryu, H.-D., Chung, E. G., Kim, Y. Only use antibiotics when prescribed by a certified health professional. Mainfactor, a Philadelphia based e-commerce company that buys, builds, and operates direct to consumer businesses emerged from stealth mode today. Environ. (p. 336) Which of the following chronic lung diseases is indicated if you have the following symptoms: an ongoing cough, shortness of breath, wheezing, and chest tightness? One of the main causes of resistant bacteria is the abuse of antibiotics. Appl. Rice, E. W., Wang, P., Smith, A. L. & Stadler, L. B. https://doi.org/10.2807/1560-7917.es.2019.24.37.1800497 (2019). D. both prediabetes and Type-1. 1. Rev. A. hypertension Front. Get the most important science stories of the day, free in your inbox. 53 thousand rdal, C. et al. Which of the following is not a recommendation for preventing infectious diseases? Selective concentrations for trimethoprim resistance in aquatic environments. A., Oluwasegun, R. D. & Church, G. M. Bacteria subsisting on antibiotics. This suggests that external environments already harbour resistance factors for all antibiotics that will ever be developed, unless we start thinking radically differently about how antibiotics are designed. Norwegian Hospital Procurement Trust. Given what is at stake, there could be good reasons also to take specific actions to reduce the risk for evolution of resistance, despite large uncertainties. Although multiple barriers restrict the flow of both bacteria and genes, pathogens recurrently acquire new resistance factors from other species, thereby reducing our ability to prevent and treat bacterial infections. Bacterial virulence factors: a target for heterocyclic compounds to Although single-species competition experiments are simple and easier to reproduce, they may not reflect the situation in more complex communities148. Insulin resistance is also the main feature of metabolic syndrome, which is a set of features that link excess fat around the waist and insulin resistance to increased risk of cardiovascular disease, stroke and Type 2 diabetes. Buschhardt, T. et al. Sci. D. An infected person remains symptomatic after the viral load set point is established. C. Malaria (p. 301) Which of the following statements regarding tuberculosis is FALSE? Integr. Even if new medicines are developed, without behaviour change, antibiotic resistance will remain a major threat. PLoS Pathog. Environ. J. Antimicrob. and C.-F.F. D. Congestive heart failure, 28. 123, 501511 (2019). Philos. Environmental analyses of antibiotics advanced greatly in the past few decades; however, it can be challenging to accurately identify and quantify antibiotics that often occur at nanogram per litre levels in complex matrices53,145. Many bacterial species evolved the ability to tolerate antibiotics long before humans started to mass-produce them to prevent and treat infectious diseases1,2. D. protozoa. Concentrations of antibiotics predicted to select for resistant bacteria: proposed limits for environmental regulation. Antibiotics 4, 567604 (2015). Sci. The Lancet Infectious Diseases Commission on antimicrobial resistance: 6 years later. The chief disadvantage, even with short reads, is the limitation in sensitivity139. Antibiotic resistance can affect anyone, of any age, in any country. Pneumonia B. basal cell Environ. Environ. Opin. Med. 32. ISME J. D.G.J.L. Lessons may be learned from sewage surveillance of poliovirus, which has been in place for decades121. On the basis of current evidence, many policymakers advocate the precautionary principle and call for actions to reduce exposures17,18,19,20,21. 18. A. Embolism Antimicrobial use in aquaculture re-examined: its relevance to antimicrobial resistance and to animal and human health. Shotgun metagenomics reveals a wide array of antibiotic resistance genes and mobile elements in a polluted lake in India. C. For most people, symptoms of lung cancer do not appear until the disease is advanced. Viruses represent some of the smallest pathogens. 11, 152165 (2017). 1441, 1730 (2019). One Health 13, 100263 (2021). Similarly, over the past year, numerous research groups across the world have monitored the dynamics of severe acute respiratory syndrome coronavirus 2 in sewage122,123, increasing the awareness of the approach. A. Alcohol use influences HDL levels. What does main factor mean? - Definitions.net 58. B. saliva. A major knowledge gap is that we still do not know what doses are required for colonization by many bacteria. or Vibrio spp.) Antibiotics are medicines used to prevent and treat bacterial infections. D. HDL levels are higher among women and Blacks. Access to Medicines Foundation. B. vector A. immunity. B. innate immunity. B. Evidence for selection of multi-resistant E. coli by hospital effluent. For example, isolate-based sewage surveillance has a greater potential to inform empirical treatment than metagenomics, as only the former can provide species-specific phenotypic data with certainty, but the simplicity of metagenomics could make it attractive for monitoring regional and temporal trends in resistance112,119. Negative environmental impacts of antibiotic-contaminated effluents from pharmaceutical industries. Prevent infections by ensuring your hands, instruments, and environment are clean. Kraupner, N. et al. Manaia, C. M. Assessing the risk of antibiotic resistance transmission from the environment to humans: non-direct proportionality between abundance and risk. Sci. D. Aspirin has been shown to decrease the risk of colon cancer. Despite, for example, ciprofloxacin being found in sewage sludge at milligram per kilogram concentrations, ciprofloxacin-sensitive strains are very common in sludge76,77, which suggests that the antibiotic is largely biologically unavailable here. A. PSA (p. 323) Which of the following conditions, with sudden onset, is NOT a signal that a stroke has occurred? R. Soc. Lugli, G. A. et al. Hence, it is crucial to understand where the bottlenecks are in the evolution towards resistance in pathogens. Science-based targets for antibiotics in receiving waters from pharmaceutical manufacturing operations. B. emphysema WHO is supporting Member States to develop national action plans on antimicrobial resistance, based on the global action plan. Infect. A. Sci. CAS C. medical X-rays Measures to limit the risk for transmission of antibiotic-resistant bacteria could involve both reducing emissions to the environment and/or reducing exposure166. (p. 298) The main factors believed to influence bacterial resistance are Sci. D. computer screens, 47. C. Oncogene Repressors decrease transcription. Using sewage for surveillance of antimicrobial resistance. New resistance mechanisms are emerging and spreading globally, threatening our ability to treat common infectious diseases. Transcription factors are proteins that help turn specific genes "on" or "off" by binding to nearby DNA. 10, 427436 (2016). https://doi.org/10.3389/fmicb.2013.00145 (2013). PLoS ONE 8, e69581 (2013). Bhullar, K. et al. Direct selection and co-selection are likely to be more critical. Genetics 61, 763771 (1969). They include antibiotics, antivirals, antifungals and antiprotozoa. Some microorganisms that cause illnesses are killed by antibiotics and antifungals, but they also destroy good germs that shield our bodies from infection. In this Review, we present our current understanding of the roles of the environment, including antibiotic pollution, in resistance evolution, in transmission and as a mere reflection of the regional antibiotic resistance situation in the clinic. Dis. Quickly and professionally. A remaining and pressing knowledge gap is our limited understanding of where and under what circumstances the critical steps occur that lead to the emergence of new forms of resistance in clinically important bacteria. The main factors believed to influence bacterial resistance are the overuse and misuse of antibiotics, genetic mutations in the bacteria, the transfer of resistant genes between bacteria, and the lack of development of new antibiotics. D. fungi, 95. Antibiotic resistance occurs naturally, but misuse of antibiotics in humans and animals is accelerating the process. Philos. D. People with diabetes are less likely to have "silent" heart attacks. Microbiol. Your body doesn't develop antibiotic resistance bacteria do. Breast feeding is not a risk for HIV transmission, and women with HIV infection in the United States and Canada are encouraged to breast feed. Hepatitis C Lewis, K. Platforms for antibiotic discovery. D. Chest X-rays are recommended as a routine screening test for lung cancer. As a comparison, typical minimal inhibitory concentrations (MICs) for many antibioticpathogen combinations often fall within the 1010,000gl1 range. 72, 27222728 (2017). Infections caused by, for example, Salmonella spp., enterohaemorrhagic E. coli and Campylobacter jejuni as a result of consumption of contaminated fresh produce occur frequently100, but we are not aware of studies showing that consumers of contaminated produce have an increased probability of being colonized by resistant strains. Identification of 76 novel B1 metallo-beta-lactamases through large-scale screening of genomic and metagenomic data. (p. 343) The replication of a single cell to produce thousands of copies of itself Steps can be taken at all levels of society to reduce the impact and limit the spread of resistance. Microbiol. The mobilized ARG can then be transferred to a pathogen in one or several steps. Having such limitations in mind is critical for both designing and interpreting environmental surveillance studies. (p. 319) The right ventricle of the heart A. receives oxygen-rich blood from the lungs. Waglechner, N. & Wright, G. D. Antibiotic resistance: its bad, but why isnt it worse? Antimicrob. The main factors believed to influence bacterial resistance are the frequency of resistance genes among bacteria, and antibiotic overuse When a tick transfers Lyme disease from a deer to a human, the tick is considered the ________ in the chain of infection. The broad coverage also open opportunities to provide an early warning for the emergence or early spread of rare resistance factors117,118, which would otherwise require extensive surveillance of individuals. J. Med. E-COMMERCE-AS-A-SERVICE. Sewage surveillance to assess the clinical resistance situation probably also has its greatest future potential in LMICs being less resource-demanding than traditional clinical surveillance systems. A. fungus Allen, H. K. et al. Antibiotic use is not a factor in antibiotic resistance. Thiele-Bruhn, S. Pharmaceutical antibiotic compounds in soilsa review. Clin. PubMed A. accidents/injury. (p. 347-348) Which of the following is NOT a source of ionizing radiation? N. Y. Acad. Examples of ectoparasites are fleas, ticks, lice, and scabies. Information and translations of main factor in the most comprehensive dictionary definitions resource on the web. C. skin A. Microbiol. B. Thrombus Bengtsson-Palme, J., Boulund, F., Fick, J., Kristiansson, E. & Larsson, D. G. J. Exposure to surface waters heavily contaminated by faecal residues can also lead to various infections97. Mechanisms of Resistance A. very low density lipoproteins (VLDLs) Given the ease and frequency with which people now travel, antibiotic resistance is a global problem, requiring efforts from all nations and many sectors. B. protozoa C. ethnicity. A., Munck, C., Toft-Kehler, R. V. & Andersson, D. I. These three processes constitute the three basic mechanisms of antimicrobial resistance. 33. Warning signs include difficulty with urination, blood in the urine, and pain. Andersson, D. I. B. Hutinel, M. et al. ABBREVIATIONS; ANAGRAMS; BIOGRAPHIES; CALCULATORS; CONVERSIONS; DEFINITIONS; GRAMMAR . A. D. smoking. Evol. wrote the article. 114, 326333 (2018). D. BRCA1, 90. 5, eaau9124 (2019). C. melanoma, basal cell, and squamous cell, 40. 20. D. PVD is often fatal in older adults. Proc. Still, many naturally occurring stressors also accelerate HGT44. Tackling antibiotic resistance is a high priority for WHO. B. PCB Accordingly, environmental microbiologists most often define resistance as a decreased susceptibility to an antibiotic compared with other strains of the same species. 13, 29272937 (2019). Environ. 17, 913930 (2015). When assessing a client with partial-thickness burns over 60% of the body, which finding should the nurse report immediately? C. CA125 54, 41104120 (2020). D. People with diabetes are less likely to have "silent" heart attacks. ISME J. B. B. B. hypertension B. Antimicrobial (Drug) Resistance - National Institute of Allergy and (p. 326) Which of the following statements regarding tobacco and cardiovascular risk is FALSE? Gullberg, E. et al. Chow, L. K. M., Ghaly, T. M. & Gillings, M. R. A survey of sub-inhibitory concentrations of antibiotics in the environment. BMC Biol. Slider with three articles shown per slide. Antibiotic Resistance: What Is It, Complications & Treatment Alternatively, increased ARG abundances could be merely the result of faecal pollution104, which primarily would be informative about risks for transmission. A major knowledge gap is still what role the low or moderately high levels of excreted antibiotics have, and what methods are most suitable to reflect risks for environmental selection. A recent study on sterile-filtered wastewaters indicated no selective effect of the investigated treated municipal effluent and a small selective effect by untreated influent. Rev. C. Aneurysm 62, 97106 (2014). PubMed Central B. Metastasis Linton, K. B., Richmond, M. H., Bevan, R. & Gillespie, W. A. The first can be the association of a chromosomal ARG (red) with, for example, insertions sequences (ISs; green), which provide intracellular mobility. Razavi, M. et al. B. thrombotic stroke The use of antibiotics on crops is only rarely studied158, but could potentially be a source of very high concentrations, particularly in low- and middle-income countries57. 130, 104880 (2019). (p. 344) What determines which type of cancer an individual is diagnosed with? (p. 288) Single-celled organisms that can be found in almost all environments The confidence interval associated with such estimates could be high150 unless there is good replication around the MSC. The relatively recent introduction of antibiotics as clinical agents radically changed the preconditions for the evolution and spread of resistance by providing unprecedented selection pressures, especially on members of the microbiota of humans and domestic animals, but also in environments heavily polluted with antibiotics. 13, 396 (2015). Ebmeyer, S., Erik, K. & Larsson, D. G. J. Google Scholar. D. high LDL cholesterol, 53. Rev. C. nitrate D. the human immunodeficiency virus (HIV). Environ. Lett. 64. Antibiotic resistance in bacteria is believed to develop largely under the selective pressure of antibiotic use; however, other factors may contribute to population level increases in antibiotic . In solid or semi-solid media, such as sediments, soils, and sewage sludge, reported concentrations can often be much higher than in aqueous media51,55,74,75. Toxicol. Although some studies report increases in the relative abundance of certain ARGs in such environments, it is difficult to distinguish whether this is a result merely of taxonomic changes, unrelated to antibiotic selection pressures, or from direct selection of resistant strains within species66,67,68. C. bacteria B cell Rev. Insulin Resistance: What It Is, Causes, Symptoms & Treatment D. Gestational, 57. C. Carcinoma Microbiol. Increased levels of several ARGs providing resistance to the same antibiotic class, but less pronounced changes in the levels of ARGs providing resistance to other antibiotic classes, also supports a specific selection pressure as the driver behind their increase124. Environ. (p. 287) When a tick transfers Lyme disease from a deer to a human, the tick is considered the ________ in the chain of infection. Milakovi, M. et al. Article What is believed to be the source of SARS-CoV2, The name for the novel coronavirus causing the new respiratory disease COVID-19? D. 79 million. Morar, M. & Wright, G. D. The genomic enzymology of antibiotic resistance. Pharmaceuticals and personal care products in the environment: what are the big questions? 2, 16270 (2017). A. Prediabetes For the last year, she took a drug treatment that worked to interfere with rapid cell division; what type of cancer treatment did Belinda undergo? When autocomplete results are available use up and down arrows to review and enter to select. An elevated triglyceride level. (p. 351) The genes BRCA1 and BRCA2 are associated with an increased risk for what type of cancer? When one is assessing evidence for on-site selection, any ARG, regardless of its clinical relevance, can be informative, as an antibiotic selection pressure would be expected to favour resistant strains of many species and ARGs in parallel. 16 Of 22 ARGs with strong evidence for their recent origin down to species level, 21 came from species that at least occasionally are associated with infections in humans and/or domestic animals49. Microbiol. Rev. . D. There is no increased risk of skin cancer associated with tanning beds. 29. A growing number of infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis are becoming harder to treat as the antibiotics used to treat them become less effective. (p. 323) A blood clot that develops at a distant site and then travels to a blood vessel, where it becomes lodged and blocks blood flow Bacteria resist a drug when the bacteria change in some way. Even single events can lead to the irreversible50 global spread of a new genotype that is it more challenging to treat. D. cardiomyopathy. Undoubtedly, the most widespread emissions, and quite plausibly the largest proportion of released antibiotics, are the result of use and excretion. Adv. Water Res. & Hughes, D. Persistence of antibiotic resistance in bacterial populations. Elevated blood glucose levels. 7, a017996 (2015). 200, 117261 (2021). Radically reducing emissions of exceptionally high concentrations from drug manufactures is one such apparent starting point17,19,59. C. tuberculosis Int. B. Nat. A. host To assign appropriate measures to reduce the risk of resistance evolution associated with human waste streams, it is critical to understand where selection primarily occurs (hospital sewers, community sewers, wastewater treatment plants, recipients and so on). Health Perspect. Does antifouling paint select for antibiotic resistance? Reid, C. J., Blau, K., Jechalke, S., Smalla, K. & Djordjevic, S. P. Whole genome sequencing of Escherichia coli from store-bought produce. Bengtsson-Palme, J. Flach, C.-F. et al. C. skin The risk of heart attack or stroke is related to the number of cigarettes smoked and the duration of use. Health 18, 95 (2019). https://doi.org/10.1186/s43170-020-00001-y (2020). the second portion of the small intestine, approximately 8 feet in length, is called the: .The needle size most commonly used in infants and the elderly is _____ guage. At all stages, compensatory mutations somewhere in the genome of the bacterium carrying the ARG may occur, lowering potential fitness costs, either through reducing niche overlap or by increasing competitive ability47. With some exceptions, environmental concentrations of antibiotics are low, much lower than the minimal inhibitory concentrations (MICs) and most often lower than concentrations predicted (or shown) to select for resistant strains in the laboratory63,64. What does main factor mean? A. Innate immunity Microbiol. Health 2, e398e405 (2018). Biol. Dantas, G., Sommer, M. O. Sci. Pathogenicity is expressed by microbes . Sewers and wastewater treatment plant environments harbour dense, complex bacterial communities that often include pathogens. Which type of microorganism has infected Megan? Proc. 121, 9931001 (2013). C. Resistant tuberculosis is becoming a concern worldwide. Resistance patterns of Escherichia coli isolated from sewage sludge in comparison with those isolated from human patients in 2000 and 2009. 217, 629645 (2018). The cost of AMR to the economy is significant. (p. 312) The most common sexually transmitted disease in the United States is C. Malaria Different types of sources of antibiotic pollution typically give rise to different levels of exposure to aquatic bacterial communities. Cabello, F. C. et al. Antibiotic resistance - WHO Compr. A. been treated. Work in the authors laboratories was funded by the Swedish research councils VR (2018-02835 and 2018-05771) and FORMAS (2108-00787) and the Region Vstra Gtaland under the ALF agreement (grant number ALFGBG-717901) to D.G.J.L. Which of the following statements regarding tuberculosis is false. A cell A survey of faecal swabs from surfers from Britain, who are more likely to ingest seawater than non-surfers, found they were more prone to carry cephalosporin-resistant E. coli92. Talk to your patients about preventing infections (for example, vaccination, hand washing, safer sex, and covering nose and mouth when sneezing). Microbiome https://doi.org/10.1186/s40168-017-0360-9 (2017). 15, 19171942 (2013). Environ. It does not mean our body is resistant to antibiotics or antifungals. Total Environ. While not neglecting the technological needs involved, creating socio-economic and legal drivers for change is often even more challenging. C. Carcinoma (p. 333-335) Which type of obesity is NOT associated with obesity? A. dioxin A global action plan on antimicrobial resistance, including antibiotic resistance, was endorsed at the World Health Assembly in May 2015. Understanding the role of pollution with selective agents in the emergence and evolution of resistance is particularly important, as neglecting an important driver could have major health consequences. A. squamous cell (p. 307) Which of the following is true regarding perinatal transmission of HIV? A. difficulty with speech The process is also independent of the genetic reservoir in other species. Agents Chemother. Complexities in understanding antimicrobial resistance across domesticated animal, human, and environmental systems. Mainfactor's founders have an extensive history in the entertainment business, and the company will . Infect. https://doi.org/10.1128/aac.01495-17 (2017). Google Scholar. The consequences of evolutionary events leading to the emergence of pathogens with new, successful resistance genotypes through any of these routes differ profoundly from those of transmission events of already widely circulating genotypes (as described later). Improve surveillance of antibiotic-resistant infections. This includes understanding the host range and ecology of the vectors involved. Assessing emissions from pharmaceutical manufacturing based on temporal high-resolution mass spectrometry data. Rev. Quiz 8.docx - Quiz 8 Question 1 1 point The term used to Int. Total. (p. 327) Which of the following ethnic population groups has the highest rate of hypertension? Lancet Infect. The general public, health care providers and hospitals all can help ensure correct use of the drugs. D. cellular growth signals. The transferable resistome of produce. Manag. Agents 45, 2532 (2015). Broad host range plasmids can invade an unexpectedly diverse fraction of a soil bacterial community. Smoking alters the blood-clotting process. J. B. Malignant tumor C. Aneurysm 15, 689696 (2017). The structure and diversity of human, animal and environmental resistomes. and JavaScript. Owing to the experimental design, it was possible to demonstrate within species selection by the antibiotics in the soil, although the study authors note that added antibiotic concentrations were higher than under normal fertilization regimens. Identifying those ARGs that are at risk of emerging or have just emerged in pathogens enables early detection in the clinic. The main factors believed to influence bacterial resistance are:___. Flach, C. F. et al. C. chronic bronchitis The genetic reservoir is considerably larger in the environment, suggesting that the source for new ARGs is often environmental bacteria.
