Trends in Antimicrobial Resistance in Europe in the Era of War, Migrations and Climate Change

Dear Colleagues,

Antimicrobial resistance (AMR) has been identified by the European Commission as one of the top three priority health threats to the EU and, due to AMR, a growing number of infections that could once be treated effectively with antibiotics are now harder to treat because antibiotics have become less effective. We are faced with a turbulent situation in Europe, with a war taking place in Eastern Europe and mass migrations from Africa and the Middle East being triggered by wars, climate change, and famine in developing countries and labor shortages in high-income countries. All of this together is affecting antimicrobial resistance in European countries and changing the face of Europe with regard to multidrug-resistant (MDR) bacteria. Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. Migrants are exposed to conditions favoring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers in refugee camps and detention facilities is a consequence of poor living conditions and overcrowding, as well as reduced access to healthcare. Moreover, tourists from Europe often visit exotic destinations in Africa and Asia and sometimes need to be hospitalized during the stay in their destinations ; therefore, international travel, particularly medical tourism, is also a vehicle for the transmission of antimicrobial resistance globally. The rapid increase in antibiotic resistance to Shigella sonnei and Neisseria gonorrhoeae among the population of men who have sex with men (MSM) is attributed to international travel. It is well known that CTX-M-15 extended β-lactamase originated from India and spread all over the world and is now the most widespread type of ESBL on all continents. The same happened with NDM metallo-β-lactamase which originated from India as well. OXA-48 carbapenemase, which is now the most prevalent carbapenemase in Europe, was first reported in Turkey in 2001, but now North Africa and Middle East happen to be the dominant reservoirs of this important resistant trait. It has, to a great extent, replaced the KPC and VIM variants which prevailed at the beginning of the spread of carbapenemase in Europe. The mixing of the populations contributes to a plethora of various resistance traits which, since pathogens do not have borders, have now been detected in the majority of EU countries. Enterobacterales, with double or triple carbapenemases in combination with genes encoding panaminoglycoside and fluoroquinolone resistance, are no longer scarce. Colistin is often the last resort antibiotic for the treatment of infections due carbapenemase producing Enterobacterales, Pseudomonas aeruginosa and Acinetobacter baumannii, but transferable, plasmid-mediated resistance, first reported in 2015 in chickens in China, has now been detected in Germany, the Netherlands, Belgium, and other European countries among human isolates. Novel combinations with inhibitors are not effective against metallo-β-lactamase producing organisms and protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated into all aspects of healthcare, including those accessible to all migrant and tourist groups, and should target determinants of AMR before, during, and after migration. Moreover, health systems should identify recent travelers to and from exotic countries to ensure that adequate precautions are taken.

We welcome the submission of articles that cover, but are not limited to:

• Resistance determinants among Gram-positive and Gram-negative bacteria (ESBLs, p-AmpC, carbapenemases);
• Laboratory detection of β-lactamases and other resistance determinants;
• Therapeutic options for the treatment of infections associated with MDR or XDR bacteria;
• Multidrug resistant bacteria associated with international travel and migrations;
• Novel therapeutic options for multidrug-resistant bacteria;
• Prevention of infections associated with multidrug-resistant bacteria;
• Molecular epidemiology of MDR bacteria in Europe.

Dr. Branka Bedenic
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Microorganisms is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

• antimicrobial resistance
• bacteria resistance
• fungi azole resistance
• molecular epidemiology
• healthcare