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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">IJMABHR</journal-id>
<journal-title-group><journal-title>International Journal of Medical and All Body Health Research</journal-title><abbrev-journal-title>IJMABHR</abbrev-journal-title></journal-title-group>
<issn pub-type="epub">2582-8940</issn>
<publisher><publisher-name>Anfo Publication House</publisher-name></publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="publisher-id">364</article-id>
<article-id pub-id-type="doi">10.54660/IJMBHR.2025.6.3.62-76</article-id>
<title-group><article-title>The Global Threat of Antimicrobial Resistance: A Microbiological Review</article-title></title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes"><name><surname>Aladeeb</surname><given-names>Mohammed</given-names></name><xref ref-type="aff" rid="aff1"/></contrib>
<aff id="aff1"><label>1</label>Department of Radiology Techniques, Mosul Medical Technical Institute, Northern Technical University, Mosul, Iraq</aff>
</contrib-group>
<pub-date publication-format="electronic" date-type="pub"><day>13</day><month>07</month><year>2025</year></pub-date>
<volume>6</volume>
<issue>3</issue>
<fpage>62</fpage>
<lpage>76</lpage>
<history>
<date date-type="received"><day>28</day><month>05</month><year>2025</year></date>
<date date-type="accepted"><day>02</day><month>07</month><year>2025</year></date>
</history>
<permissions><license license-type="open-access" xlink:href="https://creativecommons.org/licenses/by-nc-sa/4.0/?utm"><license-p>CC BY-NC-SA 4.0</license-p></license></permissions>
<self-uri xlink:href="https://www.allmedicaljournal.com/article/364/the-global-threat-of-antimicrobial-resistance-a-microbiological-review"/>
<self-uri content-type="pdf" xlink:href="https://www.allmedicaljournal.com/article/364/download"/>
<abstract><p>Antimicrobial resistance (AMR) is a growing global health threat that compromises the effectiveness of current antimicrobial therapies. This review outlines key microbiological mechanisms of resistance, including enzymatic degradation of antibiotics, efflux pump activity, and genetic mutations that enhance bacterial survival. These adaptations contribute to treatment failures and increase patient mortality and healthcare costs. Clinically, AMR limits therapeutic options, prolongs hospital stays, and complicates infections. Environmentally, the spread of resistant bacteria through wastewater, agriculture, and pharmaceutical waste plays a significant role in sustaining resistance in natural ecosystems. A thorough understanding of these mechanisms is essential for developing strategies to monitor, prevent, and manage AMR. Addressing this crisis requires global cooperation, surveillance, and investment in alternative therapies and responsible antibiotic use.</p></abstract>
<kwd-group kwd-group-type="author"><kwd>Antimicrobial Resistance</kwd><kwd>Enzymatic Degradation</kwd><kwd>Efflux Pumps</kwd><kwd>Genetic Mutations</kwd><kwd>Clinical Impact</kwd><kwd>Environmental Dissemination</kwd></kwd-group>
</article-meta>
</front>
<back><ref-list><title>References</title>
<ref id="R1"><label>1</label><mixed-citation>Nwobodo DC, Ugwu MC. Antibiotic resistance: The challenges and some emerging strategies for tackling a global menace. J Clin. 2022 , 2022. doi:10.1002/jcla.24708. Available from: https://onlinelibrary.wiley.com.</mixed-citation></ref>
<ref id="R2"><label>2</label><mixed-citation>Antão EM, Vincze S, Hanke R, Klimmek L, et al. Antibiotic resistance, the 3As and the road ahead. [Internet]. 2018 [cited 2025 Jul 28]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC61461 40/.</mixed-citation></ref>
<ref id="R3"><label>3</label><mixed-citation>Eisenreich W, Rudel T, Heesemann J, et al. Link between antibiotic persistence and antibiotic resistance in bacterial pathogens. Front Cell Infect Microbiol. 2022;12:900855. doi:10.3389/fcimb.2022.900855.</mixed-citation></ref>
<ref id="R4"><label>4</label><mixed-citation>Alara JA, Alara OR. An overview of the global alarming increase of multiple drug resistant: a major challenge in clinical diagnosis. Infect Disord Drug Targets. 2024;24(3):e170124225873. doi:10.2174/0118715265276323240111102930.</mixed-citation></ref>
<ref id="R5"><label>5</label><mixed-citation>Fongang H, Mbaveng AT, Kuete V. Global burden of bacterial infections and drug resistance. Adv Bot Res. 2023;108:1-38. doi:10.1016/bs.abr.2023.03.002.</mixed-citation></ref>
<ref id="R6"><label>6</label><mixed-citation>Qin S, Xiao W, Zhou C, Pu Q, Deng X, Lan L, et al. Pseudomonas aeruginosa: Pathogenesis, virulence factors, antibiotic resistance, interaction with host, technology advances and emerging therapeutics. Signal Transduct Target Ther. 2022;7(1):199. doi:10.1038/s41392-022-01056-1.</mixed-citation></ref>
<ref id="R7"><label>7</label><mixed-citation>Miranda C, Silva V, Igrejas G, Poeta P. Impact of European pet antibiotic use on Enterococci and Staphylococcus antimicrobial resistance and human health. Future Microbiol. 2021;16(6):373-6. doi:10.2217/fmb-2020-0244.</mixed-citation></ref>
<ref id="R8"><label>8</label><mixed-citation>Wada Y, Irekeola AA, Ensor ENS, Yusof W, Lih Huey L, et al. Prevalence of vancomycin-resistant Enterococcus (VRE) in companion animals: The first meta-analysis and systematic review. Antibiotics (Basel). 2021;10(2):138. doi:10.3390/antibiotics10020138. International Journal of Medical and All Body Health Research www.allmedicaljournal.com</mixed-citation></ref>
<ref id="R9"><label>9</label><mixed-citation>Antão EM, Vincze S, Hanke R, Klimmek L, et al. Antibiotic resistance, the 3As and the road ahead. [Internet]. 2018 [cited 2025 Jul 28]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC61461 40/.</mixed-citation></ref>
<ref id="R10"><label>10</label><mixed-citation>Zhu Y, Huang WE, Yang Q. Clinical perspective of antimicrobial resistance in bacteria. Infect Drug Resist. 2022;15:735-46. doi:10.2147/IDR.S345574.</mixed-citation></ref>
<ref id="R11"><label>11</label><mixed-citation>Wallace MJ, Fishbein SRS, Dantas G. Antimicrobial resistance in enteric bacteria: Current state and next-generation solutions. Gut Microbes. 2020;12(1):1799654. doi:10.1080/19490976.2020.1799654.</mixed-citation></ref>
<ref id="R12"><label>12</label><mixed-citation>Daily JW, Park S. Sarcopenia is a cause and consequence of metabolic dysregulation in aging humans: Effects of gut dysbiosis, glucose dysregulation, diet and lifestyle. Cells. 2022;11(3):338. doi:10.3390/cells11030338.</mixed-citation></ref>
<ref id="R13"><label>13</label><mixed-citation>Singh R, Zogg H, Wei L, Bartlett A. Gut microbial dysbiosis in the pathogenesis of gastrointestinal dysmotility and metabolic disorders. J Neurogastroenterol Motil. 2021;27(1):19-34. doi:10.5056/jnm20236.</mixed-citation></ref>
<ref id="R14"><label>14</label><mixed-citation>Perri R, Kolvenbach BA, Corvini PFX. Subsistence and complexity of antimicrobial resistance on a community‐ wide level. Environ Microbiol Rep. 2020;12(5):451-6. doi:10.1111/1758-2229.12876.</mixed-citation></ref>
<ref id="R15"><label>15</label><mixed-citation>Akhtar A, Fatima N, Khan HM. Beta-lactamases and their classification: An overview. In: Antimicrobial resistance in gram-negative bacteria. Singapore: Springer; 2022. p. 1-16. doi:10.1007/978-981-16-9655-8_1.</mixed-citation></ref>
<ref id="R16"><label>16</label><mixed-citation>Mostofian B, Martin HJ, Razavi A, Patel S. Targeted protein degradation: Advances, challenges, and prospects for computational methods. J Chem Inf Model. 2023;63(11):3241-56. doi:10.1021/acs.jcim.3c00376.</mixed-citation></ref>
<ref id="R17"><label>17</label><mixed-citation>Henderson PJF, Maher C, Elbourne LDH, et al. Physiological functions of bacterial &apos;multidrug&apos; efflux pumps. Chem Rev. 2021;121(22):13556 -89. doi:10.1021/acs.chemrev.1c00029.</mixed-citation></ref>
<ref id="R18"><label>18</label><mixed-citation>Lorusso AB, Carrara JA, Barroso CDN, Tuon FF, et al. Role of efflux pumps on antimicrobial resistance in Pseudomonas aeruginosa. Int J Mol Sci. 2022;23(13):6994. doi:10.3390/ijms23136994.</mixed-citation></ref>
<ref id="R19"><label>19</label><mixed-citation>Zwama M, Nishino K. Ever-adapting RND efflux pumps in gram-negative multidrug-resistant pathogens: A race against time. Antibiotics (Basel). 2021;10(7):774. doi:10.3390/antibiotics10070774.</mixed-citation></ref>
<ref id="R20"><label>20</label><mixed-citation>Chetri S. The culmination of multidrug-resistant efflux pumps vs. meager antibiotic arsenal era: Urgent need for an improved new generation of EPIs. Front Microbiol. 2023;14:1149413. doi:10.3389/fmicb.2023.1149413.</mixed-citation></ref>
<ref id="R21"><label>21</label><mixed-citation>Ekwanzala MD, Dewar JB, Kamika I, Momba MNB. Systematic review in South Africa reveals antibiotic resistance genes shared between clinical and environmental settings. Infect Drug Resist. 2018;11:1907-17. doi:10.2147/IDR.S170715.</mixed-citation></ref>
<ref id="R22"><label>22</label><mixed-citation>Tang KWK, Millar BC, Moore JE. Antimicrobial resistance (AMR). Br J Biomed Sci. 2023;80:11387. doi:10.3389/bjbs.2023.11387.</mixed-citation></ref>
<ref id="R23"><label>23</label><mixed-citation>Huang L, Ahmed S, Gu Y, Huang J, An B, Wu C. The effects of natural products and environmental conditions on antimicrobial resistance. Molecules. 2021;26(14):4277. doi:10.3390/molecules26144277.</mixed-citation></ref>
<ref id="R24"><label>24</label><mixed-citation>Shen Z, Tang CM, Liu GY. Towards a better understanding of antimicrobial resistance dissemination: What can be learnt from studying model conjugative plasmids? Mil Med Res. 2022;9(1 ):3. doi:10.1186/s40779-021-00362-z.</mixed-citation></ref>
<ref id="R25"><label>25</label><mixed-citation>Che Y, Yang Y, Xu X, Břinda K, Polz MF. Conjugative plasmids interact with insertion sequences to shape the horizontal transfer of antimicrobial resistance genes. Proc Natl Acad Sci U S A. 2021;118(14):e2006838118. doi:10.1073/pnas.2006838118.</mixed-citation></ref>
<ref id="R26"><label>26</label><mixed-citation>Baker KS, Dallman T, Field N, Childs T, et al. Horizontal antimicrobial resistance transfer drives epidemics of multiple Shigella species. [Internet]. 2018 [cited 2025 Jul 28]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC58935 65/.</mixed-citation></ref>
<ref id="R27"><label>27</label><mixed-citation>Sun D, Jeannot K, Xiao Y, Knapp CW. Horizontal gene transfer mediated bacterial antibiotic resistance. Front Microbiol. 2019;10:1933. doi:10.3389/fmicb.2019.01933.</mixed-citation></ref>
<ref id="R28"><label>28</label><mixed-citation>Power JJ, Pinheiro F, Pompei S, Kovacova V. Adaptive evolution of hybrid bacteria by horizontal gene transfer. Proc Natl Acad Sci U S A. 2021;118(14):e2016598118. doi:10.1073/pnas.2016598118.</mixed-citation></ref>
<ref id="R29"><label>29</label><mixed-citation>Bin Zaman S, Hussain MA, Nye R, Mehta V, et al. A review on antibiotic resistance: Alarm bells are ringing. Cureus. 2017;9(6):e1403. doi:10.7759/cureus.1403.</mixed-citation></ref>
<ref id="R30"><label>30</label><mixed-citation>Argudín MA, Deplano A, Meghraoui A, Dodémont M, et al. Bacteria from animals as a pool of antimicrobial resistance genes. Antibiotics (Basel). 2017;6(4):12. doi:10.3390/antibiotics6040012.</mixed-citation></ref>
<ref id="R31"><label>31</label><mixed-citation>Schmerold I, Van Geijlswijk I, Gehring R. European regulations on the use of antibiotics in veterinary medicine. Eur J Pharm Sci. 2023;183:106401. doi:10.1016/j.ejps.2023.106401.</mixed-citation></ref>
<ref id="R32"><label>32</label><mixed-citation>Lees P, Pelligand L, Giraud E. A history of antimicrobial drugs in animals: evolution and revolution. J Vet Pharmacol Ther. 2021;44(2):137 -71. doi:10.1111/jvp.12927.</mixed-citation></ref>
<ref id="R33"><label>33</label><mixed-citation>FakhriRavari A, Simiyu B, Morrisette T, Dayo Y, et al. Infectious disease: how to manage Gram-positive and Gram-negative pathogen conundrums with dual beta-lactam therapy. Crit Care. 2022;26(1):154. doi:10.1186/s13054-022-04026-0.</mixed-citation></ref>
<ref id="R34"><label>34</label><mixed-citation>ur Rahman S, Ali T, Ali I, Ahmad Khan N, et al. The growing genetic and functional diversity of extended spectrum beta-lactamases. Biomed Res Int. 2018;2018:9519718. doi:10.1155/2018/9519718.</mixed-citation></ref>
<ref id="R35"><label>35</label><mixed-citation>Meini S, Viaggi B, Tascini C. Mono vs. combo regimens with novel beta-lactam/beta-lactamase inhibitor combinations for the treatment of infections due to carbapenemase-producing Enterobacteriaceae. Infection. 2021;49(3):375-86. doi:10.1007/s15010-021-01577-6.</mixed-citation></ref>
<ref id="R36"><label>36</label><mixed-citation>Miklasińska-Majdanik M. Mechanisms of resistance to macrolide antibiotics among Staphylococcus aureus. Int J Mol Sci. 2021;22(12):6564. doi:10.3390/ijms22126564.</mixed-citation></ref>
<ref id="R37"><label>37</label><mixed-citation>Ghaly TM, Gillings MR. New perspectives on mobile genetic elements: a paradigm shift for managing the antibiotic resistance crisis. Philos Trans R Soc Lond B Biol Sci. 2022;377(1842):2020 0458. doi:10.1098/rstb.2020.0458.</mixed-citation></ref>
<ref id="R38"><label>38</label><mixed-citation>Jaroszewski J, Mamun N, Czaja K. Bidirectional interaction between tetracyclines and gut microbiome. International Journal of Medical and All Body Health Research www.allmedicaljournal.com Antibiotics (Basel). 2023;12(8):1324. doi:10.3390/antibiotics12081324.</mixed-citation></ref>
<ref id="R39"><label>39</label><mixed-citation>Yang Q, Gao Y, Ke J, Show PL, Ge Y, Liu R, Guo R. Antibiotics: an overview on the environmental occurrence, toxicity, degradation, and removal methods. Environ Sci Pollut Res Int. 2021;28(36):49387-415. doi:10.1007/s11356-021-15819-9.</mixed-citation></ref>
<ref id="R40"><label>40</label><mixed-citation>Dionisio F, Domingues CPF, Rebelo JS. The impact of non-pathogenic bacteria on the spread of virulence and resistance genes. Int J Environ Res Public Health. 2023;20(4):2926. doi:10.3390/ijerph20042926.</mixed-citation></ref>
<ref id="R41"><label>41</label><mixed-citation>Binda E, Marinelli F, Marcone GL. Old and new glycopeptide antibiotics: action and resistance. Antibiotics (Basel). 2014 ;3(4):572-94. doi:10.3390/antibiotics3040572.</mixed-citation></ref>
<ref id="R42"><label>42</label><mixed-citation>Li JG, Chen XF, Lu TY, Zhang J, Dai SH. Increased activity of β-lactam antibiotics in combination with carvacrol against MRSA bacteremia and catheter-associated biofilm infections. ACS Infect Dis. 2023;9(10):1917-29. doi:10.1021/acsinfecdis.3c00239.</mixed-citation></ref>
<ref id="R43"><label>43</label><mixed-citation>Dehbashi S, Tahmasebi H, Zeyni B, Arabestani MR. Regulation of virulence and β-lactamase gene expression in Staphylococcus aureus isolates: Cooperation of two-component systems in bloodstream superbugs. BMC Microbiol. 2021;21(1):163. doi:10.1186/s12866-021-02225-7.</mixed-citation></ref>
<ref id="R44"><label>44</label><mixed-citation>Aljeldah MM. Antimicrobial resistance and its spread is a global threat. Antibiotics (Basel). 2022;11(8):1082. doi:10.3390/antibiotics11081082.</mixed-citation></ref>
<ref id="R45"><label>45</label><mixed-citation>James C, James SJ, Onarinde BA, Dixon RA. A critical review of AMR risks arising as a consequence of using biocides and certain metals in food animal production. Antibiotics (Basel). 2023;12(3):462. doi:10.3390/antibiotics12030462.</mixed-citation></ref>
<ref id="R46"><label>46</label><mixed-citation>Irfan M, Almotiri A, AlZeyadi ZA. Antimicrobial resistance and its drivers—a review. Antibiotics (Basel). 2022;11(7):913. doi:10.3390/antibiotics11070913.</mixed-citation></ref>
<ref id="R47"><label>47</label><mixed-citation>Mohanavelu A, Naganna SR, Al-Ansari N. Irrigation induced salinity and sodicity hazards on soil and groundwater: an overview of its causes, impacts and mitigation strategies. Agriculture. 2021;11(10):983. doi:10.3390/agriculture11100983.</mixed-citation></ref>
<ref id="R48"><label>48</label><mixed-citation>Paneri M, Sevta P. Overview of antimicrobial resistance: an emerging silent pandemic. Glob J Med Pharm Biomed Update. 2023;18:15. doi:10.25259/GJMPBU_2_2023.</mixed-citation></ref>
<ref id="R49"><label>49</label><mixed-citation>Baquero F, Martinez JL, Lanza VF. Evolutionary pathways and trajectories in antibiotic resistance. Clin Microbiol Rev. 2021;34(4):e00050 -19. doi:10.1128/CMR.00050-19.</mixed-citation></ref>
<ref id="R50"><label>50</label><mixed-citation>Kilari VB, Oroszi T. The misuse of antibiotics and the rise of bacterial resistance: a global concern. Pharmacol Pharm. 2024;15(3):73-85. doi:10.4236/pp.2024.153006.</mixed-citation></ref>
<ref id="R51"><label>51</label><mixed-citation>Sarkar P, Gould IM. Antimicrobial agents are societal drugs: how should this influence prescribing? Drugs. 2012;72(13):1725-32. doi:10.2165/11635690 -000000000-00000.</mixed-citation></ref>
<ref id="R52"><label>52</label><mixed-citation>Petrovic M, O&apos;Mahony D, Cherubini A. Inappropriate prescribing: hazards and solutions. Age Ageing. 2022;51(2):afab269. doi:10.1093/ageing/afab269.</mixed-citation></ref>
<ref id="R53"><label>53</label><mixed-citation>Elliott RA, Camacho E, Campbell F, Jankovic D, et al. Prevalence and economic burden of medication errors in the NHS in England: rapid evidence synthesis and economic analysis of the prevalence and burden of medication. [Internet]. 2024 [cited 2025 Jul 28]. Available from: https://www.shef.ac.uk.</mixed-citation></ref>
<ref id="R54"><label>54</label><mixed-citation>Cheng G, Ning J, Ahmed S, Huang J, et al. Selection and dissemination of antimicrobial resistance in agri-food production. Antimicrob Resist Infect Control. 2019;8:158. doi:10.1186/s13756-019-0621-2.</mixed-citation></ref>
<ref id="R55"><label>55</label><mixed-citation>Low CX, Tan LTH, Ab Mutalib NS, Pusparajah P, et al. Unveiling the impact of antibiotics and alternative methods for animal husbandry: A review. Antibiotics (Basel). 2021;10(4):378. doi:10.3390/antibiotics10040378.</mixed-citation></ref>
<ref id="R56"><label>56</label><mixed-citation>Tarin-Pello A, Suay-Garcia B. Antibiotic resistant bacteria: current situation and treatment options to accelerate the development of a new antimicrobial arsenal. J Anti Infect Ther. 2022;20(3):147-64. doi:10.1080/14787210.2022.2013807.</mixed-citation></ref>
<ref id="R57"><label>57</label><mixed-citation>Streicher LM. Exploring the future of infectious disease treatment in a post-antibiotic era: A comparative review of alternative therapeutics. J Glob Antimicrob Resist. 2021;24:285-95. doi:10.1016/j.jgar.2020.12.016.</mixed-citation></ref>
<ref id="R58"><label>58</label><mixed-citation>Desai AN, Mohareb AM, Hauser N, Abbara A. Antimicrobial resistance and human mobility. Infect Drug Resist. 2022;15:127 -33. doi:10.2147/IDR.S305318.</mixed-citation></ref>
<ref id="R59"><label>59</label><mixed-citation>Wijerathna-Yapa A, Ramtekey V, Ranawaka B. Applications of in vitro tissue culture technologies in breeding and genetic improvement of wheat. Plants (Basel). 2022;11(17):2277. doi:10.3390/plants11172277.</mixed-citation></ref>
<ref id="R60"><label>60</label><mixed-citation>Theriault N, Tillotson G, Sandrock CE. Global travel and Gram-negative bacterial resistance; implications on clinical management. Expert Rev Anti Infect Ther. 2021;19(1):1-10. doi:10.1080/14787210.2020.1813023.</mixed-citation></ref>
<ref id="R61"><label>61</label><mixed-citation>Al Amin M, Pasha MH, Hoque MN, Siddiki AZ, et al. Methodology for laboratory-based antimicrobial resistance surveillance in animals. Front Vet Sci. 2022;9:1028850. doi:10.3389/fvets.2022.1028850.</mixed-citation></ref>
<ref id="R62"><label>62</label><mixed-citation>Morel CM, de Kraker MEA, Harbarth S. Surveillance of resistance to new antibiotics in an era of limited treatment options. Front Med (Lausanne). 2021;8:712472. doi:10.3389/fmed.2021.712472.</mixed-citation></ref>
<ref id="R63"><label>63</label><mixed-citation>Bertagnolio S, Suthar AB, Tosas O, et al. Antimicrobial resistance: strengthening surveillance for public health action. PLoS Med. 2023;20(7):e1004267. doi:10.1371/journal.pmed.1004267.</mixed-citation></ref>
<ref id="R64"><label>64</label><mixed-citation>Salam MA, Al-Amin MY, Salam MT, Pawar JS, Akhter N. Antimicrobial resistance: a growing serious threat for global public health. Healthcare (Basel). 2023;11(13):1946. doi:10.3390/healthcare11131946.</mixed-citation></ref>
<ref id="R65"><label>65</label><mixed-citation>Singh B, Bhat A, Ravi K. Antibiotics misuse and antimicrobial resistance development in agriculture: A global challenge. Environ Health. 2024;2(2):91-100. doi:10.1021/envhealth.3c00197.</mixed-citation></ref>
<ref id="R66"><label>66</label><mixed-citation>Roy S, Malla S, Dekari D, Choudhury TG. One Health approach: human, environment, and animal health. In: Management of fish diseases. Singapore: Springer; 2025. p. 1-20. doi:10.1007/978-981-97-3236-4_1.</mixed-citation></ref>
<ref id="R67"><label>67</label><mixed-citation>Smith RD, Coast J. Antimicrobial resistance: a global response. [Internet]. 2002 [cited 2025 Jul 28]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC25633 53/.</mixed-citation></ref>
<ref id="R68"><label>68</label><mixed-citation>Coque TM, Cantón R, Pérez-Cobas AE, et al. Antimicrobial resistance in the global health network: International Journal of Medical and All Body Health Research www.allmedicaljournal.com known unknowns and challenges for efficient responses in the 21st century. Microorganisms. 2023;11(4):1058. doi:10.3390/microorganisms11041058.</mixed-citation></ref>
<ref id="R69"><label>69</label><mixed-citation>Ackers L, Ackers-Johnson G, Welsh J, Kibombo D, et al. Introduction to antimicrobial resistance and the maternal sepsis intervention. Int J Environ Res Public Health. 2020;17(19):7045. doi:10.3390/ijerph17197045.</mixed-citation></ref>
<ref id="R70"><label>70</label><mixed-citation>Lee Y, Wakabayashi M. Key informant interview on antimicrobial resistance (AMR) in some countries in the western pacific region. Global Health. 2013;9:34. doi:10.1186/1744-8603-9-34.</mixed-citation></ref>
<ref id="R71"><label>71</label><mixed-citation>Martin G. The global health governance of antimicrobial effectiveness. Global Health. 2006;2:7. doi:10.1186/1744-8603-2-7.</mixed-citation></ref>
<ref id="R72"><label>72</label><mixed-citation>Walsh TR, Gales AC, Laxminarayan R, Dodd PC. Antimicrobial resistance: Addressing a global threat to humanity. PLoS Med. 2023;20(7):e1004264. doi:10.1371/journal.pmed.1004264.</mixed-citation></ref>
<ref id="R73"><label>73</label><mixed-citation>EFSA Panel on Biological Hazards (BIOHAZ). Role played by the environment in the emergence and spread of antimicrobial resistance (AMR) through the food chain. EFSA J. 2021;19(6):e06651. doi:10.2903/j.efsa.2021.6651.</mixed-citation></ref>
<ref id="R74"><label>74</label><mixed-citation>Gronerth RG, Calderon CR. Antimicrobial resistance in international travelers. Glob Infect Prev Control. 2023;5(2):e00123. doi:10.1016/j.gipc.2023.100123.</mixed-citation></ref>
<ref id="R75"><label>75</label><mixed-citation>World Health Organization. Global research agenda for antimicrobial resistance in human health. [Internet]. 2024 [cited 2025 Jul 28]. Available from: https://www.who.int/publications/i/item/978924009549 6.</mixed-citation></ref>
<ref id="R76"><label>76</label><mixed-citation>Mabey CS, Mattson CA. Assessing global needs when identifying potential engineering for global development projects. J Eng Des. 2022;33(10):737 -54. doi:10.1080/09544828.2022.2094825.</mixed-citation></ref>
<ref id="R77"><label>77</label><mixed-citation>Ahmed S, Zeeshan Ahmed M, Rafique S, Eid Almasoudi S, et al. Recent approaches for downplaying antibiotic resistance: molecular mechanisms. Biomed Res Int. 2023;2023:6768603. doi:10.1155/2023/6768603.</mixed-citation></ref>
<ref id="R78"><label>78</label><mixed-citation>Usman SS, Uba AI, Christina E. Bacteriophage genome engineering for phage therapy to combat bacterial antimicrobial resistance as an alternative to antibiotics. Mol Biol Rep. 2023;50(8):7019 -31. doi:10.1007/s11033-023-08563-7.</mixed-citation></ref>
<ref id="R79"><label>79</label><mixed-citation>São-José C, Costa AR, Melo LDR. Bacteriophages and their lytic enzymes as alternative antibacterial therapies in the age of antibiotic resistance. Front Microbiol. 2022;13:973063. doi:10.3389/fmicb.2022.973063.</mixed-citation></ref>
<ref id="R80"><label>80</label><mixed-citation>Parums DV. Review articles, systematic reviews, meta-analysis, and the updated preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines. Med Sci Monit. 2021;27:e934475. doi:10.12659/MSM.934475.</mixed-citation></ref>
<ref id="R81"><label>81</label><mixed-citation>Cook MA, Wright GD. The past, present, and future of antibiotics. Sci Transl Med. 2022;14(657):eabm3529. doi:10.1126/scitranslmed.abm3529.</mixed-citation></ref>
<ref id="R82"><label>82</label><mixed-citation>Caneschi A, Bardhi A, Barbarossa A, Zaghini A. The use of antibiotics and antimicrobial resistance in veterinary medicine, a complex phenomenon: A narrative review. Antibiotics (Basel). 2023;12(3):487. doi:10.3390/antibiotics12030487.</mixed-citation></ref>
<ref id="R83"><label>83</label><mixed-citation>Tilahun M, Kassa Y, Gedefie A. Emerging carbapenem-resistant Enterobacteriaceae infection, its epidemiology and novel treatment options: a review. Curr Drug Resist. 2021;14(3):183-94. doi:10.1080/14786419.2021.1931860.</mixed-citation></ref>
<ref id="R84"><label>84</label><mixed-citation>Suay-García B, Pérez-Gracia MT. Present and future of carbapenem-resistant Enterobacteriaceae infections. Antibiotics (Basel). 2021;10(10):1224. doi:10.3390/antibiotics10101224.</mixed-citation></ref>
<ref id="R85"><label>85</label><mixed-citation>Upadhayay A, Ling J, Pal D, Xie Y, Ping FF. Resistance-proof antimicrobial drug discovery to combat global antimicrobial resistance threat. Drug Resist Updat. 2023;70:100986. doi:10.1016/j.drup.2023.100986.</mixed-citation></ref>
<ref id="R86"><label>86</label><mixed-citation>Aladeeb MM, Jarjees RM, Merie GMS, Saadi AM, Al-Hamadany AYM. Phenotypic and molecular detection of some Gram-negative bacteria from water of some commercial fish tanks in Mosul City/Iraq. Microbes Infect Dis. 2024; Articles in Press. doi:10.21608/mid.2024.326054.2264.</mixed-citation></ref>
<ref id="R87"><label>87</label><mixed-citation>Aladeeb M, Al Qattan A, Al-Hamadany AYM, Saadi AM, Mohammed ZA. Efficacy of Nigella sativa and Zingiber officinale extract against multidrug-resistant Escherichia coli: an experimental study. J Biosci Appl Res. 2024;10(4):856 -65. doi:10.21608/jbaar.2024.329699.1094.</mixed-citation></ref>
<ref id="R88"><label>88</label><mixed-citation>Sharif HA, Al-Adeeb MKM, Sharif AY. Seroprevalence of (HBV and HCV) and studying the effect of some risk factors among hemodialysis patients in Mosul city. Kirkuk Univ J Sci Stud. 2017;12:1-18. Available from: https://iasj.rdd.edu.iq/journals/uploads/2025/01/05/2277 31338615996f71c69ea51987e8c7.pdf.</mixed-citation></ref>
</ref-list></back>
</article>