Nosocomial and Healthcare Associated Infections

Antibiotic resistance is regarded as a major threat to global public health, to the extent that medicine could be on its way “back to

the future” of a pre-antibiotic era. The issue is receiving high-level political attention, with resolutions passed at events such as the

G7 Health Ministries summit and the European Parliament, the endorsement by the WHO of the AMR Global Action Plan, and

culminating at the United Nations High-Level Meeting on AMR and the adoption of its declaration by the UN General Assembly.

The list was drawn up in a bid to guide and promote research and development (R&D) of new antibiotics, as part of WHO’s efforts

to address growing global resistance to antimicrobial medicines. The list highlights in particular the threat of gram-negative bacteria

that are resistant to multiple antibiotics. These bacteria have built-in abilities to find new ways to resist treatment and can pass along

genetic material that allows other bacteria to become drug-resistant as well.(27th February 2017, WHO) meantime Tuberculosis

(omitted from the list ) and resistant tuberculosis in particular (MDR/XDR) merits interest for rapid, affordable, easy diagnostic,

innovative immunology approach for vaccine research. HIV/AIDS has known link with tuberculosis but other risk factors have also

emerged in recent years as important determinants of the TB epidemic, one of which is diabetes mellitus. Bacille Calmette – Guérin

(BCG )vaccine successfully helped to interrupt transmission cycle and along with antibiotic discovery to decrease mortality. BCG

has been used for more than 90 years with astonishing safety records. However, its efficacy remains controversial. No universal

BCG vaccination policy exists, with some countries merely recommending its use and others that have implemented immunization

programs. XDR tuberculosis has evolved in several tuberculosis-endemic countries to drug-incurable or programmatically incurable

tuberculosis (totally drug-resistant tuberculosis). Of note that HIV/AIDS has known link with tuberculosis but other risk factors

have also emerged in recent years as important determinants of the TB epidemic, one of which is diabetes mellitus.This poses several

challenges similar to those encountered in the pre-chemotherapy era, including the inability to cure tuberculosis, high mortality, and

the need for alternative methods to prevent disease transmission. Another issue is reappearing of “old diseases” like pertussis, measles

but meantime existence of viral or parasitic diseases resistant to current treatment (HIV, Malaria, Hepatitis C) underline important

role of adapted immunization as one of strong tool with large impact along with role of effective diagnostic and surveillance and

better understanding of genetic and immunologic background of host specific response and pathogen evolution. Additionally, risk

or new emerging and re-emerging pathogens originated from animals after having crossed the species barrier underline importance

to implement preventive and intervention strategies including boosted vaccine research and development. Immunology and deep

understanding (along with genetics) and lesson learned from oncology research helps to orientate vaccine research for improved

delivery (use of sIgA as mucosal vaccine vehicle for example applicable for live attenuated vaccines), vectors (live attenuated,

recombinant virus vectored vaccines and to look at host improved innate and adaptive immune response (APC – DC, CD4/CD8) to

combined major pathogens and development of “universal vaccines”. Know limitations for use of anti-infectives and antivirals antiparasitic

treatments such us comorbidities, potential drug toxicity, disease related organ dysfunctions, drug–drug interactions and

overlapping toxicities, pill burden, particularities of children population and immune reconstitution inflammatory syndrome support

role of vaccines as highly potent tool to tackle resistance and valuable alternative from long term perspective and clearly recognized

being major tool for public health.