**Conflict of interest**

*Pathogenic Bacteria*

to chloramphenicol was low (7.6%) [60].

more than 1 antibiotic [46].

some patients.

**food**

from various foods that caused outbreaks of shigellosis in Brazil showed that several strains were resistant to streptomycin (88.6%), followed by ampicillin (84.6%) and sulfamethoxazole/trimethoprim (80.5%). The resistant strains were grouped into 73 patterns, where pattern A (resistance to ampicillin, sulfamethoxazole/trimethoprim, tetracycline, streptomycin, and chloramphenicol and intermediate resistance to kanamycin) grouped the highest number of isolates (*n* = 36) [59]. In Malaysia, *Campylobacter* spp. was reported with a prevalence of 17.4%, from a total of 340 cattle samples. *Campylobacter* isolates showed resistant to tetracycline (76.9%) and ampicillin (69.2%), while resistance

Even in farms of goldfish (*Carassius auratus*), 70 strains of bacterial genera such as *Aeromonas hydrophila*, *Vibrio fluvialis*, and *V. furnissii* have been identified, with 45% of the isolates being resistant to 6 of the 14 antibiotics tested; 100% of the strains were resistant to cephalothin, 94% to ampicillin, 89% to chloramphenicol, 88% to tetracycline, 85.3% to nitrofurantoin, 61.3% to carbenicillin, and 65.3% to kanamycin. Twenty three percent of the isolates presented sensitivity to amikacin, trimethoprim, cefotaxime, netilmicin, pefloxacin, and gentamicin. Only one strain, *A. hydrophila*, showed resistance to all antibiotics tested. Twenty strains generated resistance to 7 different antibiotics, and 67 of the 70 strains generated resistance to

As we can see in this overview, the resistance of the different bacterial genera isolated in a great diversity of foods is alarming, since many of these bacterial genera are the cause of many foodborne diseases. The diseases produced by these resistant pathogenic bacteria are difficult to treat, being able to provoke death in

**4. Economic implications/economic impact of the resistant pathogens in** 

As we previously mentioned, the resistance occurs when the antibiotics used for the control of bacterial diseases are no longer optimal for their elimination. The most common routes to get infected with pathogenic bacteria are air, direct contact with sick people, or consumption of contaminated water or food. Pathogenic bacteria can be spread through sick people and contaminated fruits, vegetables, or animals that are intended for consumption. Antimicrobial resistance is a risk factor and complication of the disease, being difficult to treat infections, and it could be eventually lead to death [61]. In 2019, 700,000 deaths worldwide can be attributed to antimicrobial resistance, and the figure would rise to 35 million in 35 years, due to the lack of treatments to cure diseases caused by resistant pathogens; the estimated cost for the treatment of these persons will be 100 billion dollars [62, 63]. Morbidity and mortality increase when the administration of effective treatments to counteract infections caused by resistant pathogens is delayed. The duration of the disease and hospitalization of patients with infections by resistant pathogens have an economic impact, since there are extra procedures for the treatment of the disease, the antibiotics that could be administered usually are more expensive than the ones used as first line, and also there are long hospitalization stays. The economic impact for the patient is due to the loss of productivity for taking care of themselves or a family member [61]. It is highlighted that 63.5% of infections are acquired in hospitals and that the groups with the highest incidence

In Europe and the United States, more than 50,000 people die every year from infections with drug-resistant pathogens, while in India it is estimated that close to

**178**

are under 1 year or over 65 years old [62, 63].

The authors do not have any conflict of interest.
