{"id":160,"date":"2019-10-07T20:33:01","date_gmt":"2019-10-07T15:03:01","guid":{"rendered":"https:\/\/medicineplexus.com\/?p=160"},"modified":"2019-10-07T20:33:01","modified_gmt":"2019-10-07T15:03:01","slug":"antibiotic-resistance","status":"publish","type":"post","link":"https:\/\/medicineplexus.com\/antibiotic-resistance\/","title":{"rendered":"Antibiotic resistance"},"content":{"rendered":"\n<p><strong>Antibiotic\nresistance<\/strong><\/p>\n\n\n\n<ul><li>Property of microbe &nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <\/li><li>Defined as micro-organism <strong>not inhibited by the usually achievable\nsystemic concentration of an AMA with normal dosage schedule and \/ or fall in\nthe MIC range.<\/strong><\/li><\/ul>\n\n\n\n<p><strong>Multi Resistance<\/strong><\/p>\n\n\n\n<ul><li><strong>MDR <\/strong>\u2013non-susceptibility to at least 1 agent in 3 antimicrobial categories<\/li><li><strong>XDR <\/strong>&#8211; non-susceptibility to at least 1 agent in all but susceptible to 2 or\nfewer antimicrobial categories<\/li><\/ul>\n\n\n\n<p>Initially, the term XDR was created to\ndescribe extensively drug-resistant Mycobacterium tuberculosis (XDR MTB) and\nwas defined as \u2018resistance to the first-line agents&#8217; isoniazid and rifampicin,\nto a fluoroquinolone and to at least one of the three-second-line parenteral\ndrugs (i.e. amikacin, kanamycin or capreomycin)\u2019. Subsequent to this,\ndefinitions for strains of non-mycobacterial bacteria that were XDR<\/p>\n\n\n\n<ul><li><strong>Pan-drug-resistant (PDR) <\/strong>&#8211; Non-susceptibility to all agents in all\nantimicrobial categories<\/li><\/ul>\n\n\n\n<p><strong>Cross Resistance<\/strong><\/p>\n\n\n\n<p>Acquisition of resistance to one AMA\nconferring resistance to another AMA, to which the organism has not been\nexposed. <\/p>\n\n\n\n<ul><li>Between chemically related\ndrugs.<\/li><\/ul>\n\n\n\n<p>&nbsp;&nbsp;\nEg. Aminoglycoside-modifying\nenzymes which may confer resistance to several members of the aminoglycoside\nfamily.<\/p>\n\n\n\n<ul><li>Unrelated drugs may show\npartial cross-resistance: a result\nof either overlapping drug targets <\/li><\/ul>\n\n\n\n<p>&nbsp;&nbsp;&nbsp; Eg. Macrolides and Lincosamides<\/p>\n\n\n\n<p><strong>Impact of antibiotic resistance<\/strong><\/p>\n\n\n\n<ul><li>Longer\nduration of illness<\/li><li>Longer\ntreatment <\/li><li>Increased\nmortality<\/li><li>Huge\neconomic impact<\/li><li>Patients\nto community and health care worker<\/li><li>Negates advances\nin healthcare<\/li><\/ul>\n\n\n\n<p><strong>Three\nagents of greatest concern associated with both hospital- and community-acquired\ninfections. <\/strong><\/p>\n\n\n\n<ul><li><em>E-coli<\/em><\/li><li><em>Klebsiella pneumonia<\/em><\/li><li><em>Staphylococcus aureus<\/em><\/li><li>Methicillin-Resistant\n<em>Staphylococcus Aureus <\/em>(MRSA)<\/li><li>Extended-Spectrum\nBeta-Lactamase (ESBL)<\/li><\/ul>\n\n\n\n<p>&#8211; Enterobacteriaceae<\/p>\n\n\n\n<p><em>&#8211; Acinetobacter baumanni<\/em><\/p>\n\n\n\n<ul><li>Carbapenem\nresistance<\/li><\/ul>\n\n\n\n<p>&#8211; Enterobacteriaceae<\/p>\n\n\n\n<ul><li>Non-fermenting\ngram-negative bacilli (NFGNB)<\/li><li>Vancomycin-Resistant\nEnterococcus (VRE) <\/li><\/ul>\n\n\n\n<p><strong>Other Infections<\/strong><\/p>\n\n\n\n<ul><li><strong>Kala-azar<\/strong><\/li><\/ul>\n\n\n\n<p>&#8211; 60% resistance in pentavalent antimony<\/p>\n\n\n\n<p>&#8211;\n25% in pentamidine<\/p>\n\n\n\n<ul><li><strong>Typhoid\nfever<\/strong><ul><li>MDR\nSalmonella Typhi prevalent all over<\/li><\/ul><ul><li>FQ resistance in Salmonella\ntyphi,&nbsp; 8% in 2008 to 24% in 2014<\/li><\/ul><\/li><li><strong>Vibrio cholerae <\/strong><ul><li>resistance to furazolidone,\ncotrimoxazole, nalidixic acid <\/li><\/ul><ul><li>Tetracycline remains effective <\/li><\/ul><\/li><li>A recent\nstudy in Sikkim, India found that MRSA was seen in 39% clinical specimens of <em>S.\naureus<\/em><\/li><\/ul>\n\n\n\n<p><strong>What is NDM-1?<\/strong><\/p>\n\n\n\n<ul><li><strong>New\nDelhi Metallo-beta-lactamase-1<\/strong>&nbsp;(<strong>NDM-1<\/strong>)&nbsp;\nfirst described by Yong et al in 2009<\/li><li>The gene\nfor NDM-1 is a member of a large&nbsp;gene family&nbsp;that\nencodes&nbsp;beta-lactamase&nbsp;enzymes&nbsp;called&nbsp;<strong>carbapenemases. <\/strong><\/li><li>Bacteria\nthat produce carbapenemases \u2013 <strong>superbugs<\/strong><\/li><li>NDM-1 was\nfirst detected in a&nbsp;<em>Klebsiella pneumoniae<\/em>&nbsp;isolate from\na&nbsp;Swedish&nbsp;patient of Indian origin in 2008<\/li><li>Susceptible\nto&nbsp;a few antibiotics (polymyxins, colistin)<\/li><\/ul>\n\n\n\n<p>Superbugs* are visible manifestations of\nour prolonged failure to preserve antibiotics<\/p>\n\n\n\n<p>(** Methicillin-resistant <em>Staph aureus<\/em>, MDR-and XDR Mycobacteria,\nESBL producing Gram-negative bacteria and NDM-1 producing Enterobacteriaceae\nbacteria are few examples of superbugs because these fail to respond to a large\nnumber of commonly used antibiotics)<\/p>\n\n\n\n<p><strong>Causes:<br>\nKnown but inevitable<\/strong><\/p>\n\n\n\n<ul><li>A continuous\nnatural evolution of resistance in bugs<\/li><\/ul>\n\n\n\n<p><strong>Known\nbut neglected <\/strong><strong>\u00e0 Need immediate action<\/strong><\/p>\n\n\n\n<ul><li>Accumulation\nof resistance to multiple antibiotics<\/li><li>Self-medication\nand poor compliance<\/li><li>Inappropriate\nuse of antibiotics selection &amp; multiplication of resistant strains <\/li><li>Weak\nsurveillance &amp; regulatory systems<\/li><\/ul>\n\n\n\n<p><strong>Factors of Antibiotic Resistance<\/strong><\/p>\n\n\n\n<p><strong>Patient-Related\ncauses<\/strong><\/p>\n\n\n\n<ul><li>Poor\nadherence of dosage regimens<\/li><li>Lack of\neducation<\/li><li>Self-medication<\/li><li>Misconception<\/li><\/ul>\n\n\n\n<p><strong>Drug-related causes<\/strong><\/p>\n\n\n\n<ul><li>Counterfeit\nsubstandard drugs<\/li><li>Irrational\nFDC of antimicrobials<\/li><li>Over the\ncounter availability of drugs<\/li><li>Poor\nregulatory control <\/li><li>Soaring\nuse of antibiotics<\/li><\/ul>\n\n\n\n<p><strong>Prescriber related factors<\/strong><\/p>\n\n\n\n<ul><li>Lack of current knowledge and training<\/li><li>Inappropriate use of available drugs<\/li><li>Overuse of antimicrobials<\/li><li>Inadequate dosing<\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"359\" height=\"252\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-24.png?w=359\" alt=\"\" class=\"wp-image-162\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-24.png 359w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-24-300x211.png 300w\" sizes=\"(max-width: 359px) 100vw, 359px\" \/><\/figure><\/div>\n\n\n\n<p><strong>Intrinsic mechanism<\/strong><\/p>\n\n\n\n<ul><li><strong>Innate ability<\/strong> &#8211; to resist the activity of a particular antimicrobial agent through its inherent structural or functional characteristics<\/li><li>No clinical significance, only proper drugs to be selected<\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"619\" height=\"379\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-25.png?w=619\" alt=\"\" class=\"wp-image-163\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-25.png 619w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-25-300x184.png 300w\" sizes=\"(max-width: 619px) 100vw, 619px\" \/><\/figure><\/div>\n\n\n\n<p><strong>Acquired mechanism of resistance<\/strong><\/p>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"417\" height=\"316\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-26.png?w=417\" alt=\"\" class=\"wp-image-164\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-26.png 417w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-26-300x227.png 300w\" sizes=\"(max-width: 417px) 100vw, 417px\" \/><\/figure><\/div>\n\n\n\n<p><strong>By the\nproduction of enzymes that inactivates the antibiotic.<\/strong><\/p>\n\n\n\n<ul><li>Beta lactamase enzyme &#8211; beta\nlactam antibiotics&nbsp; (S. aureus, N.\ngonorrhea, H. influenza)<\/li><li>Chloramphenicol acetyl\ntransferase &#8211; chloramphenicol&nbsp; (gram \u2013ve\n&gt; gram +ve)<\/li><li>Acetyl transferases,\nphosphotranferases and adenyltransferases &#8211; aminoglycoside<\/li><\/ul>\n\n\n\n<p><strong>Prevention\nof drug accumulation in the bacterium <\/strong><\/p>\n\n\n\n<ul><li><strong>Efflux pump<\/strong> \u2013 cytoplasmic membrane\ntransport proteins<ul><li>E.coli, P.aeruginosa, S. typhi,\nS. aureus, S. pneumonia etc.<\/li><\/ul><ul><li>A major mechanism of resistance\nfor tetracycline, increasing for FQ\u2019s<\/li><\/ul><\/li><li><strong>Inhibition of plasmid-mediated synthesis of porin<\/strong> <strong>channels \u2013<\/strong> obstruct\ninflux of hydrophilic penicillin. Eg. ampicillin<\/li><\/ul>\n\n\n\n<p><strong>Modification\nof target sites<\/strong><\/p>\n\n\n\n<ul><li>Altered DNA gyrase \u2013 FQ<\/li><li>Altered PBP in Strep.\nPneumoniae \u2013 Penicillin<\/li><\/ul>\n\n\n\n<p><strong>Use\nof alternative pathway for growth requirement<\/strong><\/p>\n\n\n\n<ul><li>Bypass the reaction inhibited\nby the antibiotic<\/li><li>Eg. Sulfonamide resistance <br>\n&#8211; Alternate folate metabolism\npathway<br>\n&#8211; overproduction of PABA<\/li><\/ul>\n\n\n\n<p><strong>Quorum sensing<\/strong><\/p>\n\n\n\n<ul><li>Mode of communication with each\nother and exchange signaling chemicals (Autoinducers)<\/li><li><strong>Allow bacteria to coordinate gene expression for virulence,\nconjugation, apoptosis, mobility, and resistance <\/strong><\/li><li>But when?&nbsp; its colony reaches a critical density\n(quorum), a threshold of autoinduction is reached and gene expression starts<\/li><\/ul>\n\n\n\n<ul><li>QS signal molecules: AHL, AIP,\nAI-2 &amp; AI-3 <\/li><li>QS inhibitors &#8211; synthesized and\nisolated from several natural extracts such as garlic extract.<\/li><\/ul>\n\n\n\n<p><strong>Genetic mechanisms<\/strong><\/p>\n\n\n\n<ul><li>Chromosomal Mutation<\/li><li>Spontaneous change in the DNA structure of the gene<\/li><li>Low mutation rate \u2013 frequency is 1\/mln cells<\/li><li>Over the course, sensitive bacteria die and resistant survive and multiple<\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"379\" height=\"277\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-27.png?w=379\" alt=\"\" class=\"wp-image-165\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-27.png 379w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-27-300x219.png 300w\" sizes=\"(max-width: 379px) 100vw, 379px\" \/><\/figure><\/div>\n\n\n\n<p><strong>Extrachromosomal\nmechanism: Plasmids<\/strong><\/p>\n\n\n\n<ul><li>Carry resistant genes to antibiotics (r &#8211; genes) aka R- plasmids<\/li><li>Transferred from one R- plasmid to another plasmid or chromosome.<\/li><li>Horizontal gene transfer<\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"467\" height=\"296\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-28.png?w=467\" alt=\"\" class=\"wp-image-166\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-28.png 467w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-28-300x190.png 300w\" sizes=\"(max-width: 467px) 100vw, 467px\" \/><\/figure><\/div>\n\n\n\n<p><strong>Transfer\nof r \u2013 genes between plasmids within the bacterium<\/strong><\/p>\n\n\n\n<ul><li><strong>Transposons<\/strong><strong> <\/strong>\u2013 mobile genetic\nelements that can move anywhere in a genome and transfer\nr \u2013 genes between plasmids or from plasmid to chromosome.<ul><li>Transposons co-integrate with\nacceptor plasmid and replicate <\/li><\/ul><\/li><\/ul>\n\n\n\n<ul><li><strong>Integrons &#8211;<\/strong> Larger mobile genetic elements<ul><li>packed with multiple gene cassettes each containing r- gene<\/li><\/ul><ul><li>It cannot promote self-transfer like transposons.<\/li><\/ul><\/li><\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"635\" height=\"447\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-29.png?w=635\" alt=\"\" class=\"wp-image-167\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-29.png 635w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-29-300x211.png 300w\" sizes=\"(max-width: 635px) 100vw, 635px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"500\" height=\"375\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-30.png?w=500\" alt=\"\" class=\"wp-image-168\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-30.png 500w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-30-300x225.png 300w\" sizes=\"(max-width: 500px) 100vw, 500px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"480\" height=\"360\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-31.png?w=480\" alt=\"\" class=\"wp-image-169\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-31.png 480w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-31-300x225.png 300w\" sizes=\"(max-width: 480px) 100vw, 480px\" \/><\/figure>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"480\" height=\"360\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-32.png?w=480\" alt=\"\" class=\"wp-image-170\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-32.png 480w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-32-300x225.png 300w\" sizes=\"(max-width: 480px) 100vw, 480px\" \/><\/figure>\n\n\n\n<p><strong>2.Genotypic method:-<\/strong><strong><\/strong><\/p>\n\n\n\n<p>Detection of genes or nucleotide sequences responsible for coding\nresistance.<\/p>\n\n\n\n<ul><li>DNA hybridization<\/li><li>Nucleic acid amplification\n(PCR) technique <\/li><li>Microarray techniques<\/li><\/ul>\n\n\n\n<p><strong>How\nto overcome antimicrobial resistance<\/strong><\/p>\n\n\n\n<ul><li>Judicious use of use antibiotics <\/li><\/ul>\n\n\n\n<ul><li>Develop new antibiotics \u00e0 Bypass the drug resistance<\/li><li>Other options<\/li><\/ul>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"658\" height=\"401\" src=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-33.png?w=658\" alt=\"\" class=\"wp-image-171\" srcset=\"https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-33.png 658w, https:\/\/medicineplexus.com\/wp-content\/uploads\/2019\/10\/image-33-300x183.png 300w\" sizes=\"(max-width: 658px) 100vw, 658px\" \/><\/figure><\/div>\n\n\n\n<p><strong>Antibiotic stewardship<\/strong><\/p>\n\n\n\n<ul><li>A program\nthat encourages judicious use of antibiotics<\/li><li>Multidisciplinary team \u2013 <ul><li>New drug development<\/li><\/ul><ul><li>Surveys and audits<\/li><\/ul><ul><li>Formulating STG, Policies for\nuse of AB in hospital, for govt.<\/li><\/ul><ul><li>Keeping formulary up-to-date<\/li><\/ul><ul><li>Essential drug list<\/li><\/ul><\/li><\/ul>\n\n\n\n<p><strong>Antibiotic stewardship at the community level<\/strong><\/p>\n\n\n\n<ul><li>Avoid\nfurther development of resistance <\/li><li>Multidisciplinary\nteam<\/li><li>Generate\npublic awareness &#8211; drug resistance, imp. of vaccination, hygiene in preventing\ninfection<\/li><li>Interventions\nto improve antibiotic prescribing \u2013 CME, educational sessions, antibiotic\nprescription charts, hospital antibiograms<\/li><li>Conduct\nsurveys and prescription audit with feedback<\/li><li>Formulate\npolicies \u2013 hospital and national use to Curb misuse of\nAMA, control the spread of infection and save money<\/li><\/ul>\n\n\n\n<p><strong>Initiatives taken by India with respect to AMR<\/strong><\/p>\n\n\n\n<ol><li><strong>The National Policy for Containment of      Antimicrobial Resistance (2011)\u2013 not yet implemented<\/strong>. <br>      &#8211; Strategy to monitor the sale of antibiotics (misuse, overuse), AMR surveillance      (lab), promote research, measures to enhance rational use of antibiotics      in hospital and curb its use in veterinary and industry<\/li><li>12th Five Year      Plan- Containment of AMR (2012 &#8211; 2017) \u2013 create awareness for rational use of antibiotics among health care      providers and common people<\/li><li>The Drugs and Cosmetic Rule, 1945 was amended in 2013 to include a new Schedule H1.<ul><li>46 drugs Sold only with the prescription of RMPThe drug\u00a0 should be labeled with the symbol Rx in red and warning<\/li><\/ul><\/li><li>National Anti-Microbial Resistance Research and Surveillance Network (AMRRSN) (ICMR) (2015) &#8211; to compile national data of AMR at different levels of Health Care<\/li><li> National Treatment Guidelines for Antimicrobial Use in Infectious Diseases (2016 v1) <\/li><li> ICMR &#8211; Treatment Guidelines for Antimicrobial Use in Common Syndromes <\/li><li> The Union Health Minister launched a\u00a0campaign called \u201cMedicines with the Red Line\u201d\u00a0&#8211; promote rational use<\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Antibiotic resistance Property of microbe &nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Defined as micro-organism not inhibited by the usually achievable systemic concentration of an AMA with normal dosage schedule and \/ or fall in the MIC range. Multi Resistance MDR \u2013non-susceptibility to at least 1 agent in 3 antimicrobial categories XDR &#8211; non-susceptibility to at least 1 agent in all[&#8230;]\n","protected":false},"author":3,"featured_media":171,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","footnotes":""},"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/160"}],"collection":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/comments?post=160"}],"version-history":[{"count":0,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/posts\/160\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/media\/171"}],"wp:attachment":[{"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/media?parent=160"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/categories?post=160"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicineplexus.com\/wp-json\/wp\/v2\/tags?post=160"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}