Resistance to two vital antibiotic types, which are often used for treating "superbugs," is widely distributed in Southeast Asia, reports a team of investigators led by Georgetown University Medical Center who published their findings in the International Journal of Antimicrobial Agents.
The World Health Organization (WHO) has urgently called for global surveillance of antibiotic resistance, and, along with U.S. Centers for Disease Control and Prevention (CDC), identified resistance to these drugs as critical threats.
To help better understand the risk in Southeast Asia, the researchers searched widely, extracting and analyzing available international scientific and clinical data. They evaluated resistance to these drugs among E. coli and Klebsiella, two common bacteria that can cause severe infections in humans, particularly in health care settings.
The investigators' findings included that resistance to carbapenems, often at significant levels, and resistance to polymyxins, were each widespread and geographically overlapped in 8 countries. Both bacteria also carry and can spread "mobile genetic elements" which can contain genes responsible for conferring resistance that may be transmitted to other bacteria, facilitating the rapid spread of resistance.
Carbapenems have, until recently, been the "go to" treatment for E. coli and Klesiella resistant to more commonly used drugs. However, carbapenem resistant strains have spread around the world. The only available "drugs of last resort" to treat many carbapenem resistant infections have been polymyxins, including colistin. Unfortunately, Goodman says, "in the last few years we have seen the shocking global emergence of colistin resistance, particularly in Asia, in part likely related to use of these drugs in food animal production."
"Although combined carbapenem and colistin resistance is fortunately still rare, the coexistence of mobile resistance genes for both drugs in the same areas, such as we describe, raises the risk of organisms acquiring both, causing essentially untreatable infections."
As the study notes, "These findings highlight the urgent need for sufficiently resourced robust antimicrobial resistance surveillance."
Goodman adds, "we need to enhance infection prevention, treatment and control practices, and related research and development globally, and ensure we use our remaining precious antibiotics wisely. This challenge is global in reach, scope and solutions."