Georgetown University Center on Medical Product Access, Safety and Stewardship, 3900 Reservoir Road, Washington, DC 20057, USA.
Cincinnati Children's Hospital, James M. Anderson Center for Health Systems Excellence, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, OH 45229, USA.
Int J Antimicrob Agents. 2019 Oct;54(4):381-399. doi: 10.1016/j.ijantimicag.2019.07.019. Epub 2019 Jul 29.
Carbapenem-resistant Enterobacteriaceae infections have spread globally, leaving polymyxins, including colistin, as 'last-resort treatments'. Emerging colistin resistance raises the spectre of untreatable infections. Despite this threat, data remain limited for much of the world, including Southeast Asia where only 3 of 11 nations submitted data on carbapenem and colistin resistance for recent World Health Organization (WHO) reports. To improve our understanding of the challenge, we utilised broad strategies to search for and analyse data on carbapenem and colistin resistance among Escherichia coli and Klebsiella in Southeast Asia. We found 258 studies containing 526 unique reports and document carbapenem-resistant E. coli and Klebsiella in 8 and 9 of 11 nations, respectively. We estimated carbapenem resistance proportions through meta-analysis of extracted data for nations with ≥100 representative isolates. Estimated resistance among Klebsiella was high (>5%) in four nations (Indonesia, Philippines, Thailand and Vietnam), moderate (1-5%) in two nations (Malaysia and Singapore) and low (<1%) in two nations (Cambodia and Brunei). For E. coli, resistance was generally lower but was high in two of seven nations with ≥100 isolates (Indonesia and Myanmar). The most common carbapenemases were NDM metallo-β-lactamases and OXA β-lactamases. Despite sparse data, polymyxin resistance was documented in 8 of 11 nations, with mcr-1 being the predominant genotype. Widespread presence of carbapenem and polymyxin resistance, including their overlap in eight nations, represents a continuing risk and increases the threat of infections resistant to both classes. These findings, and remaining data gaps, highlight the urgent need for sufficiently-resourced robust antimicrobial resistance surveillance.
耐碳青霉烯肠杆菌科细菌感染已在全球范围内传播，使包括黏菌素在内的多黏菌素类药物成为“最后手段的治疗药物”。新出现的黏菌素耐药性使无法治疗的感染成为现实。尽管存在这种威胁，但包括东南亚在内的世界大部分地区的数据仍然有限，在最近的世界卫生组织（WHO）报告中，只有 11 个国家中的 3 个国家提交了关于碳青霉烯类和黏菌素类耐药性的数据。为了更好地了解这一挑战，我们利用广泛的策略来搜索和分析东南亚国家大肠埃希菌和肺炎克雷伯菌的碳青霉烯类和黏菌素类耐药数据。我们发现了 258 项研究，其中包含 526 份关于 11 个国家中耐碳青霉烯类大肠埃希菌和肺炎克雷伯菌的独特报告。我们通过对有≥100 个代表性分离株的国家提取数据进行荟萃分析来估计碳青霉烯类耐药的比例。在所分析的 11 个国家中，有 4 个国家（印度尼西亚、菲律宾、泰国和越南）的肺炎克雷伯菌耐药率较高（>5%），2 个国家（马来西亚和新加坡）的耐药率为中度（1-5%），2 个国家（柬埔寨和文莱）的耐药率较低（<1%）。对于大肠埃希菌，耐药性总体较低，但在 7 个有≥100 个分离株的国家中，有 2 个国家（印度尼西亚和缅甸）的耐药性较高。最常见的碳青霉烯酶是 NDM 金属β-内酰胺酶和 OXA β-内酰胺酶。尽管数据稀疏，但在 11 个国家中的 8 个国家都记录了黏菌素耐药性，其中 mcr-1 是主要基因型。在 8 个国家中同时存在碳青霉烯类和多黏菌素类耐药性，包括两者的重叠，这代表着持续的风险，并增加了对这两类药物均耐药的感染的威胁。这些发现以及其余的数据差距突显了迫切需要资源充足的强大抗菌药物耐药性监测。
