Resistance to antibiotics is rising worldwide, threatening gains made over the past seventy years in reducing the burden of infectious disease. ProMED has reported news related to antimicrobial resistance (AMR) throughout its 23-year history. In the past month, we've posted several that illustrate the challenges. Here are three I found particularly interesting.
In an extended genetic analysis of 1,777 Klebsiella samples taken from patients at the 2,000-bed Houston Methodist hospital system between 2011 and 2015, a strain of antibiotic resistant Klebsiella pneumoniae was found to cause more infections than one that has been well-studied. (See ProMED Archive Number: 20170522.5055025.) Klebsiella pneumoniae causes infections - including outbreaks in health care settings worldwide - that are increasingly difficult to treat because many strains are resistant to multiple antibiotics. The researchers found that the strain that caused the plurality of infections in the hospital patients studied was as virulent as pandemic CG258 strains, leading them to hypothesize the emergence of an especially successful clonal group of antibiotic-resistant K. pneumoniae.
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Research into the multi-drug resistant fungus Candida auris was detailed in another post. (See ProMED Archive Number: 20170520.5050111.) Since the CDC released a clinical alert about the emerging fungus in June 2016, 77 clinical cases have been reported. Subsequent screening of close contacts of these patients identified an additional 45. Patients' rooms were environmentally tested and C. auris was identified from mattresses, furniture, surfaces, and infusion pumps, indicating environmental contamination; the fungus was not isolated from rooms after thorough cleaning with disinfectant.
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In Kenya, lack of sanitation, poor lab capability, and inadequate disease surveillance are enabling the spread of the H58 strain of Salmonella Typhi, which is multidrug resistant. (See ProMED Archive Number: 20170430.5005152.) The traditional first-line drugs commonly used to treat acute typhoid continue to be prescribed, but since the 1970s, S. Typhi strains have emerged that are resistant to these antimicrobials, leaving costlier second and third generation drugs as the only alternatives. This added expense increases the burden on already strapped health systems.
Incomes are expanding in low-resource countries and the accompanying increase in the use of antibiotics is saving lives. But, while it continues to be true that lack of access to these medications kills more people than does antibiotic resistance, the availability of antibiotics is not a responsible substitute for public health.
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