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High variance, gaps in global antimicrobial resistance among gram-negative urinary pathogens
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SAN DIEGO— Data presented here at ICAAC 2015 suggest highly variable rates of antimicrobial resistance among gram-negative urinary pathogens, although significant surveillance gaps remain in developing countries and regions.
“Emerging antibiotic resistance is a major global public health concern, yet reliable prevalence data from many areas of the world are limited,” Patrick N.A. Harris, FRACP, of the University of Queensland, Brisbane, Australia, and colleagues wrote. “We aimed to generate estimates of resistance rates using data reported in the contemporary literature.”
Patrick N.A. Harris
To determine antimicrobial resistance among gram-negative urinary pathogens, Harris and colleagues systematically examined data published from 2009 to 2014. They reviewed 49 studies that reported resistance to third-generation cephalosporins (3GC), fluoroquinolones, aminoglycosides or carbapenems among the general population. Further information was collected from the EARS-Net European surveillance database, and all data were pooled to create regional and country-based resistance estimates using a random-effects model.
Evidence showed extremely variable resistance rates in urinary-isolated Enterobacteriaceae across different regions of the world. For instance, estimated 3GC resistance in Enterobacteriaceae was high in Hong Kong (64%; 95% CI, 58.4%-69.4%) and Vietnam (63.5%; 95% CI, 55.9%-70.7%), but low in Canada (1.7%; 95% CI, 0%-7.1%).
Of greatest concern, Harris said, were high rates of carbapenem resistance in Greece (32.9%; 95% CI, 31%-34.9%) and India (16.4%; 95% CI, 7%-25.8%) among Enterobacteriaceae. Little data were available for regions such as sub-Saharan Africa, portions of South America and the former Soviet Union, an area which Harris said requires increased efforts.
“The take home message is … there’s extreme global variation in the prevalence of antimicrobial resistance in urinary pathogens,” Harris said during a presentation. “This is obviously an extreme problem, but for many parts of the world we really don’t know what’s going on.
“We really need much more robust global surveillance systems, particularly in developing-world countries.” –by Dave Muoio
Reference:
Harris PNA, et al. Mapping the Global Prevalence of Resistance to Antimicrobials in Gram-negative Urinary Pathogens: A Meta-analysis of Contemporary Studies. Presented at: Interscience Conference on Antimicrobial Agents and Chemotherapy; Sept. 17-21, 2015; San Diego.
Disclosure: Harris reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.