MDRO Beijing Consensus Meeting Report: Global burden of multidrug-resistant organisms' current antimicrobial resistance problems in Asia-Pacific

Prevalence of Multidrug-Resistant Organisms in Healthy Adults in Shenzhen, China

Public health problems caused by the high transmission of multidrug-resistant organisms (MDROs) have attracted widespread international attention. However, studies on healthy adults in this field are scarce. In this article, we report the microbiological screening results of 180 healthy adults recruited from 1,222 participants between 2019 and 2022 in Shenzhen, China. Findings show a high MDRO carriage rate of 26.7% in those individuals who did not use any antibiotics in the past 6 months and had not been hospitalized within the past year. MDROs were mainly extended-spectrum β-lactamase-producing Escherichia coli with high resistance to cephalosporin. With the assistance of metagenomic sequencing technology, we also performed long-term observations of several participants and found that drug-resistant gene fragments were prevalent even when MDROs were not detected by drug sensitivity testing. Based on our findings, we suggest that healthcare regulators limit the medical overuse of antibiotics and enact measures to limit its nonmedical use.

Fate and toxicity of pharmaceuticals in water environment: An insight on their occurrence in South Asia

Pharmaceutically active compounds are newly recognized micropollutants which are ubiquitous in aquatic environment mainly due to direct discharge of treated and untreated wastewater from wastewater treatment plants. These contaminants have attracted mounted attention due to their toxic effects on aquatic life. They disrupt biological processes in non-target lower organisms upon exposure. Biodegradation, photo-degradation, and sorption are key processes which determine their fate in the environment. A variety of conventional and advanced treatment processes had been extensively investigated for the removal of pharmaceuticals from wastewater. However, due to structural complexity and varying operating parameters, complete removal seems ideal. Generally, due to high energy requirement of advanced treatment technology, it is considered cost ineffective. Transport of pharmaceutical compounds occurs via aquatic channels whereas sediments and aquatic colloids play a significant role as sinks for these contaminants. The current review provides a critical understanding of fate and toxicity of pharmaceutical compounds and highlights their vulnerability and occurrence in South Asia. Antibiotics, analgesics, and psychiatric drugs were found predominantly in the water environment of South Asian regions. Despite significant advances in understanding pharmaceuticals fate, toxicity, and associated risks since the 1990s, still substantial data gaps in terms of monitoring, human health risks, and legislation exist which presses the need to develop a more in-depth and interdisciplinary understanding of the subject.

Increased multidrug resistant isolates: new clinical burdens for 66 hospitals in Shanghai, 2015 to 2017

Background

To investigate the etiology of urinary tract and respiratory infections and the rate of drug resistant bacteria in Shanghai from 2015 to 2017, provide the support to the promotion of the correct clinical etiological specimens detection.

Methods

The retrospective questionnaire survey was conducted to obtain the antibiotic prescription rate, pathogen detection rate, and isolation rate of drug-resistant bacteria of the inpatients in 66 hospitals of Shanghai in 2015 and 2017.

Results

Although the detection rate of multidrug-resistant bacteria in sputum specimens has decreased, the clinical pathogen detection still relied mainly on sputum specimens in 2017. Among the sputum specis, the detection rates of extended-spectrum β-lactamase-producing Escherichia (ESBL-ESC), extended-spectrum β-lactamase Klebsiella pneumoniae (ESBL-KP), carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA) and methicillin-resistant Staphylococcus aureus (MRSA) in 2017 were 66.67%, 32.46%, 61.74%, 32.01% and 58.55% respectively. The detection rates of ESBL-ESC, ESBL-KP, CRAB, CRPA in 2017 were increased while the MRSA was decreased than 2015 (P<0.001). Among the blood samples, the detection rates of ESBL-ESC, ESBL-KP, CRAB, CRPA, MRSA and vancomycin-resistant Enterococcus sp (VRE) in 2017 were 53.71%, 31.43%, 50.80%, 19.43%, 43.87% and 0.55% respectively. The detection rates of ESBL-KP, CRAB, CRPA and MRSA increased while the rates of ESBL-ESC and VRE decreased compared with 2015 (P<0.005). The pathogens of multi-drug resistant bacteria were mainly detected from sputum specimens in 2017, which were all higher than detected from the blood specimens (P<0.001).

Conclusions

Most of the multi-drug resistant bacteria in Shanghai, especially in Acinetobacter baumannii or Pseudomonas aeruginosa are mainly detected from sputum specimens, indicating that the actual drug resistance may be overestimated.