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Epidemiology of infections caused by polymyxin-resistant pathogens.
- Source :
-
International journal of antimicrobial agents [Int J Antimicrob Agents] 2016 Dec; Vol. 48 (6), pp. 614-621. Date of Electronic Publication: 2016 Nov 10. - Publication Year :
- 2016
-
Abstract
- Confronting the storm of carbapenemase-producing Gram-negative pathogens and thus facing the threat of untreatable infections, the medical community revived colistin. Not long since its re-introduction and despite the fact that resistance to colistin at least in Escherichia coli is rare, chromosomally-mediated colistin resistance in metallo-β-lactamase-producing Klebsiella pneumoniae strains was reported in 2004 from Greece. Subsequent studies revealed the highest predominance in Italy (38%) and Greece (26%), with colistin-resistant (Col-R) strains frequently carrying a carbapenemase. On the other hand, the international prevalence of Col-R Acinetobacter baumannii varied, predominantly in Southern Europe and Southeast Asia, with rates exceeding 80% in Italy and Greece. Risk factors have mainly incriminated the selective pressure of excess consumption of colistin both in animals and humans. In November 2015, emergence of plasmid-mediated colistin resistance due to the mcr-1 gene was reported from China, mostly in community-derived E. coli strains. As of 1 September 2016, the mcr-1 gene was detected in 35 countries worldwide in livestock/retail meat and in human sources from 29 and 22 countries, respectively. Heavy usage of polymyxins in animals has been incriminated as the reservoir of the mcr-1 gene. Therefore, it is imperative that: (i) polymyxins are banned as growth promoters and for prophylaxis in animals; (ii) targeted surveillance plus molecular epidemiology is performed in hospitals; (iii) carriers or patients infected with isolates harbouring both mcr-1 and carbapenemase genes are strictly isolated; (iv) susceptibilities are based on exact colistin minimum inhibitory concentration (MIC) determination; and (v) rational use of colistin is audited in hospitals.<br /> (Copyright © 2016 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.)
- Subjects :
- Animal Husbandry methods
Animals
Anti-Bacterial Agents therapeutic use
Antibiotic Prophylaxis methods
Global Health
Gram-Negative Bacteria isolation & purification
Humans
Microbial Sensitivity Tests
Polymyxins therapeutic use
Anti-Bacterial Agents pharmacology
Drug Resistance, Bacterial
Gram-Negative Bacteria drug effects
Gram-Negative Bacterial Infections epidemiology
Gram-Negative Bacterial Infections veterinary
Polymyxins pharmacology
Subjects
Details
- Language :
- English
- ISSN :
- 1872-7913
- Volume :
- 48
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- International journal of antimicrobial agents
- Publication Type :
- Academic Journal
- Accession number :
- 27865627
- Full Text :
- https://doi.org/10.1016/j.ijantimicag.2016.09.025