Stewardship / Resistance Scan for Apr 26, 2017

Antimicrobial resistance plan in India
High MDR prevalence in asylum seekers

India launches national plan to fight antimicrobial resistance

India's health ministry has announced the launch of a nationwide, multi-sectoral effort to curb antimicrobial resistance.

According to the British Medical Journal (BMJ), the National Action Plan on Antimicrobial Resistance aims to tackle antibiotic misuse in the country's human and animal health sectors and boost infection control and antimicrobial surveillance. The effort will involve multiple government agencies, including those that are responsible for health, the environment, agriculture, and education.

BMJ reports that the plan calls for the enforcement of regulations that prohibit the sale of antibiotics without prescriptions and promote guidelines for appropriate use, the establishment of national surveillance systems, and the introduction of lessons on antimicrobial resistance and appropriate use in schools and colleges.

The plan also proposes the phase-out of non-therapeutic antibiotic use in food animals and regulations to reduce the spread of resistance elements into the environment from farms, healthcare facilities, and pharmaceutical manufacturing plants, according to the Times of India.

Although there is scant national data on antimicrobial resistance, it's widely seen as an emerging public health crisis in India, which has one of the highest infectious disease burdens in the world, poor sanitation, and is one of the largest consumers of antibiotics for human health. In addition, antimicrobial misuse is common in the country; doctors frequently prescribe antibiotics for diarrheal diseases and upper respiratory infections for which they have limited value, and many antibiotics can be purchased over-the-counter.

A 2016 essay in PLoS Medicine by Ramanan Laxminarayan, PhD, MPH, of the Center for Disease Dynamics, Economics and Policy noted a steep increase in methicillin-resistant Staphylococcus aureus isolates (from 29% in 2009 to 47% in 2014) and  high rates of resistance in Escherichia coli to ampicillin, naladixic acid, co-trimoxazole, and third-generation cephalosporins, along with rising resistance to carbapenems. Laxminarayan said the burden of resistance was likely focused on neonates and the elderly.

"Although accurate estimates of the overall burden of resistance are not available, it is estimated that 58,000 neonatal deaths are attributable to sepsis caused by drug-resistance to first-line antibiotics each year," Laxminarayan wrote.

Under a global action plan on antimicrobial resistance put forward by the World Health Organization (WHO) in 2015, WHO member states are being asked to have national plans in place by 2017.
Apr 26 BMJ article
Apr 24 Times of India article
March 2016 PLoS Med essay


High prevalence of multidrug-resistant organisms found in asylum seekers

Researchers in the Netherlands have found a high prevalence of multidrug-resistant organisms (MDROs) among asylum seekers, according to a study yesterday in PLoS One.

In a study that aimed to assess carriage rate of MRSA and multidrug-resistant Enterobacteriaceae (MDRE) among asylum seekers (mainly from the Middle East and North Africa), investigators analyzed all cultures performed in asylum seekers from January 2014 through December 2015 and compared them with cultures from Dutch patients at risk for carriage of MDROs. The cultures were obtained from screening samples and clinical samples that were collected to diagnose possible infection.

Among the isolates collected from 898 asylum seekers actively screened for MRSA and 118 who provided clinical samples, 10.3% were found to carry MRSA (9.7% in screened patients and 18.6% in clinical cultures). The general patient population (nearly 13,000 patients) was found to have a MRSA carriage rate of 2.1% (2.8% in screened patients and 1.3% in clinical cultures). Asylum seekers also had a much higher rate of MRSA strains harboring Pantone-Valentine leucocidin, a toxin associated with higher virulence.

Among the isolates from 751 asylum seekers who were screened for MDRE and 150 who provided clinical samples, 21.4% were positive for MDRE (21% in screened patients and 21.3% in clinical samples), compared to an MDRE carriage of 5.1% in more than 32,000 patients from the general population (24.4% in screened patients and 4.1% in clinical samples). Most the MDREs were extended-spectrum beta-lactamase producers.

The authors of the study suggest high MRSA and MDRE rates in asylum seekers may be due to high prevalence in their homelands, or could be the result of transmission among refugees, and say the findings support screening policies for MDROs in asylum seekers at Dutch hospitals.

"These differences justify screening of the asylum seekers’ population at admission in the hospital as these organisms may be a threat to the patient and transmission in the hospital should be prevented," the authors write.
Apr 25 PLoS One study

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