Stewardship / Resistance Scan for Jan 19, 2018

Global risk of AMR
Drug-resistant genes in space

World Economic Forum report assesses global risk of antibiotic resistance

The World Economic Forum's 2018 Global Risks Report, released this week, includes a section on antimicrobial resistance (AMR), noting that while initiatives to address antibiotic overuse and the lack of new antibiotics have been launched, concrete successes "remain elusive."

In its 2013 Global Risks Report, the forum devoted a chapter to AMR that highlighted overuse of antibiotics in human and animal health and the fact that no new class of antibiotics had been invented since the 1980s. Revisiting this issue in a section of the 2018 report titled Hindsight, the forum suggests that the risks posed by AMR continue to intensify, both in terms of human health and the global economy.

In the years since 2013, for example, a report commissioned by the UK government ("The Review on Antimicrobial Resistance") estimated that 700,000 deaths a year can be attributed to AMR—a figure significantly higher than presented in the forum's 2013 report. In addition, while the forum estimated in 2013 that the potential economic impact of AMR was 0.4% to 1.6% of global GDP, a study published by the World Bank in 2017 estimated that AMR could have an impact of between 1.1 and 3.8 percentage points by 2050. Resistance to the strongest antibiotics has also continued to spread since 2013, highlighted by rising resistance to carbapenems and emerging resistance to the last-resort antibiotic colistin.

The authors acknowledge that global efforts to address AMR, including the World Health Organization's 2015 Global Action Plan on Antimicrobial Resistance, are encouraging, as are initiatives to encourage the discovery and development of new antibiotics. However, they write, "We still face two trends that spell potential disaster: new classes of drugs are not being invented and resistance to existing drugs continues to spread inexorably."
Jan 17 World Economic Forum 2018 Global Risks Report, section on AMR


Study identifies antibiotic-resistant bacteria, genes in space station

A team led by researchers with the California Institute of Technology's Jet Propulsion Laboratory has identified strains of drug-resistant bacteria and more than a hundred antibiotic resistance genes in microbes collected from the International Space Station (ISS), according to a new study in Scientific Reports.

In the study, researchers collected 24 samples from eight locations aboard the ISS over the span of a year. The samples were cultured to obtain isolates for phenotypic antibiotic susceptibility testing and whole-genome sequencing (WGS) and then subjected to DNA extraction to allow for molecular analysis with Ion AmpliSeq—a next-generation sequencing tool—and metagenomics. The purpose of the study was to analyze the resistome of the ISS, where human-associated opportunistic pathogens have previously been found, in order to better understand the threat of antibiotic-resistant bacteria to astronauts and develop mitigation procedures for future space flights.

In total, 57 biosafety level 2 (BSL 2) microorganisms were tested for resistance to nine antibiotics. Most of the strains (92%) were resistant to penicillin, followed by oxacillin (68%), rifampin (66%), erythromycin (64%), cefoxitin (49%), cefazolin (29%), tobramycin (19%), and gentamicin and ciprofloxacin (14%). A novel species isolated from ISS, Enterobacter bugandensis, was resistant to all 9 antibiotics; Staphylococcus haemolyticus was not resistant to any of the antibiotics. Testing of 12 S aureus isolates, conducted because of the serious health concerns associated with methicillin-resistant S aureus, showed that most strains were susceptible, except four that were resistant to clindamycin.

While WGS showed a collection of 51 genes conferring resistance to 18 antibiotics, AmpliSeq analysis of DNA from the 24 samples detected a total of 123 known antibiotic resistance genes, with those responsible for beta-lactam and trimethoprim resistance being the most abundant and widespread. The metagenomics approach showed that genes conferring resistance to metals (like zinc and copper) and those involved in multidrug efflux pumps were the most abundant. Metagenomic analysis also found widespread fluoroquinolone resistance.

"The results from this study highlight the importance of using a variety of analytical methods to get a comprehensive picture of the resistome on the ISS and to utilize this information to develop concrete antibiotic resistance mitigation strategies," the authors write.
Jan 16 Sci Rep study

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