Epidemiology and molecular characterization of multidrug-resistant Gram-negative bacteria in Southeast Asia

Nuntra Suwantarat, Karen C Carroll, Nuntra Suwantarat, Karen C Carroll

Abstract

Background: Multidrug-resistant Gram-negative bacteria (MDRGN), including extended-spectrum β-lactamases (ESBLs) and multidrug-resistant glucose-nonfermenting Gram-negative bacilli (nonfermenters), have emerged and spread throughout Southeast Asia.

Methods: We reviewed and summarized current critical knowledge on the epidemiology and molecular characterization of MDRGN in Southeast Asia by PubMed searches for publications prior to 10 March 2016 with the term related to "MDRGN definition" combined with specific Southeast Asian country names (Thailand, Singapore, Malaysia, Vietnam, Indonesia, Philippines, Laos, Cambodia, Myanmar, Brunei).

Results: There were a total of 175 publications from the following countries: Thailand (77), Singapore (35), Malaysia (32), Vietnam (23), Indonesia (6), Philippines (1), Laos (1), and Brunei (1). We did not find any publications on MDRGN from Myanmar and Cambodia. We did not include publications related to Shigella spp., Salmonella spp., and Vibrio spp. and non-human related studies in our review. English language articles and abstracts were included for analysis. After the abstracts were reviewed, data on MDRGN in Southeast Asia from 54 publications were further reviewed and included in this study.

Conclusions: MDRGNs are a major contributor of antimicrobial-resistant bacteria in Southeast Asia. The high prevalence of ESBLs has been a major problem since 2005 and is possibly related to the development of carbapenem resistant organisms in this region due to the overuse of carbapenem therapy. Carbapenem-resistant Acinetobacter baumannii is the most common pathogen associated with nosocomial infections in this region followed by carbapenem-resistant Pseudomonas aeruginosa. Although Southeast Asia is not an endemic area for carbapenem-resistant Enterobacteriaceae (CRE), recently, the rate of CRE detection has been increasing. Limited infection control measures, lack of antimicrobial control, such as the presence of active antimicrobial stewardship teams in the hospital, and outpatient antibiotic restrictions, and travel throughout this region have likely contributed to the increase in MDRGN prevalence.

Keywords: Epidemiology; Gram-negative bacteria; Molecular; Multidrug-resistance; Southeast Asia.

Figures

Fig. 1
Fig. 1
Prevalence (%) of extended-spectrum β-lactamases (ESBLs) and carbapenem-resistant organisms by country in Southeast Asia, adopted from reference 5 (COMPACT II study). The organisms were obtained during April – July 2010, from 5 Centers in Asia-Pacific countries including New Zealand (data not shown), the Philippines (3 centers, 16 A. baumannii isolates, 90 P. aeruginosa isolates, 70 Enterobacteriaceae isolates), Singapore (3 centers, 21 A. baumannii isolates, 120 P. aeruginosa isolates, 96 Enterobacteriaceae isolates), Thailand (10 centers, 59 A. baumannii isolates, 296 P. aeruginosa isolates, 239 Enterobacteriaceae isolates) and Vietnam (3 centers, 19 A. baumannii isolates, 90 P. aeruginosa isolates, 71 Enterobacteriaceae isolates). There are small numbers of A. baumannii isolations tested from reference 5. Prevalence of CRAB in other studies are #70.5-91 % (Singapore) [6, 43, 44], ¶46.7-80 % (Thailand) [–31] and §more than 90 % (Vietnam) [48]. *Recent studies have been shown the increasing prevalence of CRE in Singapore and Thailand [1, 3, 4, 6, 22]. Abbreviation; CR, carbapenem–resistant; CRE, carbapenem-resistant Enterobacteriaceae; ESBLs, extended-spectrum β-lactamases

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