Monday, April 11, 2016

Three Reports On India's Growing Antibiotic Crisis

Klebsiella pneumoniae - Credit CDC PHIL


Over the years we've looked often at India's problems in controlling the use antibiotics - both in humans, and in agriculture - and that country's dramatic rise in antibiotic resistant bacteria (see here, here, and here). Unregulated for decades, antibiotic use in India has reached crisis proportions.

Although new laws have recently been put in place to reduce India's OTC antibiotic consumption, their effectiveness remains untested.

Last month, in PloS Medicine's Antibiotic Resistance in India: Drivers and Opportunities for Action the authors described India's growing resistance crisis, opening with: 
Antibiotic resistance is a global public health threat [1], but nowhere is it as stark as in India. 

And then going on to describe some of the impacts.
New Delhi metallo-β-lactamase (NDM) enzymes, first reported in 2008, are now found worldwide[5]. In India, Escherichia coli (n = 1,815) isolated from the community showed high overall resistance to ampicillin, naladixic acid, and co-trimoxazole (75%, 73%, and 59%, respectively) between 2004 and 2007 [6]. Nearly a third of isolates are resistant to injectables like aminoglycosides (represented by gentamicin).
From 2008 to 2013, E. coli resistance to third-generation cephalosporins increased from 70% to 83%, and fluoroquinolone resistance increased from 78% to 85%. Ten percent of E. coli isolates were resistant to carbapenems in 2008, increasing to 13% in 2013 [7].
Among Klebsiella pneumoniae isolates, third-generation cephalosporin resistance decreased from 90% to 80%, and fluoroquinolone resistance increased from 57% to 73% [7]. Carbapenem resistance among K. pneumoniae increased from 2% in 2002 to 52% in 2009 in one tertiary-care hospital in New Delhi [8].

While inappropriate human consumption of antibiotics is a major driver of antimicrobial resistance, far more antibiotics are used in agriculture - legally and illegally - than in humans.

These antibiotics not only end up in the food chain, their improper use can help create new resistant strains in livestock and/or the environment.

So dire is this threat that in 2014 it was declared by WHO: Antibiotic Resistance – Serious, World-Wide Threat, which warned of a post-antibiotic future. 

“Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill,” says Dr Keiji Fukuda, WHO’s Assistant Director-General for Health Security.

My thanks to Jason Gale, who overnight posted links to three recent Bloomberg News articles on India's impending antibiotic apocalypse - driven in large part by the indiscriminate use of antibiotics in agriculture.  

All three are sobering reads on this Monday morning:

Antibiotic Apocalypse Fear Stoked by India’s Drugged Chickens
Feeding chickens antibiotics may speed diseases costing $100 trillion

For more on the newest antimicrobial threat - MCR-1 - you may wish to revisit:

Eurosurveillance Editorial: Plasmid-Mediated Colistin Resistance (MCR-1 gene):The Story Unfolds

The Lancet: Dissemination Of The MCR-1 Colistin Resistance Gene 

MCR-1: The Return Of The Plasmids

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